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Vetting the Health Care Rhetoric
Posted By jwilkes - Wednesday, September 2nd, 2009 at 1:50 PM
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Vetting the Health Care Rhetoric

By Megan McCarthy, Drew Armstrong and Alex Wayne, CQ Staff

www.cqpolitics.com

As politicians and interest groups try to shape the outcome of the health care overhaul, they've offered interpretations that are so wildly different that truth sometimes seems to be taking a vacation.

Some — like the contention that a House health care overhaul (HR 3200) would create "death panels" that decide end-of-life care — are false. Some are misleading, and others are true.

 

Many of the claims are being floated by advocacy groups, then amplified on the Internet and at town hall events hosted by members of Congress. Lawmakers have contributed to the rhetoric, as well.

The majority of the claims deal with the House bill that awaits floor action in September. The Senate is not as far along in the process with its legislative proposal. The Senate Health, Education, Labor and Pensions Committee has approved a draft bill, but the Finance Committee is still working on its version. The lack of a unified Senate approach has led proponents and opponents to focus much of their criticism on the House measure.

The following examination of health care claims and their sources is not comprehensive but provides an overview of the commonly recited talking points in the debate.

• • •

Claim: The House bill would create a government committee to decide what treatments or benefits patients may receive in a retooled health care system.

Source: The office of House Minority Leader John A. Boehner, R-Ohio, made the claim in a news release. It also was found in a Web publication by the group Family Security Matters.

MISLEADING. A committee would make recommendations on what sorts of minimum benefits insurers should be required to provide, but these standards are a floor, not a ceiling. Insurers could offer more benefits if they chose, perhaps to gain a competitive advantage to draw customers, but they could not offer less.

 

• • •

Claim: Under the House bill, health care will be rationed, especially care for seniors.

Source: A number of congressional Republicans and conservative groups have made this claim. It's been repeated online and in some television advertisements by groups such as Patients United Now, which is funded in part by another right-leaning interest group, Americans United for Prosperity.

FALSE. The House bill says almost the opposite — that insurers can't charge patients more than $5,000 a year for an individual or $10,000 for a family toward the cost of their own health care. It does not set limits on how much the plans can spend on each patient, however. As for seniors, they would still be covered by Medicare, and the bill does not set any benefit limits for that program.

 

• • •

Claim: Employers will have to automatically enroll their workers in the public plan, according to the House bill.

Source: This assertion originated from a handout that conservative groups circulated via e-mail and at rallies. It's derived from a Web publication by Family Security Matters and has been repeated online by groups such as Patients United Now.

FALSE. The House bill would require companies to enroll workers in whatever group insurance plan they offer as part of the mandate that employers provide health insurance coverage. But workers could opt out of automatic enrollment in an employer's plan if they want. The House bill is silent about enrolling in a specific plan.

 

• • •

Claim: Any individual who doesn't have acceptable health insurance as defined by the government will have to pay a 2.5 percent income tax.

Source: Several places, including a Boehner press release.

TRUE. The bill requires all Americans to obtain insurance or pay a penalty. There would be exemptions for children and other dependents, people living overseas and members of religious faiths that believe in limiting medical treatment, among other groups.

 

• • •

Claim: A government-run insurance plan would drive all private insurers out of business.

Source: A Conservatives for Patients Rights advertisement.

MISLEADING. A number of conservative groups have argued that a public plan would squeeze concessions out of health providers, undercut private plans and drive those insurers out of business. But a Congressional Budget Office (CBO) analysis of the House bill says that, of the people who would get coverage in the new health insurance exchange, 21 million would go to private plans, while 9 million would go to the public plan.

 

• • •

Claim: The government would have "real-time access" to individual bank accounts and create a "national ID health card."

Source: Conservative groups opposed to the Democrats' health care overhaul have asserted this in chain e-mails and at rallies across the country. Many claims emanate from the Family Security Matters Web publication.

FALSE. A section of the bill would require insurers to make it easier for patients to calculate the cost of their care by providing information about the prices of treatments in the doctor's office. The House bill also would allow — but not require — insurers to issue patients a "machine-readable health plan beneficiary identification card," similar to the insurance cards most people with coverage already carry. The card would not be issued by the government.

 

• • •

Claim: The government would provide an "approved list of end-of-life resources," require health care providers to consult with the government on end-of-life care, require individuals to create living wills or advance directives regarding end-of-life care. Such mandates will lead to government-ordered "assisted suicide" or "euthanasia."

Source: Most famously, Alaska's Republican former Gov. Sarah Palin stated this on her Facebook page. The claim has been repeated by overhaul opponents.

FALSE. Claims that the legislation would establish "death panels" have made this one of the most controversial and talked-about provisions in the House measure. But they are fiction. The bill would authorize Medicare reimbursement for doctors who consult with their patients on end-of-life care, including the creation of advance directives, powers of attorney and orders for life-sustaining treatment — documents that allow individuals to control the care they receive when they are incapacitated.

Nothing in the bill would mandate such consultations, nor would patients be required to create advance directives or other documents related to end-of-life care in order for doctors to be paid.

 

• • •

Claim: The bill tells doctors what and how much they can own.

Source: A handout being circulated via e-mail and at rallies by conservative groups opposing Democrats' health care effort, with many of the claims taken from the Web publication by Family Security Matters.

MISLEADING. Congressional Democrats and some Republicans have long sought to limit the creation and growth of "physician-owned" hospitals. Studies have shown that physicians tend to refer patients to hospitals in which they hold a financial stake and prescribe more procedures than necessary when they have a financial stake in the hospital. Over the last decade, Congress has periodically enacted moratoriums on physician-owned hospitals.

The House bill spells out a limited set of circumstances in which physicians would be allowed to invest in hospitals and how much of an ownership stake they can take. Existing hospitals owned by physicians would be "grandfathered" in, but their stakes would not be allowed to expand.

 

• • •

Claim: Preventive screenings for disease, aggressive treatments to keep illnesses from becoming acute and making changes in communities to promote healthier lifestyles would reduce the cost of health care.

Source: Many overhaul proponents inside and outside of government have made this claim. Democrats have cited it as a rationale for using preventive care as a source of cost-savings: The Senate Health, Education, Labor and Pensions Committee's a Health Care for America Now fact sheet, and a Prescription For Change fact sheet.

MISLEADING. Although liberal lawmakers and advocacy groups frequently say preventive care will lower health care costs, experts disagree when it comes to preventive care provided by doctors. The cost of screening and treating a large population is often greater than caring for the smaller groups of people struck with diseases. A CBO analysis of the House bill found that provisions that would remove co-payments for preventive services for Medicare and Medicaid patients would cost $9.9 billion. The CBO has not released an analysis of the Senate's draft bill, but past CBO reports have calculated preventive care as a cost, not a savings.

However, advocates argue that preventive care goes beyond medical treatments. Significant savings could be gained from investing in sidewalks to promote exercise, and making other changes such as healthier food in schools and labeling menus to promote good heath, proponents say.

 

• • •

Claim: Legislation restructuring the health care system will not add to the federal budget deficit.

Source: Top Democrats, including President Obama and Senate Majority Leader Harry Reid of Nevada have made such claims.

FALSE. A CBO analysis of the House bill found that it would produce a deficit of $239 billion over 10 years. House Democratic aides contend that this figure is inaccurate because it includes a $245 billion provision to adjust Medicare payments to physicians. They argue that the fix to physician payment rates is undertaken every year, and Congress is likely to pass it again with or without a health care overhaul.

In the Senate, the CBO scored portions of a measure being drafted by the Finance Committee at a lower cost than the House bill. The Senate Health, Education, Labor and Pension Committee's draft bill was scored at $611.4 billion, meaning it would not impact the deficit. Senate Finance Committee members also have talked about keeping the Medicare physicians' payment adjustment off the books, as well — meaning that the Senate bill could boost the deficit.

 

• • •

Claim: Individuals who like their current health insurance plans can keep them.

Source: President Obama and many other Democrats have cited this in calling for a health care overhaul.

MISLEADING. Neither the House nor Senate legislation would require individuals with insurance to change their coverage. Both bills would continue the practice of workers enrolling in plans offered by their employers. But, if enacted, the overhaul would trigger significant changes in the health insurance industry, which could prompt employers to change the menu of plans they offer employees. An insurance plan offered by employers before the overhaul may not be the same one offered after the overhaul.

An overhaul also is expected to reduce reimbursement rates for a private-sector Medicare alternative called Medicare Advantage, leading some insurance companies to decrease plan offerings. Seniors covered by those plans would likely end up back in regular Medicare.

 

• • •

Claim: A health care overhaul will lower premiums for people buying insurance.

Source: Democratic leaders have made the claim, and it was a centerpiece of Obama's justification for a health care overhaul. More recently, the president has talked about slowing the growth of health care costs.

MISLEADING. While the jump in the cost of premiums may slow, it's unlikely that their cost will decline. The House bill with its public option aims to lower government payments to providers. Reduced payments mean the government could charge those enrolled in the public option lower premiums than private insurers charge. Such a move could put pressure on private insurers to lower their premiums.

However, in a concession to fiscally conservative House Democrats known as Blue Dogs, the legislation would require public option administrators to negotiate rates with providers, instead of pegging payments at a fixed level above Medicare rates. If public option administrators are unsuccessful in negotiating lower payments to providers, there will be significantly less pressure on private insurance companies to lower premiums.



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