nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Sunday, March 28, 2010

Poison Pill Of The Day: Law Does Not Prohibit Rationing.

Poison Pill #6:  Section on coverage does not exclude cost considerations.

Boring and nearly incomprehensible quotations below are taken from Section 1302(b)(4)  of the new health care law (formerly "the Senate bill").  See page 107 and following.

The Secretary of Health and Human Services shall

"not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life;"
"take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups;"
"ensure that health benefits established as essential not be subject to denial to individuals against their wishes on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree of medical dependency, or quality of life;"

That is, no discrimination, and no denial based on group, and ensure coverage of diverse needs--that's good.  As you can see, the law is explicit about many things above on gender, age, disability, etc.

Note that none of this prohibits the Secretary from making decisions (regarding coverage or needs) on the basis of cost.

There's an old saying in government work that "an action not prohibited is an action allowed."  So, the door is open to exclude coverage that exceeds the revenue alloted for care; i.e. rationing.

Concerningly, the same section does require the Secretary to make

"an assessment of the potential of additional or expanded benefits to increase costs and the interactions between the addition or expansion of benefits and reductions in existing benefits to meet actuarial limitations described in paragraph (2);"

The law puts great resonsibility and power in the hands of the Secretary of Health and Human Services (HHS).  While searching for signs of how cost and coverage would be related, I came across hundreds of statements that she will "decide" this, "determine" that, "include or exclude" whatever, and "report" all kinds of things.  Note that the Secretary of HHS is a political appointee of the President.

For a lesson in how government funding of healthcare can go wrong financially, see the article in the Telegraph (Mar 26) on the desperate measures under consideration in Great Britain.


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