The major difficulty in creating a public health insurance option is deciding what the plan covers. The most obvious contentious issue is abortion, so this should be no surprise: Pro-Life Democrats Urge Pelosi to Exclude Abortion Funding from Health Care Reform Bill
But all the nitty gritty details are contentious, as anyone who has ever had the fun of choosing a healthcare plan knows, there are some things you want covered, and some things you don't want to pay for.
The only acceptable solution is to remove all controversial and ideological funding from the plan and leave only the most basic uncontroversial medical care, like circa 1980 medical care. Abortion and other extras can be covered by private supplemental plans.
Please share widely!
Abortion should only be covered if it is medically necessary. If it is a choice, then not covered.
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p>Anything medically necessary should be covered.
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p>Although not medically necessary…birth control should be covered. Reproductive health exams should be covered. As it stands now, going to the MD every year for required follow-ups regarding birth control pills gets a big fat DENIED-NOT A COVERED SERVICE from some insurers. This is wrong, wrong, wrong.
Seriously, putting aside the abortion question… I’ve never understood the insurer’s logic here. Birth control retails around 30 bucks/month, and I’m sure large insurers pay less than that. But even at the retail price — $30 x 12 months = $360. My wife just gave birth (standard dellivery, no complications) and I saw the bill… it was huge, upwards of $10k. So this means that for less than the cost of one delivery, an insurer could provide birth control for the entirety of a woman’s reproductive life (~30 yrs). People who work for insurers are smarter about this stuff than I am… it seems in their economic self-interest to provide birth control to limit the number of deliveries they have to cover. I don’t get it. Can someone enlighten me?
Private insurance, and Medicaid usually and routinely cover birth control.
but some clearly don’t. it’s why most states have gone to the trouble of passing laws mandating it — http://www.guttmacher.org/stat… So in some states, and for some self-insured / ERISA beneficiaries, there is no requirement and therefore no coverage. It seems economically illogical to me.
Maybe, over the course of their lifetime, babies that were born pay more in premiums than those that were not born? Some might even become insurance executives, creating intense self-interest.
Surgery. We should only allow medical procedures that God would support. Like if I got a fever, it should pay for an ice bath. Or if I get a headache, it should pay for a whiskey. That way, no one will have their feelings hurt that, my god, people may just be getting health care. And why should other people be able to get necessary care they want, if I don’t want them to? My god!!!
I hadn’t thought it was, but it is true there are people morally opposed to all medical intervention. Should Christian Scientists (or any other people) be forced to buy surgery insurance? Maybe people should be allowed to opt out of paying for surgery insurance or other things they don’t want to subsidize, but since I think most people would opt in on that one, and it actually isn’t controversial (no reps sent a letter to Pelosi about surgery), I don’t think it would be wrong to for the public plan to cover it. The fewer supplemental plans that people buy, the better.
I like it.
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p>But my thoughts when reading this is that they are resigned to the fact that there will be a public option. The argument is no longer being for or against a public option it’s evolved to what would be covered.
I’d be much happier. Alas.
you are so good at snark.
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p>I think maybe the controversial things he is talking about are things like abortion, birth control, viagra, etc. But I could be wrong. I don’t follow dcsurfer’s comments closely enough to know what his thought process is. But without the history of knowing him well, I think his post is sincere and asks a really good question.
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p>I do think elective abortion should not be covered. My hope for abortion rights is that it will be legal but rare. If a couple chooses to have an abortion, then they can also pay for it. For some people, it will make them more responsible about using birth control next time. I would also say that abortion providers could have payment options that will ease the burden of the cost for low income people.
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p>With that said, reproductive education is a must for all people, beginning in their early teens. Contraceptive options should be made available; the morning after pill is an inexpensive way to avoid an abortion if a couple has an “oops” moment.
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p>Aside from that, there are concerns about other non-lifethreatening illnesses that could be corrected by surgery or some other procedure that might be left out
of plans. They would be considered elective also, mainly done for comfort and quality of life, such as maybe bunion repair, or removal of a birthmark on the face or deviated septum for snoring, that type of thing. Procedures to resolve quality of life issues do have to be considered when a public option is being put together. They are important to a person’s overall well being.
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p>This is an important topic to talk about.
While I agree that abortion should be legal but rare, some women when faced with the question of whether or not to have an abortion may be under a lot of pressure to make the wrong choice, i.e., to not have an abortion. Adolescents, for example, are not known for their future orientation. A disincentive, like not being covered by insurance, could be a disservice.
and each situation is going to be different, depending on many things including where the couple stand socio-economically.
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p>I know three people who have had abortions, many years ago,
they and their partner paid out of pocket for it. It seemed that money was not even the big part of their concern, it was the unintended pregnancy and their future.
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p>Maybe limits could be placed on how many abortions a woman will be covered for. Perhaps a lifetime limit of one. I think that is a good idea.
the woman is raped?
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p>Leave the moralizing to doctors and their patients.
in those circumstances.
… undercuts the moral objection to abortion in the first place.
it’s about whether it should be a covered service. Terminating a pregnancy does not cure an illness. It does not treat an illness and it does not prevent and illness.
… is that the whole point of making it not covered is because some might raise moral objections, not if it’s an illness. If this is so, it should be understood that those who object might not find the exception less objectionable.
and there will be a lot of outrage coming from the extremists when and if a public plan is being pull
together. While the extremists are the noisy ones, there are people in the center who would be accepting of the middle ground.
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p>There should be at least some effort at compromise, and I think limited coverage is a reasonable idea. This will help to cancel out some of the outrage that will surely spill out in the media from the anti-abortion extremists.
means the possibility of coat hangers, or babies birthed in public toilets, then it should be soundly rejected.
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p>I’ll tell you what, as soon as we provide the sort of social nets to cover women who we don’t allow abortions because we let the whackos in charge of our new public health care option (instead of doctors and patients), then maybe I’ll concede you have some kind of point. Until then, I’m sorry, I find it unconscionable. We’re not exactly going to be giving out this health care for free… which your entire point seems to rest on. People have to buy into it. Everything normally covered by “rigorous” health insurance should also be covered under the public option.
on legal clinical procedures because you don’t approve? Are you going to impose other limits on clinical treatment based on your sensibilities around other issues?
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p>What does that scenario sound like? Okay, here’s the deal people. You have to toe the line, live life as we tell you, or you don’t get full benefits. Otherwise, it’s to the alley for you for a little black-market surgery. And don’t expect any care in the ER if you resort to a back-alley abortion! We aren’t gonna help you! Tough luck!
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…to have my own opinion, just like everyone else here.
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p>Pregancy is a natural function of a woman’s body, it is far from an illness.
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p>I’m not saying that there shouldn’t be exceptions for
risks to life of the mother, rape, etc.
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p>There is no excuse to be using abortion as a form of birth control. Not only is it expensive, but it does take it’s toll on a woman’s body. There are amazing ways to avoid having to have one, including the morning after pill. I will never, as a Democrat, promote the party as one that finds abortion of no consequence. It should absolutely be legal, but it should also be rare.
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p>I think providing a lifetime benefit of one elective abortion as a covered service(with the exception of rape, woman’s health, or fetus viability) is reasonable. Actually, I will compromise on that. One elective abortion as a covered service during a 5 year period.
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p>I will… for the rest of my life….promote responsible
use of contraception to reduce abortion and to prevent STD’s.
by pricing people out of it, that’s asinine. If people can’t afford to have an abortion, what on earth makes you think they can afford to have a baby? As I’ve repeated several times now, you make it rare by providing the social nets that allow people to afford to have that baby, or by making adoption more accessible.
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p>Or, how about this, by stopping government-paid health classes that teach abstinence only? We do have “amazing” contraceptives to prevent pregnancies, but when around one out of every four teenagers in this country are taught abstinence only, they don’t have the facts. Moreover, many women cannot use the pill – and many people in general are allergic to latex. I don’t know any women who jump at the chance to have an abortion — no one uses it as “birth control.” Accidents? Sure. They happen, even with those “amazing” contraceptives, especially when so many in this country are actually taught — using public funds, no less — not to use them.
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p>Seriously, your point falls flat. I get that you want abortions to be rare. I agree with you. It’s a surgical procedure, often with consequences – the worst of which is psychological. If you want to make abortions rarer, do so by proposing more social nets for young and/or poor parents — from free health care to free child care. Do that and I’m sure there will be thousands fewer abortions every year.
and I agree, prevention is key here. As well as support for those who choose to continue their pregnancy.
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p>Teaching abstinence is asinine, but can be taught alongside other methods of contraception, I mean in the same class, as an alternative, not as the only option.
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p>This is idiocy. You really should get your facts straight. Abortion is far safer for females 15 and under than pregnancy. (Indeed, abortion is far safer than pregnancy in any age group.) Are you really going to withhold abortions for young girls because you don’t approve? Pardon me if I value the life of the nation’s young daughters over your sensibilities.
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p>Pregnancy entails risk–for any woman at any age. You wholesale dismissal of that burden for populations that most need thoughtful and responsible clinical care is appalling.
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p>How magnanimous of you. I’m relieved you won’t be deciding the fate of millions of women around the country.
and the first one will be paid for. And if there should be another incident after 5 years, that could be covered as well. I would hope, sincerely hope, that after that 15 year old has the abortion, she will be far more cautious about sexual activity in the future. My hope would be that she would be empowered to seek contraception options, to say NO to someone who wanted to have unprotected sex, and to play a responsible and proactive role in her future.
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p>I think it would be great to require counseling with an abortion. To provide women with the education they need on how to prevent pregnancy and STD’s. They can then be given a years supply of contraception, with a followup appointment in one year at the nearest Planned Parenthood clinic. This should be done without judgement or condemnation, but with the care and concern that we have for these women.
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p>What about the young woman who would have an abortion every 3 months because she can, after all, it’s paid for, no problem? I can’t even comprehend how someone could not care about having one unintended pregnancy after another.
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p>But you know, perhaps I feel this way because I don’t know a single woman who is irresponsible about preventing pregnancy. I know women who have had abortions, and it made them more determined than ever to prevent another unintended pregnancy. I guess because of this, I feel it is a universal fact that a woman would choose to “not” have multiple abortions, and take the steps necessary to avoid having to have one.
It’s not for me to decide what’s moral in the medical treatment that takes place between a doctor and his or her patient. I gave a (yes) snarky response, because even basic things are controversial to some people. There’s always going to be a religion against some form of medicine. Even the Mormons, for example, wouldn’t support the free whiskey-for-a-headache idea.
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p>We legalized abortion in this country because it wasn’t safe when it wasn’t legal and available to everyone. Women died all the time, or were left so damaged that they could never have a baby again. Hangers. Need I say more?
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p>If we don’t provide it, people will just, again, go to those lengths — be it in harming themselves, or finding funding somehow, somewhere – which could be just as bad, or worse. Keeping it rare has everything to do with other, non-medical policies — providing women with the social net to be able to raise a child regardless of her salary, or the advertisement and pushing of adoptions.
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p>Abortions can’t just be available to the rich and privileged, lest we force people into the shadows and start seeing all the same abuses and tragedies happening that existed pre-Roe, and we especially can’t punish those who can’t afford it when we don’t even provide them with the means to an alternative.
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p>But the broader point is, if we make moral decisions on the availability of a procedure as a society, what’s to stop making moral decisions on the availability of HIV medications to gay patients? Or dialysis? Or when to shut off the plug? There’s a reason why we leave the moral decisions in medicine to the purview of doctors and their patients — they’re the only ones equipped to make them.
What in the world does that mean? Are you saying that all advances since 1980 in the treatment of cancer, cardiovascular disease, diabetes and obesity are “controversial” and should not be covered? For those that didn’t pass math, that’s nearly 30 years of medical progress out the window. Why in world would we want do that? Having a “supplemental plan” for certain therapies will be administratively complex and probably lead to adverse selection–all in all a big step backwards.
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p>Other complexities abound. For example, the guidelines used by the Roman Catholic Church do no just apply to abortion. They bar a lot of procedures that might be covered by conventional insurance but are not supposed to be performed in hospitals that follow Catholic teachings. As far as I know, it has never been a problem for Catholics to be covered by policies that pay for these procedures–its only a problem if a Catholic hospital performs them.
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p>Jehovah’s Witnesses are not supposed to get blood transfusions. Are you saying that blood transfusions should not be covered for anyone? Really?
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p>are not supported by the Catholic Church? I’ve never heard of any.
actually not sure about hair restoration…
Anyone with AIDS, breast cancer, high cholesterol, drug-resistant bacterial infections, SARS and other life-threatening viral infections is in deep trouble if treatment advances since 1980 are not covered.
The point is, no blank check to bring us 2020 medicine in as few years as possible. We can’t have open-ended demands of a surefire cure for every illness that people might get, we have to grow up and lower our demands and accept illness and death.
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p>And to the extent that we don’t accept illnesses, how about instead of demanding everyone give drug companies and researchers a blank check, we should spend money researching the causes of diseases and working on prevention as much as possible, raising the minimal standards and leaving the high standard where it is.
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p>Our current system prefers sickness because it is a chance to get rich, they know we can’t say no when they invent a new drug or procedure or device and ask for billions of dollars for it. We have to learn somehow to say no.
An article by Atul Gawande in The New Yorker (“The Cost Conunudrum”) asks why medical costs in McAllen, Texas are so much higher than nearby towns. Consider what happens when a patient complains of gallstones.
The surgeon [in McAllen] gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.
Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.
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p>So what we have are two incentives to do more surgery for gallstone disease than is necessary:
Next question is, who do you want controlling such policy strings? Who do you trust the most?
Note that the first two have rather strong financial incentives, don’t they?
Would that we had more like him in health care. I read both his books and found them provocative and compelling. I would highly recommend anything he’s written; he’s a bright guy.
Covered for free: annual physicals, ER visits (for true 911 type emergencies), screenings, vaccinations, possibly specialist visits if refered by a PCP, possibly semi-annual dental and optometric appointments.
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p>Varying degrees of copay: most prescriptions, specialist visits if not refered by PCP.
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p>Not covered: elective surgery, operations, and medications.
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p>I’m very much of the “ounce of prevention is worth a pound of cure” school so I tend to be more generous with the former than the latter.
will be mandated. Covered items will include expensive drugs for ills you can cure by eating right, but hey, you can’t afford that anymore anyway.
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p>You will also pay for the digital medical records plus monthly software “upgrade” subscriptions looking for those refusing their unicorn flu shots.