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Sen. Al Franken during the health care bill debate taking on Republican talking points on rationing, tort reform, taxes on CEO compensation and the need for reforming our health care system.
On MSNBC this afternoon, Dr. Nancy Snyderman took Blackburn to task for getting the “public health message lost in the politics.” “Now, there’s nothing that came out of this panel recommending rationing,” said Snyderman. “Just a prudent use of screening tests.” When Blackburn tried to claim that the guidelines meant “bureaucrats deciding what they’re going to allow,” Snyderman pointed out that Blackburn was acting as a “bureaucrat” standing between patients and “the best possible evidence”. [...]
As the Washington Independent’s Mike Lillis notes, the concern of the congresswomen about rationed mammograms is especially ironic considering that they oppose legislation that “would require insurance companies that cover diagnostic mammograms also to cover routine, annual breast cancer screenings for all women 40 and older.”
Among the most pernicious and blatantly false Republican talking points designed to obstruct health care reform is the fear-mongering claim that Democratic proposals will lead to "rationing." Of course, with almost 50 million uninsured and another 25 million underinsured, Mitch McConnell's dystopian future of a system which "denies, delays, or rations health care" is already today's nightmare for millions of Americans. But as it turns out, recent studies show that the market failure that is the crumbling U.S. health care system is producing a another, often hidden crisis: self-rationing.
As McClatchy reported last week, a new Consumers Union survey revealed that due to skyrocketing costs and reductions in coverage, Americans are forced to deny themselves needed medical treatment. Among the findings of CU's poll of a 1,002 respondents:
In the new poll 59 percent said that the cost of their health care had increased more than their other expenses over the past two years. Fifty-one percent said they had faced difficult health care choices in the past year. The most common responses were putting off a doctor visit because of cost (28 percent), not being unable to afford medical bills or medication (25 percent), and putting off a medical procedure because of cost (22 percent).
Twenty-eight percent said they had lost or experienced cutbacks in their health care coverage in the past year. The greatest concerns about health care expressed by respondents were a major financial loss or setback from medical cost due to an illness or accident (73 percent), not being able to afford health care in the future (73 percent), necessary care being denied or rationed by health insurance companies (73 percent), and the prospect of rising costs forcing them to choose between health care and other necessities (64 percent).
Those dismal results echoed the shocking revelations from an April 2009 Thomson Reuters survey.
(Disclosure: I'm working with Brave New Films on their Sick For Profit campaign, exposing insurance industry practices. Check us out on Facebook.)
The New York Times published a very nice press release from the desk of Humana, one of the nation's largest health insurance companies. The reporter interviewed a bunch of employees at Humana, all of whom were horrified to see themselves depicted as "villains" in the health care debate. I agree with Yves Smith, this is an absurd angle for a story, an extreme example of selection bias. The people who work at Humana probably have a sense that their employer, um, pays their salary, and thusly, what's good for the employer is probably good for them. Similarly, most people hold a favorable opinion of themselves just as a matter of getting through the day. Not to mention the fact that their understanding of the functioning of Humana is limited to their job description. It is not possible to gain much of a perspective on the health care debate or industry practices by asking a midlevel manager "Do you think you're the worst person alive?"
Since when is it legitimate, much the less newsworthy, to get a company's perception on its embattled status, at least without introducing either some contrary opinion or better yet, facts, to counter the views of people who will inevitably see what they are doing as right? I hate to draw an extreme comparison to make the point, but staff in Nazi concentration camps also thought they were good people. It is well documented that for all save the depressed, people's assessments of their own behavior is biased in their favor.
There is some revelatory stuff in the article, however. David Sirota flags one employee saying that Humana believes in keeping down costs by "controlling utilization":
Now, I know we're supposed to think that private for-profit health care companies don't ration care, while government-run programs like Medicare do - but as the insurance industry admits right here for all to see, that's just not the case. The obvious truth is that the health insurance industry works hard to "control utilization" - that is, it works hard to make sure that when you need a costly medical service, you are "controlled" (read: prevented) from getting it.
Sure, we're all against excessive testing - and there are good ways to deal with those inefficiencies. But that's not what the insurance industry is talking about. It is talking about its practice of rationing care - and now that reality is right there in black and white for all to see.
The truth of the matter is that many of the charges that insurance companies like WellPoint level at the public option and regulatory changes sought in the health reform bill mirror accepted industry practices. WellPoint, which emailed its own customers yesterday attacking the Democratic plan, claimed that health reform will “increase the premiums of those with private coverage.” Yet WellPoint routinely hikes their own premium prices by close to double digits annually, leading to ever-increasing profits. The email stated that millions of Americans would lose their private coverage and be forced onto a government-run option if the Democratic bill passed (nothing could be further from the truth); yet WellPoint routinely uses the practice of rescission to drop their own customers from coverage if they ever try to use it, and they've admitted they would continue doing so unless forced to stop by law.
The email is an example of the astroturf practices from the industry, including, no doubt, pitching to the New York Times a story putting the human face on insurers. Many of these astroturf efforts spring from the same sources as the corporate lobby groups activating the tea party protests at town hall meetings throughout the country this August. They're trying to change the subject, away from facts, like how they're spending less of their premium revenue on medical care over the years, from 90% in the early 1990s to around 80% today. Or how they use rescission and pre-existing condition to make profits off cherry-picking the healthy and denying everyone else care. House and Senate leaders have requested more and more information about insurance company practices; Dennis Kucinich has joined that effort. But the insurance industry, while nominally siding with reform, wants to keep the focus on efforts against it, in service to de-fanging it.
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Orrin Hatch rails against rationing if the government gets control of health care, but when asked by Andrea Mitchell if we're rationing now, he espouses the dangers of the English health care system as a reason to be very, very afraid of a nationalized health care system. He actually avoids answering her question and I've got one better for him.
I want to know when any of these talking heads are going to ask one of these Congressman when they're going to give up their government health care coverage and move to the private sector instead, since they claim the government being involved in health care is such a bad thing. I want to see a list of how many of them are willing to give up their tax payer sponsored plans.
Digby points out the obvious class system that's firmly in place for health care. There are so many exceptions, so much denial of care, we really should start calling it "KatrinaCare." (h/t DCBlogger)
Other countries have systems that prioritize health care treatment on the basis of need --- a triage system. We prioritize health care on the basis of who can pay. And in the most perverse form of rationing there is, we make the sickest people have the most difficult time getting access to health care. (The sickest, after all, can't hold down a job, so the employer based system doesn't really work for them, at least not in the long term.)
And let's not forget: If you get sick while you're on unemployment, they can stop your benefits because you're no longer ready to work!
The idea that the US doesn't ration health care is absurd. We certainly do. We just make people do it to themselves out of economic hardship. I guess that's supposed to be a tribute to our sense of individualism and personal freedom.
Hey, nobody's going to tell you you can't be treated --- you made that decision all by yourself when you opted not to have a lot of money. That's what freedom's all about. (Unless you're sick and you want to die, of course, in which case the state won't let you.)
The debate is really about irrational rationing vs rational rationing -- and the US is the undisputed leader of the first method. When we set our minds to it, nobody can be as irrational as we are.
This program is controversial because at some point, it probably will be used to influence care - and payment. Women's health activists warn that women respond differently to treatment than men, and surgeons look on it as an infringement on their medical judgment. (Even though their judgment is often demonstrably bad.)
But since the medical-industrial complex (and the wingnut media) is so firmly against it, how bad could it be?
WASHINGTON — The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.
Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.
The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.
The soaring cost of health care is widely seen as a problem for the economy. Spending on health care totaled $2.2 trillion, or 16 percent of the nation’s gross domestic product, in 2007, and the Congressional Budget Office estimates that, without any changes in federal law, it will rise to 25 percent of the G.D.P. in 2025.
