H. R. 3962 Not Perfect, but Is a Beginning

To The Editor:
As the Baby-Boom (of which I am a member) ages, health care will be a gold rush growth industry and that industry needs a few new rules.
Health care insurers are businesses. Their function is to improve their bottom line. I have no problem with that, however, this points to the need for sunshine, limits on exclusions and clear terms of coverage. The marketplace will take care of itself but the services that marketplace renders must be subject to rules of conduct. To put it another way, the reason the marketplace (or any society) can function at all is because it is subject to the rule of law.
This accountability applies to health care providers, pharmaceutical companies and manufacturers as well as consumers. There is an argument to be made that many of our health care problems are brought on by our own bad behavior.
H.R. 3962 may not be perfect and represents a compromise between the various ideological and business interests involved, but it is a beginning.
Historically through the 60’s, 70’s and 80’s the tobacco lobby kept coming up with studies that threw a shadow of doubt about the health effects of smoking. Back in the late 20’s the pharmaceutical companies kicked and screamed about removing morphine from cherry cough medicine despite the fact that a good many people were addicted. That is the seminal event that created the Food and Drug Administration.
There will always be naysayers, who would prefer business as usual, but history and the health and well being of all of us usually win out. So, what’s the problem with the Health Care Reform Bill? I spent a few days browsing through the bill known as HR 3962 and here are a few excerpts. There are parts of the bill that deal with how insurance companies work
Like, Sec. 104, Sunshine on price gouging by health insurance issuer. This simply asks insurers to justify price increases based on actual market conditions, not just their bottom lines.
Sec. 262. Restoring application of antitrust laws to health sector insurers, which would outlaw price fixing between companies for services and assure true competition, which is a free market cornerstone.
Sec. 232. Requiring fair grievance and appeals mechanism. Anyone who has ever been denied treatment or coverage will welcome this standardization of the process.
And my favorite, Sec. 107. Prohibiting acts of domestic violence from being treated as preexisting conditions. That payment has been refused under domestic violence situations strikes me as a new low even for insurance companies.
The plan also calls for the creation of health insurance cooperatives (Sec. 310) so that people can form groups and buy insurance at the better rates enjoyed by large employers.
Sec. 2534. Calls for the creation of community-based collaborative care networks and there is a call for helping with Long-Term Care and Family Caregiver Support. (Sec. 2589).
There is also accountability for doctors and hospitals covering everything from their relationships with drug companies (Sec. 1128H), instances of infections contracted while in hospitals (Sec. 1138A), along with a mechanism to protect against fraud, waste and abuse (Sec. 1651).
JAMES DIMARTINO
Cape May