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WHY NO HEALTH CARE BILL IS BETTER THAN A BAD ONE
John Geyman MD, Physicians for a National Health Plan - The new House bill for health care reform will not fundamentally reform U. S. health care. If you would believe the hype that accompanied its release, you might think that it would be as important as Medicare and Social Security. The New York Times concluded that "This bill will take a long stride toward universal coverage while remaining fiscally responsible." Nobel laureate economist Paul Krugman added: "The political environment is as favorable for reform as it's likely to get. The legislation on the table isn't perfect, but it's as good as anyone could reasonably have expected."
After all of the political compromises along the way that have led to the introduction of the new bill, on the positive side we can say that it will introduce some reforms to the health insurance market, expand coverage by about 36 million to health insurance by several means (especially through government subsidies to individuals and small employers and expansion of Medicaid), and help to address some other major system problems, such as the growing shortage of primary care providers.
But the negative side far outweighs the positive:
- There are no effective cost containment mechanisms built into the bill, either for the costs of health insurance or for health care itself. As it whines about loosening of the individual mandate that will likely limit some of its big increase in the insurance market, the health insurance industry is already warning that sharp premium increases will result. The most the bill will do is to require disclosure and review of premium increases, without any regulatory teeth. Although the bill would set up a Health Benefits Advisory Committee to recommend a minimal essential benefits package (with four tiers), insurance industry lobbyists will argue for the most minimal levels of coverage, and we can anticipate an exponential growth in underinsurance. Moreover, there are no price controls to be applied anywhere in the system, except perhaps in authorizing the government to negotiate drug prices with manufacturers. But that provision will almost certainly not clear the Senate, where we can expect even less concern for affordability and prices.
- Although the public option has been the target of intense controversy, it will play a negligible role in health care reform. The CBO has concluded that it would cover no more than 6 million Americans, just two percent of the population, in 2013, and will cost more than private programs, mostly due to adverse selection in attracting sicker individuals and its inability to set reimbursement rates for physicians and hospitals as is done by Medicare. Moreover, middle-income families may be required to spend 15 to 18 percent of their income on insurance premiums and co-payments.
- HR 3962 will not result in making health care more affordable, despite allocating some $605 billion over ten years for subsidies to low- and middle- income Americans to buy insurance on exchanges. We can count on continued increases in the cost of health insurance as far as the eye can see, together with less actuarial value of coverage.
- Buried in the fine print of this monster bill are many provisions that will benefit corporate stakeholders in the medical industrial complex on the backs of patients and their families. . .
In sum, this $1.055 trillion plan over ten years will not fix the major problems of cost and affordable access to health care in our deteriorating system, will add new layers of bureaucracy and complexity to the present system, is not fiscally responsible, and is not sustainable.
Rather than accept an unworkable bill that is politically expedient, we would be better off to make a major course change. The best first option would be to call for a floor vote, as originally promised by the House Speaker Pelosi, for the amendment proposed by Anthony Weiner (D-NY) to substitute a single-payer proposal. If that fails, shelving this bill would be the best option, but if that is not possible, lawmakers should be pressed to retain the amendment proposed by Dennis Kucinich (D-OH) to allow states to experiment with single-payer plans, as a number of states would like to do (eg. California, Colorado, Illinois, Maine, New Mexico, New York and Pennsylvania). That amendment has already been passed by a rare bipartisan vote of 27-19 in the House Education and Labor Committee.
Whether a health care bill survives the end game in both chambers of Congress in this session is still up in the air. If a bill is finally enacted into law, however, it will be ineffective in remedying the big problems of cost and access to health care. We should be gearing up for an intense effort in 2010 to push for real health care reform-Medicare for All.
After all of the political compromises along the way that have led to the introduction of the new bill, on the positive side we can say that it will introduce some reforms to the health insurance market, expand coverage by about 36 million to health insurance by several means (especially through government subsidies to individuals and small employers and expansion of Medicaid), and help to address some other major system problems, such as the growing shortage of primary care providers.
But the negative side far outweighs the positive:
- There are no effective cost containment mechanisms built into the bill, either for the costs of health insurance or for health care itself. As it whines about loosening of the individual mandate that will likely limit some of its big increase in the insurance market, the health insurance industry is already warning that sharp premium increases will result. The most the bill will do is to require disclosure and review of premium increases, without any regulatory teeth. Although the bill would set up a Health Benefits Advisory Committee to recommend a minimal essential benefits package (with four tiers), insurance industry lobbyists will argue for the most minimal levels of coverage, and we can anticipate an exponential growth in underinsurance. Moreover, there are no price controls to be applied anywhere in the system, except perhaps in authorizing the government to negotiate drug prices with manufacturers. But that provision will almost certainly not clear the Senate, where we can expect even less concern for affordability and prices.
- Although the public option has been the target of intense controversy, it will play a negligible role in health care reform. The CBO has concluded that it would cover no more than 6 million Americans, just two percent of the population, in 2013, and will cost more than private programs, mostly due to adverse selection in attracting sicker individuals and its inability to set reimbursement rates for physicians and hospitals as is done by Medicare. Moreover, middle-income families may be required to spend 15 to 18 percent of their income on insurance premiums and co-payments.
- HR 3962 will not result in making health care more affordable, despite allocating some $605 billion over ten years for subsidies to low- and middle- income Americans to buy insurance on exchanges. We can count on continued increases in the cost of health insurance as far as the eye can see, together with less actuarial value of coverage.
- Buried in the fine print of this monster bill are many provisions that will benefit corporate stakeholders in the medical industrial complex on the backs of patients and their families. . .
In sum, this $1.055 trillion plan over ten years will not fix the major problems of cost and affordable access to health care in our deteriorating system, will add new layers of bureaucracy and complexity to the present system, is not fiscally responsible, and is not sustainable.
Rather than accept an unworkable bill that is politically expedient, we would be better off to make a major course change. The best first option would be to call for a floor vote, as originally promised by the House Speaker Pelosi, for the amendment proposed by Anthony Weiner (D-NY) to substitute a single-payer proposal. If that fails, shelving this bill would be the best option, but if that is not possible, lawmakers should be pressed to retain the amendment proposed by Dennis Kucinich (D-OH) to allow states to experiment with single-payer plans, as a number of states would like to do (eg. California, Colorado, Illinois, Maine, New Mexico, New York and Pennsylvania). That amendment has already been passed by a rare bipartisan vote of 27-19 in the House Education and Labor Committee.
Whether a health care bill survives the end game in both chambers of Congress in this session is still up in the air. If a bill is finally enacted into law, however, it will be ineffective in remedying the big problems of cost and access to health care. We should be gearing up for an intense effort in 2010 to push for real health care reform-Medicare for All.
1 Comments:
I think I've seen this movie before, Bridge Over the River Kwai. Only here, we the people are a toxic asset on the books of Big Health Insurance. Rather than dissolve an industry that leaves about 45,000 of us for dead each year, we are asked to build a bridge for an industry too big to fail. Escapees will be dealt with by the IRS.
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