The contraception decision was just the beginning of our finding out what is in Obamacare. Scott Gottlieb, a physician and resident fellow at the American Enterprise Institute, explains that we are in for some nasty surprises:
It gets worse: In the future, thanks to ObamaCare, the government will issue such health edicts on a routine basis—and largely insulated from public view. This goes beyond contraception to cancer screenings, the use of common drugs like aspirin, and much more.
The insurance companies were pilloried by the President during the debate over Obamacare (though of course he delivered them a captive clientele), but you could argue with an insurance company. You won’t get anywhere arguing with the government.
A single committee, the United States Preventative Services Task Force, will evaluate preventive health services and make decisions on what will be covered. They will not consider an individual who might benefit from a program that doesn’t seem to work for many people.
The task force will give services a letter grade. Services rated “A” or “B”—such as colon cancer screening for people aged 50-75—must be covered must be covered by health plans in full and provided without a copay. Services that get "Cs" and "Ds"—such as screening for ovarian or testicular cancer—might be disallowed altogether.
The reason is that the full coverage for the "A" and "B" services be so expensive. You might prefer something more flexible—say, pay copays on “A”-rated services in exchange for having screenings for ovarian cancer. Dream on. This is the government in charge. Indeed, such services may be dropped altogether from coverage:
Health plans will inevitably choose to drop coverage for many services that don't get a passing grade from the task force and therefore aren't mandated. Insurance companies will need to conserve their premium money, which the government regulates, in order to spend it subsidizing those services that the task force requires them to cover in full.
Often life-saving treatments will not be available:
The task force relishes setting a very high bar. Like the Food and Drug Administration in approving new drugs, it usually requires a randomized, prospective trial to "prove" that a diagnostic test or other intervention improves clinical outcomes and therefore deserves a high grade of "A" or "B."
This means its advice is often out of sync with conventional medical practice. For example, it recommended against wider screening for HIV long after such screening was accepted practice. As a result, many of its verdicts are widely ignored by practicing doctors.
The task force is also the only federal health agency to have the explicit legal authority to consider cost as one criterion in recommending whether patients should use a medical test or treatment.
Consumers will have no way to challenge these decisions. The taskforce is not required to hold meetings open to the public and it is not required to announce its decisions in draft form. We will find that important, life-saving treatments are more expensive but that there is an increased array of “free” services. Gottlieb sums up the situation:
It's all a reminder that President Obama's decision on contraception isn't a one-off political intervention but the initial exploit of an elaborate new system.
Gottlieb doesn’t raise the issue of the politicization of services, but can’t we also see the list of services provided being affected by politics? Contraception, for example, is widely available (and in many instances available free to low-income women). But there is enormous feminist support for free, government-mandated contraception, and the president wants to get this vote in November.