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Health Insurance Reform - DAILY MYTHBUSTER: Rationing of Care

Some opponents of health insurance reform are spreading the myth that reform causes rationing of care - with government bureaucrats deciding what treatments individuals can and cannot receive. The facts are:

  • Under America's Affordable Health Choices Act, there is not one provision in the bill that gives any government bureaucrat the ability to determine what treatments an individual can receive.  The House bill will put patients and doctors where they belong - in the driver's seat.
  • Actually, care is being rationed now--by insurance companies--which are making coverage and care decisions based on profits, not what's best for patients.

Myth: “The President claimed the plan will not lead to rationing.  But the bill…would create a ‘Health Benefits Advisory Committee' that would make determinations about what kinds of treatments, items and services can be covered.” - Republican Leader John Boehner Op-Ed [8/13/09]

Fact: The Health Benefits Advisory Committee does NOT have any role in determining what treatments individuals are entitled to; its primary role is simply to recommend the minimum benefit package insurers must offer under the bill, to protect consumers.

  • Nothing in the role of the Health Benefits Advisory Committee infringes on the ability of an individual and the individual's doctor to make medical decisions.
  • The primary role of the Health Benefits Advisory Committee is to make recommendations about the minimum covered benefits that all insurance companies have to offer - in order to ensure that everyone has a health plan that provides them with adequate coverage. (It will also make recommendations on the cost-sharing levels for the “enhanced” and “premium” insurance plans that insurance companies may also wish to offer under the bill.)  (See H.R. 3200, pages 30-37)
  • This is not a “government” committee.  It will be made up of mostly of providers, consumer representatives, employers, labor, health insurance issuers, and independent experts.

Myth: The role of the Center for Comparative Effectiveness Research created by the bill is to ration care - to determine what treatments individuals are entitled to.

Fact: Comparative effectiveness research, which has been funded by the Federal Government for years, has NOTHING to do with rationing.  Instead, this research is simply about giving doctors information they need and want to better serve their patients.  The bill explicitly PROHIBITS the Center for Comparative Effectiveness Research and the Comparative Effectiveness Research Commission from using this research to define, limit, or mandate treatment or services.

  • The whole point of comparative effectiveness research is to compare the effectiveness of a range of treatments for a particular condition for specific patient populations to provide doctors and patients with useful information in determining what particular treatment might best benefit a particular patient - promoting “patient-centered” health care.
  • America's doctors strongly support comparative effectiveness research because they want the best information available.
  • Comparative effectiveness research is nothing new; the Agency for Healthcare Research and Quality has been funding it for years (the bill creates the Center within this existing agency). Indeed, throughout the six years of the Bush Administration and a GOP-controlled Congress, the agency funded comparative effectiveness research without controversy - with, for example, appropriations of $304 million in FY 2004, $319 million in FY 2005, and $319 million in FY 2006.
  • The bill prohibits the Center for Comparative Effectiveness Research and the Comparative Effectiveness Research Commission from using this research to define, limit, or mandate treatment or services.  The precise wording of the bill is as follows: “Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.”  (Section 1401(h) of H.R. 3200 - page 524)

For more health insurance reform myth busting, please click here.

For more information on America's Affordable Health Choices Act, please click here.