ACA Reform: the newest wrinkle

OK, it’s widely understood that “ethical Congressman” is an oxymoron if not an entirely extinct species.

Georgia Representative Tom Price is a Congressman.  He also invests iskunksn medical technology and pharmaceutical companies to the tune of about $300,000.  He also introduces bills and writes letters to regulators to help the companies whose stock he owns — boosting the value of  his own investment.   In turn, the companies donate to his re-election campaigns. (The Wall Street Journal first broke this story in December; CNN added new information today.)

Basically Tom Price is a poster child for “conflict-of-interest.”  Government is supposed to be “for the people”, not for your own wallet.

Price is also Trumps nominee for Health and Human Services Secretary and Trump’s designated leader on ACA reform.

If he’s leading the charge, just who is the real beneficiary of ACA reform going to be? 

In fairness, Price says that if he gets this new job, he will get rid of all of his stocks within 90 days.  However, he’s been in Congress for 11 years, with a consistent pattern of behavior.  That’s going to change overnight?? Plus ACA repeal reportedly will occur before he has liquidated his stocks, if it happens as promised.

Of course, the voters of Georgia share the blame for this mess. You elected someone five times who has consistently violated ethics rules.  How exactly does that work?   

Price’s original proposals for ACA repeal included the following five elements (quoted from NPR article cited below):

  1. Price’s plan offers fixed tax credits so people can buy their own insurance on the private market. The credit starts at $1,200 a year and rises with age, but isn’t adjusted for income. Everyone receives the same credit whether they are rich or poor. People on Medicaid, Medicare, the military health plan known as Tricare, or the Veterans Affairs’ health plan could opt instead for the tax credit to buy private insurance.
  2. Price advocates for expansion of health savings accounts, which allow people to save money before taxes to pay for health care. This includes allowing people who are covered by government health programs including Medicare and the VA to contribute to health savings accounts to pay for premiums and copayments. These proposals are included in Ryan’s plan.
  3. People with existing medical conditions couldn’t be denied coverage under Price’s plan as long as they had continuous insurance for 18 months prior to selecting a new policy. If they didn’t, then they could be denied coverage for that condition for up to 18 months after buying a new plan.
  4. The Price proposal limits the amount of money companies can deduct from their taxes for employee health insurance expenses. Companies can deduct up to $20,000 for a family health insurance plan and $8,000 for an individual. The goal is to discourage companies from offering overly generous insurance benefits to their workers. Ryan’s plan proposes a cap on the employer tax deduction but doesn’t specify the level of the cap.
  5. States would get federal money to create so-called high-risk pools under Price’s plan. These are government-run health plans for people with existing medical conditions who can’t get affordable health insurance on the private market. Critics say high-risk pools have been tried in as many as 34 states and largely failed because they were routinely underfunded.

Given that a Silver level ACA plan in NJ can cost upwards of $900 per month, a $1,200 annual credit doesn’t amount to much. And why should the credit be the same for a millionaire as for someone making minimum wage?  The pre-existing condition rule means that some people with long term health issues will be excluded from coverage. 

Finally, do Price’s ethics issues have anything to do with GOP efforts earlier this month to reduce or eliminate the independent Congressional Ethics Office? 

The Affordable Care Act (aka Obamacare) repeal is turning into a circus.  I’m sure there are more acts to follow.


Sources:

  • http://www.cnn.com/2017/01/16/politics/tom-price-bill-aiding-company/index.html
  • http://www.npr.org/sections/health-shots/2016/11/29/503720671/5-things-to-know-about-rep-tom-prices-health-care-ideas
  • http://ktla.com/2017/01/16/trumps-hhs-nominee-introduced-legislation-to-help-company-soon-after-investing-in-it-house-records/
  • http://www.msnbc.com/rachel-maddow/watch/ethics-questions-loom-over-trump-hhs-pick-rep-tom-price-839983683992
  • http://www.wsj.com/articles/donald-trumps-pick-for-health-secretary-traded-medical-stocks-while-in-house-1482451061

New Reasons Why You Need a Second Opinion

Ownership interest in dealers of medical devices can encourage doctors to recommend surgeries that are not medically necessary.

Most consumers view their doctor as a professional who will treat their illness in an objective and unbiased manner.  Unfortunately, some doctors have conflicts of interest of which their patients may be unaware.

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The Wall Street Journal reports a new study that shows that  some doctors invest in dealers or distributors of medical devices used in surgery.  The doctor profits on sales of surgical products.  The profit motive may cause the doctor to refer patients for surgery more often than is medically necessary.(1)

The idea of medical conflict of interest isn’t new, but has traditionally focused on the relationship between doctors and drug companies.  The American Medical Association set for guidelines for doctors to follow regarding conflicts in 2009.(2)  However, there is no measure of how well doctors are following those rules.

A “conflict of interest” is a situation in which  someone who has to make a decision in an official capacity stands to profit personally from the decision”.(3)  Regardless of legality, anyone who makes a  decision when there is a conflict of interest is acting in an unethical fashion.  Judges are expected to recuse themselves (reassign a case to a different judge) when a conflict arises.  Ethically, that’s what every public official or business executive should do.  In practice, most don’t.

At the very least, officials should disclose possible conflicts and let the consumer or patient decide how to deal with them.  Licensed financial advisors are required to do this.  Others should be, but are not.

You don’t want your health to be compromised by a conflict of interest.  Even a successful surgery can have a lasting impact on your quality of life.  That means getting a second opinion on a diagnosis and recommended course of treatment, preferably from someone in an entirely separate medical practice.  If the doctors disagree, you may need a third opinion.

If your doc has a conflict of interest and doesn’t  disclose it to you, you need a new doc.  Integrity matters.


Sources:

(1)  Armour, Stephanie.  “Doctor-Device Deals Need Scrutiny, Report Says,”  The Wall Street Journal.  May 10, 2016.  P. A3.  (Yes, some of us still use printed versions of newspapers.)

(2) Institute on Medicine as a Profession.  “Conflict of Interest Overview”. http://imapny.org/conflicts-of-interest/conflicts-of-interest-overview/

American Medical Association, “American Medical Association Conflict of Interest Principles – Councils, Committees, and Task Forces.”  http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/conflict-interest-principles.page?

(3) http://www.dictionary.com/browse/conflict-of-interest