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Fortune Article: Universal Care Creates Five "Endangered Freedoms"

Sarah's picture

because the plan doesn't enforce payment differences (downwards) on services provided by nurse practitioners. Claiming patients risk losing five freedoms under a national healthcare plan, the copyrighted article in Fortune enumerates what look to me like hazards. Author Shawn Tully claims:

A close reading of the two main bills, one backed by Democrats in the House and the other issued by Sen. Edward Kennedy's Health committee, contradict the President's assurances. To be sure, it isn't easy to comb through their 2,000 pages of tortured legal language. But page by page, the bills reveal a web of restrictions, fines, and mandates that would radically change your health-care coverage.

Those five freedoms? Let's have a quick look at each one, shall we?

1. Freedom to choose what's in your plan

The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state. The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.

Explain to me how this is a bad thing. Oh, wait -- it means, no matter how much I pay out, there are certain things the insurance company cannot refuse to pay for, right? So, for consumers (read: customers, regular people, the poor sod paying the premiums) this is a plus. For the health insurance companies, not so much (cuts profits 'cause you actually have to, you know, honor the contract with the policyholder).

2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Oh, right. Again, I could not be charged extra the day after I turned 35 for the same coverage I had the day before I turned 35. Looks to me like this is actually a bonus again for that policyholder. Yeah, I can see how the parasitic companies hate this, all right. Cuts right into that automatic hike in premiums they've gotten used to using to extort even more money from policyholders.

3. Freedom to choose high-deductible coverage

The bills threaten to eliminate the one part of the market truly driven by consumers spending their own money. That's what makes a market, and health care needs more of it, not less.

Hundreds of companies now offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan -- say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care.

I can see how taking this option off the table would be a problem for the insurance companies. It would make their collection of money from frightened people more difficult.

4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise. It's worth diving into the weeds -- the territory where most pundits and politicians don't seem to have ventured.
The legislation divides the insured into two main groups, and those two groups are treated differently with respect to their current plans. The first are employees covered by the Employee Retirement Security Act of 1974. ERISA regulates companies that are self-insured, meaning they pay claims out of their cash flow, and don't have real insurance. Those are the GEs (GE, Fortune 500) and Time Warners (TWX, Fortune 500) and most other big companies.
The House bill states that employees covered by ERISA plans are "grandfathered." Under ERISA, the plans can do pretty much what they want -- they're exempt from standard packages and community rating and can reward employees for healthy lifestyles even in restrictive states.
But read on.
The bill gives ERISA employers a five-year grace period when they can keep offering plans free from the restrictions of the "qualified" policies offered on the exchanges. But after five years, they would have to offer only approved plans, with the myriad rules we've already discussed. So for Americans in large corporations, "keeping your own plan" has a strict deadline.

Hmmm. Here again, I'm having trouble understanding how this is a bad thing for the American policyholder, although clearly it looks like a threat to the insurance company's guarantable profit margins.

Then there's the last one:

5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.

So, um, whose freedoms are they trying to protect?

The best solution is to move to a let-freedom-ring regime of high deductibles, no community rating, no standard benefits, and cross-state shopping for bargains (another market-based reform that's strictly taboo in the bills). I'll propose my own solution in another piece soon on For now, we suffer with a flawed health-care system, but we still have our Five Freedoms. Call them the Five Endangered Freedoms.

Oh, right. The companies.

No votes yet


NAVDOC3RDMAR's picture
Submitted by NAVDOC3RDMAR on

baucus $2.8 Mil, conrad $2.1 Mil, demint $1.3 Mil, reid $1.5 Mil fr MEDICAL INDUSTR-IAL COMPLEX

Follow the Money: Link

Call Congress and demand, Single-Payer Health Care for All Now!

Sign the Single-Payer Petition: Link


a little night musing's picture
Submitted by a little night ... on

When I saw the title of your post in the sidebar, my first thought was: Freedom to be sick? Freedom to die?

And I wasn't too far off, except that I forgot about the all-essential Freedom to bankrupt yourself with a high-deductible policy when you do suddenly need healthcare.

Well, at least we know where the battle lines are being drawn.

Submitted by jawbone on

now discussing public plan. Ezra said he can't tell what it would be like since each bill is different.

In looking for a link for tonight's NewsHour (which I can't find for love or money), I did find this NPR poll on Obama and the Dems' prospects for 2010:

Despite the overwhelming unhappiness with a Congress now dominated by Democrats, those polled said the majority was slightly better than the minority at addressing the nation's priorities. On a scale of zero (very bad) to 10 (very good), those polled gave the Democrats an average of 4.4, the Republicans an average of 3.9. The Democrats got a rating of 5 or below from 61 percent, the GOP got a rating of 5 or below from 75 percent.

The so-called "generic ballot question" was also very close. Asked whether they would support a Democrat or a Republican for Congress in 2010 if the election were held today, 42 percent said they would choose a Democrat and 43 percent a Republicana difference well within the poll's margin of error (plus or minus 3.4 percentage points for each number in each question).

Maybe Dems should reconsider their sucking up to Big Insurance Parasites and give the people real health care?

Plurality slightly considers Obama to have not handled the economy well. Uh oh.

Submitted by jawbone on

and makes me very, very nervous. One of the freedoms I look forward to with Medicare is being able to choose my own docs. What will be going on in 17 months, who knows?

Has anyone found what happens to insurees when out of the area of their "medical home"? I guess that is a bit better than "gatekeeper" doc, but it does sound kind of paternalistic. But then I'm a youngest child, and I read some book which said those tend to resist authority and chafe at lack of choices. Just hate being told what to do.

a little night musing's picture
Submitted by a little night ... on

Is this even true? I do not recall this being in the Senate HELP bill. And I haven't seen it in the summaries. Dang. Now I'll have to go back a read those abominable snowbills.

This last point, though, coupled with their others, sounds as if they are really trying to protect the right of executives of Really Big Companies to have gold-plated insurance that allows them to spend hours with their doctors and get full-body scans and other such nonsense.

[There is such a thing as too much testing, and it is a concern, not just because of the cost of the tests themselves, but because of the increased chance of false positives.]

a little night musing's picture
Submitted by a little night ... on

(I have not got the whole bill on this computer and I'm damned if I'll download it again)

See here, for instance...

The Medical Homes in the Senate HELP bill seem to be designed as a way to manage treatment of chronic illnesses when a number of different specialists need to be coordinating care. And they don't seem to be mandatory, just something that is to be investigated. But I'll have to [choke] go back and read the fracking bill to be sure.

In other words, so far, it appears that the author of the Fortune article was.... what's the word?... oh, yeah: LYING.

a little night musing's picture
Submitted by a little night ... on

While it does not appear that you would be forced to accept a certain PCP, once you had done so, in particular if you had a chronic condition, you might have to use the specialists in their "medical home" if they were participating in one of those. Nothing seems to rule out moving to another "home" or something else (depending what's available).

What is does rule out in that scenario is assembling your own "team" of specialists.

In other words, he wants to protect a "freedom" that only execs with gold-plated policies really now enjoy.

Remember who the audience is.

* I'm so fair today. I can't stand it. I think I'll go yell at someone.

Submitted by hipparchia on

it would be much like an hmo, and probably if your preferred specialist was out of network you'd still get to see that person by paying more [just like now].

Submitted by gmanedit on

I agree with point 5. Medical homes are HMOs are managed care. Doctors will be forced into organizations whose interests are at odds with patients’ (the return of the evils of capitation; summarizes the latest recommendations for MassCare). Electronic recordkeeping and P4P (pay for permance) will monitor doctors for compliance with abstract standards rather than the doctors’ clinical judgment, and reward or punish them accordingly. Mandated “wellness” screenings will make a noncompliant patient (like me: don’t want to take cholesterol drugs, don’t want to be lectured about my bad habits, don’t want to take tests that might lead to pills despite the absence of symptoms) a liability to doctors, who will be punished for failing to coerce desired patient behavior.

Spend some time reading at Blogger Sandy Szwarc has many thoughtful, link-heavy essays on the pitfalls of government control of health care, the unsavory industry groups and foundations working behind the scenes, and the dangers of medicine by press release (you wouldn’t believe how many medical guidelines are based on hidden interests, to the point of endangering patients). There are many ways to screw up single payer, too.

The French seem to do a better job of running health care. I think we should be looking more closely at that.

Jawbone: Based on the latest recommendations for MassCare, it won’t matter who you see, as they will all be under the same constraints. I, too, was looking forward to Medicare, but it looks as if old people (useless eaters) will be the first under the bus.

Hey, is dental care covered? Eyes?

Damon's picture
Submitted by Damon on

Spend some time reading at Blogger Sandy Szwarc has many thoughtful, link-heavy essays on the pitfalls of government control of health care, the unsavory industry groups and foundations working behind the scenes, and the dangers of medicine by press release (you wouldn’t believe how many medical guidelines are based on hidden interests, to the point of endangering patients).

What's with all of the right-wing-tinged talking points popping up around here, lately, concerning "government control of health care"? You seem to be conveniently leaving out that this is already happening in the private system, and in the private system, unlike in a government system, this is a not a bug of their system, but a blatantly built in feature.

Government administration of health care is simply superior, and that's what it comes down to. I don't think anyone has to be told that there isn't such thing as a perfect system, yet concerning trolling about government care is getting really out of hand.

This whole throwing out the baby with the bathwater take on managed care is simply bizzare, particularly if we're supposed to be advocating for single-payer, where it is an integral part of every successful single-payer system in the world.

Submitted by gmanedit on

That's why I'm concerned (not troll-concerned) about Trojan horses—plans that allegedly are to serve the people, but actually are designed to put the full force and credit of the government behind corporate interests.

One thing I'd hoped we had learned since last year is that we can't reflexively accept or dismiss facts and arguments based on the "team" they come from; I don't even know what my team is any more. Since last year, I've found myself reading people I would have automatically dismissed before. Szwarc does not discuss what she would want to see in medical care or payment mechanisms, but she does document the extensive connections of the government-medical-industrial complex. (For example, at she discusses and links to information about the industry background of health-policy czar Nancy-Ann DeParle and warns, "What most consumers don’t realize is that healthcare reform chiefly isn’t about helping people, covering the uninsured or addressing health disparities, but about increasing the private-public medical industry and making money for them." Isn't this why we're tearing our hair out? Are we supposed to trust "government control" when this administration won't even let us know what the plan is, but it has to be passed right away? Lambert and Bruce Dixon are right: legislate in haste, repent at leisure. (Are those sources impeccable enough?)

All I'm saying is that there are many ways to deceive us about something with a pleasing name, and Szwarc is good on the deceptions. Fore-warned is fore-armed. If there is a respectably lefty site that covers this material in detail, please point me there. Thanks.

Sarah's picture
Submitted by Sarah on

like the "freedoms" they want to protect are the companies' freedoms to rip off their customers.

I wasn't here when y'all were reading sections of the bill (had a kid getting a bone graft IIRC) and discussing them. Anybody see anything in either the House or Senate bill reinforcing that PCP assignment point? I've never heard the President say the plan would stop you picking your own plan, but I can't remember whether he's ever said anything about picking your own doctor(s). Now, picking your own doctors isn't happening with the system today -- the insurance company gives you a list to pick from, right? Otherwise you have to pay "out of network" or out of pocket, right?

I will say I didn't find the contention in that article that a nutjob in comments on another site said -- it would make people quit going to US med schools because they could get the same compensation for becoming nurse practitioners they could for becoming MDs, with a lot less time and expense invested -- I would find there. But what I did find made me sit back, stare at the screen, and curse steadily for about five minutes.

cal1942's picture
Submitted by cal1942 on

and these points are sort of like a Libertarian manifesto. Liberty for the big to rape everyone else.