HOUSE HEALTH BILL CONTAINS DANGEROUS RATIONING PROVISIONS
Part Three of Three

Editor’s note. This is reprinted from the invaluable blog of the Robert Powell Center for Medical Ethics-- http://powellcenterformedicalethics.blogspot.com.

Thursday morning, House Speaker Nancy Pelosi (D-Ca.) unveiled the House Health Care Restructuring bill. H.R. 3200 contains many dangerous mechanisms, which, when coupled with inadequate funding, will inevitably lead to rationing. A manager's amendment to the bill is expected early next week, with the full bill scheduled to be brought up on the floor Friday (Nov. 6). House Leadership has promised that both the bill and the manager's amendment would be available for review 72 hours before a vote.

RATIONING THROUGH INADEQUATE FUNDING

H.R. 3200 contains premium subsidies to help the uninsured obtain health insurance. The problem is that a substantial part of the subsidies are paid for by “robbing Peter to pay Paul”--reducing Medicare funding for older people in order to cover the uninsured. The dangerous consequence is that in a few years, having over-promised and under-funded, the government will be faced with the choice of adding other means of revenue or, far more likely, in some way imposing rationing.

RATIONING THROUGH COMPARATIVE EFFECTIVENESS PROVISIONS

The House bill, as reported, allows comparative effectiveness research (CER) to be used in making coverage decisions, determining reimbursement rates, and in establishing incentive programs in ways that discriminatorily deny or limit health care based on age, present or predicted disability, or expected length of life. [Editor’s note. Scroll down to the October 16 entry for more about CER.]

SAVING MONEY THROUGH DANGEROUS END-OF-LIFE PROVISIONS

Section 3200, contains the newly renamed “Voluntary Advance Care Planning Consultation.” The section provides for government funded “advanced care planning” sessions. These could easily be used to subtly or not so subtly pressure patients and older people to reject treatment. Advocates of such measures frequently cite the cost savings if, as they expect, this promotion results in more directives rejecting life-saving treatment. Efforts to push patients and older people to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money.

Further, Section 240 also requires qualified health benefit offering entities to disseminate information related to “end-of-life” planning to people seeking enrollment in the exchange.

There have been several recent studies showing how advance directives and end of life conversations generally yield cost savings. See http://www.nrlc.org/HealthCareRationing/HouseLegislation.html for more description.

RATIONING THROUGH PRICE CONTROLS

The bills give broad authority to the Exchange Commissioner to review bids and to use that review as the basis for the exclusion of plans. This will effectively lead to premium price controls.

When the government limits by law what can be charged for health care, it limits what people are allowed to pay for medical treatment. Under a scheme of premium price controls, health insurance companies will ration life-saving medical treatment as they are squeezed more and more tightly each year by the declining “real” (adjusted for health care inflation) value of the premiums they take in. These day-to-day rationing decisions will have the most direct and visible impact on the lives--and deaths--of people with a poor “quality of life.”

Part One
Part Two