Obama’s Orwellian Health Care Reform
Written by Steven Yates
29 July 2009
President Obama promised the country healthcare reform. With the number of uninsured or underinsured Americans now exceeding 45 million, the country’s mood appears ready to accept his plans. In fact, he has continued to make any number of promises regarding health care reform, e.g., that under “his” plan you’d be able to choose your primary care physician, or through your employer, the insurance plan that best fits your needs. Now, however, as we read the fine print of the two 2,000-plus page bills currently before each of the two branches of Congress, evidence is emerging that “Obama care” would make George Orwell spin in his grave.
Our current health care system is far from perfect, but does afford consumers a range of choices such as those mentioned above. These choices would disappear in the long run under “Obama-care.” The present plan under consideration amounts to a federal takeover of the entire health care industry in America. Under it, you would lose many more freedoms than you would gain.
Fortune at CNNMoney.com recently took us on an excursion through the fine print of “Obama-care.” Their conclusion is that you would lose five specific freedoms under the plans currently being considered by Congress:
(1) You would lose the freedom to choose what is in your plan. The bills before both houses would require you to purchase insurance through “qualified” (by government) plans offered by health care “exchanges” to be set up in every state. The federal government would impose a minimum list of benefits each plan must offer. Many states already have such a list in place, and such policies have driven up health-care costs. The bills before Congress would allow the Department of Health and Human Services to add to the list of required benefits based on new recommendations from a panel of “experts,” meaning that the costs to Americans could be ratcheted up after a final version of “Obama care” is signed into law.
(2) You would lose rewards gained for not smoking or otherwise pursuing healthy lifestyle options as an individual. “Community rating” (already existing in 11 states) requires all patients to pay the same rates for their level of coverage regardless of age or medical condition. Younger and healthier people are forced to pay more than their actual cost, while older workers who can afford to pay more are afforded discounts. Under “Obama-care” this system would be federalized. Moreover, the bill specifically bars rewarding people who pursue healthy lifestyles such as participating in worksite exercise programs as being no different then barring insurance companies from charging higher premiums for customers with known health conditions such as diabetes.
(3) You would no longer be able to chose high-deductible coverage to lower your rates. Hundreds of employers offer employees Health Savings Account plans. Employees can deposit portions of their paychecks into the account with matching contributions from their employers. The employees can use their deposits to purchase a high-deductible plan for major medical costs (e.g., over $12,000) while also using the fund to pay for routine doctor’s appointments. HSAs prompt cost-consciousness. The bills before Congress endanger consumer cost-conscious health care. The required minimum packages would prevent patients from choosing plans covering only major medical expenses. Again, the federal government could set low deductibles that would eliminate HSAs after the bills are signed into law, according to John Goodman of the National Center for Policy Analysis.
(4) President Obama has insisted that under “Obama-care” you would have the freedom to keep your present plan. Those who have closely read the bills before Congress contend that over the long run the reality would be otherwise. The legislation divides the insured into two main groups—employees covered by the Employee Retirement Security Act of 1974 (ERISA) as part of their benefits packages from their employers, and those not covered by ERISA but who have private insurance or through small businesses. The former may indeed “keep” their existing plans, but only because they have been “grandfathered” for five years. Afterward their employers would have to offer government-approved plans through the “exchanges” with all their rules and restrictions noted above, and below. The legislation would require all insurers offering plans to the second group to offer the government-approved plans. Employees who purchased their plans before the law goes into effect could again “keep” them, but with a major restriction: if their plan changes in any way, e.g., through switching coverage for a drug, the employee would be forced to drop out and seek coverage through the “exchange.” Millions of employees would lose their freedom to keep their existing health care plans within the first year. (You would not, it should go without saying, be allowed to choose to be uninsured under “Obama care.”)
(5) President Obama has maintained that under “Obama-care” you would retain the freedom to choose your own doctor. The Senate version of the bill requires that Americans buying health insurance through “exchanges” must obtain care through what it calls “medical home”—the Obama-care equivalent of an HMO. You would be assigned (not allowed to choose) a doctor, and that doctor would control your access to specialists if needed. Health care gatekeepers would guide patients to tests and treatments that have proven cost-effective. The danger here is obvious: patients could be denied necessary care if it couldn’t be shown to be cost-effective.
The present system has its faults. Some of us are wondering if the coupling of health care benefits to employment, a practice dating back to the 1930s, was a good idea to begin with. Our problem in a nutshell has long been that we Americans have wanted quality health care but have not wanted to pay for it, and have instituted mechanisms of avoiding paying for it. Consequently the system has delivered services at below-market-value rates. Moreover, the offering of health care services at below-market rates has failed to encourage healthy behavior within the population. Basic economics dictates that the costs have to be made up somewhere, and the consequences of offering health care services at below-market rates has been the explosion of costs we have seen recently—along with many employers no longer offering health care benefits to their workers.
What are we to conclude from this excursion? Perhaps that in true Orwellian fashion, Obama has said one thing while the massive proposal for health care reform will actually do something quite different — possibly moving us closer to the sort of society in which the elderly and others not contributing directly to the economic system would technically be part of the health care system but be denied crucial medications or procedures not deemed “cost-effective” — euthanasia without its name, in other words.
What can we do? First, we must go back to basics and realize that health care choices are decisions that stem from an individual’s basic and unalienable rights to life and liberty. As such health care decisions and expenditures should be made by individuals of their own free will. That won’t be the case under the Obama plan.
Steven Yates earned his Ph.D. in philosophy in 1987. He is the author of one book, Civil Wrongs: What Went Wrong With Affirmative Action (San Francisco: ICS Press, 1994) and numerous articles both in academic journals and elsewhere. He has taught philosophy at Clemson University, Auburn University, Wofford College, the University of South Carolina, Southern Wesleyan University–Columbia, and Midlands Technical College, and has held fellowships with or worked on projects with the Institute for Humane Studies, the Heritage Foundation, the Heartland Institute, and the Acton Institute for Religion and Liberty.
Author of this article: Steven Yates
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