Government-controlled health insurance may politicize health

During President Obama’s final push for “universal health care” legislation, his biggest obstacle was not Republicans but rather anti-abortion Democrats let by Congressman Bart Stupak (D-Michigan).

Stupak eventually reached a last-minute deal with the White House on federal funding of abortion services. But no one should be surprised that under government-controlled health insurance, medical coverage decisions will be based on political considerations. Rather, the recent wrangling over abortion will be a mere preview of special-interest battles to come as health care becomes a permanent political football.

Abortion has already been a political football in those sectors of health insurance under government control. In 1985, the Department of Defense denied abortion coverage for women with military health insurance unless the mother’s life was in danger. In 1988, the DOD issued additional rules prohibiting women from obtaining abortions with their own private money at military facilities overseas. President Clinton reversed this ban in 1993, but anti-abortion lawmakers reinstated it in 1995 through the defense appropriations bill.

Women covered by the Federal Employees Health Benefits Program (FEHBP) have been similarly affected. Over the past thirty years, their abortion coverage has also swung from permitted to highly restricted depending on which political party was in power.

Nor will the problem of politicized health benefits be confined to abortion. ObamaCare gives the U.S. Preventative Services Task Force (USPSTF) the authority to determine which preventive health services must be covered by private insurance. The USPSTF is the same group that recently issued controversial guidelines recommending that screening mammography be restricted to women over age 50, despite the fact that medical organizations such as the American Cancer Society have long recommended routine mammography beginning at age 40, based on years of scientific research.

Due to public outrage, the Senate later amended its bill to override the USPSTF guidelines — in this particular case. As with abortions for military families, mammography coverage under government-controlled health insurance was determined primarily by politics and lobbying. Similar lobbying will occur as Americans start demanding coverage for other procedures not approved by the USPSTF, such as virtual colonography (a new method of detecting early colon cancer which President Obama himself recently underwent).

Such lobbying is already a constant feature under the Massachusetts system of mandatory insurance in place since 2006, which was the model for ObamaCare. Under any system of mandatory insurance, the government must necessarily determine what constitutes an “acceptable” policy. This creates a giant magnet for special interest groups seeking to include their favorite benefit in the mandatory package.

Massachusetts residents must therefore purchase numerous benefits they may neither need nor want, such as in vitro fertilization and chiropractor services. Since 2006, special interest groups have successfully lobbied to include 16 new benefits in the mandatory package (including lay midwives, orthotics, and drug abuse treatment) — and the state legislature is considering 70 more.

Although I am pro-choice on abortion, abortion opponents should not be forced to fund another woman’s abortion. More broadly, individuals have the right to spend their own money for their benefit according to their values. ObamaCare would violate that right by forcing each person to spend his own money on terms set by lobbyists and bureaucrats, rather than based on his individual needs and values.

Instead of politically-controlled mandatory health insurance, we need free-market reforms that allow consumers to decide which benefits they wish to purchase. Such reforms include eliminating mandatory benefits, allowing insurers to compete across state lines, and allowing patients to use Health Savings Accounts for routine expenses, and low-cost “catastrophic-only” plans to cover rare expensive events.

Not only would these reforms reduce insurance costs by up to 50 percent, they would respect each individual’s right to make insurance decisions for himself.

Government-controlled health insurance will mean politically-controlled medicine — not only with respect to abortion but for health services in general. ObamaCare will turn medicine into a game of permanent political football, where the politically favored perpetually pound ordinary Americans without special “pull.” Until we replace ObamaCare with free-market reforms, Americans had better get used to being the permanent tackling dummies for special-interest groups.

Paul Hsieh is a radiologist and co-founder of Freedom and Individual Rights in Medicine at www.WeStandFIRM.org.

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  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    “Government-controlled health insurance may politicize heatlh”

    Really? Ya think?

  • Doc99

    “MAY?”

  • Reasonable RPh

    “Although I am pro-choice on abortion, abortion opponents should not be forced to fund another woman’s abortion.”

    sorry, I’m not buying that argument. The price we pay for living in a democracy is that sometimes our money is used for things we don’t personally support. If abortion opponents can somehow opt out of having their money used for reproductive health, can people whose values include a good diet and exercise refuse to pay for medicines for obese Type II diabetics? What about chemo for people with lung cancer? Why should others pay for the bad decisions some people make? Can Catholics say they don’t want their money going to oral contraceptives? Where do you draw the line?

    Heck, I was personally opposed to the war in Iraq, yet thousands of the dollars I’ve given the IRS in the last 7 years have gone to that venture, technically against my will. That’s just the way it is in a representative democracy.

    • Sarah

      Did you oppose the war in Iraq so much that you were out there with signs and megaphones, declaring your hatred?

      There’s a huge difference between abortion and war. There’s a huge difference between contraception and abortion. I’m catholic, and I whole-heartedly believe I should not have to pay for some one to get an abortion because she got drunk and made a bad choice. But I welcome the opportunity to help her pay for birth control.

      As a country, we need to start treating the cause of problems, and not the effect of problems. And this new health care reform is not addressing the cause. It’s putting a bandaid on the symptoms. Like with your example of obese people and diabetes, we need to put money into helping people go to gyms, and give tax breaks and credits to people that maintain good health. We’ll save money in the long run.

      And we need to put money to safe sex and abstinence education. We need to offer girls the ability to get on birth control. We need to not punish women or men when they make responsible decisions like using condoms or birth control by making it impossibly awkward to go in and purchase these things. And quite frankly, maybe even parents need to be educated on these things.

      And if the government does these sorts of programs, we may have to worry less about funding abortions.

    • John

      “The price we pay for living in a democracy is that sometimes our money is used for things we don’t personally support.”

      Really? Then maybe the problem is a system where our money is used for things we don’t personally support. Democracy can be used to change the system. The price for living in a democracy is you get what you voted for but that doesn’t mean it can’t be changed.

  • http://fertilityfile.com IVF-MD

    I echo the “MAY???” sentiment.

    Sure, government-controlled health insurance MAY politicize health just as smashing your car into a brick wall at 90mph MAY scratch the front bumper a bit.

    • John

      I’m sure politicians will smash their car into a brick wall over controlling every decision in health care.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    I’m sorry, RPh, I’m not buying the argument of slippery slopes. And war is not health care.

    Feel free not to pay your taxes if that floats your boat. Obozocare just gave the IRS loads more to do/police. If my own experience in government healthcare is any measure, they won’t get around to policing you for a very long time.

    It may not be “reasonable”, or politcally-correct or even progressive to say so, but we as a society should draw the line at PAYING FOR a procedure that deprives a human being – an INNOCENT – of even the right to life.

    I’ve got no problem with public money funding birth control before the fact of conception. Indeed, one would think that with all of the methods of birth control that are now available (much of it for “free”), the “need” for abortion would be next to nil.

    But I have very big problems – both religious and Constitutional – with public money funding abortion. And I am not alone.

  • Healthcare Observer

    No, in time universal healthcare will depoliticize health. Politics is about struggle between the haves and the have nots, so the US ‘system’ was heavily political when so many were shut out or underinsured, and when those with vested interests in keeping it that way held sway. When healthcare is a universal system, as in Europe, while there are always arguments about funding there is little real politics.

  • http://www.howlandhealthconsulting.com Wendie Howland RN MN CRRN CCM CNLPC

    May? MAY? ::is there an echo in here?::
    The free-enterprise system has been tried on health insurance… and that piteous squawking you hear is health plan big guys and shareholders figuring out that they will ever be able to fly first-class again now that they are looking at a 15-20% max on the premium dollars not spent on actual, y’know, health care. What a concept, eh?

    • http://www.howlandhealthconsulting.com Wendie Howland RN MN CRRN CCM CNLPC

      That is, of course, “never.”

  • http://blog.headache-treatment-options.com/appliedobjectivism/ David Allen, MD

    Paul Hsieh is right on and most of the above comments echo that. What has been amazing in watching this ‘debate’ between the Democrats and Republicans is that very little attention was paid to why there are problems with the system. Instead of an attack on the third-party payer system (the routine use of insurance for everything) and the already intrusive and deleterious effects of government on the system, politicians just spoke about the results: higher premiums, reduced access, the inability of insurance companies to cover many people. The closest the Democrats came to an explanation was ‘insurance company greed’ – which really explains nothing.

    Please pay attention to Paul’s actual solutions:

    “Such reforms include eliminating mandatory benefits, allowing insurers to compete across state lines, and allowing patients to use Health Savings Accounts for routine expenses, and low-cost “catastrophic-only” plans to cover rare expensive events”

    These alone would do wonders for the health care system.

    • H

      “allowing patients to use Health Savings Accounts for routine expenses, and low-cost “catastrophic-only” plans to cover rare expensive events”

      When I got my first job working in a bank 20 years ago, a high deductible plan was one of my options. This is already allowed.

      “low-cost “catastrophic-only” plans to cover rare expensive events”

      I know you think that $10,000 is a low expense and I know you think expensive medical care is rare.

      “in 2007, nearly two thirds of U.S. adults, or about 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses).”

      “A recent study by Thomson Reuters found that an increasing number of patients are postponing medical care because of cost, and that includes people with high deductibles.”

      35% used home remedies or over-the-counter remedies instead of going to see a doctor.

      23% skipped a recommended test or treatment.

      http://www.managedcaremag.com/archives/1001/1001.downstream.html

      I have read Ayn Rand. I prefer Bill McKibben.

      • http://blog.headache-treatment-options.com/appliedobjectivism/ David Allen, MD

        H-
        I think you are still committing the error I was speaking about. Instead of an analysis of why the system is bad (what leads to higher prices and poor service in this industry) you simply complain about it and document the problems. The implication being that the government must do more to correct these problems. In reality, it is government meddling in the market that has created most of these problems. The same liberal mentality that said “wouldn’t it be nice if the government could provide health care for those over 64 years of age” is now wondering why everything is so darned expensive! It must be those damned insurance companies, or doctors! In reality, the elephant sitting in the room (and its a big one) is Medicare – which has distorted the market in so many ways that it would take a book just to document them all.

        But let’s also speak of pre-existing conditions. Health insurance companies should simply be able to offer people scaled down (catastrophic) insurance and change their rates according to the risk the patient represents. That is the only honest way of handling it. Does this create an incentive for patients who have this insurance to not spend as much money and to try to take care of their own health, and to have a healthier lifestyle? Of course – and those are the kind of naturally occurring incentives that we actually want in the system. Could there be a person who decided not to buy insurance and who suffered from a horrible medical condition (cancer, a bad fall, etc.) – yes – of course this will happen. Such have made a mistake, were too poor to buy it, and/or have had some bad luck. Such people will have to be dependent on the good will and charity of those who can help them. This includes doctors, hospitals, their families, and actual charities. The right to pursue your own best health is certainly a right. The right to force others to provide you with medical services is not.

        • H

          You don’t seem to understand that catasptrophic health insurance is already available. No one is forcing you to accept Medicare. No one is forcing you to take insurance. I see no where in the law that says an insurance company must pay 20% of Medicare rates. It is the doctors that have accepted these payments. If you don’t like them, shop elsewhere. What makes you think if you get rid of Medicare and Medicaid that the insurance companies are going to give you more money?

          Where is your study that shows those that must pay for their own health care out of pocket are healthier? Or do they just avoid care? Which country has been successful with a market based health care system?

          Anyway, if charities work so well for health care, why do we have this health care crisis?

          • David Allen

            I stand corrected, you can buy catastrophic-only insurance, it appears. Maybe I’ll look into buying this for myself! Currently I use a Health Savings Account – which is one method of helping to keep more dollars in your own pocket.

            No one is forcing me to accept insurance, I agree. Did I imply otherwise? Also, I didn’t and don’t think that getting rid of Medicare and Medicaid would result in my getting more money.

            The United States, say in the early 1900s, was successful in having a market-based health care system. Gradually this has been replaced by more and more government intrusion. Now about 50% of all health care dollars are spent by the government.

  • H

    “I’ve got no problem with public money funding birth control before the fact of conception. ”

    Since life starts a conception, I do not want my tax dollars going toward hormonal contraceptives that prevent pregnancy by making the lining of the womb inhospitable for implantation.

    • H

      Oof course, the child know nothing of rape and incest. These should not be exceptions for an abortion.

    • J

      Just to point out on a pharmacological basis, most hormonal contraceptives also prevent the ovary from even releasing an egg – nullifying your objection.

      • H

        Hormonal contracetive work several ways…one way is to make the lining of the uterus inhospitable for implantation. Since it is unknown how offen this occurs, birth control pills are like abortion. Likewise, an IUD can also be considered to kill an unborn child.

        • J

          Actually, an IUD most likely interferes with the ability of the sperm to reach the fallopian tubes to fertilize the egg. See study mentioned below. In terms of contraceptives, the progestin component of most biphasic/triphasic oral contraceptives prevents ovulation by inhibiting LH surges during the ovulatory cycle while the estrogen component involves the prevention of implantation (regardless of fertilization status).

          Alvarez F, Brache V, Fernández E, et al. New insights on the mode of action of intrauterine contraceptive devices in women. Fertil Steril 1988;49(5):768-73.

          • H

            That study is an abomination.

  • H

    “The United States, say in the early 1900s, was successful in having a market-based health care system.”

    So you would accept a few chickens for compensation? I have a few organic chickens, how many for an office visit?

    • David Allen

      You’ll get the chicken discount, but small increase due to chicken exchange costs.

      I’ll also accept: certified gold or silver.

      • H

        Sorry, can’t afford that. Have to eat.

        • ninguem

          Praciticing in a fishing port, I actually DO have patients who pay me in fish.

          I’ve got a couple where I think I owe them medical care.

  • Ron P.

    Bless you, ninguem! I hope there are more out there like you.

    Return to topic. The politicization of medicine is nothing new. When was the last time anyone heard of a “Walk to Cure Prostate Cancer?” Or saw a telethon for Pulmanary Fibrosis? Without thinking very hard, I’m sure every reader can think of dozens of diseases that kill more people yearly than AIDS. Politics directs where the research money goes, and always has. Now that insurance (prepaid medicine) is to be government controlled by “approvals,” what basis did you think POLITICIANS would use to decide what to “approve?”

    This is exactly what all the fuss was about: the right to keep government OUT of the decision-making process. True, some of those decisions are currently influenced by the evil insurance companies; but, we have the right to change companies to one whose policies we like better. It is much easier to change insurers in a free market than it is to change governments, even in a representative democracy.
    Ron Pittenger

  • pat

    Government health care will politicize healthcare…that’s the whole point. More power for the government. If you want proof, look at Medicare. It has already politicized healthcare. Private companies follow Medicare’s lead, and Medicare is susceptible to lobbying. If you’re on Medicare, you get what Medicare pays for and if that’s not what you need, too bad. And who decides what Medicare pays for? Doctors and patients? If only. Committees and boards, bureaucrats and appointees, all ultimately answerable to elected officials. We should start all over and let individuals buy their own insurance and receive the tax credit that employers now receive. Generous HSAs would encourage young people who could stash some money, tax-free, for their futures. Healthcare needs to be given back to patients and doctors, with patients paying doctors and doctors having an undivided commitment to their patients. Nothing else will make it better, more efficient or less costly.