The devil is in the details

The devil is in the details and nothing can be more devilish than having government bureaucrats decide whether you can or cannot receive needed health care.

While supporters and critics of Obama’s heath care “reform” argue about whether to have a “Government” (or “Public”) option, “Co-ops”, or a “Trigger” to activate the Public option, completely overlooked is the most insidious aspect of health care plans demanded by Obama and proposed by Democrats. Every one of these Democrat plans to change the health care system includes a "Government Health Care Board and Health Care Choices Commissioner" to dictate what and to which Americans medical care can be provided.

House Speaker Nancy Pelosi said at a news conference in San Francisco on Thursday, Aug. 20, 2009, (CNSNews.com) that the health care bill (H.R. 3200) under consideration in the House of Representatives would give President Obama the authority to name a new federal “Health Choices Commissioner” who would have the power to dictate the health insurance plans offered in a so-called "exchange" where millions of Americans would get their health insurance if the bill is enacted.

These powers would include deciding which treatments are covered, which insurance companies can participate, which states can run their own health care plan, what medical care may or may not be provided to individuals on a cost effective basis and rules for enrolling individuals into the public insurance program.

The Bill calls for establishing a health insurance “exchange” where people earning up to 400 percent of the poverty level will be able to purchase health insurance with the help of federal subsidies or given to them at no cost. This exchange would include a "public option" government-run health care plan as well as private plans that provide a minimum benefits package dictated by the government.

The Health Choices Commissioner would establish “the benefits to be made available under Exchange-participating health benefit plans during each plan year,” according to page 84 of the 1,018-page bill. That means the Commissioner would determine what benefits the participating insurance companies must offer participating customers in the exchange, and also dictate what benefits or coverage cannot be made available. The commissioner would also set rules for insurance companies to participate in the health insurance exchange and establish criteria for individuals to receive federal subsidies to purchase insurance in the exchange, according to section 142 on page 42 of the legislation.

In addition the Commissioner would have the authority to establish “automatic enrollment” of individuals who qualify for the health insurance exchange:

“The Commissioner shall provide a process under which individuals who are Exchange-eligible individuals described in subparagraph (B) are automatically enrolled under an appropriate Exchange participating health benefits plan.” The legislation says, beginning on page 97: “Such process may involve a random assignment or some other form of assignment that takes into account the health care providers used by the individual involved or such other relevant factors as the Commissioner may specify.”

House Republican Minority Leader John Boehner (R-Ohio) expressed the views of many of us about giving one bureaucrat this much power over the health insurance and medical care of Americans and the fact that this is among the least noticed provisions of the legislation.

“The American people want two things from health care reform: lower costs and more choices,” Boehner said in a statement. “Yet Democrats have done exactly the opposite coming up with a bill that actually raises costs--increasing the deficit by $240 billion--and letting a new federal bureaucrat make health care decisions that should be left to patients and their doctors.”

The legislation also gives the commissioner sole power to determine who can participate and under what conditions.

“The Commissioner shall have the authority to establish such rules as may be necessary to deal with special situations with regard to uninsured individuals and employers participating as Exchange-eligible individuals and employers,” the bill says on page 82, “such as transitions periods for individuals and employers who gain or lose, Exchange-eligible participation status, and to establish grace periods for premium payment”

The Commissioner would also decide the “cost sharing” difference between each available plan, according to pages 85-87 of the legislation.

Supporters say the national exchange would not replace state Universal Health Care programs, such as the Commonwealth Connector in Massachusetts but this is not entirely true. State plans would only be approved if the state plan meets federal criteria set by the Commissioner. Otherwise, the commissioner could shut the state plans down.

“The Commissioner may terminate the approval (for some or all functions) of a State-based Health Insurance Exchange,” the legislation says on page 114. Page 112 of the legislation says a state plan “must demonstrate the capacity to provide assurances satisfactory to the Commissioner that the State-based Health Insurance Exchange will carry out the function specified for the Health Insurance Exchange in the State (or States) involved.”

The health care “reformation” contemplates making insurance coverage available to some 45 million or so alleged uninsured which is certainly an idealistic result that satisfies our altruistic better nature but at the cost of ruining health care now enjoyed by the 135 million families and individuals who are happy with their existing insurance coverage. The Democrat proposals also fail to deal with the obvious shortage of medical care providers needed to treat the increased number of people insured. This in itself would necessarily lead to delays in medical treatment which, like in Canada and the UK, can be fatal.

Furthermore, concern for the cost of the Democrat universal health care plans has injected the concept of “cost effectiveness” in the decision making by the "Health Choices Commissioner” and the national board as they dictate who can receive needed health care and what treatments are covered and available to a particular individual on a cost effective basis. It does not take a genius to realize this means providing treatment to seniors is not as cost effective as providing such treatment to younger people. Giving power to make such decisions to government bureaucrats and a single Commissioner amounts to allowing them to decide who lives or dies.

This is the ultimate in government control sought by Marxist/Socialists.