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On the Third Hand: Acupuncture

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To me, the idea that the essential health benefits (EHB) package could actually require health plans to cover acupuncture, chiropractic care and even adult hearing aids seems pretty shocking.

Robert Cosway talks about variations in the various plans states are supposed to use as EHB benchmarks in a paper on the Patient Protection and Affordable Care Act (PPACA) EHB program.

Starting in 2014, all major medical medical plans sold through the PPACA exchange system are supposed to cover a state’s EHB package, and carriers are supposed to determine whether a plan they offer is at the platinum, gold, silver or bronze “metal level” by calculating how much of the actuarial value of the EHB package the plan covers.

The benchmark candidate plan benefits packages don’t really differ all that much within states or from state to state, but they do differ significantly in terms of six types of benefits, Cosway said.

To me, questions about what kinds of services plans should cover for children with autism and how much physical and occupational therapy the EHB package should include seem reasonable. I don’t know what the right answer is, but those types of benefits are widely accepted treatments for people who obviously have serious problems.

Coverage for hearing aids for adults who aren’t poor seems much more questionable. Why should moderate-income workers pay for high-income workers’ hearing aid benefits? I think the idea that the EHB package could include this benefit is absurd But at least a hearing aid is a well-understood, well-tested kind of machine that helps people with ear problems cope with ear problems. I can understand why we’re talking about that.

Debating whether to cover artificial reproduction therapies, such as in vitro fertilization, seems way, way more out there. But, on the other hand, that kind of therapy is a way that some people can cope with a serious physical difference. I think imposing an in vitro fertilization benefits mandate in the EHB package would be absurd, but I can grasp why others might think differently. Maybe the cost will come down, and the number of super-twins born will go down.

But the idea that we’re even thinking about requiring the EHB package — the basis for health benefits that the government would be subsidizing for many — cover acupuncture and chiropractic care seems pretty absurd. That kind of debate seems to be driven more by alternative care practitioners’ lobbyists than any kind of serious interest in providing a decent level of health care for all.

The experimental evidence that those types of care work seems weak, and who has ever died or lost a limb due to lack of acupuncture or chiropractic care?

Some of my most intelligent, most passionate readers really oppose any significant government intervention in the ordinary acute health care insurance market.

They might accept the idea that the government could manage vaccination programs, disaster area health programs and military health programs, and possibly oversee some kinds of programs for controlling air pollution, water pollution and other activities that cause the kinds of harm to others that can only be controlled peacefully by a government.

Maybe they’d support the idea of the government for paying for care people who came into a hospital unconscious, up to the point when it was clear whether those patients had made adequate efforts to insure their health or make other preparations for paying their bills.

Maybe they’d even support the existence of small government charity care programs to pay for the care for people who are very truly destitute through no fault of their own, such as the victims of crime, natural disasters or acts of war or, maybe, even a combination of catastrophic unluckiness and an exhaustion of what would have looked to a reasonable person as if it were a reasonable amount of health insurance, disability insurance and long-term care insurance (LTCI).

But I think those great readers would also warn that every effort to have the government take charge of any health-related activity, even vaccination programs, can lead to all kinds of red tape, inefficiency and unfairness.

A government vaccination program might take money from Jane Doe, a low-paid worker who would like to have children but cannot, to pay for vaccinations for the much-coddled children of her boss, John Smith, who earns a hundred times what Jane Doe earns.

In the worst case scenario, government health programs might actually increase costs so much money from low-paid workers, and transfer so much of their money to others, that they end up having a much harder time paying for the health care they need than if no such programs existed.

On the one hand, I think one moral here is that, if you’re going to try to cheat the Second Law of Thermodynamics and have any government health care finance programs at all, they should be as small and cheap as humanly possible.

On the other hand, maybe, in this real, complicated world that we live in, the Patient Protection and Affordable Care Act (PPACA) should keep all sick people off the nation’s sidewalks, no matter how irresponsible those sick people have been when offered health insurance.

But, on the third hand, I think that government-funded and government-subsidized programs should not be requiring plans to include alternative care benefits in the basic package of benefits. Jane Doe should not have to scrimp for her well-paid boss’s crystals, dream catchers, chiropractic manipulation treatments or acupuncture.

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