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Quick Fact: Ignoring that rationing already exists, Bream advanced GOP attacks on health care

December 03, 2009 12:14 am ET — 18 Comments

On the December 2 edition of Fox News' Special Report, correspondent Shannon Bream advanced the Republican argument that recommendations like the mammogram screening guidelines recently released by the U.S. Preventative Services Task Force "will enable insurance companies to ration care and deny reimbursement for various procedures," suggesting that insurance companies don't already ration care. Indeed, many insurance companies already keep patients from getting the medical treatments they need and the recommendations are not legally binding.

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Bream: Republicans say "recommendations by this kind of group will enable insurance companies to ration care"

From the December 2 edition of Fox News' Special Report with Bret Baier:

BREAM: While today's Capitol Hill hearing [on the new mammogram guidelines] was quickly scheduled with the primary goal of getting an explanation and guidance from the task force, it rapidly morphed into a renewed debate over the health care reform bill passed weeks ago by the House with a number of Republicans saying recommendations by this kind of group will enable insurance companies to ration care and deny reimbursement for various procedures.

Fact: Task force recommendations "do not set federal policy"

Sebelius: Recommendations are from "an outside independent panel," "do not set federal policy." From HHS Secretary Kathleen Sebelius's November 18 press release:

"There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government.

"There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.

"What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect, and fight breast cancer, the second leading cause of cancer deaths among women.

"My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions, and make the decision that is right for you."

Fact: Recommendations are not legally binding

Task force recommendations not legally binding. The task force's recommendations are not legally binding, and the task force encouraged policymakers to include additional considerations and "individualize decision making to the specific patient or situation."

NBC's Snyderman: "It's important to remember that these new recommendations from this independent task force are just that -- they're recommendations." In a Nightly News report on the task force recommendations, NBC chief medical correspondent Dr. Nancy Snyderman stated, "It's important to remember that these new recommendations from this independent task force are just that -- they're recommendations. They don't mandate any changes in who should get mammograms and when." [NBC's Nightly News with Brian Williams11/17/09]

Task force previously recommended against certain preventive cancer screenings under Bush, undermining efforts to connect guidelines, "rationing" charge to Democrats. For example, in 2004 the task force recommended against screening for ovarian cancer, routine screening for testicular cancer in "asymptomatic adolescent and adult males," and routine bladder cancer screening in adults; in 2005, it recommended against routine screening for peripheral arterial disease; in 2006, it recommended against routine genetic screening of the asymptomatic general population for hereditary hemochromatosis; and in 2007, it recommended against screening the general adult population for asymptomatic carotid artery stenosis.

Fact: Insurance companies already ration care

Insurance companies acknowledge rationing care. Insurance companies acknowledge that they ration care, restricting coverage of procedures and tests like MRIs and CAT scans and denying coverage for pre-existing medical conditions.

Sanjay Gupta: "I can tell you, as a practicing physician ... who deals with this on a daily basis, rationing does occur all the time." As Dr. Sanjay Gupta, CNN's chief medical correspondent, explained: "[P]eople always say, 'Is there going to be rationed care?' And I can tell you, as a practicing physician, as someone who deals with this on a daily basis, rationing does occur all the time. I mean, I was in the clinic this past week. And I -- you know, at the end of clinic, I get all this paperwork that basically says, 'Justify why you're doing such and such procedure. Justify why you're ordering such and such test.' And if the justification is inadequate, the answer comes back, 'Well, that's not going to be covered.' Which basically is saying that the patient is going to have to pay for it on their own, which is, in essence, is what rationing is, in so many ways."

Insurance companies ration care by rescinding coverage. As former senior executive at CIGNA health insurance company Wendell Potter explained in June 24 Senate testimony, insurance companies restrict or deny coverage by rescinding health insurance policies on the grounds that people had undisclosed pre-existing conditions. President Obama cited one such example in an August speech, noting that "[a] woman from Texas was diagnosed with an aggressive form of breast cancer, was scheduled for a double mastectomy. Three days before surgery ... the insurance company canceled the policy, in part because she forgot to declare a case of acne. ... By the time she had her insurance reinstated, the cancer had more than doubled in size."

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    • Author by DellDolly (December 03, 2009 12:48 am ET)
      5 1
      Insurance companies already ration care. There's already someone between us and our doctors - the for profit healthcare insurance clerk who follows the directives of people who earn more money if they disallow claims.

      I'd rather have a govt official who's not interested in a profit motive be between my doctor and me than a for profit insurance company.
      Report Abuse
      • Author by ex-punk (December 03, 2009 2:05 am ET)
           
        That's a good way of putting it. I also have to wait between two and three months to see my doctor. If it's an ememrgency you have to go to the ER or the "doc in the box" clinic. Then they make you get another appointment to see your doctor. By then, anything can get worse. Since insurance companies began dictating which doctors are on their lists and who they cover, we get less than average medical care.
        Report Abuse
        • Author by boulderhippy (December 03, 2009 12:28 pm ET)
             
          Let us change everything because you are unhappy with your insurance plan.

          There are some people very content with their plans. That is why the legislators in this country are going to keep theirs.

          The problem is cost and who pays for it. My insurance goes up every year and my benefits seem to be the same. I am happy with the delivery of medical care, not the cost.
          Report Abuse
      • Author by dexteritas0071418 (December 03, 2009 9:49 am ET)
        1 6
        They don't already "ration" care. You need to have a shortage/limited supply of "care" in order to "ration" it, which doesn't currently exist.

        VS, if there was a single-payer system with a finite amount of funds to support it, care would be "rationed" if that finite amount wasn't plenty to cover any and all needs.

        BTW, when's the last time you went to your insurance company's office because you needed an Rx? When you had an injury?
        Report Abuse
        • Author by Old_Benjamin (December 03, 2009 12:06 pm ET)
          1  
          You need to have a shortage/limited supply of "care" in order to "ration" it, which doesn't currently exist.


          Really? That's the only way? It can't be an artificially constructed situation created by insurance companies to increase/protect their profits?
          Report Abuse
          • Author by dexteritas0071418 (December 03, 2009 12:14 pm ET)
              2
            Nope, in that case it would be an "artificially-constructed situatino created by insurance companies to increase/protect their profits", which would not be in any definition of "rationing".

            Besides, your definition doesn't include the uninsured or under-insured, situations which may not have anything to do with the health insurance companies. Our current system is not the best, for sure, but it's not "rationing".

            Besides, if healthcare itself was more affordable, you wouldn't need insurance companies anyway, at least not for relatively-common issues.
            Report Abuse
            • Author by vhw28672478 (December 03, 2009 12:19 pm ET)
                 
              We need health care reformed
              Report Abuse
            • Author by Old_Benjamin (December 03, 2009 12:22 pm ET)
                 
              So your quarrel is with the word rationing. I would say since the effects are the same whatever you call it, it is a minor point.

              I did find the following which kinda disputes your point anyway;

              Synonyms:
              1, 2. portion, allotment. 1, 3. See food. 4. mete, dole, allot.

              http://dictionary.reference.com/browse/rationing
              Report Abuse
              • Author by dexteritas0071418 (December 03, 2009 12:33 pm ET)
                  1
                Doesn't "rationing" also imply that everyone gets the same amount? Like if you "rationed" water after a hurricane?
                Report Abuse
                • Author by Old_Benjamin (December 03, 2009 12:34 pm ET)
                  1  
                  Given the synonyms, I'd say no.
                  Report Abuse
                  • Author by dexteritas0071418 (December 03, 2009 12:50 pm ET)
                       
                    Gee, if we define words by synonyms, why don't we just have Thesauruses instead of all those dictionaries?

                    From YOUR SOURCE, the FIRST DEFINITION:

                    1. a fixed allowance of provisions or food, esp. for soldiers or sailors or for civilians during a shortage: a daily ration of meat and bread.
                    Report Abuse
                    • Author by Old_Benjamin (December 03, 2009 4:15 pm ET)
                         
                      Why are you yelling?

                      Anyway - that was the 1st definition of the word as a noun.

                      As a verb (as it is used here) the 1st definition is...

                      to supply, apportion, or distribute as rations (often fol. by out): to ration out food to an army.


                      Anyway, the point stands that insurers are controlling (rationing) the distribution of medical services. They have been shown they do this due to the profit motive. Which would also explain those uninsured/underinsured people you mentioned earlier. I don't know the actual numbers, but there is plenty of anecdotal info. out there about how this to is the result of insurers not wanting to take on "risky" clients and therefore denying them outright by charging astronomical premiums and deductibles or by finding some pre-existing condition.
                      Report Abuse
                      • Author by dexteritas0071418 (December 03, 2009 4:25 pm ET)
                           
                        What I was getting at was that they aren't "rationing" because health insurance companies don't control access to healthcare. Do they always operate honestly or always in the best interest of the consumer? No. But there is NO set amount of healthcare out there that the insurance companies have complete control of and distribute as they see fit....you can still go into a hospital or doctor's office and pay outright for their services.

                        The other side uses "rationing" as a derogatory term, which it could be if it came to pass that there was a single-payer operation and there was a wait or denial of necessary services and drugs because of its expense and accessibility. There are plenty of bad things out there with the current system though that you don't need to mess with "rationing" or accuse the "other side" of it to win the debate.
                        Report Abuse
                        • Author by Old_Benjamin (December 03, 2009 4:37 pm ET)
                             
                          Fair enough.

                          However, I take issue with a statement such as...

                          No. But there is NO set amount of healthcare out there that the insurance companies have complete control of and distribute as they see fit....you can still go into a hospital or doctor's office and pay outright for their services.


                          You must realize that is not at all a realistic solution for the vast majority of citizens. We see that in the bankruptcy numbers.

                          And as far as "the other side" using rationing, I think it's a fair tactic for reform proponents to turn that type of terminology back on the reform reticent side.
                          Report Abuse
            • Author by bluestate69 (December 04, 2009 3:55 am ET)
                 
              not rationing? there are insurers that will only cover a finite number of cat scans in a single year. why? because of cost. i know many doctors who much prefer medicare patients. yes medicare patients, because they can provide better care. medicare will cover almost all tests and procedures, but private companies won't. why? because of cost. that's rationing, no matter how you look at it, or try to look at it. in short, you're wrong dexteritas.
              Report Abuse
      • Author by boulderhippy (December 03, 2009 12:09 pm ET)
           
        You would turn over your healthcare to a George W. Bush clone? You might have the government you want now, but things change. When it cost too much to go to college to become a doctor and govt. doesn't pay enough to pay off student loans, there will be rationing for everyone.

        I trust private insurance companies far more than any politician. When the govt. gets their hands on it there is no recourse in the courts. Governmental immunity will take away your rights.

        Private insurance companies keep down fraud and waste. Government programs invite corruption therefore increased cost.
        Report Abuse
    • Author by Publius39 (December 03, 2009 9:47 am ET)
         
      I've never understood the acceptance by the right of private corporations rationing care. They simply don't even address it when they slam health care reform, but they know that it happens on a daily basis.
      Report Abuse
    • Author by shaggles (December 03, 2009 11:21 am ET)
      1  
      That's been the story all along. There has not been one thing that opponants of a public option have complained about that doesn't happen right now with rivate insurers.
      Report Abuse

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