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Health Freedom Watch
June 2006

Contents:

President Bush and Congress Need Your Input on National Health Reform

You Count...
Your Health Counts...
Your Desire for Health Freedom Counts...

So Make Sure YOUR Voice is Heard

If you, your family, and friends care about health freedom, you all will want to know about and respond to several important upcoming national activities—activities mandated by law and funded by your tax dollars. Following are vital information and steps you can take to help restore and maintain your freedom to choose your health-care treatments and providers without interference from government or private third parties.

Taxpayer-Funded Group Calls for Public Comments on Its Recommendations for Universal Health Insurance and Electronic Medical Records

The taxpayer-funded Citizens' Health Care Working Group ("the Group") has drafted recommendations for reforming our nation's health-care system and is required by law to obtain public comment on them. Thus you have the opportunity to help shape the recommendations that will be sent to President Bush. Then Congress is required by law to hold five public hearings on the recommendations. (These activities were mandated by Section 1014 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.)

Why Reform the Health-Care System?

After reviewing the health-care system, the Group has provided strong arguments for reform. In its preface to recommendations the Group notes, among other concerns:

"The health care system gets Americans the right care, and only the right care, about 50% of the time. As many as 98,000 Americans die because of medical errors each year. Polls of American households reveal that about one third of Americans report that they or a family member have experienced a medical error at some point in their life. While no system can ever eliminate all error, we can do better. While most Americans are generally satisfied with their health care, too many Americans are being let down by their health care institutions. Many people are afraid of the health care system, they are bewildered by its complexity and are suspicious about who it aims to serve."

But while the Group has identified serious problems, its solutions may pose equally serious concerns to Americans who cherish the freedom to choose their health care. It's well known that he who pays the piper calls the tune, and if government has a larger role in paying health-care bills, then logically it will assume a larger role in our personal health-care decisions.

Consider the Group's values and six interim recommendations (on which it is requesting public comment):

The Group's Values

The Group believes, among other things, that:

  • It should be established in law that all Americans have affordable health-care coverage.
  • Assuring health care is a shared social responsibility—a public responsibility for the health and security of its people.
  • Shared "social responsibility" implies consideration of health-care costs.
  • All Americans should have access to health-care services across the continuum of care throughout the lifespan.

The Group's Interim Recommendations

1. All Americans will have access to a set of affordable and appropriate core health-care services by the year 2012. The Group states, "We recommend adopting financing strategies...that are based on principles of fairness, efficiency, and shared responsibility. These strategies should draw on dedicated revenue streams such as enrollee contributions, income taxes or surcharges, 'sin taxes', business or payroll taxes, or value-added taxes that are targeted at supporting these new health care initiatives.... We understand that the transition from the current system to a system that includes all Americans will take time and that multiple financing sources will need to coexist during the move to universal coverage. However, the disparate parts must be brought together in a way that ensures a seamless and smooth transition."

2. Define a 'core' benefit package for all Americans and identify recommendations for what would be covered under high-cost protection and core benefits. It continues: "The set of core health services will go across the continuum of care throughout the lifespan. Health care encompasses wellness, preventive services, primary care, acute care, prescription drugs, patient education and treatment and management of health problems provided across a full range of inpatient and outpatient settings. Health is defined to include physical, mental and dental health. Core benefits will be specified by taking into account evidence-based science and expert consensus regarding the medical effectiveness of treatments."

3. Protect Americans from the high costs of health care and improve and expand access to health-care services. This recommendation aims to "guarantee financial protection against very high health care costs" and "ensure coverage for all Americans."

4. Support integrated community health networks. The Group recommends that the federal government lead an initiative to develop and expand integrated public/private community networks of health-care providers to deliver services to vulnerable populations and people living in rural and underserved areas.

5. Use the resources of public health-care programs, such as Medicare and the Veterans' Health Administration, to:

  • Develop and implement the use of electronic medical record systems;
  • Enforce use of "evidence-based best practices";
  • Reduce fraud and waste;
  • Promote consumer-usable information about health-care services; and
  • Promote health education.

6. Restructure the way that palliative care, hospice care and other end-of-life services are financed and provided. The Group writes, "Public and private payers should integrate evidence-based science, expert consensus, and culturally sensitive end-of-life care models so that health services and community-based care can better deal with the clinical realities and actual needs of chronically and seriously ill patients of any age and their families."

Public Comment

Americans who want to restore and maintain their health freedom should submit comments on the Group's interim recommendations. Consider emphasizing that any reform should include the:

Freedom to choose one's health-care providers, treatments, and insurance without interference from government or private third parties;

  • Freedom to maintain private contracts with one's health-care providers;
  • Freedom from being coerced into government health-care programs;
  • Freedom from government-impelled rationing; and
  • Freedom of conscience for health-care providers.

Comments must be submitted by August 31, 2006 in one of three ways:

  • online at (http://www.citizenshealthcare.gov/speak_out/comment.php).
  • e-mail to (citizenshealth@ahrq.gov).
  • mail to:
    Citizens' Health Care Working Group
    Attn: Comments, Interim Recommendations
    7201 Wisconsin Avenue, Rm. 575
    Bethesda, MD 20814

The best way to assure your comments are read is to submit your comments by certified mail to the Citizens' Health Care Working Group and also send copies (by certified mail) to President Bush and your congressional representatives.

Have Your Views Represented at Congressional Hearings

Have you ever watched on C-SPAN a congressional hearing about health reform and thought, "Gee, none of those people testifying represents my views on health care?" You're not alone. And that's why it is imperative for citizens who want to be heard to contact their congressional representatives and demand fair hearings on the Group's final recommendations. This is your right. Here are some qualified advocates of health freedom whom you might consider recommending as expert witnesses on health reform:

  • Twila Brase, Citizens' Council on Health Care (expert on medical privacy);
  • Jonathan Emord (advocates freedom to choose and pay privately for dietary supplements);
  • Rep. Ron Paul (strongly supports freedom from mandatory mental-health screening);
  • Michael Tanner, Cato Institute (expert on how an individual mandate for health insurance destroys freedom); and
  • Julian Whitaker, M.D. (makes the case for freedom to choose and pay privately for alternative health care).

Schedule of Activities

  • June 1 - August 31, 2006: Opportunity for public to comment on interim recommendations.
  • September 27, 2006 and forward:
    • Group will submit final recommendations to President Bush and Congress.
    • President Bush is required to submit a report to Congress containing his "additional views and comments on such recommendations; and recommendations for such legislation and administrative actions as [he] considers appropriate."
    • These five congressional committees are required to hold hearings on the final recommendations:
      • Senate Committee on Finance
      • Senate Committee on Health, Education, Labor and Pensions
      • House Committee on Ways and Means
      • House Committee on Energy and Commerce
      • House Committee on Education and the Workforce

According to the Group's website, its mission is twofold:

  • "Provide for a nationwide public debate about improving the health-care system to provide every American with the ability to obtain quality, affordable coverage."
  • "Develop an action plan for Congress and the President to consider as they work to make health care that works for all Americans."

Thus your input really matters because this Group has legislative authority for providing President Bush and Congress with an action plan for reform. Make sure your voice is heard and that the action plan includes your views.

Source: Citizens' Health Care Working Group: (http://www.citizenshealthcare.gov).

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What We Cannot Afford...

It's clear that once again we're headed for a national debate on health reform. Many Americans are frustrated with the serious shortcomings of the existing system and see universal health insurance as a panacea. Many also believe that a wealthy nation like ours can afford to pay for the care of less-well-off citizens. Thus reform will likely focus on the key issues of access and whether the United States can afford to finance health care for all.

But as P.J. O'Rourke stated in 1993, "If you think health care is expensive now, wait until you see what it costs when it's free."

If history is any indication (as pointed out in Medicare's Midlife Crisis), universal health care would most certainly end up costing much more than experts predict. Just consider what happened with Medicare. When Medicare was debated in 1965 (the year it was signed into law), people were concerned that the costs might grow out of control. However, advocates of universal health care assured them that all seniors could easily be covered with only a small increase in workers' payroll taxes. The federal government's lead actuary in 1965 projected that Medicare Part A (the hospital program) would grow to only $9 billion by 1990. Medicare Part A ended up costing more than $66 billion that year!

Moreover, just three years after Medicare was enacted, a 1968 Tax Foundation study found that government spending on medical care had nearly doubled in the first few years of the program. Not surprisingly, Medicare payroll taxes and general taxes have continued to rise over the decades to pay for skyrocketing health-care costs.

Whether Americans think we can afford to increase taxes to pay for more medical services remains to be determined. But one thing we cannot afford is to give up our liberty—especially regarding health-care matters.

As we celebrate Independence Day this year, let's remember that this country was founded on the principle of the "consent of the governed." And no national health-reform policy, no matter how expensive or inexpensive, should override the precious freedom to make one's own health-care decisions.

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Mandatory Health Insurance: Health Care by Force
By Richard E. Ralston

When the United States of America got its start, the general idea was that individuals should be left free to carve out their own lives free of government interference, based on the principles of "life, liberty, and the pursuit of happiness." Gradually over the last 230 years, our public discourse has turned those principles on their head in favor of just one idea: How should we use the force of government to compel our fellow citizens to live their lives as the government thinks best? Nowhere is this trend more conspicuous than in the politics of health care.

Recently an alternative has been advocated to a complete government takeover of every detail of our health care: mandatory insurance. At first glance, anything sounds better than turning the preservation of our bodies over to the tender, loving, and solicitous arms of the federal government. Who, after all, could possibly care more about the welfare of each one of us than our beloved politicians, or the selfless kindness of the heads of public employee health-care unions? Surely it is better to avoid this by the simple expedient of requiring everyone by law to buy their own insurance. That may be a pleasant illusion, but it is a deadly one. It is based on the central fallacy that state capitalism is preferable to socialism.

Mandatory insurance is of course an exercise in euphemism. It means "do what we say or become a criminal." It does not even mean go into the marketplace and buy insurance—which would be bad enough. No government is going to require you to buy health insurance without regulating in exquisite detail what it must cover and what you must do. This is well demonstrated by the mandatory program recently implemented in Massachusetts, which in several ways disguises government control in the form of "market" reforms.

The clearest example of this is a private, statewide connector through which individuals can purchase insurance. Private in this case means a single, state-chartered monopoly through which individuals must purchase their insurance. This supposedly creates a marvelous new marketplace through which the citizens of Massachusetts can now buy insurance. What did they have before? Uhh...a marketplace. That has now been abolished in favor of one-stop government shopping, which greatly reduces the choices available. Most adults, for example, will not be able to buy preferred provider plans (PPOs), but will be required to join an HMO. Once compulsion enters the picture, government influenced by interest groups cannot resist the effort to micromanage exactly how you manage your health care.

The Commonwealth of Massachusetts already has some of the most expensive health insurance in America because of its coverage requirements. Whether or not you want coverage for chiropractic care, or in-vitro fertilization, or acupuncture, you may be required by law to pay for it. The Massachusetts commissioner of insurance and the secretary of health and human services now have the monopoly of the connector to expand such regulation. In addition, the new program creates a flock of new state bureaucracies to help them along, such as the new Massachusetts Payment Policy Advisory Board. And the new Health Care Quality and Cost Control Council. It appears this last body will be unable to function without an additional Advisory Committee to the Health Care Quality and Cost Control Council. These organizations have many members and will presumably soon develop hefty staffs.

Will all these government agencies control costs? Or just increase the cost of cost control? The new program provides over 500,000 low-income citizens of Massachusetts with "free" insurance—all the health care they want with no deductibles and no co-payments. That is what now passes for restraint in government spending. (It is a non-essential detail that the Massachusetts program is not funded. The annual tax of $295 per worker on small employers with more than 10 uninsured employees will not pay for much, although those working for companies with 11 or 12 employees might be sweating a little. As struggling small employers who do not provide health insurance for their workers are now also responsible to pay any health-care bills when they go over $50,000, perhaps all of their employees should worry about what happens to their jobs.)

It is the importance of health care that lends itself to such fatuous concepts as mandatory insurance. While we are at it, why not just require everyone to buy a nice house and make the mortgage payments? Food is necessary for life—should we shut down the supermarkets and get all of our food from the Department of Agriculture? Obviously not. While some conservatives have praised mandatory insurance as an example of individual responsibility, that is a perversion of the concept of individual rights. Mandatory speech—the government forcing you to say something—would not be freedom of speech. [Emphasis added]

It is precisely because health care is so important that it should be sustained on a solid foundation of personal choice and individual freedom for patients and health-care professionals alike. The Massachusetts program fails this most important test and does not merit duplication elsewhere.

Richard E. Ralston is executive director of Americans for Free Choice in Medicine (www.afcm.org).

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Informed Consent Waived in Public Health Emergency

The Associated Press (AP) reported that under a new FDA rule published June 7, individuals would no longer have to give their permission before experimental tests are conducted on blood (and other body samples) during a public health emergency.

"Privacy experts called the exception unnecessary, ripe for abuse and an override of state informed-consent laws" reports the AP. "Health care workers will be free to run experimental tests on blood and other samples taken from people who have fallen sick as a result of a bioterrorist attack, bird flu outbreak, detonation of a dirty bomb or any other life-threatening public health emergency, according to the rule issued by the Food and Drug Administration."

The FDA rule took effect on June 7, but remains subject to public comment until August 7.

To read the AP article, see: (http://www.nytimes.com/aponline/us/AP-Informed-Consent.html?ex=1150430400&en=adcaefcabf049db1&ei=5070&emc=eta1) [registration required].

The FDA rule is here: (http://www.fda.gov/OHRMS/DOCKETS/98fr/E6-8790.htm).

Source: "Informed Consent Waived in Public Crisis," Associated Press, New York Times, June 7, 2006.

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Health Freedom Watch is published by the Insitute for Health Freedom. Editor: Sue Blevins; Assistant Editor: Deborah Grady. Copyright 2006 Institute for Health Freedom.