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Thursday, August 20, 2009

Health Care Reform: Myths vs. Facts

By Andy Miller
WebMD Guest Blogger

August has turned into a month of myth-making on health reform.

Half-truths, distortions, and downright falsehoods have mixed freely with the facts in the incendiary debate, stoked by town hall meetings, talk radio, and the Internet.

Misinformation can travel as fast as email. Some unfounded rumors have received mainstream attention, such as former vice-presidential candidate Sarah Palin’s claim that ”death panels” would encourage euthanasia. Another widely circulated myth: Bureaucrats would deny care to a person going blind in one eye if the other eye functions normally.

Neither side in the battle appears to have a perfect truth-telling score. Here’s a look at the facts behind several claims about reform:

CLAIM: The health care reform bill does this and that…

THE FACTS: There isn’t just one bill. The Senate has produced one, and the House has created another version. Yet another bill is expected to emerge soon from the Senate Finance Committee, and it may look very different from the others. The legislative process has many miles to go before each chamber enacts a final version of reform — if it gets that far. Reform opponents, meanwhile, may have an advantage in that it’s easier to make charges about a moving target — or targets.

CLAIM: The Democrats’ health reform will require counseling sessions that will encourage seniors on how to end their life sooner.

THE FACTS: The noisiest fact-defying issue of all. The House legislation would let Medicare reimburse doctors for their time if seniors choose to consult them on end-of-life issues, such as making a living will or hospice care. There’s no requirement for Medicare members to do this; it’s voluntary. The reform legislation has nothing regarding euthanasia. AARP’s John Rother says rumors that suggest the provision calls for government to encourage euthanasia ‘is a gross, and even cruel, distortion — especially for any family that has been forced to make the difficult decisions on care for loved ones approaching the end of their lives.”

CLAIM: Health care reform will lead to rationing of medical services, and the government will decide what care people get.

THE FACTS: Plenty of rationing already exists in the health care system. Insurance companies and employer benefit plans often limit a person’s choices of medical services. For the uninsured, elective procedures are difficult to get, if not impossible. But reform would specifically bar some forms of rationing: Insurers would no longer discriminate against an individual with a pre-existing medical condition.

The rationing argument ignited when former New York Lt. Gov. Betsy McCaughey wrote in an opinion piece that government research comparing the effectiveness of medical treatments would eventually limit seniors’ access to services.

But FactCheck.org says the council overseeing the research is barred from issuing requirements on insurance coverage. President Obama says the research goal is to provide information to doctors and patients about what treatments may work best for a medical condition. And Julius Hobson, a health policy adviser for the law firm Bryan Cave in Washington, says private insurers would be more likely than Medicare to use that treatment information to make rationing-style decisions.

CLAIM: If you like your health plan, you can keep your health plan; if you like your doctor, you can keep your doctor under reform.

THE FACTS: President Obama has used this line often to tamp down fears about change. But keeping a health plan or a doctor isn’t a guarantee even under the current insurance system. Employers now switch insurance plans frequently to get the best possible deal. Doctors, if dissatisfied, can drop out of health plans. So it’s difficult to see how reform could ensure that individuals can keep their health plan or doctor.

Obama’s plan builds on the current job-based coverage system, and insurance provided by large employers may stay the same. But reform may mean some employers may choose to drop their current coverage and pay a penalty instead. The Congressional Budget Office (CBO) says millions would gain job-based coverage under the House Democrats’ legislation, and that millions would lose it.

CLAIM: The House bill is entirely paid for by a combination of Medicare cuts and taxes, and won’t add to the deficit.

THE FACTS: The CBO says the House bill would add $239 billion to the deficit over 10 years, with that extra money reversing a scheduled Medicare pay cut to doctors. Democrats don’t count that increase as part of the cost of reform, saying it’s a separate issue.

Obama has estimated that about $500 billion to $600 billion in Medicare and Medicaid savings can be achieved by restructuring the delivery system, establishing new ways of paying doctors, reducing waste, decreasing medical errors, increasing efficiency, and other changes.

Long-term savings from such ”game-changers” could be substantial, but would accrue over a 20- to 30-year timetable, says Josh Gordon, policy director for the Concord Coalition, a grassroots organization advocating fiscal responsibility.

The reform bills aren’t yet paid for fully, FactCheck.org concludes.

CLAIM: Health reform will cover illegal immigrants.

THE FACTS: Not true. Both the House legislation and the Senate health committee bill rule out subsidizing insurance coverage for anyone who is not a citizen or legal resident. Illegal immigrants get care now — often in emergency rooms, with the cost frequently borne by hospitals, those who have private insurance coverage, and even taxpayers.

CLAIM: Reform will lead to socialized medicine, like the British system.

THE FACTS: Some Republicans and other opponents of the plan have repeated phrases such as ‘government takeover of health care’ to rouse opposition. But the Democratic legislation doesn’t create a ”single-payer” system in which government controls health care. The bills would preserve the private insurance system.

Reform would increase government regulation over health insurers. And an option for a public insurance plan, run like Medicare, would inject more federal funding into health care and could alter the market while competing with insurers in an exchange. A public plan would add to government’s role, ”but it’s not a takeover of health care,” Hobson says. Recently the White House has backed off somewhat in its insistence on a public plan as part of reform.

CLAIM: Reform will raise your taxes.

THE FACTS: True for the richest Americans, under the House legislation. House leaders have proposed a surcharge or tax on the wealthiest individuals to help pay the cost of reform.

Obama has talked about limiting tax deductions for the wealthiest, and has insisted that the middle class not receive higher taxes. ‘It’s clear that some taxes will be raised to pay for reform,” says Gordon. Other tax
ideas include a levy on lush, Cadillac-style benefits plans.

CLAIM: Health care overhaul will contain health care costs.

THE FACTS: Health care costs for years have risen faster than inflation, and as a result, insurance premiums have more than doubled over the past decade. But while containing these costs is a goal of reform, many experts believe the current House legislation doesn’t do enough. Gordon says greater cost control could be accomplished by capping the tax exclusion on employer health benefits, creating an independent commission to evaluate Medicare payments, and moving Medicare to a system that rewards quality of care, not quantity of services.

CLAIM: The U.S. has the best health care system in the world.

THE FACTS: Statistics suggest we’re not getting enough bang for the buck. The U.S. spends 20% more per capita on health care than the next highest-spending country, and 50% more than the third. Countries in the Organization for Economic Co-operation and Development with the highest life expectancy spend half as much per capita as the U.S., notes FactCheck.org, which also cites a 2000 report from the World Health Organization that ranked the U.S. 37th in overall health system performance and 72nd on level of health. ‘If you’re concerned about primary care, you may be better off in another developed country,” says Hobson.’ If you need to see a specialist, you can’t beat the U.S.”

CLAIM: Reform will cut benefits to people on Medicare.

THE FACTS: Obama calls this a myth, and he’s right, according to AARP. None of the proposals would reduce seniors’ benefits, the organization says. And Obama says reform will narrow the infamous ‘doughnut hole’ in Medicare prescription drug coverage. Health reform supporters do plan to eliminate subsidies to private insurance companies who offer Medicare Advantage coverage; the effects of the cuts on those plans are unknown.

CLAIM: Reform will lead to government subsidizing abortion.

THE FACTS: PolitiFact.com, a fact-checking web site, says the legislation contains nothing that would require the use of taxpayer money for subsidizing abortion. An amendment in House legislation aims to ensure that federal funds are not used for this coverage.

Obama noted recently that ‘we also have a tradition of, in this town, historically, of not financing abortions as part of government-funded health care.” PolitiFact also says people could have a choice of a health plan that has payment for abortion coverage, and one without it. It’s possible that women with subsidized coverage could buy a plan that has abortion coverage. The final wording on this issue, though, won’t be clear till later in the process.

SOURCES:

Politico; CNN; Medical News Today; PBS.org; The Wall Street Journal; AARP Bulletin; FactCheck.org; Dow Jones Newswires; The Los Angeles Times; Kaiser Family Foundation; The Washington Post; The Associated Press; PolitiFact.com; NPR; Julius Hobson, health policy adviser, Bryan Cave LLP; Josh Gordon, policy director, the Concord Coalition

Posted by: Sean Swint at 11:07 am

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