Friday, December 11, 2009

Tightening The Noose Around Private Medicine

As many know, the U.S. Preventive Services Task Force (a government task force) made headlines recently when it recommended new restrictions on screening mammography for women.

There are two critical dangers these sorts of government guidelines pose for private insurance plans if ObamaCare becomes law.

First, plans may be required to include certain types of preventive care as covered services, whether or not patients want them. Such benefits mandates would raise prices and violate the rights of patients and insurers to freely contract for lower-priced plans without such mandates.

In the December 2, 2009 Baltimore Health Examiner, Dr. Delia Chiaramonte notes that it will do exactly that. From her article, "What the healthcare reform bill says about preventive care":
The section on preventive care has a hidden limitation that is likely to escape the notice of non-physician Senate reviewers. It states "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of 'A' or 'B' in the current recommendations of the United States Preventive Services Task Force."

That is, health insurers must pay for preventive services that the U.S. Preventive Services Task Force (USPSTF) recommends.
(Emphasis in the original.)

Second, government rules may make it more difficult for patients to receive preventative care that diverges from government guidelines.

Sue Blevins of the Institute for Health Freedom notes in her December 2009 article, "Health-Reform Bills: Would Restrictions on Cost-Sharing for Preventive Services Outlaw Private Payment?":
Regardless of whether you agree or disagree with the U.S. Preventive Services Task Force's recommended changes for mammograms, its recent proposal raises important questions for all Americans: Do you want government panels making preventive health-care decisions for you? And do you want government to outlaw private payment for preventive care? Government could end up with both powers under the health-reform bills being considered.

...[I]t appears the House version could prevent Americans from paying privately for covered preventive care. That's because H.R. 3962 states that there shall be no cost-sharing for covered preventive services. (The Senate bill includes a similar provision.) The definition of cost-sharing appears to include out-of-pocket spending. Thus without further clarification, this provision could be interpreted to prevent anyone from paying out of pocket for covered preventive care.

If this were to become law, what would happen if a physician doesn't accept insurance payments? Would he or she be legally free to bill patients directly for covered preventive services? And would patients be legally free to pay out of pocket? If the answer to both of these questions is no, then physicians who currently do not accept insurance will either have to begin doing so or stop offering preventive services.

It appears the following provisions in the House bill would infringe on both patients' and physicians' freedom to contract privately for preventive health-care services...
(Emphasis in the original.)

In other words, under ObamaCare you will be forced to pay for certain kinds of preventative care whether you want it or not. And you may not be able to pay for other kinds of medical care outside of government-set guidelines, even if you want to!

Note that the latter problem is already a serious issue in other countries with "universal health care". Canada and the UK typically forbid patients from paying out-of-pocket for many medical services on the private market on the grounds that it would permit a "two-tiered" system of care. The way they avoid having a two-tiered system (one good and one bad) is to force everyone into a single-tiered bad system.

Let's hope this doesn't happen in the US.