Consequences of Ten “Essential Benefits”

What's essential for one person may be tangential or inconsequential for others.

One Man's Interpretation of  "Essential Benefits" Clause in Health Reform Law

Let me explain in a roundabout fashion where I am coming from:  In other languages, one of them a dead language,  "One for all, all for one" sounds like this.

Unus pro omnibus, omnes pro uno.  Latin

Un pour tous, tous pro uno.   French

Uno para todos, todos para uno.  Spanish

Obamanese

In Obamanese,  It sounds more like this:

One set of essential benefits for all,  all essential benefits in one standard plan,  or no "substandard "health plan for you.

“One for all, all for one,” and its French equivalent,  was the rallying cry for the Three Musketeers.

Now experts  say U.S health plans, under the ObamaCare law,   must contain ten “essential benefits “to qualify for health exchanges, for health plan members to receive federal subsidies, and for employers to legally offer any health plan. 

It's one plan for all, in the form of  its bronze, silver, gold, or platinum equivalent, and all for one, or needless to add, none for all.

The Ten Essential Benefits

What are these ten essential benefits?

The Affordable Care Act, (sections1302) lists “essential benefits” as,

A Ambulatory patient services

· Emergency services

· Hospitalization

· Maternity and newborn care

· Mental health and substance use disorder services, including behavioral health treatment

· Prescription drugs

· Rehabilitative and habilitative services and devices

· Laboratory services

· Preventive and wellness services and chronic disease management

· Pediatric services, including oral and vision care.

     What Doesn't Matter

Whether you want to receive this “benefits, is not a matter of whether, you are:

·         young or healthy

·         of sound mind and

·         do not take prescription drugs

·          Have any need for laboratory have no need for maternity, newborn care, or pediatric services

·         you are single,  and do not have a child who needs dental care, or eye glasses

·         You do not want to seek preventative, substance abuse, behavioral health treatment, wellness, chronic disease management, or rehab or habiliative (whatever that is).

What Matters

 What matters is that we are all in this thing called life and health and citizenship together.  It’s all for one, one for all, that’s what counts.

But now, experts at the American Institute and the Manhattan Institute are telling us that as many as 80 million to 100 million Americans may lose their employer-provided health insurance by 2015 because existing plans do not contain these benefits.  No matter that routinely including these benefits drives up costs on average by 41% in the individual markets (Manhattan Institute).

Middle class Americans who do not qualify are aghast and angry that routine inclusion of ten essential benefits for services they do not seek or want, is causing them to lose plans they chose and drives up health premiums and deductible to unaffordable levels in a health law ironically title “The Patient Protection and Affordability Act.”

How Could This Be?
 

How could this be?    It’s really quite simple.  Their plans do not meet federal standards.   Ergo, their plans are “substandard.”

This state of affairs stems from the doctrine of “essentialism,” namely, that all health care services are essential to society and should be available to all regardless of individual abilities, skills, need, education, or economic status. Essentialism ignores merit, risk, and economic growth. These factors apparently deserve no special rewards. Presumably, when government homogenizes humankind into one lump, all will be well, and the nation's level of health will be elevated.

Every American, in more prosaic language, should have equal access to comprehensive care, regardless of age, health, pre-existing illness, geographic location, insurance coverage, or citizenship status.

• If you are young and healthy, you should pay the same as the old and sick, even if you cost society nothing in the short run. In the long run, you will become old and sick.
• If you are poor, the government should subsidize you to raise you to the level of more affluent citizens.
• If you are in a small business, you must pay for comprehensive coverage of your young healthy employees as you would for a more mature and older work force.

Charity for all and all eggs in one basket is the goals of progressive, as long at government is directing the effort and the "rich" are paying their "fair shar

No doubt this is a  noble goals The problem is, of course, that even an affluent society like America cannot afford “Gold,” “Platinum,” and “Cadillac” plans for all and still provide services that allow for personal freedom and choice that fits the needs of individual segments of the population.

In America, the land of capitalism, individualism, meritocracy, entrepreneurialism diversity, and regional variation, one-size-fits-all does not fit all and  will  raises the cost for many.

Tweet: Health reform doctrines such “comprehensive essential benefits,” have enormous cost and cultural consequences.