As to play “Fact Checker” to a few of the health care related items mentioned at the debate last night.

1) Pre-Existing Conditions

This problem was handled in HIPPA and the reality is each state must provide a system that provides coverage (High Risk Pool – HIPPA COverage) for anyone who has been continuously insured for 18 months. So since at least 2006 the only people who really had issues with Pre-Ex are those who waited until they got sick or injured to buy “insurance”.  You can’t insure your house while it is burning. 

2) Expansion of term dependents

For the most part carriers and states allow this for those who are truly dependents already.  For the past two years this has been pretty much a free ride for parents (at least those already with family coverage when adding one more person doesn’t increase the cost share).  For 2013 and beyond look for larger companies to start charging on a per “child” basis.  

3) Insurance purchased “Across State lines”  

Thankfully this only came up once.  While it would be an improvement to have uniform benefit provisions and regulations for at least a small segment of plans, the idea that a New Yorker will be able to buy a “Kansas City” plan (and rate) is misleading.  Maybe there will be a great plan or company that operates in Kansas City, but they rates for residents in NYC would be a lot higher for all the other reasons that goods and services delivered in New York are a lot higher.  

Who wouldn’t love to have a Park Avenue address at the “Kansas City” price?

4) Medicare “Vouchers”

This proposal is a voucher program only if you believe ObamaCare is a voucher program.  It is a Defined Contribution program that will ultimately have to be means tested if anyone under 55 wants to have some sort of health care safety net when they retire.

Health care costs will continue to rise and individuals will continue to be at the mercy of the payor as long as we have a 3rd party payment system.  So I guess the immediate debate is who do you want to ration your care?  Your choice now is the insurance company who sells you a policy (aka contract) that says what wil be paid and what won’t.  When they deny a claim it doesn’t mean a person can’t have the treatment.  While not having the money to pay for a particular treatment may be the same as not being able to have it, there is at least an option.  

Since ObamaCare sets the standard for essential benefits, the government will dictate which services are covered.  While there are still “insurance” companies the system will look like it does today – meaning the insurance company may say “we don’t cover that” but you still get the treatment.  When ObamaCare evolves to the models in Canada and England (which it will have to) the government will decide if you can have a service and when you can have it.  

The fact of the matter is that in any 3rd party payment system their will have to be rationing of care.  No one has proposed infinite resources, so any government managed/controlled system will make rationing choices.  One former administration official has some ideas about this now.