On Monday, the Senate began debate on its monumental health-care reform package. Senator Barbara Mikulski (a Maryland Democrat) introduced the first amendment, which is an omen of what the future will hold when Congress takes over the health-care system. If passed, Senator Mikulski’s amendment would require insurers to provide women with free preventative screenings for breast cancer, cervical cancer, post-partum depression, diabetes, and other ailments that are common causes of disease, disability and death in women. Insurers could not charge a copay or any other fee for these services. So here we are, just the first day of debate and already the Genie is out of the bottle.
While we might all agree that screening for a range of diseases and conditions is important, and that better screening might reduce long-term health-care costs, it is hard to see how we will reduce health-care spending if members of Congress are going to start handing out services for free, especially if those services are provided to people who can afford to pay. I can afford a copay for routine screening and care, as can Senator Mikulski, Speaker of the House Pelosi, and millions of other women who can and should pay for the care we receive. I can’t help but wonder how Senator Mikulski would have reacted if the first amendment out of the chute had been one that provided free screening for men, rather than for women. In the political game of up the ante and vote buying, it is easy to see how additional screenings (for prostate cancer, skin cancer, lung cancer, and cardiovascular disease) and preventive-care regimes (well-baby visits, immunizations, dental check- ups and eye exams) will be added to the list of “free” services that insurers or the government must provide.
The problem is that there is no such thing as free health care. Somebody has to pay for care, and if it isn’t through copays, then it will be through more expensive premiums or higher taxes, and not just for the idly rich. By providing free screenings for women who can afford the copay, we reduce our ability to subsidize care for those who are truly in need and we make it even harder for middle-class families to afford health insurance at all. The unintended consequences of Senator Mikulski’s amendment are tremendous, including that it establishes precedent for politicians rather than doctors or expert panels to determine standards of care and fee schedules. Moreover, while none of us likes to pay for medical care, some research has shown that patient cost-sharing encourages increased patient involvement in health-care decision making, which appears to be linked to improved health-care outcomes. Free care just might rob those who can pay of the very incentive they need to take control of, and improve, their overall level of health.
I could support the idea of income-sensitive copays, but if positive outcomes are our top priority, then perhaps copays should be linked to behavioral risk factors. For example, a system that charges higher copays to women who smoke, who are obese, or who delayed childbirth beyond the age of 30 (I know this will stir up anger among the educated elite, but delayed childbearing is a risk factor for breast cancer) might be the most effective way to both reduce total health-care costs and improve outcomes.
What concerns me most about Senator Mikulski’s amendment, however, is that it signals two important realities that should trouble all Americans. First, while members of Congress love to say that doctors, not insurance companies, should determine an individual’s treatment plan, it is clear that politicians will now decide, based on political expediencies and the ever-growing thirst for votes, what care we will receive and who will pay. Second, Senator Mikulski’s amendment now makes it clear that it is not just Republicans who have concerns about care rationing as a result of the elephant-sized health-care reform bill.
11 Responses to Free Health Care Is Never Free
suomynona - December 2, 2009 at 6:46 pm
“…which is an omen of what the future will hold when Congress takes over the health-care system.”Ahem, what? WHEN congress takes over the healthcare system? So you’re suggesting that Congress will be paying doctors and abolishing private doctors, taking over insurance and abolishing private health insurance? I haven’t read about that bill yet. Can you tell me more?
livefreeordie2 - December 2, 2009 at 10:42 pm
suomynona – When it’s public option – government run health care – that requires hundreds of billions of tax dollars per year, where do you think the tax legislation is going to come from? Who do you think will be setting the rules private insurance – mandating what they must pay? Who will be holding hearings every time there’s a sob story or some dolt thinks he didn’t get proper care or any other kind of misery they stir up? And then come up with a new unfunded mandate or reduce reimbursements even more? Sheesh! You really are clueless about this, aren’t you? Why do you think so many people are up in arms about this? OF COURSE the congress will be paying doctors. . and hospitals. They already are! What do you think Medicare is? Have you any idea how vulnerable your local doctors and hospitals are to the whims of Congress? Not after some new bill is passed – RIGHT NOW! If you don’t, then you really need to educate yourself. . .if possible.
rbrunson56 - December 3, 2009 at 5:22 am
Ms. Jones comments are some of the most rational thoughts I’ve read via the Chronicle. Excellent work!What amuses, amazes, and disheartens me is the fact that there are so many who see government run healthcare (which to some degree it already is) as some sort of improvement on our current system.
rufojr - December 3, 2009 at 7:40 am
I agree with rbruson56! Excellent article! It’s about time everyone begins to pay attention to what is going on in Washington, D.C. Why do you think so many people were there protesting on September 12? They were not all Republican as the media would have you believe. We are average middle class Americans who are actively voicing our concerns over the blatant abuse of power and corruption in our political system. Wake up people!
kffdn - December 3, 2009 at 9:12 am
Job well done, Ms. Jones.
suomynona - December 3, 2009 at 9:21 am
1) It’s not a public option. It remains to be seen whether even a public option will exist in whatever bill that passes.2) ‘Government-run healthcare’ is an insurance lobby talking point, and has been. I think you need to educate yourself on the history of health reform in this country. I can’t counter your claims because they amoun to wild speculation and fearmongering. I can’t prove that what livefree says will never happen in the future. But, of course, neither can livefree.3) Once someone comes out with a stock line from the health insurance lobby in the second sentence of an article, a good reader proceeds with caution. There are some excellent points in this article; but apparently DAJ couldn’t resist being polemical from the outset. That’s a shame.
suomynona - December 3, 2009 at 9:28 am
And also, I don’t think anyone actually thinks that ‘free health care is free.’ People in favor of government subsidies for health insurance, or a government health insurance option, or a restructuring of health insurance such that it isn’t employer-controlled, and thus doesn’t limit consumer choice, are simply in favor of reallocating government funds toward something we view as a higher priority. All of this ‘outcomes-orientation’ garbage glosses over what should be the primary reason for health care reform: none of our basic rights mean anything without the right to health care access. People aren’t looking for an entitlement or a handout (people who would fall under the category of the handout-eligible probably aren’t participating much in the debate, for a whole set of reasons, as usual); we’re looking for the government to re-prioritize. The suggestion that pro-reform people are actually thinking there’s a magical solution that involves free health care at no cost is intellecutally dishonest.
tesol - December 3, 2009 at 9:59 am
“For example, a system that charges higher copays to women who smoke, who are obese, or who delayed childbirth beyond the age of 30 (I know this will stir up anger among the educated elite, but delayed childbearing is a risk factor for breast cancer) might be the most effective way to both reduce total health-care costs and improve outcomes.”We’re moving dangerously close to a “blame the fat people” approach to health care reform. Obesity is quickly becoming the new smoking, but not every obese person chooses to be obese. It’s not simply a matter of overindulgence. “Let them eat fruit!” they say, as they check your BMI. But not everyone has access to healthy food, and not everyone can afford it. Try fitting in an exercise regime when you’re working two jobs. And what about a genetic predisposition to obesity? I know someone who recently had surgery to help him lose weight because diet and exercise weren’t working. He’s lost 200 pounds and he’s eating what his doctor tells him to. But he’ll never have a “normal” BMI.
jgallagheraiaonline - December 3, 2009 at 10:05 am
The best background on health care and health insurance, and the most cogent plan for a better system that I have read was by Mark Goldhill in The Atlantic (Sept 2009 I think). Not the separation of health care and health insurance — they are different issues but usually muddled and mangled to the point where ‘free’ preventive screenings are considered part of one’s insurance plan. Can you imagine car insurance that provides ‘free’ oil changes? Relative to the current health care/insurance reform movement, it is important to understand the fundamental market laws. When you increase demand (by ‘insuring’ ~30 million more people and adding new mandated benefits) without doing anything to increase supply (there are no provisions to train and certify more doctors or other health providers or build new hospitals or clinics) you will end up with higher costs or if costs are held down artifically, rationing in the form of longer wait times or denial of care. Please keep the government from extending it’s reach and control over health care, and let’s get our employers out of it too while we’re at it. Then, when those who have the most to lose or gain from bad or good health care know what they are paying for and how much it costs because they pay for it themselves, we might see some meaningful, productive change in the health care and health insurance system.
suomynona - December 3, 2009 at 11:59 am
I’m all for putting healthcare in the hands of consumers, while providing government healthcare subsidies for those who can’t afford to purchase insurance. Currently, most health insurance markets are dominated by one or few companies. This means that companies are virtually guaranteed customers without having to compete for them, and without having to be accountable to customer demands. Particularly when health care is sourced through employers, consumers have even fewer choices. What are we supposed to do, quit our jobs because they offer one lousy insurance plan and move to a new state with a different dominant insurance company or two controlling the market?There is something to the argument that when consumers are aware of what they’re paying for healthcare, there could be productive changes and cost decreases. But this will only happen if insurance companies are made to compete, for once, like real businesses. If consumers learn the value of care by paying directly, and develop a sense of ownership with respect to the product they’re getting, and concomitantly develop a sense of the quality (or lack thereof) of the product they’re getting, they must have the choice to choose a better plan at a better company to actually create a competitive situation and reduce costs. The same logic applies to physician choice: the in-group/out-group organization of private health insurance currently means that consumers are once again limited in their choice of doctors. If the best doctor in the world has an office down the street for me but he’s not on my insurance plan, I have to go somewhere else. Often new patients have the experience of calling doctor after doctor in the area, even after getting a list after calling the insurance provider, and hearing ‘I’m not taking new patients’ or ‘I’m no longer affiliated with that insurer.’ Talk about bureacracy (you can’t just call the doctor; you have to call the inept insurance rep first so they can give you an outdated list) and rationing of care. This stuff already happens, quite obviously.
marzipanmouse - December 3, 2009 at 12:46 pm
tesol, and what about the fat people who actually do eat well and exercise? Or the thin people who don’t? The difference between smoking and “obesity” is that smoking is a behavior, and “obesity” is a number the American Medical Association pulled out of a hat.I would like to see more Health at Every Size incentives set up for all Americans, though I’m not sure mandating them at a governmental level is any more sane than mandating weight loss.