Found in multiple websites across the internet is the assertion that the bill provides for rationing of health care. The cited passage of the bill is section 122, page 29.
(B) APPLICABLE LEVEL.
—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
The applicable level does not refer to benefits paid by the plan. Reading before this section explains what the Applicable level is for:
(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE.—
(1) NO COST-SHARING FOR PREVENTIVE SERVICES.—There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.
(2) ANNUAL LIMITATION.—
(A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B)."Cost-sharing" includes copays and co-insurance for covered services. The annual limitation is the "Annual Out of Pocket Maximum" that is present in almost all private insurance policies that exist today.
What this means is that there will be a maximum that an insured individual or family will be expected to pay under the plan of $5,000 or $10,000 respectively. Once the Annual Limitation (OOP Max) has been met, the insured or insureds will no longer have to participate in cost-sharing: in other words, no more copays will be required for the remainder of that plan year for covered services.
This does not mean that health care will not be rationed, it means that there is no such provision for rationing in the bill itself. I believe the bill will evenutally lead to rationing, as every other plan based on this structure has. Some in the not so distant past (see Commonweath Health Insurance [or Massachusetts health care reform law of 2006]).
I read some interesting "letters to the editor" on factcheck.org, and one of their main criticisms of the site were that it stuck to closely to what the bill actually said, and not on the fact that politicians often break their promises. The suggestion being that if the folks at factcheck looked at the bigger picture, they might share in the paranoia of what MIGHT happen if the bill were passed. I'm thinking about developing this idea for a future blog post--dividing concerns about what the bill actually says from concerns about what a person might realistically expect the government to do with it. (This is why I have been asking people if they would react differently to the bill if it were proposed by politicians they trust. I'm trying to determine if the ideas in the bill are bad, or if the politicians promoting it have done a terrible job of winning the peoples' confidence.)
ReplyDeleteSorry, forgot the link: http://www.factcheck.org/2009/09/factcheck-mailbag-week-of-aug-25-aug-31/
ReplyDelete(This is why I have been asking people if they would react differently to the bill if it were proposed by politicians they trust. I'm trying to determine if the ideas in the bill are bad, or if the politicians promoting it have done a terrible job of winning the peoples' confidence.)
ReplyDeleteI wouldn't trust a politician who would propose this bill, or any other kind of government run health care plan.
That's fair. I'm curious--would you get rid of existing govt-run health plans--such as Medicare? Or is this different, because of the scope of the plan?
ReplyDeleteWell, that leads to another problem with government programs. Once you give a group or class a something, it can not be taken away. People grow to depend upon it. Then they vote for the politician who will expand that program so they can get even more of it.
ReplyDeleteThis is why I do not trust politicians who push socialized programs. They are not altruistic; they have ulterior motives and a desire to remain in power. The more their constituents need them (and I do mean rely heavily upon them), the more power they hold over them. It's not freedom, and it's not representative government. It's people in power exploiting those who need representation the most so they can continue to stay in power. And those who are in most need of help don't even realize that they are actually being held down instead of being given a helping hand.
But I digress. Let me answer your question a different way. If I could go back in time and prevent Medicare from being created, would I? Absolutely. It's a flawed system, but at this point it is all the elderly will have until it implodes. And it will implode. It's unsustainable.