Ezra has a post today, talking about the important rule that healthcare reform is going to establish. "As the exchanges open up -- if they open up, more to the point -- all of this will work better and more smoothly. This is how the Netherlands' health-care system looks, and few would accuse their insurers of being evil."
The problem with this argument, the problem many of us of had all along, is that the United States is not the Netherlands. We don't have a private industry that is particularly committed to following the rules, nor do we have a government that is particularly adept at enforcing them. But it's even worse than that--we have a Congress that's already subverting the rules before they've even started.
WASHINGTON — A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.
The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.
As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not "unreasonable." The bill does not define what level of limits would be allowable, delegating that task to administration officials.
Adding to the puzzle, the new language was quietly tucked away in a clause in the bill still captioned "No lifetime or annual limits."
Maybe they were hoping nobody was going to read what was actually under the section title until the bill was actually passed and signed by Obama. Who, btw, as Jane points out expressly promised that lifetime limits on coverage would be banned in his healthcare speech on September 10. That's a promise that the Senate can't break.
Let's just get this clear--annual limits are just as pernicious as lifetime limits, perhaps even more so. Here's Stephen Finan, a policy expert with the cancer society's advocacy affiliate.
"The primary purpose of insurance is to protect people against catastrophic loss," Finan said. "If you put a limit on benefits, by definition it's going to affect people who are dealing with catastrophic loss." The cost of cancer treatment can exceed $100,000 a year.
But Finan said the change in the Senate bill essentially invalidates the legislation's ban on lifetime limits.
"If you can have annual limits, saying there's no lifetime limits becomes meaningless," he said. A patient battling aggressive disease in its later stages could conceivably exhaust insurance benefits in the course of a year.
My brother-in-law's treatment for a rare and aggressive lymphoma reached over $400,000 in nine months, and by the luck of the draw he had fantastic insurance that covered it all. But that's not something that should be left to the luck of the draw for anyone, particularly after the system has supposedly been reformed.
This provision is a deal-breaker, and now that it's been exposed will undoubtedly be removed in the manager's amendment. But it's a great example of the larger problem in our system. This is just one of the reasons why those of us who have been arguing so hard for so long for a public option continue to do so. Because the power of the providers in this system is so strong, because it's had its thumb on the scale in this process from the get-go. Because there has to be a counter to the private system if reforms are actually going to work. The only counter that has ever proven to really work in this country is competition, and the only entity big enough to provide adequate competition is the government.
There's ongoing discussion in slinkerwink's diary.
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