From the August 16 edition of Fox Broadcasting Co.'s Fox News Sunday:

WALLACE: Will the plan lead to the rationing of care? Mr. Rother, when we're talking about half a trillion dollars in Medicare savings, when the president talks about creating a Medicare panel, which may impose new restrictions, how can you guarantee to your AARP members that this won't end up as rationing of care?

[...]

WALLACE: But when you're cutting half a trillion dollars out, and you've got a government panel that's going to impose restrictions, how -- I mean, when you've got on the one hand medical treatment, on the other hand government spending and concerns about spending, doesn't something have to give, and couldn't that be treatment?

[...]

WALLACE: Senator Shelby, what about that argument that this isn't going to result in rationing of treatment for seniors and for all of us?

SEN. RICHARD SHELBY (R-AL): Well, I think rationing is underlying all of this. There's a lot of denial out there, but you look at the other plans -- you look at the Canadian plan, the British plan, and so forth, and you have long lines. People decide who's going to get treatment and when. That's rationing health care. If you don't get health care when you need it, you know, ultimately, it's going to affect your life.

[...]

WALLACE: Dr. Rohack, I want to turn to the -- perhaps the most explosive charge about rationing, and that is that the Democrats, in these various plans, create death panels. They're going to pull the plug on seniors. Is there any truth to that?

[...]

WALLACE: And what about the argument, well, maybe now is just a voluntary consultation, but when you've got all these cost considerations from the government, eventually it is going to lead to rationing and perhaps saying in the last year of life, that's just not something we're going to pay for.

Insurance companies already ration care

AMA president Rohack tells Wallace that health care reform bill gets rid of some of the rationing that happens now. After Wallace asked Rohack, "[W]hat about the argument, well, maybe now is just a voluntary consultation, but when you've got all these cost considerations from the government, eventually it is going to lead to rationing and perhaps saying in the last year of life, that's just not something we're going to pay for," Rohack responded:

Well, there's a myth that rationing doesn't occur right now. In the United States, if a woman's pregnant and on the individual market tries to get health insurance, that's called a pre-existing condition, and it's not paid for. That's why this bill's important. It gets rid of some of the rationing that's occurring right now.

Sebelius saw rationing by “private insurers” on “a regular basis” while serving as Kansas insurance commissioner. During her confirmation hearings, Health and Human Services Secretary Kathleen Sebelius stated, “I, frankly, as insurance commissioner, where I served for eight years, saw [rationing] on a regular basis by private insurers, who often made decisions overruling suggestions that doctors would make for their patients, that they weren't going to be covered. And a lot of what we did in the office of the Kansas Insurance Department was go to bat on behalf of those patients to make sure that the benefits that they had actually paid for were, in fact, ones that were delivered.” [Senate confirmation hearing, 3/31/09]

CNN's Gupta: “I can tell you, as a practicing physician ... rationing does occur all the time.” On CNN's Anderson Cooper 360, chief medical correspondent Dr. Sanjay Gupta said:

GUPTA: People 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 in the clinic I get all of this paper work 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's going to have to pay for it on their own. Which is, in essence, is what rationing is, in so many ways. So it does occur, much to your point, Anderson. [Anderson Cooper 360, 08/12/09]

Sebelius: “Health care providers,” not “private insurers,” should make coverage decisions. In Sebelius' words:

SEBELIUS: It's private insurers who often are telling their clients that, “No, you can't get this recommended treatment that the doctor has made”; “No, you can't get this drug”; “No, you're not going to be able to stay in the hospital an extra day”; “No, you're not going to get this because we're concerned about costs.”

So, people who say that, “Oh, this is a terrible idea; this could happen someday in the future,” it's happening every day. But it's really private insurance plans that are making those decisions. What we're hoping to do is change that situation. Private insurance companies should no longer be able to decide who gets health coverage and who doesn't, what kinds of benefits are available. And we want to make sure that it's really health care providers that make those choices in the future. [MSNBC's Hardball, 6/15/09]

Health care reform designed to “end barriers to coverage for people with pre-existing medical conditions.” Discussing the administration's health care reform goals, Sebelius stated that “we must end barriers to coverage for people with pre-existing medical conditions.” She continued: “In Kansas and across the country, I have heard painful stories from families who have been denied basic care or offered insurance at astronomical rates because of a pre-existing condition. Insurance companies should no longer have the right to pick and choose. We will not allow these companies to insure only the healthy and leave the sick to suffer.” [House Ways & Means Committee testimony, 5/6/09]

Insurance companies acknowledge that they already ration care. On the July 15 edition of Morning Edition, WellPoint chief medical officer Dr. Sam Nussbaum stated that “where the private sector has been far more effective than government programs is in limiting clinical services to those that are best meeting the needs of patients.” Nussbaum continued, “When we look at advanced imaging, and these -- this is MRI, CAT scan, PET scans -- we know that as much as 30 percent of those procedures are not necessary. And we've been able, over the last several years, to have growth in imaging procedures of between 0 and 5 percent. The government, under CMS, has seen imaging grow 15 to 20 percent a year during the same time interval.” [NPR's Morning Edition, 7/15/09]

Wendell Potter, a former senior executive at CIGNA health insurance company, has detailed ways in which the insurance industry makes cost-based coverage decisions. In June 24 testimony before the Senate Committee on Commerce, Science, and Transportation, Potter urged the committee “to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world.” Later in his testimony, Potter discussed how “insurers routinely dump policyholders who are less profitable or who get sick” and “also dump small businesses whose employees' medical claims exceed what insurance underwriters expected.”

Insured individuals are currently subject to rescission of their coverage if they become ill. Insurance companies restrict or deny coverage by rescinding health insurance policies on the grounds that customers had undisclosed pre-existing conditions. On June 16, a House Energy and Commerce subcommittee held a hearing exploring this practice, with the goal of examining “the practice of 'post-claims underwriting,' which occurs when insurance companies cancel individual health insurance policies after providers submit claims for medical services rendered.” The committee also released a memorandum finding that three major American insurance companies rescinded 19,776 policies for more than $300 million in savings over five years, and that even that number “significantly undercounts the total number of rescissions” by the companies.

From the August 16 edition of Fox Broadcasting Co.'s Fox News Sunday:

WALLACE: Talk of cost and savings brings us to our next issue. Let's watch.

OBAMA [video clip]: If a family care physician works with his or her patient to -- I recognize there's an underlying fear here that people somehow won't get the care they need. You will have not only the care you need, but also the care that right now is being denied to you.

WALLACE: And that's our third fact check. Will the plan lead to the rationing of care? Mr. Rother, when we're talking about half a trillion dollars in Medicare savings, when the president talks about creating a Medicare panel, which may impose new restrictions, how can you guarantee to your AARP members that this won't end up as rationing of care?

JOHN ROTHER (AARP executive VP of policy and strategy): I think the first thing to acknowledge is that many people, even on Medicare, can't afford the care available to them today. Particularly, for instance, in prescription drugs, which once people hit the infamous “donut hole,” they have to pay full price.

WALLACE: Well, that's going to be fixed supposedly.

ROTHER: Well, I hope so -- so that this plan would actually make medicines more affordable to seniors and help them stay out of the hospital. So we don't see rationing in this plan. What we see are efficiencies that actually could improve care, not deny care.

WALLACE: But when you're cutting half a trillion dollars out, and you've got a government panel that's going to impose restrictions, how -- I mean, when you've got on the one hand medical treatment, on the other hand government spending and concerns about spending, doesn't something have to give, and couldn't that be treatment?

ROTHER: I don't think so. If we had savings that were many times this, perhaps that would be the case. But this is actually a small percentage of the total that will be spent for Medicare over the coming 10 years. And certainly there's enough waste in the system that by smart savings, we can save money and improve care at the same time. No question.

WALLACE: Senator Shelby, what about that argument that this isn't going to result in rationing of treatment for seniors and for all of us?

SEN. RICHARD SHELBY (R-AL): Well, I think rationing is underlying all of this. There's a lot of denial out there, but you look at the other plans -- you look at the Canadian plan, the British plan, and so forth, and you have long lines. People decide who's going to get treatment and when. That's rationing health care. If you don't get health care when you need it, you know, ultimately, it's going to affect your life.

WALLACE: Dr. Rohack, I want to turn to the -- perhaps the most explosive charge about rationing, and that is that the Democrats, in these various plans, create death panels. They're going to pull the plug on seniors. Is there any truth to that?

J. JAMES ROHACK (American Medical Association president): That's absolutely wrong. It's a falsehood. You know, right now the law says that when a patient comes into the hospital, a clerk -- a hospital clerk -- has to give them the information on advance directives. Well, you know, we think that's crazy.

WALLACE: Advance directives meaning --

ROHACK: Meaning living wills.

WALLACE: -- living wills, do not resuscitate.

ROHACK: That's a decision that we as the AMA have been very forceful about. The decisions on what a patient needs should be between the patient and the physician. And it takes an act of Congress to get anything paid for. We advocated for screening mammograms and immunizations and screening colonoscopies.

This is another example where we have to go to Congress to say, this ought to be paid for. The decision should be between the patient and the physician when the patient's healthy, not when they show up at the hospital.

WALLACE: And what about the argument, well, maybe now is just a voluntary consultation, but when you've got all these cost considerations from the government, eventually it is going to lead to rationing and perhaps saying in the last year of life, that's just not something we're going to pay for.

ROHACK: Well, there's a myth that rationing doesn't occur right now. In the United States, if a woman's pregnant and on the individual market tries to get health insurance, that's called a pre-existing condition, and it's not paid for. That's why this bill's important. It gets rid of some of the rationing that's occurring right now.

And as far as end-of-life care, that's just so important to have a discussion with the patient and the family and the physician while the person's healthy. Right now we're backwards. We're doing this when they hit the hospital. That's too late. We want to make it up front, when the patient can decide what do they want to do at their end of life.

WALLACE: Senator Shelby, for all of the criticism from your side of the aisle, the fact is is that the 2003 Medicare bill, which was passed by a Republican Congress and signed by President George W. Bush, had an end-of-life consultation provision in there. Is there some hypocrisy from the GOP on this issue?