In our youth many of us learned orderly reasoning skills through a little game called 20 questions. One person would think of a person or an object and the others could ask twenty “yes” or “no” questions in order to identify something, perhaps a place or an object or a person, living or dead, anywhere in the world. This technique taught reasoning skills by going from general to specific, in order to synthesize information, eliminate alternatives and come up with the right answer.
We think the American public could essentially apply the same process to help thoughtful, but perhaps currently confused, citizens determine how they feel about the emerging health-care plans wending through Congress.
The recent spectacle of so-called town-hall meetings does not seem to have produced a better informed electorate. The raucous gatherings and the often vacuous answers that were elicited from the hapless Congressmen or Senators being grilled or shouted at have not been helpful.
Thus, we have prepared 20 simple yes or no questions citizens should ask in reaching their own conclusions; (we couldn’t resist the temptation of drawing our own conclusions following each of the questions.)
1. Will all participants in the new health care program be required to pay, through added taxes or premiums, the cost of covering those who join the plan with pre-existing conditions, many of whom will increase the cost to insurance carriers from the day they enroll in the plan? (If answered “yes,” the added cost to everyone covered under the proposed plan for these pre-existing conditions should be disclosed to the public.)
2. If there is to be no cap or limit on what insurers pay for catastrophic illness, will those costs be covered by taxes or premiums that everyone pays? (If answered “yes,” everyone is entitled to know what these added taxes or premiums are estimated to be.)
3. Will the number of years of life expectancy anticipated subsequent to a prescribed procedure be a factor in the approval or rejection of that procedure under the national health-care plan? (If answered “yes,” the age (or the formula) for determining whether or not a procedure will be approved or denied and the identity of the decision-making panel should be specified.)
4. If, as the Congressional Budget Office (CBO) has determined, the government plan costs more than the Administration and Congress have projected, will the additional cost be borne by the participants in the plan through across- the- board tax or premium increases? (If answered “yes,” the amount of estimated increased premiums or taxes that would be required to cover the CBO projections should be revealed.)
5. Will there be any limit to the litigation awards that will be allowed in cases where a patient or a patient’s family believes a doctor or hospital to be responsible for an outcome they consider to be unsatisfactory or suggestive of malpractice? (If answered “no,” the Administration should be asked how that is compatible with efforts to eliminate defensive medicine.)
6. Will additional taxes or premiums be charged to participants in the program to pay for the additional doctors, nurses and hospitals that will be required to provide service to the estimated millions who are currently uninsured in the United States? (If answered “yes,” this anticipated added cost and who will pay this added cost should be revealed.)
7. Will an individual who is in the United States illegally and who has paid nothing into the plan be entitled to the same benefits to which American citizens who pay into the plan are entitled? (If answered “no,” the lawmakers should reveal what provisions are in the bill that provide for the enforcement of this prohibition.)
8. Will an individual’s or a family’s income be a determining factor in assessing that individual’s or family’s premium or tax for participating in the plan? (If answered “yes,” the formula for that calculation should be determined and made public.)
9. Will costs be controlled by periodically reducing what doctors or hospitals are paid for providing service? (If answered “yes,” doesn’t that mean that doctors and hospitals will be required to subsidize these costs?)
10. Will costs be controlled by limiting payments to pharmaceutical manufacturers for new drugs they bring to market? (If answered “yes,” won’t this mean that less money will go into the R&D programs which are responsible for finding new cures?)
11. Will fees be capped so that a hospital receives a flat fee for hospitalization for a given illness or procedure regardless of the time a given patient needs to be hospitalized to sufficiently recover? (If answered “yes,” what protections will there be to assure the public that hospitals aren’t incentivized to discharge patients who may not be ready or healthy enough to be released?)
12. If an individual or family decides to change insurers will they be required to select only from insurers approved by the government or that are part of a government determined insurance exchange? (If answered “yes,” won’t an individual’s or a family’s freedom to choose its own health-care provider be diminished.)
13. Will malpractice insurance be provided by the government to physicians and hospitals should the fees they are allowed to charge be insufficient to cover the cost of private malpractice insurance? (If answered “no,” how will physicians or hospitals cover these premium costs and remain in the practice of medicine?)
14. Will there be a mechanism in the plan to enable hospitals or physicians to obtain fee adjustments if they can demonstrate they are losing money adhering to the plan’s fee schedule? (If answered “no” won’t many physicians and hospitals be forced to exit the field?)
15. Will a doctor or hospital with extensive experience and success in treating any given illness be limited to the same compensation for treating that illness as a doctor or hospital with less experience or success in treating that same illness? (If answered “yes,” won’t the level of medical expertise available to the public diminish over time?)
16. Will Medicare Advantage programs be eliminated in favor of a government substitute? (If answered “yes,” won’t the legislation eliminate the most successful and popular Medicare program?)
17. Will individuals who do not wish to participate in the national plan have the right to “opt out” by paying their own medical expenses under an arrangement they negotiate with a doctor (or hospital) of their choice and at no expense to the government? (If answered “no,” doesn’t this amount to the loss of a very basic freedom many families currently enjoy?)
18. Are any plans under consideration that confine coverage to the approximately 15% who are uninsured in the United States? (If answered no, such an insurer or subsidizer of last resort should be considered as an alternative to “shoe-horning” everyone else into a so-called comprehensive national health-care plan.)
19. Will non-US citizens who travel to the United States for treatment, tests or other diagnostic procedures be charged the same fees as US citizens who are covered under the national plan? (If answered “yes,” won’t American taxpayers be subsidizing the cost of providing these services to non-American individuals?)
20. Will participants in the national plan who have exemplary health experience, causing little or no expense to the plan, receive any good-health benefit in the form of reduced premiums or tax credits for a portion of the premiums they pay? (If answered “no,” won’t those participants in the plan who maintain healthy life-styles be paying more in order to subsidize those participants whose life styles (eating, drinking, smoking, etc.) are deleterious to their health?
We appreciate that the answers to some of these questions open a proverbial Pandora’s Box of unintended consequences and unpredictable ramifications. Nonetheless, we hope these questions help focus our readers’ attention on some of the important issues that must be considered in the enactment of a national health-care plan. More to the point, the answers the Administration or the Congress provides to these questions should help all of us decide how we feel about a government controlled and administered health-care plan.