Health Choices Commissioner: A Case Study In Ambiguity…and Michael Chiklis

After meandering through a tedious few sections on other consumer protections that are definitely important (non-discrimination rules, parity in mental health, and other vaguely defined things that sound really good on paper but are going to be pretty painful in person – that means you, “Ensuring Adequacy of Provider Networks”) but definitely not that interesting, one laboriously comes upon something called “Subtitle E – Governance”. Somewhere around here, this bill takes a fascinating turn into the definition of a new government position. Wait, sorry, it’s still really boring. But it does provide a lot of fodder for the “Big Brother Is Taking Over Our Lives!!!” freak-out camp that is wholly against this health care bill. It does so by defining a new commissioner intended to oversee the American health care system. Oh, that sounds so scary! Is the commissioner a good guy or a bad guy. Superhero or villain. Batman or The Joker. Anyone else or Rush Limbaugh. Yankees fan or a Red Sox fan (well, in that case, the Commissioner is a douche no matter what). But then even a superhero in charge can have its perils (look no further than to The Terminator’s fiscal policy). So what am I actually referring to? Something called the Health Choices Commissioner.

OK, take a deep breath.

Done? Good, because before you get your panties up in a bunch (Glenn Beck, I’m looking at you) about the “Health Choices” part of that title, let’s actually look at what this person will be doing before wondering when the Commissioner to decide whether you can get that hemorrhoid clipped. In Sec. 142 the duties and authority of the Commissioner are outlined:

(1) Qualified Plan Standards - establishing qualified health benefits plan standards. This includes leading something called a Health Insurance Exchange, which I am pretty sure has nothing to do with anything interesting, but it sounds a lot like the stock market exchanges we, as strident capitalists, strive for, so it can’t be that bad. Right? Individual affordability credits are also mentioned and sound ominous, but seeing as both of these topics appear later in this bill they’re probably worth tackling at a future time.

(2) Promoting Accountability – This includes complying with audits, ensuring that only qualified health benefits plans are available, and making sure the insurance companies pay for the studies done to determine whether they are kosher or not. While there is probably plenty of legal gobbeldy-gook to prevent the following scenario, it warrants mentioning because it seems so easy given the corruptible nature of our political-lobbyist-insurance company complex:

INSURANCE COMPANY PRICK: How much will it cost us to have you guys audit our insurance performance? And by audit I mean turn the other way while we do business as usual and deny little Billy that new kidney.
COMMISSIONER: Umm…well…my wife’s breasts are sagging, so a couple of implants…oh and I need a pre-auth to cover Viagra for…umm…my friend. You scratch my back and I’ll scratch yours.
INSURANCE COMPANY PRICK: Sorry, your wife’s saggy breasts are a pre-existing condition, you should have known they were going to be scraping the floor when you were younger and they were already swinging at the knees. We won’t cover that.
COMMISSIONER: Wait but you aren’t allowed to invoke pre-existing conditions anymore. That’s why I am auditing you.
INSURANCE COMPANY PRICK: Damn, you’re right. OK deal. So the audit is done, right?
COMMISSIONER: Yep, you passed!
INSURANCE COMPANY PRICK: Great! Thanks! By the way, your wife’s sagging breasts are considered elective surgery and we cannot cover their repair, have a nice day! [click]
COMMISSIONER: Damn.

Other Commissioner roles include data collection for the promotion of “quality and value, protecting consumers, and addressing disparities in health and health care”. Again, this all sounds reasonable and nice, but I suspect the details will get far more hairy. For example, some would likely key on the “addressing disparities” phrase and immediately sound alarm that about what that means. The government, at the hand of the Health Choices Commissioner, putting its hand into the healthcare system to make sure that Botox injections in Indiana end up as beautiful as those in Beverly Hills? Or, even worse, the Commissioner encouraging studies to address outcomes for different drugs and procedures to figure out which ones actually work? The horror.

Looking globally, the Commissioner has broad authority to enact many rules and regulations aimed at reigning in the powerful insurance companies, promote accountability, jump-start quality and cost-effectiveness research, and solve health care disparities. This brings up a few interesting points. First, who is responsible for this stuff now? I fear that no one is, and if so, that is really rather depressing but not that surprising, as this explains why insurance companies can do whatever the hell they want without any fear for real punitive damages. It is just depressing that our society long ago decided the government should institute mechanisms to make sure my Tiger Beat arrives in my mailbox on time, but no one gave a shit about making sure your health care was being followed.

That said, where does the Commissioner’s power end? Frankly, after reading this section, I have absolutely no idea. The Commissioner could model other kinds of commissioners in the feeble, pathetic mold (Bud Selig), the gentle-hearted, retarded-son-having mold (Michael Chiklis circa The Commish), or the psychotic, power-hungry, lawless mold (Michael Chiklis circa The Shield). In other words, I don’t think the bill makes this clear, so depending on who’s in charge, it could vastly change the health care landscape for better…or worse. I guess it just depends on whether you trust the government to govern or not. I, for one, am a bit skeptical…but on the other hand, Tiger Beat comes on time every month like clockwork.