Thursday, July 30, 2009

I'm Worried About Health Insurance Reform

I'm not worried very much about what the Congress is going to pass. Sure, I care whether it includes a public alternative as one option that people can choose instead of private, commercial insurance. And there will be a big difference if there are subsidies for people earning 300 percent of the federal poverty level (FPL) or 400 percent of FPL. But there appears to be consensus about several core items:

1. There will be insurance regulations that prevent insurers from excluding people with pre-existing conditions, and health status and even gender will not be the basis for calculating premiums.
2. There will be annual caps on out-of-pocket costs, such as co-pays and coinsurance.
3. Insurance regulations will ban lifetime maximums.
4. There will be some type of mandate -- individuals who aren't exempt will have to have insurance, and at least some employers who aren't exempt will have to provide coverage or pay a fee or fine. But there will be exemptions.
5. Insurance companies will not be allowed to drop someone simply because of their health issues.
6. Preventive care will be covered 100 percent, with no copays or coinsurance, including but not limited to routine mammograms and colonoscopies.
7. There will be some sort of marketplace where consumers can go -- probably on the internet -- to review the plans that are available to them and compare them and make informed decisions.

For most of us, if we just got that much, it would be a huge improvement over the status quo. So I'm not all that worried about what they're actually going to pass. It's going to be better than the horribly broken system we have today. Once the new law takes effect, I will never have to explain to another person with a chronic illness why there is no insurance for them, even if they can afford to pay.

But we all read in our morning papers today that a new poll shows Americans are apprehensive about health insurance reform -- and most of the reasons they are worried are just plain false.

THIS is what worries me about health insurance reform. Those who are against it are willing to lie about it, and people believe them.

There's the absurd notion that someone from the federal government is going to require everyone on Medicare to make end of life decisions. Now, having a living will is a smart thing, and everyone should have one, but I've read every page of every draft of health insurance reform legislation and I swear on a stack of Bibles that there's absolutely nothing in any of them that would lead to such an Orwellian result.

There's the idea that our taxes are going to increase. For most of us -- for those of us who earn less than $250,000 per year AT LEAST -- this is false. Right now, we are paying for people who don't have insurance and can't afford health care to be seen for free at emergency rooms and hospitals. Once people have insurance, we should be able to decrease the amounts that we are paying to hospitals for "uncompensated care" dramatically. This will result in a huge savings to the federal government.

And having a public option will not result in our taxes going up. It won't be free for people who can afford to pay. Indeed, the Commonwealth Fund has issued a report that says that we will save $200 billion over ten years with a public alternative.

So yes, there will be increased Medicaid costs as we cover people whose income is so low that they can't afford to pay an insurance premium, even with a subsidy. And there will be the costs of the subsidy itself. But these costs will be largely off-set by the savings that will accrue.

Then there's the claim that the federal government will force you to change doctors or change insurance. Poppycock! First of all, right now, if you have insurance, you are forced to choose doctors who are in your insurer's network or to pay a higher copay if you don't (if you have a plan that allows out-of-network coverage). Nothing will change. Second of all, right now, if you have insurance through an employer, the employer can change your insurance. Nothing will change.

There is NO plan on the table for government-run health care -- period. Did you get that? Although some of us are in favor of a single-payer system of government run health care such as exists in the United Kingdom, IT IS NOT EVEN ON THE TABLE. I don't know how many ways I can say this. I swear it's true.

The government isn't going to ration healthcare any more than insurance companies already do so by telling us what they will pay for and what they won't. The legislation may well contain an outline of the basic benefits that have to be provided by any insurance -- but many states already do that. And if there's a public option as an alternative to private, commercial insurance, that public option probably will make decisions about what they will and won't cover, just like private insurance, and just like Medicare.

And while we're on the topic of Medicare, no, this legislation is not going to cut your benefits. In fact, it's entirely likely that it will expand your prescription drug benefit, especially when you are in the "doughnut hole" coverage gap that already exists.

Yes, there are other cost-cutting proposals out there that might make a difference. The White House supports comparative effectiveness research, so scientists will decide whether a more expensive therapy really will result in a better health outcome. They also support an outside panel of doctors who will propose changes to Medicare that will take effect if Congress doesn't act. But if you think these things wouldn't be happening if we weren't looking at insurance reform, think again. The Medicare trust account will run out of money in our lifetimes if there aren't savings. So yes, there will be changes -- small changes that will affect small numbers of people with specific health care needs. And we won't like them all. But these changes are going to happen even if we don't make other reforms to the system. Indeed, if we don't make other reforms, a whole lot more is going to change.

It's simply no longer economically feasible for employers to pay premiums that double every four years or so, as ours have, and still give us salary increases and make investments in the future. We cannot sustain the cost of caring for the uninsured. And waste in Medicare -- such as inflated fees paid to private insurance companies that are called Medicare Advantage Plans -- has to end if Medicare is to continue to exist. As the President has said over and over again, the status quo simply is not an option.

So yes, I'm worried. I'm worried about what happens when all of these lies about the reforms that are proposed scare people to the point at which they become opposed to reform. I'm worried about how members of Congress will react if that happens. I'm worried that we will throw away the really important consensus that has been reached because people who oppose reform are fear-mongers. I'm worried that not enough people are speaking the truth, not enough people KNOW the truth, and I can't really suggest that you all read the thousands of pages of draft legislation.

So I guess I have to hope that you will consider the sources of the information you rely on -- and if you have a question, write me at Jennifer

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