Monday, November 8, 2010

Don't Repeal;Fix

Reprinted from the November 3 Advocacy for Patients Newsletter:

I wrote this before the November 2 elections; by the time you see this, you will know whether Republicans have regained control of either or both houses of Congress. If they do, it will be, in part, due to opposition to the health reform law. Whether or not they do, there surely will be members of Congress advocating for repeal.

A lot of you don't like the health reform law, too. Each time I write something favorable about it, a few people unsubscribe to this newsletter!!! I understand your reaction. First, the new law has not been explained adequately to you. You are hearing all kinds of things and you can't sort the truth from the lies. I've tried to be a trusted source of information for you, reading every word of the law and the implementing regulations. But why should you trust me more than you trust FOX News or your member of Congress?

That said, I want to dispel a few of the rumors. First, there are no death panels. There is no public funding for abortions. There is no coverage of illegal immigrants. All of those things came up during the debate over health reform, and there were quite a few Democrats who needed those things nailed down before they would vote for the law. I promise you, those are plain lies -- period.

Second, we're all seeing our premiums increase again this year, and the insurance companies are quick to tell us that it's because of the health reform law. However, I've read a lot, and it's just not true. The Department of Health and Human Services, as well as an independent report from the Urban Institute, says the cost of the few pieces of reform taking effect now -- coverage of kids with pre-existing conditions, coverage of kids to age 26, new appeals procedures, preventive care without copay, etc. -- warrant an increase of about 1-2%. Roughly this same figure is used by consultants Mercer and Hewitt. Yet, health insurance premiums are going up at a rate of about 9 percent for large groups and up to as high as 47% for individual plans here in Connecticut. Nobody really believes that these huge increases are due to the health reform law. Indeed, we've had double-digit increases for each of the last 5 years, before the health reform law was in play. Why are premiums going up? Because health care costs are going up -- and possibly (this is my conjecture) because next year, insurers have to limit their administrative expenses to 20-25 percent of premium dollars, so they are better off if premiums are higher when that percentage (called the medical loss ratio) kicks in. What we know, though, is that it's not due to the new law. Indeed, Secretary Sebelius has demanded that insurers stop spreading the misinformation that these huge rate hikes are due to the new law.

But most of all, I think a lot of us are just plain scared. There's a lot in this legislation that we don't know is even there, not to mention understanding how it will all play out. Some of the rumors are really nuts -- that the law requires that we all be implanted with computer chips, which comes from the law's expansion of the Children's Health Insurance Program or CHIP!!!

One evening during the debates leading up to reform, I was watching a talk show when the woman who leads the "birthers" movement claimed to have a copy of the law in front of her. She cited to a particular page number and said the death panel section was there. I ran to look it up. Complete and total lie -- it wasn't there at all. Those are the lengths to which some people will go to defeat this law.

So how do you know who's telling you the truth and who's not? I don't want to say that you should take my word for it. Don't take anybody's word for it -- and that includes media that has a point of view. Just like MSNBC airs opinion programs that discuss the news that are very liberal/progressive, FOX News airs opinion programs that discuss the news that are very conservative. You hear good things about health reform from Keith Olberman and bad things about health reform from Glenn Beck. It's all fine as long as we all realize it's opinion, not fact.

If you don't have someone knowledgeable whom you can trust to give you the facts, then it's important for you to read and learn for yourself. Every single morning, I read the NY Times, Washington Post, LA Times, USA Today, Politico, Huffington Post, and sometimes the Wall St. Journal, as well as Kaiser Health News, which collects and summarizes health-related news every day (to which you can subscribe for free). Every morning, I post a summary with links on my blog, which you can find here. Don't just read what I write; read the articles to which I link so you know your source and can decide whether or not to trust it.

Here's the bottom line. The status quo is unsustainable. Health care costs are skyrocketing. Premiums are increasing by double-digits. We are spending more and more on health care, but we're not getting any healthier. We couldn't keep going without doing something.

There are two big issues: cost and coverage. To deal with coverage, we had to eliminate pre-existing condition exclusions. I think it's fair of me to assume that most of you favor this since most of you have a chronic illness that would make it impossible for you to buy individual policies in most states. However, the insurance companies said: We can't take on all of the sick people unless they are balanced out by healthy people. This, too, makes business sense. And in order to make sure that healthy people without insurance would come into the system, we had to require that everybody buy insurance. But in order to do that, we had to provide subsidies for people who can't afford insurance. And then we had to figure out how to pay for those subsidies. And so that's how addressing the coverage issue got to be so big.

And it's true that we have not yet really grappled with cost. I do believe that premiums will come down in 2014 and beyond. First, there are the medical loss ratios that I mentioned above, that limit the percentage of premium dollars that can go towards administrative costs. Those will go into effect sooner. But beyond that, when the Exchanges are up and everybody has insurance, the sick and the healthy will all be pooled together so that costs can be spread over a very large number of people. The more you spread cost, the less each individual is going to have to pay. That's why bigger employers spend less per employee than individuals or small groups. I believe this will work -- to an extent.

But we have not done enough to control costs. And so you are seeing and hearing about lots of pilot programs -- patient-centered medical homes, accountable care organizations, pay-for-performance, for example -- that are trying out different ways of paying for and delivering health care to see if we can reduce costs without sacrificing quality of care. At least some of those pilot programs are part of the health reform law. As we find things that work, those things will be implemented on larger scales until we are able to make a real dent in health care spending.

Is everything in the new law great? No, it's not. It's pretty unusual for everybody to be thrilled by any large legislation because legislation of this scope is arrived at by negotiation and compromise. I suspect that, even if Democrats were to control both houses of Congress and the White House, there would be amendments to the current plan. That happened with Social Security, Medicare, Medicaid, and CHIP, so there's every reason to believe it will happen here, too, regardless of which political party is in charge.

What we cannot allow, in my opinion, is a return to the status quo, in which health care providers and insurers keep raising prices while more and more people -- and particularly those with pre-existing conditions -- are squeezed out of the health care market entirely. My insurance has gone from $440 per month in 2005 to $1165 per month today. That's $14,000 per year, and that's not including deductibles and copays. Eventually -- sooner than later if things keep going at this pace -- I would not be able to afford either insurance or health care, in which case I would get very sick and die. I know -- because I know most of you -- that you'd be in a similar boat. Indeed, some of you already are there. We cannot be a compassionate society and limit access to health care to the wealthy. That is where we were headed. So yes, we may have to give up something, but the health reform law does not mean giving up quality of care. And at bottom, that's what really matters.

I know many of you will disagree. Others will have questions. Please feel free to engage in a dialogue with me by phone or email or by commenting on my blog. My contact info is at the bottom of this page. And read and learn for yourself; don't take anybody's word for it. Get educated. If you are a person with a chronic illness, it behooves you to understand health insurance since you will be dealing with it regularly for the rest of your life. There are great health reform tools at the nonpartisan Kaiser Family Foundation, for example, that will allow you to better understand what health reform means to you. But pay attention to your sources and try to understand whether they have a political bias. They may still be worth reading; opinions are interesting and important, but they're not hard news, and you need to know the difference.

Educated consumers are going to fare better, whether under the new law or some other scenario. So get educated. If you're comfortable relying on me -- you know my bias is that everybody should be able to get and afford health care -- fine, stick with these newsletters and my blog. If you're not comfortable relying on me, then either find someone else who you know for sure is telling you the truth, or do the work to become educated for yourself. But don't be taken in by people who are out to scare you into voting for them, or by media that pretends to be news when, in fact, it's opinion. The fear-mongering, misinformation campaigns do us all a great discredit.

Whatever happens on Election Day, this national discourse is not over. So become educated and take a stand for affordable, available health care for all Americans, and let's focus our attention on how to get there. Jennifer

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