One of the truisms in Left Blogistan, where I frequently hang out, is that "reality has a well-known liberal bias." Fortunately, that matters less to those unfettered by actual facts, a point illustrated today by Senator (yes, really, a US Senator) Ron Johnson who, in a Wall Street Journal op-ed piece performed a reprise of 2009's Lie of the Year: Death Panels wherein bureaucrats ration care:
My daughter probably wouldn't have survived in a system where bureaucrats stifle innovation and ration care.
Some years ago, a little girl was born with a serious heart defect: Her aorta and pulmonary artery were reversed. Without immediate intervention, she would not have survived. [...] If you haven't guessed, this story touches my heart because the girl is my daughter, Carey. And my wife and I are incredibly thankful that we had the freedom to seek out the most advanced surgical technique. The procedure that saved her, and has given her a chance at a full life, was available because America has a free-market system that has advanced medicine at a phenomenal pace.
I don't even want to think what might have happened if she had been born at a time and place where government defined the limits for most insurance policies and set precedents on what would be covered. Would the life-saving procedures that saved her have been deemed cost-effective by policy makers deciding where to spend increasingly scarce tax dollars?
Yes, that dystopian future where we stand aside an allow infants to expire from treatable illnesses would be terrible. It is, incidentally, not the dystopia which we currently inhabit. The dystopia now is one in which 46 million americans do not have access to routine care, and those infants born to parents unlucky enough to be uninsured may receive heroic lifesaving care on a charity basis -- or maybe not, depending on the whims of chance and the severity of their illness. Most hospitals will perform heart surgery on an otherwise dying infant and eat the cost (or retroactively enroll them in medicaid), but if your child has, for example, moderate severity cerebral palsy, good luck getting him or her the intensive physical therapy, occupational therapy, and speech therapy that will be needed to get her functioning at her best possible level. You need insurance to get thigs like these, and sometimes to get lifesaving treatment -- and getting more people insurance is the whole point of the PPACA.
That's the world as it is, until 2014 anyway. It was a terrible decision to defer implementation of the PPACA (aka "ObamaCare") until then, but that's water under the bridge. So am I to take it from Sen Johnson's testimony that at that time we will suddenly be in a situation where the government will be imposing limits on what lifesaving procedures must be covered by insurers? You may be surprised to learn that the answer is ... yes! The funny thing, the insidious lie at the heart of Sen Johnson's heart-tugging testimony, is that the government is setting minimum standards for coverage, not maximum standards. In fact. several republican governors have criticized the standards set by the PPACA as being too high. Previously, your private insurance, purchased in your behalf by your employer probably had a lifetime limit of how much it would cover -- likely $2 million, though policies vary. If your kid happens to be a cardiac kid, you can blow through that in just a couple of operations and ICU stays. ObamaCare outlaws these lifetime coverage caps, and sets mininum standares as to what insurers must cover, and cost-effectiveness is not part of the equation. Also, ObamaCare bans insurance companies from discriminating against children with pre-existing conditions.
"But wait!" A chorus of commenters are ready to retort, " What about the CER death panels, where the government will pick and choose which therapies to cover?" It is true that this research is going to be done, and likely that it will be utilized in reimbursement decisions in the future. However, the C stands not for "cost" but for "comparative" in which we will try to determine which of multiple treatments for a given disorder is the best. And yes, in a world where health care consumes 16% of GDP, cost should be a component of rational, value-based purchasing. But that assumes that there are multiple accepted treatments for a given condition, and does not in any way imply, as Senator Johnson falsely insinuated, that patients' lives will be weighed and valued by bureaucrats. But like many opponents of the PPACA, Johnson seems to be railing not against what the bill is, but against the bogeymen of what he fears it could someday be.
Bottom line: the PPACA leaves the commercial, employer-sponsored insurance that about 58% of americans have untouched. It leaves medicare and medicaid essntially untouched, but possibly marginally more efficient. For those on the individual market, it will make insurance radically more accessible. And for those currently uninsured, it either opens the individual market to them, opens the individual market with subsidies, or puts them on medicaid. That's it. Nothing which would prevent a commercially-insured child from getting her heart fixed.
Oh, and as an aside, Sen Johnson cites some cherry-picked and misleading statistics about the cancer care in the US compared to other countries. I would refer you to The Incidental Economist for an evisceration of that talking point.