List of essential services under U.S. health reforms is ‘skimpy’ and dangerous, say doctors

BMJ

A national doctors’ organization says that most of the authors of a federally sponsored report on recommended health insurance coverage have financial ties to insurers and drug companies and that the insurance scheme will leave many U.S. citizens without access to health care.

The Institute of Medicine, which was contracted by the federal government to write the report, brought in security guards at the institute’s annual meeting to prevent doctors from distributing leaflets outlining the financial conflicts of interest of the report’s authors. The doctors, former institute fellows and members of Physicians for a National Health Program, were registered at the meeting and tried to give the leaflets to colleagues attending it.

Danny McCormick, assistant professor at Harvard Medical School and a former fellow of the institute, distributed leaflets at the meeting. He has signed a protest letter sent to the U.S. secretary of health and human services, Kathleen Sebelius, along with more than 2,400 doctors, nurses, and health advocates, stating that the recommendations for “essential benefits” to be provided under the Affordable Care Act will provide “skimpy” care that would endanger the health of many citizens.

Although the report outlines 10 categories of benefits that insurers must cover, such as costs of hospitalization, preventive care, and ambulance transport, it does not prohibit insurers from shifting costs to patients through premiums, co-payments, deductibles, and cost sharing. In the event of a catastrophic illness or injury, patients could be hundreds of thousands of dollars in debt.

Dr. McCormick said that a serious pitfall of the recommended essential benefits is that they would give patients the illusion that they have “real insurance.” He said, “Most patients, no matter how well informed, have no idea what their insurance policy covers. It’s only when some catastrophic event occurs that they find out that they are not fully covered.”

Nor would the insurance scheme necessarily cut over-testing and over-treatment, which Dr. McCormick says should be cut. Although the report panel recommends establishing an independent “national health benefits council” to review scientific evidence regarding new technologies, the plan does not task the council with assessing current testing and treatment strategies that might be unnecessary or dangerous.

Howard Brody, a member of the Institute of Medicine and Physicians for a National Health Program, told the BMJ that the Affordable Care Act “is truly a game changer” that will extend coverage to more people. Nevertheless, he added, “It’s not enough.”

Dr. Brody called the act a “sop to the insurance industry” and a “political decision, not a scientific decision,” since a single-payer system is considered unacceptable in the United States. He said that the institute was assigned a narrow task of defining only “what absolutely must be covered.” Unfortunately, he said, nothing in the recommendations would prevent insurers from providing “shoddy” coverage.

Dr. Brody said that the institute’s actions to prevent doctors from leafleting about the panelists’ conflicts of interest were “indefensible.” He said, “The institute is supposed to be an educational organization, the elite of American medicine, yet they treat their own members as if they were children incapable of assessing the information for themselves.”

The institute said that it complied with its policy on conflicts of interest by promptly disclosing committee members with a conflict of interest but whose expertise was needed to fulfill the committee’s charge.