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Health Freedom Watch
September 2009


Who’s Against Health Reform?
by Sue Blevins

I’m amazed to hear politicians claim that some people are against health reform.  The term “reform” means: to convert into a better form; to improve by alteration, correction of error, or removal of defects; and to put into a better form or condition.  I don’t know a single person who opposes making our nation’s healthcare system better.  Do you?

On the other hand, I know lots of people who are opposed to a mandate for health insurance.  And many Americans are opposed to directing our nation’s healthcare system down the path to socialized medicine or a single-payer system for all age groups.  And regarding the existing single-payer Medicare program, some seniors are attempting to forgo the “free” hospital coverage but are denied that freedom. Currently the federal government requires retirees applying for Social Security benefits to enroll in Medicare Part A (hospital coverage) or lose their cash benefits.1

I can’t help but wonder if the same politicians who think we need a public option to compete with private insurers would be willing to let these seniors buy private insurance as an alternative to Medicare.  Considering that the program is alleged to be riddled with waste and that it’s the most expensive single-payer health program in the world ($338 billion in 2005), it sure seems like it’s time to allow seniors the freedom to buy competing coverage.2

In the reform debate we need more facts not attacks, more light and less heat. Politicians could begin by being more clear and honest about what they mean by “healthcare reform.”  If a politician’s goal is socialized or single-payer care, Americans who oppose those traditionally un-American goals aren’t opposing health reform.  Rather they’re opposing socialism and standing tall for reform that respects the liberty that so many Americans have fought hard for over the years.

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Americans Must Reject Insurance Mandate to Prevent Rationing and Privacy Invasions

President Obama and leaders in the House and Senate are planning to require Americans to buy health insurance.  As the Institute for Health Freedom (IHF) has previously reported, the leading House health-reform bill (H.R. 3200) would require everyone to buy “acceptable” coverage.3  A panel of up to 27 medical and other experts would determine what constitutes acceptable health insurance; the Secretary of Health and Human Services would have the final veto power.4

Do Americans really want to hand over their power to determine what constitutes “acceptable” coverage to a panel of experts and the HHS secretary?

If government can define acceptable coverage, then government would determine what that care would be.  The next logical step would permit government to cap and redistribute (ration) health-care resources, as proposed by some policy experts. Clearly, the proposed bill paves the way to federal control over personal health-care decisions. 

Health-Insurance Mandate Means Loss of Medical Privacy

Additionally, a federal requirement that everyone must buy health insurance, and the necessity to check that an individual has done so, will lead to greater government access to everyone's health-insurance and tax records.

Consider the implications of Section 163 (in H.R. 3200) titled “Administrative Simplification.”  If passed, it would, among other things “enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card…”5 This means government and other administrators would have the ability to search "real-time (or near real time)" individuals’ financial (i.e., tax records) and medical information to determine (1) financial responsibility for paying and (2) approval for “a specific service with a specific physician.”

Moreover, H.R. 3200 requires insurers to comply with the HIPAA privacy rule, which permits individuals’ health data to be shared—for many purposes—without patients' consent.6

The result?  Control over the flow of personal health information legally drifts into the hands of many anonymous intermediaries who legally can exchange this information without patients' consent.  Once compromised, how does an individual regain his or her medical privacy?  Put simply, one doesn't.  (For those unfamiliar with the history of the HIPAA privacy rule—which will govern the national health information system and Electronic Health Records—see “What Every American Needs to Know about the HIPAA Medical Privacy Rule”:

On the other hand, if Americans want to maintain control over their personal health-care decisions and health privacy, then they must reject a federal requirement for everybody to buy health insurance.  Instead, they should consider policies (see below) that encourage responsible ownership of insurance as well as a safety net for the poor.

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Health-Reform Options for Expanding Coverage, Without Expanding Federal Role in Personal Healthcare Decisions

At a time when Americans are concerned about health-care costs, choices and confidentiality, a federal-health insurance mandate would have many negative unintended consequences.  Requiring every citizen to buy “acceptable” coverage would give the Secretary of Health and Human Services (HHS) the final say in defining what type of health insurance everyone can purchase.  The HHS Secretary would effectively serve as THE single federal insurance agent for every American, deciding what types of plans they can—and must—buy. 

Also, a new federal Commissioner would be responsible for overseeing more than $700 billion in federal funds over 10 years, but would be exempt from following the Federal Acquisition Regulations (regulations to promote competition and keep government and contractors honest) in getting bids from qualified health insurance plans.7  This is clearly the wrong direction to take in attempting to increase health-care competition to help reduce costs.

So instead of nationalizing health care, what realistic steps could Congress take now to help increase competition, and thus improve access to affordable care?

Here are some options that would incentivize, rather than penalize, Americans into obtaining competitive (relative to today’s standard) health insurance:

  • Change the federal tax law for health insurance so that all Americans are qualified to deduct the cost of health insurance, whether they buy it on their own or receive it through employers.
  • Provide a tax credit for health insurance to those with no tax liability.
  • Permit everyone to buy health insurance—including catastrophic only plans—across state lines.
  • Allow state Medicaid programs to serve as a public option for low-income persons, with the option of receiving a private voucher for comparable coverage and costs.
  • Establish state-based high-risk pools for persons with pre-existing conditions or otherwise denied care.
  • Uphold everyone’s right to freedom of association in determining whether they want to participate in for-profit or non-profit health insurance and healthcare delivery systems, including non-profit cooperatives.
  • Allow funds not claimed for the health-insurance tax deductions, credits, Medicaid, high-risk and state pools to be provided to community hospitals for emergency services on a sliding-scale fee schedule.

As the Institute for Health Freedom (IHF) has stressed for many years, it is well known that he who pays the piper calls the tune.  Thus until individuals are the ones paying the bills and choosing their insurance, they won't have the final say over personal health-care decisions. 

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1. See “What Every American Needs to Know about Social Security and the Mandatory Medicare-Enrollment Policy: Government Imposes a Huge Financial Penalty on Seniors Who Reject Socialized Medicine,” Institute for Health Freedom, February 11, 2005:

2. “Health Spending Projections Through 2017: The Baby-Boom Generation is Coming to Medicare,” Health Affairs, February 26, 2008; Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group; Organisation for Economic Co-operation and Development (OECD) Factbook 2009: Economic, Environmental and Social Statistics; and Organisation for Economic Co-operation and Development (OECD) OECD Health Data Set.

3. See Section 401 “Tax on Individuals Without Acceptable Health Care Coverage” (pp. 167-173) of “America’s Affordable Health Choices Act of 2009,” H.R. 3200.

4. See Section 123 “Health Benefits Advisory Committee” (pp. 30-35) of “America’s Affordable Health Choices Act of 2009,” H.R. 3200; See Section 124 “Process for Adoption of Recommendations; Adoption of Benefit Standards” (p. 37) of “America’s Affordable Health Choices Act of 2009,” H.R. 3200.

5. See Section 163 “Administrative Simplification” (pp. 57-58) of “America’s Affordable Health Choices Act of 2009,” H.R. 3200.

6. "Under the HIPAA privacy rule, individuals do not have the final say in whether their personally identifiable health information—including genetic information—is shared with more than 600,000 health-related organizations.  Their personal information can be shared for purposes related to treatment, payment, and health-care operations without individuals’ consent. See 45 CFR Subtitle A, Subpart E—Privacy of Individually Identifiable Health Information; section 164.502(a)(1)(ii) “Permitted uses and disclosures.”

7. "Congressional Budget Office, Analysis of America’s Affordable Health Choices Act of 2009, July 14, 2009; See Section 204 “Contracts for the Offering of Exchange-Participating Health Benefits Plans” (p. 89) of “America’s Affordable Health Choices Act of 2009,” H.R. 3200.

Health Freedom Watch is published by the Insitute for Health Freedom. Editor: Sue Blevins; Assistant Editor: Deborah Grady. Copyright 2009 Institute for Health Freedom.