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In recent weeks, the Democrats have said that people with an acceptable health care plan could keep their insurance. That’s been frequently disputed and refuted on the Right Blogosphere. Nonetheless, for the sake of this discussion, let’s stipulate that it hasn’t been refuted.

We’ve also heard Democrats say that they don’t want anything or anyone to step in between the patient and their physician. In Section 122 of HR 3200, they list the things that must be covered to be considered a “qualified health benefits plan.” Here’s what must be included to qualify for a “qualified health benefits plan”:

Minimum Services To Be Covered- The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services, including emergency department services.

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.

(5) Prescription drugs.

(6) Rehabilitative and habilitative services.

(7) Mental health and substance use disorder services.

(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.

(9) Maternity care.

(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

That isn’t the end of the qualifications. Here’s a section that bothers me:

(1) IN GENERAL- There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.

(2) CHAIR- The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.

(3) MEMBERSHIP- The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:

(A) 9 members who are not Federal employees or officers and who are appointed by the President.

(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.

(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint.

In other words, H.R. 3200 establishes a bureaucracy that regulates the definition of a Qualified Health Benefits Plan.

If Democrats wanted nothing getting between a patient and their physician, why is there such a list of federally-imposed regulations on what is or isn’t a qualified health benefits plan? One possible answer is that they want this commission to establish what isn’t a qualified policy. That way, the gutless politicians can claim that they didn’t push people into the public option, that they passed well-intentioned legislation, then blame ‘Washington bureaucrats’ for the mess that they created.

For years, conservatives have been pushing cafeteria-style plans that let a patient and their physician sit down and figure out what coverages are high priorities and which coverages are less important. The health care consumer then figures out what their budget is and buys a policy that fits him/her and their family best.

That’s something that I discussed with Paul Ryan in this post:

2. Shouldn’t people, working in concert with their physician, have the option of putting together a customized health insurance policy?

Yes – that’s a great idea and just the type of innovative thinking we don’t want the federal government to squash. Patients have different needs, and that’s exactly why health insurance shouldn’t be run by the federal government. The government does not know what is best for patients. Patients and doctors should be able to make decisions together about the types of health plans that best suit their individual needs. That concept is exactly what motivated the Patients’ Choice Act. We don’t want the federal government taking over these decisions, and we want to show people that there is another way that allows the individual to maintain control over these personal decisions.

It’s never been the Democrats’ goal to eliminate obstacles that get in the way of the doctor-patient relationship. It’s been about controlling people’s lives. Democrats are, by nature, control freaks. I don’t say that vindictively. It’s purely observational. That’s why they love putting massive amounts of mandates into every bit of legislation they write. It’s genetic.

Republicans are fighting to give people lots of options, including a custom-built policy that the health care consumer and their physician put together. The Democrats are pushing for a regulation-infested plan that limits options, inflates the deficit and that pushes people into rationing.

Which sounds more appealing to you? Make your voices heard because now’s the time for choosing.

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Cross-posted at California Conservative

11 Responses to “Qualified Health Benefits Plans”

  • eric zaetsch says:

    Gary, that’s not a plan. That’s carping over one.

    What’s the GOP answer, besides stall and push to keep the sorry status quo?

    I realize that’s an oversimplification of all the sophistry. But, it is the gist.

    What, Gary, is the GOP alternative plan?

    What terms and conditions?

    How financed?

    What firm future cost containment proposals do the GOP make? Be specific.

    What is the GOP position on age discrimination and preexistent condition exclusionary practices currently practiced by private sector insurance companies?

    I am unaware of any. Do you know what I do not?

  • Gary Gross says:

    Eric, The PCA’s cost is born by individuals, not through taxes. Ryan’s reform is based on truly getting the government out of being the arbiter between the physician and the health care consumer. It lets people set their own priorities instead of letting government tell them what their priorities should be.

    It’s based on the belief that people, acting after consulting with an expert, make better decisions for their families than does a disinterested DC bureaucrat.

    Real reform isn’t possible if the government sets down page after page of assinine regulation. Each mandate drives up the cost of the insurance premium.

    The GOP is opposed to people being denied health insurance because they have a pre-existing condition. That’s been their position for a decade.

  • Alec says:

    It has been the GOP’s position for a decade that pre-existing conditions shouldn’t disqualify someone? Really? Then you are either incompetent or lying. The GOP had all three branches of government for almost 8 years! Nothing was stopping them from realizing their position.

  • Alec says:

    In the system right now, a bureaucrat from a health insurance company makes decisions about our health in consultation with his actuary tables.

    The insurance companies make money by denying care. Do you honestly think a free market entity is going to quit trying to make money?

    A corporations job and responsibility to their stock holders is make as much profit as they can. Providing care is a liability for insurance companies. Is that who you want making your medical decisions?

  • Dennis Elliott says:

    In the late 19th century, insurance companies were numerous and activity was extreme with players entering the market at an ever increasing rate until competition became cutthroat. Many states saw this as a tax windfall and used those powers unmercifully and, at the same time, imposed large numbers of regulations that were highly variable between the states. State supervision was in many cases ignorant and corrupt as well. The companies were trapped between extremely high competition and equally high government-imposed costs and petitioned Congress for relief through a national regulation scheme with basic standards that they could all work under. This was stymied by a Scotus decision (Paul vs, Virginia, 1868) which essentially ruled that insurance was a contract as opposed to commerce and, hence couldn’t be controlled by the national government. The Gordian Knot of state control continued. (This information is from The Triumph of Conservatism by Gabriel Kolko).

    Assuming that the industry is still under that ruling and that fact is responsible for at least part of the cost problem (That every insurance company has to set up separately under the regulations imposed by each state it wants to do business in) it seems like that might be a good place to start to reduce costs. That is, untie the knot that restricts companies to state regulation.

    I worked for the Federal Government and our insurance allowed us to choose from a bewildering array of companies and plans and the costs seemed to be fairly reasonable because of that competition. I believe this is the same plan that Congress is under.

    With this as background, I think the Feds setting some basic ground rules could be in order as long as the purpose for them is to move to a position where insurance companies could offer their products nationwide. This would offer the competitive situation the Fed employees and Congress Critters have. The standards should be a basic entry level package that most anyone could afford.

    The current proposal offers a Premium+ package for no other purpose than control of the system. Wrong strategy;wrong goal;wrong package.

  • Jim says:

    the patients choice act…the government doesn’t know what’s best, i agree. but, how can conservatives reconcile their current position of – the government doesn’t should get in the way of an individual and their reaction to terri schiavo?

    thanks for the posts!

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