The TRUTH ABOUT HEALTH CARE REFORM

THE TRUTH ABOUT HEALTH CARE REFORM

Excerpts from articles by: Patricia Barry in the AARP Bulletin August 14, 2009, articles in McClatchy Washington Bureau, and articles on huffingtonpost.com

FIRST LETS LOOK AT A WONDERFUL SUCCESS OF HEALTHCARE REFORM IN MASSACHUSETTS:

Republicans are convinced healthcare reform in Massachusetts has failed. They're wrong

By Andrew Leonard

iStockphoto/imagetwo/Salon

In April 2010, Texas Gov. Rick Perry declared in a column for the American Statesman that "the number of uninsured people in Massachusetts is about the same as it was when the mandates were passed in 2006."

The governor was wrong. And not by a little. Lies and misinformation are commonplace in the fight to reform healthcare, but Perry's claim was an out-and-out howler. As Boston Globe reporter Brian Mooney informs us in his magisterial "'RomneyCare'"-- a revolution that basically worked," around 530,000 people were uninsured in Massachusetts before healthcare reform. Since 2006, "that number has dropped dramatically, by more than 400,000." Massachusetts now boasts the lowest uninsurance rate in the nation -- 1.9 percent.

In Texas, by contrast, around 20 percent of the population is uninsured -- the highest rate in the nation.

Brian Mooney's wrap-up comes fast on the heels of a new paper, "The Impacts of the Affordable Care Act: How Reasonable Are the Projections?" from MIT healthcare economist Jonathan Gruber, who played an instrumental role in designing both Massachusetts' healthcare reform legislation and the Affordable Care Act -- which makes him practically the living embodiment of "ObamneyCare" -- the derogatory term coined by Republican presidential candidate Tim Pawlenty. Taken together, the two analyses offer a clear look at the available facts about healthcare reform in Massachusetts that might help us answer the all-important question: What will happen to ObamaCare?

First, the executive summary from Mooney, which is worth repeating in full, and is largely backed up by Gruber's data:

• Many more businesses are offering insurance to employees than were before the law. The fear going in was that the opposite would happen.
• The cost of the changes, while large, has proved manageable thus far, though there are some serious warning signs on the horizon, especially as federal stimulus funds, which have helped defray the cost, run out.
• The plan remains exceptionally popular among state residents -- indeed its popularity has only grown with time. There are some unhappy sectors -- notably small business owners, who had hoped to see moderating premiums and chafe, in some cases, at the heavy-handed enforcement of the rules by the state. And support for the requirement that individuals obtain insurance is down to a slender majority, a recent poll shows. But there is no significant constituency here for repeal.
• And while health care costs continue to grow at alarming rates, as they have nationally, the consensus of industry leaders and health care economists is that this trend cannot be fairly traced to the makeover but rather to cost pressures baked into the existing health care payment system. Massachusetts does have the highest health care costs in the nation, but it owned this dubious distinction long before "RomneyCare" was born.

So to sum up: Healthcare reform in Massachusetts is popular, covers just about everyone, and hasn't (yet) broken the state bank. However, premiums paid by employers have yet to fall, and the long-term challenge of rising healthcare costs poses a major threat to financing the system in the future.

It's probably worth noting that the Massachusetts healthcare reform effort was not designed with cost-control measures included -- the primary goal was to get people covered and then figure out the hard part later. The Affordable Care Act, however, includes dozens of pilot projects and experiments in cost containment -- including the controversial Independent Payment Advisory Board, which is specifically empowered to lower Medicare costs. To make real progress on "bending the curve" of rising healthcare costs, the administrators of healthcare reform at the national level will need to pay attention to what works and what doesn't and expand the programs that have potential -- something that will obviously be problematic if the White House and Congress become dominated by a political party devoted to repealing the Affordable Care Act.

Gruber argues that what we know about how healthcare reform in Massachusetts has worked should give us confidence in the projections that the Congressional Budget Office has made with respect to the Affordable Care Act -- in particular, the prediction that the ACA will ultimately bring down the deficit. But there's a big caveat. "That said," writes Gruber, "the fiscal responsibility promised by this legislation does depend on the ability of future Congresses to hold to the reimbursement reductions and tax increases laid out in the ACA."

And that's where we see the biggest difference between the healthcare reform record of Massachusetts and the prospects for the Affordable Care Act. The Boston Globe's Mooney reports that Mitt Romney was far from fully satisfied with his healthcare reform triumph -- for example, he didn't think that the government should decide what benefits were included in plans, or that employers should be required to have at least 25 percent of their workers covered by an employer plan. But he supported the ultimate goal: near-universal healthcare coverage, which means that both major political parties shared a progressive consensus.

That consensus doesn't exist in Washington. Mooney relates another incident that illustrates how hard it is to cut through the willful ignorance rampant in Washington.

And then there was Governor Patrick's experience in Washington, when he went to testify earlier this year about how the Massachusetts plan has worked. Before he could open his mouth, he received this blunt greeting.

"Looking forward to what you have to say about a failed program in your state, MassachusettsCare," said Representative Marsha Blackburn, Republican of Tennessee.

Blackburn didn't back up her slam at the time, and her office promised specifics to the Globe, but never delivered.

The evidence suggests that, while not perfect, MassachusettsCare is certainly not a failure. That alone should provide some grounds for optimism that the Affordable Care Act could ultimately be a success. But there are some awfully big ifs between here and there. Court challenges, the prospect of a Republican takeover of both Congress and the White House, the difficulty in making sure that Congress will permit tough decisions on cost containment sure to rile doctors and, biggest of all, a long-term strategy on the federal budget that includes enough revenues to support a decent social welfare safety net.

We're going to hear a lot more about ObamneyCare in the next year and a half, and that will undoubtedly include an avalanche of further misrepresentations about what has happened and is happening in Massachusetts. For now, just remember this: Almost everyone has healthcare coverage, and that's popular.

• Andrew Leonard is a staff writer at Salon. On Twitter, @koxinga21. More: Andrew Leonard

NOW LETS LOOK AT THE PATIENT PROTECTION AND AFFORDABLE CARE ACT:

"IMMEDIATE BENEFITS" OF The Patient Protection and Affordable Care Act

The bill includes numerous benefits that will "be available in the first year after enactment" of the bill. Indeed, WashingtonPost.com blogger Ezra Klein published the following list of benefits that the Senate bill will provide "before 2014":

1) Eliminating lifetime limits, and cap annual limits, on health-care benefits. In other words, if you get an aggressive cancer and your treatment costs an extraordinary amount, your insurer can't suddenly remind you that subparagraph 15 limited your yearly expenses to $30,000, and they're not responsible for anything above that.

2) No more rescissions. No more cancelling your policy when you get sick.

3) Some interim help for people who have preexisting conditions, though the bill does not instantly ban discrimination on preexisting conditions.  That comes in 2014.

4) Requires insurers to cover preventive care and immunizations.

5) Allows young adults to stay on their parent's insurance plan until age 26.

6) Develops uniform coverage documents so people can compare different insurance policies in an apples-to-apples fashion.

7) Forces insurers to spend 80 percent of all premium dollars on medical care (75 percent in the individual market), thus capping the money that can go toward administration, profits, etc.

8) Creates an appeals process and consumer advocate for insurance customers.

9) Develops a temporary re-insurance program to help early retirees (folks over 55) afford coverage.

10) Creates an internet portal to help people shop for and compare coverage.

11) Miscellaneous administrative simplification stuff.

12) Bans discrimination based on salary (i.e., where a company that's not self-insured makes only some full-time workers eligible for coverage.

The health care plan provides numerous benefits effective immediately or within the first year, including protections for Americans with pre-existing conditions, tax breaks for small businesses, and aid to seniors participating in Medicare Part D. From the House Committee on Education and Labor:

Access to Affordable Coverage for the Uninsured with Pre-existing Conditions

Will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective 90 days after enactment, and coverage under this program will continue until new Exchanges are operational in 2014.

Access to Quality Care for Vulnerable Populations

Makes an immediate and substantial investment in Community Health Centers to provide the funding needed to expand access to health care in communities where it is needed most. This $11 billion investment begins in 2010 and extends for five years.

No Pre-existing Coverage Exclusions for Children

Eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the plan prohibits health insurers from excluding coverage of pre-existing conditions for children, effective six months after enactment and applying to all new plans.

Re-insurance for Retiree Health Benefit Plans

Will create immediate access to re-insurance for employer health plans providing coverage for early retirees, effective 90 days after enactment. This re-insurance will help protect coverage while reducing premiums for employers and retirees.

Closing the Coverage Gap in the Medicare (Part D) Drug Benefit

Begins to fill the "donut hole" by giving seniors a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.

Small Business Tax Credits

Will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.

Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage; later, when Exchanges are operational, tax credits will be up to 50 percent of premiums. The full credit will be available to firms with 10 or fewer employees with average annual wages of $25,000, while firms with up to 25 or fewer employees and average annual wages of up to $50,000 will also be eligible for the credit.

Patient Protections

Protects patients' choice of doctors by allowing plan members to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care. This provision takes effect six months after enactment and applies to all new plans.

Extension of Dependent Coverage for Young Adults

Will require insurers to permit children to stay on family policies until age 26. This provision takes effect six months after enactment and applies to all plans for young adults who are not offered qualified coverage elsewhere.

Free Prevention Benefits

Will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. This provision takes effect six months after enactment and applies to all new plans and all plans in 2018.

Beginning on January 1, 2011, Medicare beneficiaries will receive a free, annual wellness visit and will have all cost-sharing waived for prevention services.

No Lifetime Limits on Coverage

Will prohibit insurers from imposing lifetime limits on benefits. This provision takes effect six months after enactment and applies to all plans.

Restricted Annual Limits on Coverage

Will tightly restrict insurance companies' use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned for all plans in 2014.

Protection from Rescissions of Existing Coverage

Will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact. This provision takes effect six months after enactment and applies to all plans.

Prohibits Discrimination Based on Salary

Will prohibit group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. This provision takes effect six months after enactment and applies to all group health plans in 2014.

But this past summer something new has entered the political arena?a tsunami of rumors, myths, fear-mongering and misinformation about the proposals that surges around the Internet in nanoseconds. ?I?m totally confused about what?s going on,? one reader wrote to the AARP Bulletin. ?How do I know who to believe??

Misinformation Spreads at Rapid Speed

It?s a good question. Another is how this new phenomenon?the ability to spread misleading information at rapid speed through chain e-mails, blogs, text-messaging and ?tweets??will affect the reform debate.

?What we?re seeing is a flood of viral content that distorts the Obama effort to reform health care,? says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania, who codirects www.FactCheck.org, a website that examines questionable claims from all sides of the political spectrum.

Today?s opposition tools are very different from those used against previous attempts at health care reform in the Clinton era. Then, the key means of attack available were television advertising and direct-mail campaigns, which were expensive and took time to organize.

?Extremists and people who are so locked into their own ideology that they?ll distort anything. ? Jamieson says. ?But they haven?t had a way to reach out to as many people as efficiently as they have now.?

To the credit of opponents of health-care reform, the lies and exaggerations they're spreading are not made up out of whole cloth?which makes the misinformation that much more credible. Instead, because opponents demand that everyone within earshot (or e-mail range) look, say, "at page 425 of the House bill!," the lies take on a patina of credibility. Take the claim in one chain e-mail that the government will have electronic access to everyone's bank account, implying that the Feds will rob you blind. The 1,017-page bill passed by the House Ways and Means Committee does call for electronic fund transfers?but from insurers to doctors and other providers. There is zero provision to include patients in any such system. Other myths that won't die:

Understanding Healthcare

Health care reform has ?serious consequences to people?s lives, and it would be useful if as many people as possible actually understood what the proposals are about,? Jamieson says. But the rise of the Internet and the decline of the mainstream press as a prime source of information, she adds, puts that prospect at risk.

To add to the confusion, Obama, while talking up his overall goals for reform, left it to Congress to work out the details. The result: a number of committees, each developing and announcing scores of proposals, which change as negotiations progress. ?This process has not been a success in garnering public support for reform, and has left people nervous,? says Robert Blendon, professor of health policy and political analysis at Harvard University?s School of Public Health. ?So the headlines every day, because the bills are different, scare different people.?

Recent angry exchanges and violent interruptions at lawmakers? town hall meetings during the August recess suggest that it might. Members of Congress faced a barrage of questions based on the same Internet-spread myths.

Blendon, though, thinks most voters, especially the independents, ultimately won?t be swayed by the myths. ?The real debate for them is: What happens to me and my family out of this thing?? he says.

Meanwhile, here are some of the persistent myths about health care reform, how they arose:

Q. Will the government take over health care so we end up with socialized medicine?

No. Neither the president nor the congressional committees have suggested anything remotely resembling a government takeover of health care.

Obama has specifically rejected the idea of a ?single payer? system, like Canada?s, in which the government insures all citizens. None of the leading proposals in Congress even considers going down this road?a fact that has brought strong protests from some consumer and doctor groups that favor this approach. And although Sen. Edward Kennedy, D-Mass., has long called for a ?Medicare for All? program, this is not included in proposals from the Senate health committee that he chairs.

Even further off the table is the concept of ?socialized medicine??in which the government not only runs health care but also owns hospitals and pays doctors? salaries. Great Britain has this kind of setup, as do the Veterans Affairs and Department of Defense health programs in the United States.

Where did this myth come from? Opponents of reform constantly use the term ?government-run health care? to disparage the reform proposals, despite the popularity and success of existing government-run programs like Medicare. The tactic often works. Even some Medicare beneficiaries say they?re worried about a ?government takeover? of Medicare.

What do the proposals say? Obama proposed setting up a single ?public plan??available only to those without employer insurance?to provide a voluntary alternative to the many private plans that offer individual health insurance.

LIE: ILLEGAL IMMIGRANTS WILL GET FREE HEALTH INSURANCE

The law says that "individuals who are not lawfully present in the United States" will not be allowed to receive subsidies.

The claim that taxpayers will wind up subsidizing health insurance for illegal immigrants has its origins in the defeat of an amendment, offered in July by republican rep. Dean Heller of Nevada, to require those enrolling in a public plan or seeking subsidies to purchase private insurance to have their citizenship verified. Flecksoflife.com claimed on july 19 that "hc [health care] will be provided 2 all non us citizens, illegal or otherwise." Rep. Steve king of Iowa spread the claim in a usa today op-ed on aug. 20, calling the explicit prohibition on such coverage "functionally meaningless" absent mandatory citizenship checks, and it's now gone viral. Can we say that none of the estimated 11.9 million illegal immigrants will ever wangle insurance subsidies through identity fraud, pretending to be a citizen? You can't prove a negative, but experts say that medicare?the closest thing to the proposals in the house bill?has no such problem.

LIE:  You'll have no choice in what health benefits you receive.

TRUTH:  The myth that a "health choices commissioner" will decide what benefits you get seems to have originated in a july 19 post at blog.flecksoflife.com, whose homepage features an image of Obama looking like heath ledger's joker. In fact, the house bill sets up a health-care exchange?essentially a list of private insurers and one government plan?where people who do not have health insurance through their employer or some other source (including small businesses) can shop for a plan, much as seniors shop for a drug plan under medicare part d. The government will indeed require that participating plans not refuse people with preexisting conditions and offer at least minimum coverage, just as it does now with employer-provided insurance plans and part d. The requirements will be floors, not ceilings, however, in that the feds will have no say in how generous private insurance can be.

LIE: PRIVATE INSURANCE WILL BE OUTLAWED OR WITHER ON THE VINE

TRUTH. Obama and the congressional committees say their objective is to build on the current system?keeping employer-sponsored group insurance and giving more consumer protections to people who are employed by small businesses or buy insurance as individuals.

Supporters of a public plan option argue that it would act as a safety net for the uninsured, provide competition for private insurers and, in Obama?s words, ?keep them honest.? Opponents of the public option, including the health insurance industry, contend that it would ultimately destroy private insurance because the government could offer lower payment rates to doctors and hospitals, as Medicare now does.

Where did this myth come from? Currently 177 million people have employer or individual insurance. The issue caught fire after the Lewin Group, a research consulting firm owned by UnitedHealth Group, estimated that 119 million of them would switch to a public plan, if everybody were allowed to join it. But the proposals actually exclude those with employer insurance from the public plan. On that basis, the group estimates that 34.9 million would exit private insurance?but it was the high 119 million figure that ricocheted around the Internet.

Another public policy group, the Urban Institute, calculated that after reform, 161 million (or 91 percent) would still enroll in private plans. A third group, the Economic Policy Institute, examined how employers would react to a ?pay or play? mandate, which would require them to either provide coverage or contribute up to 8 percent of payroll to cover the uninsured. Fears of a mass exodus from employer insurance ?are overblown,? the study found. ?Millions of workers will keep the employer-sponsored insurance they have today.?

What do the proposals say? Each of the proposals calls for national or regional heath insurance exchanges that would allow people without employer or public insurance and small employers to choose from a menu of private insurance plans (and a public option, if there is one), with online information to help compare them.

Subsidies would be available for people unable to afford the premiums, on a sliding scale according to income. And under the House bill, people with employer insurance would be eligible for government help if their premiums exceeded 11 percent of their income. Small businesses would also get subsidies.

People with existing insurance would be able to keep it after reform begins. But after that date, new individual policies could no longer be sold unless they met required standards of benefits. After five years, all plans?including group employer insurance?would have to meet those standards.

LIE: Government will encourage euthanasia to save costs.

TRUTH: This false but scary idea?now surging around the Internet in blogs and e-mails?claims that the House bill would require Medicare beneficiaries to have mandatory classes every five years to decide how to end their lives earlier. Typical e-mails add: ?They?re going to push suicide to cut Medicare spending!? All identify page 425 of the bill as their source.

Where did this myth come from? On July 16, Betsy McCaughey, a former Republican lieutenant governor of New York, appeared on a conservative radio show. Citing page 425, she said: ?Congress would make it mandatory ? that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner ? all to do what?s in society?s best interest.?

On July 23, Rep. John Boehner of Ohio, leader of the House Republicans, issued a statement saying: ?This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.? On Aug. 7, former Alaska governor Sarah Palin described the proposal as setting up a ?death panel.?

What does the proposal say? The clause on page 424 (section 1233) would require Medicare to pay doctors for their time if beneficiaries chose to consult them for information on advance care planning, such as making a living will, appointing a health proxy, and hospice care (already covered by Medicare). Medicare would pay for these sessions only once every five years.

AARP described McCaughey?s claims as ?rife with gross?and even cruel?distortions? of legislation that ?would not only help people make the best decisions for themselves [on end-of-life care], but also better ensure that their wishes are followed.?

Republican Sen. Johnny Isakson of Georgia, who has sponsored a bill that would also allow Medicare to cover end-of-life planning, characterized the death panel talk as ?nuts.?

LIE:  DEATH PANELS WILL DECIDE WHO LIVES.

TRUTH: On July 16 Betsy Mccaughey, a former lieutenant governor of New York and darling of the right, said on Fred Thompson's radio show that "on page 425," "congress would make it mandatory ? That every five years, people in medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition." Sarah Palin coined "death panels" in an Aug. 7 facebook post.

This lie springs from a provision in the house bill to have medicare cover optional counseling on end-of-life care for any senior who requests it. This means that any patient, terminally ill or not, can request a special consultation with his or her physician about ventilators, feeding tubes, and other measures. Thus the house bill expands medicare coverage, but without forcing anyone into end-of-life counseling.

The death-panels claim nevertheless got a new lease on life when Jim Towey, director of the White House office of faith-based initiatives under George W. Bush, claimed in an Aug. 18 Wall Street Journal op-ed that a 1997 workbook from the department of veterans affairs pushes vets to "hurry up and die." In fact, the thrust of the 51-page book, which the va pulled from circulation in 2007, is letting "loved ones" and "health care providers" "know your wishes." Readers are asked to decide what they believe, including that "life is sacred and has meaning, no matter what its quality," and that "my life should be prolonged as long as it can...using any means possible." But the workbook also asks if readers "believe there are some situations in which I would not want treatments to keep me alive." Opponents of health-care reform have selectively cited this passage as evidence the government wants to kill the old and the sick.

LIE: Medicare will be eliminated or gutted to pay for reform

TRUTH. It?s inconceivable that any lawmaker would commit political suicide by proposing to get rid of Medicare. But the rumor has fast gained ground.

Where did this myth come from? Dick Morris, a political commentator, posted an article on his blog that began: ?Obama?s health care proposal is, in effect, the repeal of the Medicare program as we know it.? Morris claimed that the proposals ?will totally gut Medicare and replace it with government-managed care and rationing.? His article was picked up within days on some 281,000 websites.

What do the proposals say? It?s true they all seek to save billions from Medicare costs?not by cutting benefits, but by setting up new ways to pay doctors more fairly and to reward providers for quality of care instead of (as now) paying them a fee for each separate service; reducing waste and fraud; and reducing preventable hospital readmissions.

All the proposals would cut the amount of subsidies now paid to Medicare Advantage private health plans, which cost an average of 14 percent more per person than traditional Medicare does. Without subsidies, the private plans could become more efficient, or they could raise premiums, reduce benefits or withdraw from Medicare.

The proposals also add benefits to Medicare??such as covering more preventive services and narrowing the Part D ?doughnut hole.?

LIE:  No Chemo For Older Medicare Patients.

TRUTH: The threat that medicare will give cancer patients over 70 only end-of-life counseling and not chemotherapy?as a nurse at a hospital told a roomful of chemo patients, including the uncle of a NEWSWEEK reporter?has zero basis in fact. It's just a vicious form of the rationing scare. The house bill does not use the word "ration." Nor does it call for cost-effectiveness research, much less implementation?the idea that "it isn't cost-effective to give a 90-year-old a hip replacement."

What we can say is that there is de facto rationing under the current system, by both medicare and private insurance. No plan covers everything, but coverage decisions "are now made in opaque ways by insurance companies," says dr. Donald Berwick of the institute for healthcare improvement.

A Related Myth is that health-care reform will be financed through $500 billion in medicare cuts. This refers to proposed decreases in medicare increases. That is, spending is on track to reach $803 billion in 2019 from today's $422 billion, and that would be dialed back. Even the $560 billion in reductions (which would be spread over 10 years and come from reducing payments to private medicare advantage plans, reducing annual increases in payments to hospitals and other providers, and improving care so seniors are not readmitted to a hospital) is misleading: the house bill also gives medicare $340 billion more over a decade. The money would pay docs more for office visits, eliminate copays and deductibles for preventive care, and help close the "doughnut hole" in the medicare drug benefit, explains medicare expert Tricia Neuman of the Kaiser Family Foundation.

LIE: The Government Will Ration Care

TRUTH: No. But the specter of ?rationing? is the battle cry of reform opponents. They say people in their 90s, 80s or even 70s will be deemed ?too old? for joint replacements and cancer care?and even, in one persistent rumor, that ?Obama​care? would deny treatment to people going blind in one eye as long as their other eye still works.

Where did this myth come from? It?s part of the ?government takeover? argument, playing on often inaccurate beliefs that countries with national health systems severely ration care. In a widely circulated memo, political consultant Frank Luntz offered Republicans language that he believed would most resonate with Americans to defeat the Democrats? push for reform. He suggested they say: ?In countries with government run healthcare, politicians make your healthcare decisions. They decide if you?ll get the procedure you need ? We can?t have that in America.?

What do the proposals say? In fact, they seek to prevent denial of care. Under every proposal, insurance companies would no longer be able to deny coverage on the basis of current health or preexisting medical conditions.

The proposals also would require plans to offer benefits packages with a comprehensive range of medical services equal to those in typical employer-sponsored plans. An independent advisory board, removed from political influence, would recommend new specific services to be covered based on scientific evidence. Annual or lifetime limits on coverage would be prohibited. None of the bills places any age limits on receiving medical care.

Where to go for the facts on health care reform proposals:

The following websites are run by nonpartisan organizations with no stake in the proposals:

• The Kaiser Family Foundation's side-by-side comparison of the details of the leading proposals
• The Annenberg Public Policy Center's fact checker
• Politifact.com's Truth-O-Meter

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LIE: The government will set doctors' wages.

TRUTH: This, too, seems to have originated on the Flecksoflife blog on July 19. But while page 127 of the House bill says that physicians who choose to accept patients in the public insurance plan would receive 5 percent more than Medicare pays for a given service, doctors can refuse to accept such patients, and, even if they participate in a public plan, they are not salaried employees of it any more than your doctor today is an employee of, say, Aetna. "Nobody is saying we want the doctors working for the government; that's completely false," says Amitabh Chandra, professor of public policy at Harvard's Kennedy School of Government.

To be sure, there are also honest and principled objections to health-care reform. Some oppose a requirement that everyone have health insurance as an erosion of individual liberty. That's a debatable position, but an honest one. And many are simply scared out of their wits about what health-care reform will mean for them. But when fear and loathing hijack the brain, anything becomes believable?even that health-care reform is unconstitutional. To disprove that, check the commerce clause: Article I, Section 8.

With Katie Connolly, Claudia Kalb, and Ian Yarett