I am sure we have all seen the videos circulating about the town halls and the amount of passion, anger and unrest evident there. It seems that Senator Arlen Specter is featured a lot for some reason. I have had the opportunity to meet the Senator and think he is a really nice guy. I admire him for continuing to put himself out there. I do not think many of his answers have helped his cause with the voters.
As someone who has been a leader in the aging and disabilities field, I have long thought we needed healthcare reform. People with disabilities in particular have a very difficult time getting affordable insurance. They often have numerous pre-existing conditions that make them such a high risk that no one wants to cover them. I think that is why disability advocacy groups are mistakenly supporting healthcare reform however it is presented.
Despite my belief that we need healthcare reform, HR 3200 is one of the most poorly conceived pieces of legislation I have ever seen. It creates more than 50 new federal commissions or agencies, and leaves open to interpretation too many important policies. On page 354 there appears to be the intention to ration healthcare coverage for those with special needs. Section 1177 clearly gives the federal government the authority to limit special needs coverage.
Reading through the more than 1,000 pages, there is also no mention of tort reform, which would reduce litigation. Unfettered litigation is driving much of the cost increases in healthcare.
I have had the misfortune of being exposed to CMS, the federal bureaucracy that manages Medicare and Medicaid. I was part of a group that worked to get some coverage policies changed. My experience with their unresponsiveness, callousness to the average citizen, and lack of accountability, make me very cautious about any new agencies and commissions that might be created.
So, in my own opinion we need two things. We need an insurer of last resort set up for people with disabilities and others who cannot otherwise get insurance because of pre-existing conditions. This will protect the most vulnerable of our society, which I think is an important role for the government. Secondly, we need reform to a system that is driving malpractice claims up to a point that doctors are finding it too expensive to practice, especially in certain states.
Terry, thanks for this post, but I disagree with you on 2 points:
Section 1177 is about when enrollment can occur, not who is allowed to enroll. It says that the public option plan — like every private plan I’m aware of — can accept new participants during an annual enrollment period, but also right after diagnosis. The latter provision allows for people who are newly diagnosed with a disability to change their coverage to reflect the disability. It’s more inclusive and patient-focused than private plans, not less.
Tort reform is not a goal of mine. Litigation and malpractice insurance now amounts to less than 1% of health care costs. In a time when medical treatments are moving away from immediate physician supervision and off to other professionals and even automated systems, medical mistakes are growing — this is well documented. A malpractice lawsuit is the only remedy a patient has in the event of such a mistake. I can’t think of a good reason to limit the leverage that patients have, when I look at the huge insurance, pharmaceutical, and hospital corporations on the other side of the scale.
Jim, thank you for your comment. I think we read Section 1177 differently, which is understandable given the wording of it. However, the section is called “Extension of Authority of Special Needs Plans to Restrict Enrollment.” It is difficult for me to come away with any other conclusion.
I am not talking about tort reform in a way that limits the ability of people to seek remediation in court. In my opinion we need to stabilize the malpractice insurance system by installing some level of predictability. I think this can be done in a way that protects patients. I would be not be in favor of any tort reform that does not protect patients and allow them to seek a significant financial settlement in the event of malpractice.
I agree that legislative language isn’t very clear, but I don’t see how you can read it the way you indicate. It uses the word “enrollment” to mean the act of joining a plan, not who can join. That’s why this part of the bill uses dates. See the previous page, p. 353, to see the beginning of this Part (which is very small) entitled “PART 3—TREATMENT OF SPECIAL NEEDS PLANS”. The “extension” referred to is a date, amended from 2010 to either 2013 or 2016, depending on the plan under discussion. In any event, the only kind of plan referred to here is a “Specialized MA plan”, where “MA” stands for “Medicare Advantage”. It is in no way a new policy (just an amended date), a new program, a rule regarding existing private coverage, or any major change at all. Looking at the stuff collecting in my email inbox, I know that opponents of health insurance reform are seizing on “hot button” words and phrases and using them out of context, or, as in this case, inaccurately.
Jim, your explanation makes perfect sense and may indeed be the intent. This language, then, should be made more clear.
In emails I have had with various leaders in education and human services, there seems to be a lot of confusion and mis-information. I would say this is true proponents and opponents. People are not reading the bill, or are reading it and honestly coming to different conclusions as to what it says.
We need to make a distinction for those of us who are for healthcare reform, and yet do not believe the model proposed in this bill is the answer.