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.