Myths. Distortions. Outright lies.
All characterize the debate about health care reform. From a congressman shouting, “You lie!” at the president, to a myriad of special interest groups “spinning” what’s in the proposed legislation — how can anyone tell what really is part of the reform package and what isn’t?
Let’s try to set the record straight — particularly on those issues that are getting the most attention.
Health care for illegal aliens
President Barack Obama has said that none of the health reform bills have a provision to provide government-sponsored health care to illegal immigrants.
Rep. Joe Wilson shouted that the president was lying — but he wasn’t. Both factcheck.org and the conservative think-tank Heartland Institute agree: there is no provision to provide health care to illegal immigrants.
And further, of the 11.1 million illegal immigrants estimated to be in this country, the Pew Institute says 47 percent have insurance.
“Conservative critics complain that the bill lacks an enforcement mechanism, but that hardly makes the president a liar,” said the factcheck.org Web site.
The American Immigration Lawyers Association said that attempting to get a health care credit would have legal repercussions — in fact, it could get a person deported.
The president was wrong when he said no federal money would be spent for abortions, said Ben Domenech of the Heartland Institute. The House bill specifically permits the public option to cover abortions, and would allow federal subsidies to purchase insurance that covers abortions.
“The House bill even has a provision that at least one health plan in every region offer coverage for abortions,” Domenech said. “So that is one of the misleading things the president has said.”
However, the House bill includes an amendment that says money for abortions would only be collected in the form of premiums, not taxpayer dollars.
While the president said “not one dime” would be added to the deficit — both the Max Baucus-sponsored bill in the Senate and the House bill would add billions to the deficit. The Congressional Budget Office estimates that the House bill would add $239 billion to the national debt during a 10-year period, while the Senate Finance Committee bill would add $49 billion.
Obama incorrectly blames Medicare and health care costs for the rising deficit, Berkshire said.
“Medicare is supposed to be funded from a trust fund, but Congress never adequately funded it — they spent that money on other things,” he said. “So now when they need more money and the deficit is rising, they blame Medicare. But that isn’t the whole story.”
Choice of care; public option
As far as choice about insurance plans — there is no plan to take away private, employer-based insurance. None of the bills include that as an option. But that’s misleading, said Domenech.
“The bill allows government to compete with private insurers,” he said. “That will drive them from the market, no matter what the bill’s intentions are.”
Medicare is a public option, said Steve Berkshire, professor and director of the health administration program at Central Michigan University, and in poll after poll, people want it left alone.
“So some of the misinformation out there about the public option, that it’s going to end the health insurance business as we know it, that’s not true,” he said. “We already have one public option, and that hasn’t happened.”
Factcheck.org says the public option is open to people with individual policies and to people who work for businesses with fewer than 20 employees. While the public option is aimed at the uninsured, they won’t be the only ones who can buy it.
Death panels & rationing care
Myths involving “death panels” enraged senior citizens early during the debate, but while the bills do offer support for end-of-life decisions, Domenech said they are not death panels.
“But there is real concern that because of financial decisions, the government could decide whether or not treatment was financially a good choice — depending on age,” he said. “But the bill doesn’t have a panel deciding to end the life of old people. It could end up rationing care for those old people, however.”
And Berkshire said that fears about the death panels and changing Medicare have led the elderly to believe that health reform could affect the way they receive care.
“Death panels, those are an exaggeration of something that is in the bill,” he said. “The bill discusses using quality and evidenced-based outcomes to determine reimbursement rates.”
Those provisions — which are in both the House and the Senate versions of the bill — led opponents to say that the very sick and elderly would go before “death panels” to decide if they need treatment. Opponents also claim care would be “rationed” by the government.
“Strictly speaking, that isn’t true,” Domenech said. “Obama wants to create national standards based on research and review. The research would lead to national standards a doctor would have to follow when caring for a patient. But people aren’t like cars — there is no standard way of treating — so there’s some flexibility.”
The idea of rationed care stems from those national guidelines. Doctors who do not follow the guidelines, or whose outcomes are not up to national standards, would receive lower Medicare reimbursement.
“For instance, if the evidence shows one particular treatment out of many — say the choice is between therapy, surgery or some other kind of treatment — and one is cheaper and has the same outcome, or close to it, that’s the one the doctor will have to choose,” he said. “It isn’t rationed care like the British have, but if you want to do a more expensive option; you’ll have to have a very convincing argument for it.”
Some proponents of the bill argue that reform is essential to continuing to provide health care in the United States. They claim the system will “implode” under the weight of ever-rising medical costs, ever-increasing numbers of the uninsured and lowering reimbursement rates.
“This is an exaggeration,” Berkshire said. “But we are at a point where we have to decide how much we want to spend on health care. Right now, it’s 16 percent of our gross domestic product. Do we want to spend more?”
People worry about reform because it will — by necessity — change the industry, he said. Money already in the system will have to be funneled elsewhere as the reformers try to include between 25 million and 40 million more people.
“And the best of the bills leave about 10 million people without insurance,” he said. “But no matter what, it’s going to cost money to include more people. The road we’re headed down is too expensive.”