Tuesday, 4 August 2009

Health care: Facts, Fiction and Fury

There's been much hand wringing on both sides of the health care reform discussion right now. I'd like to address both sides.

Among those who support reform, there's a lot of concern that we are entering the Congressional recess without a final bill in the Senate - they worry that President Obama may be losing "momentum" and that the August recess will be an opportunity for the voices of opposition to make their case. They also, understandably, are a little green around the gills at the prospect of the right wing's reported strategy to disrupt town hall discussions with angry shouts and chanting.

(By the way, for the record: attending town hall meetings = good. Asking questions at town hall meetings = good. Confronting lawmakers directly with your arguments, even emotionally so = good. Preventing others from speaking by disrupting the meeting to the poitn where no one can be heard = bad. Hope that's clear.)

To worried supporters I say this: to some extent, you SHOULD worry. Just because Barack has a massive majority to work with in both houses of Congress does NOT mean that he gets what he wants. There are powerful forces at work against reform, not the least of which is a force of nature... simple inertia. The status quo always has a structural advantage over change.

But the status quo is NOT an acceptable option. 46 million Americans are without health care, and that number is growing every day as unemployment rises. Millions more Americans who are currently insured are nevertheless destroyed by punitive costs. So if you're worried that health insurance reform will be stymied yet again, don't just sit there - pick up the phone. I bet your Senator or Representative would love to hear from you.

Go on. Shoo. Do it now. Then call your friends and ask them to do the same.

Now, for those of you who are opposed to reform, I know you have your own set of concerns. Let me try and summarise some of the concerns I have seen raised, and let you know why I don't think they outweigh the risk of staying as we are. FYI, some of this is a rephrasing of things I wrote on Facebook in a conversation with an anti-reform friend. I know that there are lots of good people out there who disagree with me about this. BUT, I have also seen a lot of "facts" flying around about the bill being proposed that just aren't true.

Worry 1) Health Insurance Reform will provide "Free health services for illegal immigrants."

This is not true. In fact, Section 246 of the House health care plan, or HR 3200, states:

Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.

As you can see, undocumented immigrants are prevented from taking advantage of publicly funded federal healthcare under this plan, just as they are already.

Worry 2) My health insurance will disappear if the reform is passed.

President Obama has repeatedly stated, since early in the campaign, that anyone who is currently with an insurance that they like can keep it. The plan being developed is built around reforming the existing system, but preventing insurers from overcharging or denying coverage based on pre-existing conditions. A good plan should be able to adapt to those changes, especially since the market for insurance will itself be growing - with millions more Americans now buying in.

However, many worriers have a more complex concern in mind: that a successfully run public option in health care could drive out most private sector providers.

I don't think this is very likely, for a lot of reasons. Insurers are currently VERY profitable, and are appallingly inefficient. Like in other industries where competition suddenly increases (e.g., telecomms services after Ma Bell was broken up) those in the market should be able to find cost savings that they weren't looking for when they were in a more protected position.

And by the way, don't kid yourself - there is very little choice in health insurance right now:

Far from healthy market competition, HCAN describes the situation as "a market failure where a small number of large companies use their concentrated power to control premium levels, benefit packages, and provider payments in the markets they dominate."

So extreme is the level of consolidation, in fact, that one former top Federal Trade Commission official working with HCAN has sent a letter to the Justice Department's Antitrust Division, asking for an investigation into the health insurance marketplace.

But let's suppose for a moment that this were true. Let's imagine that, as my friend wrote: "Private insurance can not in any way, shape, form or otherwise compete with the government. They will all be out of business and there will be no "option" for private insurance."

I think it's worth unpacking that logic a little bit. First off, I assume what we're talking about here is the public insurance exchange allowing individuals and small businesses to buy into a gvt negotiated plan - rather than Medicare, Medicaid, the VA or other current health plans that are gvt run (and, by the way, very popular).

If that's right, then it will be because private sector insurers are abandoned by their customers. Presumably, the assumption here would be that they would not be able to produce a plan as cheap as the public one. (Which people BUY, don't get it for free.)

But if that were true the plans would have failed because people CHOSE to buy the other plan. Why wouldn't this be a victory for consumer choice and a successful market? I don't think this is likely to happen - but in theoury how would you be harmed if an insurance plan that is more expensive and less desirable goes out of business? Isn't tougher competition good for consumers?

Worry 3) Health reform will require taxes to be raised.

To some extent this is true. Right now, all of the proposals around the reform amount to a tax increase only on those Americans who currently earn more than $250,000 - less than 1% of the population. But still, if we are going to increase access to care for the 46 million currently insured we are indeed going to have to come up with some money from somewhere. Even if the plan is - as predicted - successful in bringing down costs, this would be a long term benefit that would require initial investment.

I do understand the concern about higher taxes. But it is misleading to pretend that the choice is between paying higher taxes or ... Read Morepaying nothing at all. Health care is a service that at some point in their lives everyone needs. Americans currently pay much more for it than anyone else in the world - by a huge margin. Much of that is already paid in taxes - we pay more in public health care than any other country already. The rest is in very high premiums and co-payments from private providers. The goal of the current plan is to produce a health care system in which the average family, such as yours, pays significantly less than they currently do for care that is as good or better. But yes, more of that money may come in the form of taxation.

Worry 4) The new health care plan requires seniors to report to the government every 5 years how they wish to die.

Obama got asked about this particular myth, which has been terrorising the elderly, at his AARP town hall last week. I find it terribly sad that some people are spreading this lie and frightening people off of what could be a wonderful benefit for seniors.

The back story is this. Medicare currently excludes from coverage any counseling services related to end of life care. This means that if you are facing a terminal illness or an imminent decline into age-related disability, and if you would like to speak to an expert in end of life issues to, for example, write a living will stating your wishes, you must pay for that out of pocket.

One small provision in the new plan allows for Medicare to cover a consultation on request - but not more than one every 5 years.

This has been twisted by some folks who are either very confused or very cruel into telling people that they MUST have a consultation. This is no more accurate than saying that if your plan covers plastic surgery they are requiring you to get a nose job.

There is a good debunking of many other health care myths here.

1 comment:

Hilary in Berlin said...

#1 hit on google searching "obama care fact fiction" -- good on you!