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Tilting at Windmills

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July 19, 2009

ORSZAG SETS THE RECORD STRAIGHT.... Fox News' Chris Wallace asked OMB Director Peter Orszag this morning if the administration will be "rationing" health care by establishing a commission of doctors and medical experts to oversee medical practices. Orszag, thankfully, called this a "canard" and pointed to the status quo.

"The fact of the matter is, right now, politicians and insurance companies are making decisions," Orszag explained. "We're saying, we want doctors to be making decisions."

Wallace said once these physicians start "making decisions," they'll be in the business of telling consumers which medical treatments they can and cannot have. So, Orszag turned the question around: "Do you think that politicians are currently rationing care? Or insurance companies are currently rationing care? There are no set of decisions that this commission would have that is not currently resting with either members of Congress or insurance companies."

Now, Orszag rejected the idea that the status quo, in fact, "rations" medical care. I disagree with that. But his larger point is fair -- if the current system is already rationing care, then the concerns about doctors and medical experts overseeing medical practices would itself be a valuable improvement on the status quo.

Expect to have this come up quite a bit. On "Meet the Press," David Gregory asked HHS Secretary Kathleen Sebelius if federal bureaucrats may not want to pay for some medical procedures.

It may not happen to hosts of national news programs much, but in reality, plenty of Americans find that their insurance companies decide not to pay for treatments all the time. In fact, they have a financial incentive to do just that.

Who gave media anchors the idea that insurance companies reflexively approve payments on everything?

Steve Benen 11:15 AM Permalink | Trackbacks | Comments (33)

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"Who gave media anchors the idea that insurance companies reflexively approve payments on everything?"

Hah! Incredibly simple: either THEIR gold-plated insurance plans do pay for everything, or else when claims are rejected, they just tell their secretaries to pay the bill.

If there were no millionaire talking heads, this would be a very different country.

Posted by: John Hamilton Farr on July 19, 2009 at 11:35 AM | PERMALINK

Bottom line: We don't need insurance companies.

They serve no one but their investors.

They are a barrier between patient and doctor.

I repeat: Insurance companies are superfluous.

h

Posted by: h on July 19, 2009 at 11:37 AM | PERMALINK

Wasn't it Sinclair Lewis who said that it's very difficult, if not impossible, to make a man believe something when his paycheck depends on him not believing it? (I'm paraphrasing, of course.) Well, media anchors get a much larger percentage of their paychecks from insurance companies than from poor people who have their claims rejected. Is it any wonder that David Gregory and Chris Wallace refuse to believe that insurance companies are bloodsucking monsters?

Posted by: Singularity on July 19, 2009 at 11:37 AM | PERMALINK

Why do Chris Wallace and David Gregory both talk about rationing heath care? Because it's a Republican Talking Point. Rationing Health Care is BAD, except when it's done by private, for profit companies.

Posted by: OwnedByTwoCats on July 19, 2009 at 11:38 AM | PERMALINK

Who gave media anchors the idea that insurance companies reflexively approve payments on everything?

Who gave the talking heads the idea that insurance companies will actually make the payments that they've already approved without forcing the insured to make half a dozen phone calls and fill out an additional twenty-seven forms -- all in the hope that the insured will finally just give up (or die)?

Who gave the press-titutes the idea that the insurance companies let you pick your own doctors?

Who gave the thralls of the corporate controlled media the idea that someone with a pre-existing condition can get any coverage at all? We're sorry Mr. Smith, but with your medical history of three ingrown toenails, coverage for any medical care for you below the collar bones will cost you $12,000.00 per month in premiums.

Just askin'


Posted by: SteveT on July 19, 2009 at 11:38 AM | PERMALINK

Well gee, would I rather have my physician or some profit-obsessed schmuck who doesn't know me make decisions about the care I receive? Hmmm.

Here's what happens in The Real World: Doctor A tells Patient B he needs Test X or Procedure Y. Insurance Provider says Yes or No. Sometimes the No comes after X or Y has occurred. If the answer is No, A and B (neither of whom have a lot of spare time) can get into a prolonged dog fight with the I.P. Sometimes the I.P. will give, sometimes it won't. In other words, sometimes B is screwed because of a decision made by the I.P.

But on BizzaroWorld this isn't rationing. This is the majick of the All Powerful Free Market.

Now, what will sometimes happen is B wants a procedure and A will say based on your medical history you don't need it. B will get pissed. Sure, A could be just plain wrong. But again, B can get a second opinion ... if his I.P. allows it. On BizzaroWorld, this still isn't rationing.

But hey, watching people line up to defend an industry that is only slightly more popular than hemorrhoids is good fun. Popcorn?

Posted by: The Answer WAS Orange on July 19, 2009 at 11:41 AM | PERMALINK

if you dont watch the teevee, you dont hafta eat the shit.

Posted by: neill on July 19, 2009 at 11:43 AM | PERMALINK

Wallace said once these physicians start "making decisions," they'll be in the business of telling consumers which medical treatments that can and cannot have.

I realize that the people who deal with Rush Limbaugh must be under the impression that doctors should be writing Oxycontin prescriptions for anyone who wants one, but the rest of us know that maybe people should get treatments that are medically necessary as decided by their doctor and not just be able to get any procedure they want at any time even against their doctor's advice as long as they can pay for it.

Posted by: Mnemosyne on July 19, 2009 at 11:44 AM | PERMALINK

Who gave media anchors the idea that insurance companies reflexively approve payments on everything?

Their corporate masters, who expect their blow-dried, pre-purchased mouthpieces to catapult the propaganda or else.

Posted by: Screamin' Demon on July 19, 2009 at 12:03 PM | PERMALINK

singularity, it was Upton Sinclair, not Sinclair Lewis who made that observation. An understandable bit of confusion.

By the way, there's an excellent book on Upton Sinclair's 1934 run for the governorship of California. Campaign of the Century by Greg Mitchell. You'll have to find it in a library or used book store, but it's quite illuminating. All that is bad about modern campaigning seemed to have its genesis in the smear campaign mounted against Sinclair.

Posted by: Roddy McCorley on July 19, 2009 at 12:05 PM | PERMALINK

I have insurance. I just had surgery-- and the doctor's assistants called the insurance company beforehand and checked about the coverage and got approval.

The insurance company paid for the surgeon-- well, they paid 20% of what was billed, or rather put $2000 of that into the deductible, and paid the remainder, adding up to 20%, that is, the doctor only ended up with 20% of what was billed. But the insurance company denied the bill of the anesthesiologist. "Unnecessary."

Whole bill. Anesthesia unnecessary during surgery? I guess I could have bitten on a bullet. Bullets are cheap.

The daughter of a friend of mine had to have a trach because spasms of the throat made it hard to breathe. The insurance paid for that (or part of it anyway). The condition resolved. The insurance company would NOT pay to have the trach closed. She walked around for weeks with an open trach until she found a surgeon willing to donate her services (friend paid for the hospital bill).

Another friend broke his finger. Insurance company paid to put two pins in (sort of-- it happened out of town, and the surgeon was "out of network," so the insurance company charged a $800 "out of network fee" and the rest, natch, went to the deductible. However, they completely denied the minor follow-up surgery of removing the pins.

So what was that about rationed care?

Posted by: petronia on July 19, 2009 at 12:19 PM | PERMALINK

"...Orszag rejected the idea that the status quo, in fact, "rations" medical care. I disagree with that."

Really?

And what do you call it when those who cannot for whatever reason be insured cannot receive the same care as those who do?

Medical health care is rationed in exactly the same way as dental care. Advanced cosmetic treatments, root canals, implants, crowns, etc. are rationed according to one's ability to pay, not according to need. The marketplace is the original rationing authority.

The words "rational" and "rationing" have the same root. Too bad more people can't seem to make the connection.

Posted by: John Ballard on July 19, 2009 at 12:26 PM | PERMALINK

Hmmm ... perhaps the news anchors get that idea from the those self-same insurance companies. The same ones that pay their networks all that advertising revenue.

Perhaps this conflict of interest - and the massive power of advertising money - also explains why our courageous, crusading television news reporters haven't tackled things like the spike in gasoline prices last summer (and excused this at the time as a normal function of the free market).

Posted by: Bokonon on July 19, 2009 at 12:26 PM | PERMALINK

The Answer WAS Orange says: Here's what happens in The Real World: Doctor A tells Patient B he needs Test X or Procedure Y. Insurance Provider says Yes or No. Sometimes the No comes after X or Y has occurred. If the answer is No, A and B (neither of whom have a lot of spare time) can get into a prolonged dog fight with the I.P.

And don't forget, the free market doesn't operate in any case, as Patient B can't shop around for a new Insurance Provider after receiving crappy service. S/he is stuck with CrappyIP until the next selection term, when Patient B finds out employer still has only one option for coverage - CrappyIP!

Posted by: CParis on July 19, 2009 at 12:46 PM | PERMALINK


Orszag used the word "canard" on TV? Sadly, most of the audience doesn't know what that word means.

Posted by: Bat of Moon on July 19, 2009 at 1:44 PM | PERMALINK

its funny how fox and the GOP consistently refer to us as "consumers," instead of "people."

Posted by: Paul on July 19, 2009 at 1:51 PM | PERMALINK

Well CParis, you don't want commoners getting their grubby hands on the majickal free market fairy's wand. They might do something that benefits themselves! [swoon]

Hmmm ... perhaps the news anchors get that idea from the those self-same insurance companies.

Maybe. More likely really good benefits packages + high salaries means the idea of the word No or even Wait in regards to health care is inconceivable. I'm sure this gives them lots of credibility with those members of their audience who aren't so fortunate.

Posted by: The Answer Was Orange on July 19, 2009 at 2:00 PM | PERMALINK

these are millionaire gasbags who negotiate their several millions in salary -- wanna bet that a very sweet premium healthcare benefit isnt part of those negotiations. and i'm talking something separate and apart from what the regular employees of g.e. and news corp, et al, get.

Posted by: linda on July 19, 2009 at 2:02 PM | PERMALINK

Of Obama's three legged money stool -- Summers, Geithner and Orszag -- Orszag is the only leg that's not rotten or termite ridden to the core. Maybe because his name means "country" (in Hungarian), while the names of the other two are really Goldman Sachs and J P Morgan.

Posted by: exlibra on July 19, 2009 at 3:01 PM | PERMALINK

The walls around the Village are pretty high.

Posted by: jean on July 19, 2009 at 3:19 PM | PERMALINK

Are these people too stupid to realize that Medicare already makes these kinds of decisions?

Posted by: Barbara on July 19, 2009 at 3:48 PM | PERMALINK

@petronia
... The insurance company would NOT pay to have the trach closed. She walked around for weeks with an open trach...

... However, they completely denied the minor follow-up surgery of removing the pins.

One thing I've noticed wrt health care reform is how the "anti-" crowd brays about how we will "lose" the advanced and cutting edge procedures, those heroic procedures affecting the minority of patients. However, it seems most non-scheduled medical intervention is more mundane: you fall and break your wrist, you're in a vehicle accident and require pins, or your child is born with a cleft palate. These common accidents are expensive and can their expense breaks budgets. While technological advances can and do help here, these are more mundane medical procedures which are well understood and which should be available everyone without bankrupting them.

Does anyone have a list showing what are the most common reasons for hospital admittance? That might be useful information in the debate.

Posted by: Principal Agent on July 19, 2009 at 4:18 PM | PERMALINK

WTF did Mike Wallace do wrong as a dad?

Posted by: demoraptor on July 19, 2009 at 6:24 PM | PERMALINK

Does anybody think that the famous David Gregory and the very famous Chris Wallace son of the very very famous Mike Wallace ever been denied any care? You think insurance cos. don't know these people? I am willing to bet no pol has been denied care. Seriously, does anybody think the George Washington Hospital in D.C. doesn't get "taken care of" as far as funding because you have all these pols living around there? I remember a discussion about the ER at the hospital which happens to a very good ER because theres a very good chance that the POTUS may end up there.

Posted by: warren terrah on July 19, 2009 at 7:46 PM | PERMALINK

Today, when an insurance company denies payment for some kind of treatment THEY are rationing health care.

The reform will make that illegal and decrease rationing.

Care effectiveness shll only help to inform the medical profession of what works best.

We've got to keep responding to all of their anti-reform statements to ensure that inside the Village wall they get the message.

Posted by: MarkH on July 19, 2009 at 8:34 PM | PERMALINK

Advice to the Obama administration - lets have a clear message here when questioned by the idiots in the MSM:

Those Republicans and Blue Dogs opposed to real health care reform which includes a strong public option are f&*king the American public, American industry, and especially American small businesses.

Posted by: Glen on July 19, 2009 at 8:42 PM | PERMALINK

From Mr. Benen:

"Now, Orszag rejected the idea that the status quo, in fact, "rations" medical care. I disagree with that. But his larger point is fair -- if the current system is already rationing care, then the concerns about doctors and medical experts overseeing medical practices would itself be a valuable improvement on the status quo."

Was Mr. Orszag intending that the "status quo" includes rationing? Certainly it does if the status quo is referring to private insurance companies. They ration all of the time by their very practices! But Medicare, with which I'm familiar, does as well, evertime they deny a claim (which is far less frequent than the private insurance company's record).

(I might refer readers to Peter Singer in the New York Times Magazine, July 15, 2009, regarding an intelligent, provocative essay on rationing.)

Posted by: shadou on July 19, 2009 at 9:37 PM | PERMALINK

Thanks for the book recommendation, Roddy.

Posted by: Bob M on July 19, 2009 at 10:06 PM | PERMALINK

Just to add to the documentation, AIG refused to pay a bill for lab tests that were ordered by the doctor after I had a period of bloody diarrhea. They never gave a reason. They just refused to pay. My policy had no deductible.

Posted by: Texas Aggie on July 20, 2009 at 12:26 AM | PERMALINK

'Wallace said once these physicians start "making decisions," they'll be in the business of telling consumers which medical treatments they can and cannot have.'

Um, doesn't your doctor do that already? I mean, your doctor is not necessarily going to give you a coronary bypass operation if he doesn't think that's called for, just because you want one.

Posted by: Nancy Irving on July 20, 2009 at 3:25 AM | PERMALINK

Why do Chris Wallace and David Gregory both talk about rationing heath care? Because it's a Republican Talking Point. Rationing Health Care is BAD, except when it's done by private, for profit companies.

See page 23 [PDF] of Frank Lutz's The Language of Healthcare 2009.

Actually, Chris Wallace and David Gregory don't get the Luntz talking points exactly right. "A commission of doctors and medical experts to oversee medical practices"? What the heck is supposed to be wrong with that? I'd rather see doctors and medical experts overseeing medical practices than, say, Joe the Plumber. And "bureaucrats"? Luntz says

"Bureaucrats are scary - but at least they are professionals. But politicians? They bring all the wrong things to something as vital as healthcare. Both words do damage to the Democratic plan, but 'politicians' does the most."

Keep trying, guys.

Posted by: Jeff W on July 20, 2009 at 4:37 AM | PERMALINK

Orzag dances as well as he can to avoid the word ration but as he admits, that's what the current system entails. The Rs have done a great job in attaching scary connotations to the word which is why I'd like to have heard Orzag use a variant of "best practices."
Many people wok for companies, large and small which are constantly examining their procedures to alter current practices to best practices, whether it's a brand name like Six Sigma or something like that, people are used to hearing it.
What's proposed is to have doctors, researchers constantly re-evaluate processes and prescriptions for what works best for patients.

Insurance company has similar connotations but insurance is a fundamental part of any health care system. Just ask the French.

Posted by: TJM on July 20, 2009 at 6:06 AM | PERMALINK

Looking at all this from outside the US it's hard not to come to the conclusion that you have the best government money can BUY.

Business interests have the media bought and paid for and have become the defacto 4th branch of government.

Alternatively - you're all nuts.

Posted by: Polaris on July 20, 2009 at 7:16 AM | PERMALINK
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