The Conservative Health-Insurance Fantasyland

In today's installment of Questions Reporters Should Ask Republicans, we begin with Sen. Ron Johnson's inane op-ed in The Wall Street Journal, in which he argues that because his daughter got life-saving heart surgery 27 years ago, we should repeal the Affordable Care Act. As Ezra Klein points out, not only does Johnson never say what in the Affordable Care Act would actually prevent a little girl from getting such a surgery, the reason his daughter got it was that...she had health insurance! And making sure everyone has health insurance was kind of the point of the ACA.

The essence of Johnson's argument, evidence-free as it is, is this:

I don't even want to think what might have happened if she had been born at a time and place where government defined the limits for most insurance policies and set precedents on what would be covered. Would the life-saving procedures that saved her have been deemed cost-effective by policy makers deciding where to spend increasingly scarce tax dollars?

You'll be hearing a lot of this argument about rationing in the coming months. It goes like this: ObamaCare will ration health care, with a bunch of pointy-headed bureaucrats deciding whether your loved ones will get the procedures they need or be left to die in a ditch. In other words: Death Panels!

Let's dispense quickly with this: the ACA contains no provision under which the government tells a private health plan that they can't cover a particular procedure, medicine, or anything else. What it does do is invest some money in comparative effectiveness research, so that Medicare and Medicaid can be better informed about which treatments and medicines actually work, to help guide future decisions about what to pay for.

Here's the key point: Medicare and Medicaid, and every private insurance company, already make these decisions every day. This is where we get to the fantasyland. Republicans like Johnson seem to want people to believe that in our current blessed system, insurance companies will pay for any procedure, any medicine, any medical anything, without any limit. Only in the bleak future under ObamaCare will some awful bureaucrat say to a patient, "We won't pay for that procedure."

But of course, that is a complete and utter lie. Insurance company bureaucrats already decide that there are some things they'll pay for, and some things they won't. They do it every day. There are lots and lots of treatments and procedures and medicines insurance companies refuse to pay for. Is that rationing? You bet it is.

So, these are the questions reporters should ask people like Johnson when they raise the specter of rationing: Are you aware that insurance companies don't actually pay for every possible treatment anyone could get? Do you think we should pass a law mandating that insurance companies pay for every procedure any patient wants? If not, how do you think insurance company bureaucrats should make those decisions? Since you're opposed to comparative effectiveness research, which compares the effectiveness of various treatments, but you acknowledge that neither Medicare nor private insurance companies are going to pay for absolutely everything, how do think the public and private bureaucrats should make their decisions?

What reporters shouldn't do is allow Republicans to pretend that we're actually living in this no-rationing fantasyland.