Myth 21. Proposed health care reform would offer more choices.

White House spokesman Robert Gibbs used the phrase “choice and competition” three times, and variations on the words “choice” and “competition” five times each, in a 1 minute, 10 second interview with CBS’s Face the Nation, noted Mike Gonzalez. That is once every 8.7 seconds.

Kathleen Sebelius, Secretary of Health and Human Services, used one of these words or a combination only once every 16.7 seconds in a 1 min, 56 second interview with CNN’s State of the Union.

If “choice” means abortion, then proposed reforms will probably increase it, while decreasing or eliminating one’s freedom to choose not to pay for—or perform—abortions.

For people who have only one health plan offered by their employer, proposed Exchanges might increase the number of choices—within the narrow range approved by the authorities.

Proposed plans would, however, markedly reduce freedom, and eliminate many choices. Keep in mind that proponents of reform generally believe that most Americans are incapable of understanding complex medical issues—except those involving abortion or refusal of life-saving care—and are confused by having too many choices.

“Beware of choice overload,” write Richard G. Frank, Ph.D., and Richard J. Zeckhauser, Ph.D. (N Engl J Med 7/22/09). “Consumers facing complex, high-stakes choices are prone to make predictable errors.”

“Ironically, one way to enhance the prospect of informed choices is to limit the number of options,” they say.

Among the choices to be eliminated soon after “reform” passes:

True casualty insurance for medical expenses

Except for individual grandfathered plans, for as long as they survive without enrolling new subscribers or making changes in the policy, “health insurance” must meet rigid bureaucratic requirements. Insurers will not be able to price according to risk. Americans will not be allowed to save money through prudent lifestyle or personal assumption of risk as through high deductibles. Everyone will have to pay a “fair” share, based primarily on ability to pay, into the collective pot for paying everyone else’s medical expenses.

In a mailing of “facts AMA members need to know,” the AMA says it is a “myth” that “the current House bill makes private insurance illegal.” Of course the bill does not (at this time) make private coverage illegal. But it does outlaw true insurance, replacing it with prepayment schemes that function like social welfare/wealth redistribution programs.

Self insurance or sharing ministries

Americans will not be allowed to opt out of mandatory insurance and choose another way of meeting their financial obligations, as by saving, borrowing, or sharing expenses through a private, voluntary Christian community. Rather, they will all be forced to “contribute” to the revenue stream to bureaucrats, as well as to the care of the less productive, less frugal, or less prudent.

Medicare Advantage plans

Reformers have targeted these for “savings” to help fund expansions in coverage. At least one in five seniors, most of them with low or moderate income, chose to enroll in such a plan (Karl Rove, Wall St J 8/27/09 ; John Goodman, Health Alert 8/24/09).

Trading cash for better, more timely care

While “providers” may “negotiate” rates with the plan, there will be fixed payments—price controls. Reformers are very concerned about the percentage of GDP, or of a person’s income, spent on medical services. Leading-edge methods may be costly, but many would trade everything they have for a chance to extend their own, or a loved one’s life. Our representatives should “commit themselves to action that will preserve the ability of Americans to choose life over money,” writes Chris S. Karpel (Wall St J 8/17/09). That ability is threatened.

White House spokesmen promise that reform will outlaw lifetime limits on coverage. That is possible only by assuring that no one will be able to choose treatments that would make him a “six-million-dollar [bionic] man.”

Some people might be willing to pay more for treatment in a facility that has “no bureaucracy to be negotiated with the skill of a white-water canoeist.” Or one in which “there is no tension, no feeling that one more patient will bring the system to a point of collapse, and all the staff go off with nervous breakdowns.” Or one with “perfect calm in the waiting room,” where relatives are “not on the verge of hysteria” and do not “suspect that the system is cheating their loved one.”

This description applies to veterinary clinics in Britain, as contrasted with National Health Service facilities, according to Theodore Dalrymple (Wall St J 8/8/09). In Canada, human patients don’t have the right to choose private payment for “covered” services. This choice is now threatened in America, at least for those who can’t afford to pay twice, once through mandatory, costly “insurance” that they don’t use.

Unapproved tests or treatments the patient wants

Because “any reform initiative must control spending,” writes Allan S. Brett, M.D., of the University of South Carolina School of Medicine, “unproven or unnecessary medical interventions should not be available in any system” (N Engl J Med 7/29/09). “Policymakers debating health care reform should stop hiding behind the smoke screen of ‘American values’.” Those values include “individualism.”

Note that Brett does not say that government should not pay nor force insurers to pay for such procedures; he says they should not be available. Period. Not to anyone—rich, poor, severely disabled, terminally ill—no matter how desperate.

Anointed authorities, of course, set the standards for proof and necessity.

A plan that a commissioner disapproves of

According to Congressman Michael J. Rogers (R-MI), the House bill gives officials the power to disenroll an individual from his current chosen plan, or to even to disenroll all employees from their employer-sponsored plan.

Direct access to specialists

“Innovations” such as the “medical home” or “accountable care organizations” are variations on the HMO gatekeeper model. In Canada, patients must have a referral from a primary care physician to get an appointment with a specialist. In proposed Massachusetts reforms, likely to serve as a model for federal plans, all health plans would “require the selection of a primary-care physician,” and all payments would go to the organization with which the physician was affiliated. Restricting patients in this way would be a “huge change” and is a “sensitive issue.” However, “allowing a greater choice…for patients who were willing (and able) to pay more would undermine the cost-control, quality-improvement, and care-coordination purposes of global payment” (Robert Steinbrook, M.D., N Engl J Med 7/29/09).
The only choice you will have, writes Bill Turner, “is one you must make now, to give the government control over our life and 20% of the economy, or to draw the line in the sand and say no, you cannot take away my freedom” (Canada Free Press 8/19/09).

To many reformers, proposals now under consideration are but a stepping stone to their ultimate objective: involuntary universal participation in a system totally financed and controlled, even if not formally owned, by government—the “single payer.”

While the Administration has denied trying to enact single payer, Obama has previously expressed his support for the idea, and has never disavowed it on principle.

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3 thoughts on “Myth 21. Proposed health care reform would offer more choices.

  1. The bottom line on government take over of the health care system is the underlying helplessness of the people. This loss of independence has been slowly progressing since WWI and seen a dramatic accelleration since the latter part of the twentheth century. This has beem acccompanied by widespread anti-authoritarian counter culture which is now embedded in our educational system judicial institutions and government entitlement programs This nation was founded through a war waged for independence. We are the land of the free only because of those who were brave. Government officials, right down the line, starting with president Obama are designing programs and passing legilation that result in redistrtibuting the wealth, edging this country closer to socialism and undermining core values of independence and resposibility.When it comes to health care, the result of these changes put Americans in the position of “….being no different from anybody else and therefore are just like everyone else in wanting something for nothing. The worst thing that could happen would be to hold out hopes of getting it” (Thomas Sowel).

  2. As a liberal, I thoroughly enjoy the liberal use of “scare quotes” in all of these “myth busters” articles. It helps one to avoid mistaking these as serious opinion pieces with actual facts or legitimate arguments.

    As for the points raised, there is a phenomenon known as the “paradox of choice” familiar to the most skilled industrial designers, engineers and businessmen. Ask Apple about it. They’ve made boatloads of money by increasing their customers’ freedom to use advanced electronic devices as they choose through a deliberate decrease in the number of useless and confusing options, features and choices. As Einstein said, “Everything should be made as simple as possible, but not simpler.”

    Regarding the comment on increased access to abortion: the left-center majority of this country has repeatedly demanded that abortion be legal, safe and available (as measured in poll after poll after poll). Are you trying to argue that the increased freedom to have an abortion is somehow actually a *decrease* in freedom? Please explain that to me. Go ahead, take your time.

    And apparently you think it’s a horrible idea that the government should require that services advertised as health insurance actually deliver a minimum level of health insurance. Yes, surely the world will come to an end if that happens.

    Regarding the references to redistribution of wealth, “collective pot” and other tired terms apparently meant to evoke the old timey red scare, I agree with Bill Gates and William Buffett that it is a critical duty of government to redistribute wealth to prevent the substitution of democracy with aristocracy. I prefer a vibrant capitalism where wealth and power trades hands based on innovation and hard work rather than the dead inertia of ossified family dynasties and corporate monopolies. I would like to see a return to a post World War II America at the height of its powers, with an expanding and powerful middle class. This is supposedly what a lot of conservatives would like to see as well, but they usually leave out the fact that the government was redistributing up to 90% of the income of the most wealthy segment of society and the implementing massive public programs like the G.I. bill and the forced industrialization of our economy to produce weapons and equipment.

    Back to the concept of freedom, in our current system we have the freedom to be kicked off our health insurance when we are no longer deemed sufficiently profitable, to go bankrupt when we or a loved one become sick, to go without vital medications because we can’t afford them and to lose our health insurance when we lose a job. I won’t argue that all of those things are indeed a form of freedom — the kind of freedom that works quite well for insurance and pharmaceutical company executives and a handful of wealthy medical specialists. I simply prefer a different kind of freedom: the freedom to live without an unreasonable fear of sickness. In order that I might have this freedom, others will have to sacrifice some of their freedom (such as accepting slightly lower profit margins). I know that conflicts with the fashionable conservative notion of freedom as a convenient political slogan representing all that is good with America, but then again most modern conservative notions conflict with actual facts and the well known liberal bias of reality.

    As a bonus, since the article mentions Canada, here is my obligatory quote on what Canadians think about their government-run, choiceless, one size fits all system:

    “A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada[6] while a Strategic Counsel survey in 2008 found 91% of Canadians preferring their healthcare system to that of the U.S.[7][8]. In the same poll, when asked “overall the Canadian health care system was performing very well, fairly well, not very well or not at all?” 70% of Canadians rated their system as working either “well” or “very well” [9] A 2003 Gallup poll found only 25% of Americans are either “very” or “somewhat” satisfied with “the availability of affordable healthcare in the nation,” versus 50% of those in the UK and 57% of Canadians. Those “very dissatisfied” made up 44% of Americans, 25% of respondents of Britons, and 17% of Canadians”

    http://en.wikipedia.org/wiki/Health_care_in_Canada

  3. Why should we “ask Apple about” medical choices? With Patriot’s ideological bent I would think making so much money would be judged to be evil. Why ask Einstein either for that matter (basically taken out of context – he was arguing against quantum mechanics – guess what? he lost that one)? Besides, the proposed health care reform measures can be called many things, but simple is not one of them – the level of complexity indicates many authors and special interests to be addressed – too bad that health care is not one of the priorities.

    Basically, choice in medical matters is almost always good. In my life I have had different strategies at different times. I used an HMO when I was young and healthy. It was cheap and they were good at simple stuff. When I developed a heart problem, one of the HMO docs advised me to get my own cardiologist because the HMO’s weren’t very good. I did. and then I joined a PPO that included my cardiologist. Now that I am retired I have a fee for service plan that is good in many states. My secret? I was in the Federal Employee Health Benefit Progrram.

    Let me disclose that not all of the millions of folks covered by this program are geniuses. We have something called “open season” and there are pamphlets and charts and websites that help you make informed decisions. It is really not that hard.

    The Congressional Budget Office included an option to extend the FEHB to all citizens and employers in its December, 2008 Budget Options document which outlined 115 possible methods to lower costs. This option actually saved expenditures over our current system! But it was projected to lose tax revenue because some employers might reduce taxable salaries to offer this benefit. Of course, that was before the many current proposals still on the Congressional table to tax such benefits.

    Of course the paragraph about evil pharma, insurance companies and specialists is the entire playbook of the true communitarian health lackies. First of all, President Obama has included all these evil folks (especially PhRMA) in deals – estimates are that PhRMA gave up $80 billion in price cuts to get $3.6 trillion in revenue. PhRMA loves the proposed reforms because they exactly emphasize “pill medicine” by GP’s over the more costly interventions performed by specialists. This bias has now been reinforced by the decision to tax medical devices that are used and implanted in such procedures. I could go on and on, but I am getting bored – I will just point out that, in the end, a Government- administered (or just mandated on private insurers) system will have lower efficiencies than our current system – pushing most of the cost of that inefficiency down onto the patient in the form of delays and onto the doctor in fee cuts. The only actual operational advantage that the Government has is that it can print its own money whereas actual evil insurance companies must have “cash reserves” set aside. Apart from the delays and cuts expect huge bureaucracies, hand-tying regulations, guidelines for practice that supersede the doctor-patient relationship etc. etc.

    When I hear folks talk about Canada or Europe, I just don’t get it. American bureaucracy is uniquely onerous and pernicious because our legal system is “positivistic” as opposed to the “natural law”-based systems in most of the Socialist democracies. Believe me when I say that a U.S. Government-guided system will be one bureacratic mutha with no wiggle room for doctor or patient choice. The hatred we now harbor for our insurance companies will be reserved for our Government – not that it will matter – because we will have no recourse.

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