THE TREATMENT DECEMBER 2, 2009
Republicans haven’t wasted any time in accusing Democrats of putting faceless bureaucrats in between patients and their doctors, attacking Barbara's Mikulski amendment for relying on government entities to create coverage guidelines. Under the amendment, an HHS agency—the Health Resources and Services Administration (HRSA)—would determine what women’s services would be exempt from co-pays, and the US Preventative Services Task Force (USPSTF) would help determine other types of preventative coverage. “Instead of letting doctors and their patients make the decision about when a woman needs a mammogram we now have not one government task force but two,” Kay Bailey Hutchison thundered yesterday on the Senate floor.
But though the GOP says that doctors should be the ones to decide what their patients need, who’s actually calling the shots in the proposals they’ve put forward? Judging by their first amendments to the health-care bill, the answer is obvious: private insurance companies.
Today, Lisa Murkowski offered an amendment on women’s preventative services as an alternative to Mikulski’s—one that would rely on private insurers to set the standards for preventive coverage. The Alaska Republican’s amendment would cover preventative care as delineated by “the 2 largest plans (by enrollment) participating in the Federal Employees Health Benefits Program,” which covers members of Congress. As such, private insurers—not medical doctors—would have free reign to determine what preventative services should be offered without patient co-pays. And as a for-profit industry, insurers naturally have the incentive to offer less generous benefit packages that would require customers to shoulder more out-of-pockets expenses like co-pays.
Murkowski insists that her amendment would require health plans to “consult with the recommendations of professional organizations” to determine their preventative benefits package. But ultimately, there’s no oversight to ensure that private insurers are making such determination in the public interest: at the end of the day, their motive is their own bottom line.
Mikulski’s amendment, in contrast, would also rely on the Federal Employees Health Benefits Program to provide a template for women’s preventative services. But ultimately, it’s up to the discretion of HHS to decide what the scope of all preventative benefits will be, regardless of external recommendations. And while both HRSA and USPSTF consult with professional organizations and current research, their underlying mandate is “to review scientific evidence,” USPSTF chair Ned Calonge said in a House hearing this afternoon. “Politics play no role in our deliberative processes. Costs were never considered in our considerations.”
While Republicans will continue insisting that they’re empowering doctors to make treatment decisions without interference, in reality, the GOP is leaving patients completely subject to the whims of the private insurance market. In the end, it boils down to a simple question: Who should the public entrust with deciding the minimum benefits they’ll receive—for-profit insurers or government agencies?