I’ve read all of the health reform laws, as well as most of the regulations. So I consider myself pretty well informed on the subject. It’s my job to be up to date on this. After all, I answer questions about health care and health insurance every day.
In my experience, most of the hostility that is generated by even the most innocuous statements about health reform are based on complete and total lies. The death panel rumor? An earlier draft of the bill provided that Medicare would reimburse doctors for providing end-of-life counseling. We all know that doctors have to have that talk with patients and their families when care decisions need to be made. All this provision of the law would have done is compensate them for having that conversation. But the provision got pulled because of the outcry.
People will be implanted with computer chips? This one appears to derive from the mention of the CHIP program – Children’s Health Insurance Plan.
And then there’s the email that’s been circulating for two years purportedly written by a county court judge that cites to pages and lines of the bill that supposedly says all kinds of things – like the federal government would pay for abortions, and illegal immigrants would be entitled to free health care. The version of the bill that became law does not contain any of the supposedly offending statements. I’ve looked at the page and line numbers and the stuff’s just not there.
And the biggest lie of all: Rationing of health care. Again, it’s just not there. And if you think insurance companies aren’t already rationing care by deciding which treatments they believe are medically necessary and which are not, you’re fooling yourself. But there’s nothing in the health reform law that permits anybody to limit the care that is provided, except, of course, for the private insurance companies, who will continue to make medical necessity decisions. But the government saying who can get care and who can’t? Not there.
Most of the outcry, of course, has arisen from the requirement that people buy insurance. So here’s how the argument goes. We want people with pre-existing conditions to be able to find affordable health insurance. In order to do that, we have to do two things: first, require coverage of pre-existing conditions as some states already do; and second, find a way to make sure that healthy young people also come into the system to balance the costs of people with pre-existing conditions to make insurance more affordable. The only way to guarantee that is to require that everybody buy insurance.
There are other good reasons for the individual mandate. There are 50 million people in the United States without insurance. When they get sick, they put off going to the doctor or taking any medicine because they can’t afford it. So they get sicker and sicker until they end up in an emergency room and spend a month in the hospital, racking up a $200,000 bill – and guess who pays that bill? We, the taxpayers.
Massachusetts is the only state that has universal coverage. And indeed, almost everybody in Massachusetts has insurance. Now, they are very focused on continuing to experiment with ways to make care more affordable.
You don’t try to redesign the health care financing system all in one fell swoop. And since Americans don’t want government run health care, we’re really designing a system that’s going to be unique. That means trying lots of pilot programs like you’ve been hearing about, from prevention to nutrition to smoking cessation to patient centered medical homes. We will keep trying new and different ways to deliver health care until we find the right answers. But first we have to get everybody into the system; then we can figure out how best to meet their needs.
People with acute illnesses might need a different model of care delivery than people with chronic illnesses, as will people who are pretty healthy and just need to focus on prevention. So it may be that there are different types of delivery systems for different segments of the population. We can’t know that yet because we don’t have everybody on the same playing field. In order to get there, everybody has to be part of the system.
Starting in 2014 – assuming the law is not repealed before then – we will begin to find out whether we’ve done a good job getting people into the system. There are a whole lot of people working hard on implementation to make sure that it works. There is a lot of flexibility for states under the reform law, so Utah’s exchange (marketplace where you can buy insurance) is very different from the Massachusetts model, and so there will be at least 50 exchanges (some large states may have more than one) and they will all be tailored to the unique needs and desires of that state. I know we here in Connecticut have been engaged in a lively discussion about how best to set up the exchange, and I know similar discussions are happening all over the country. And there are still a lot of important details that will be filled in by federal regulations that were issued, as well as some yet to come, on things like the essential benefits package – the benefits that every plan has to include, to make sure the essentials are covered for everybody.
The fact is that nobody knows how well this is going to work. Massachusetts has been studied, and based on those studies, we should be on the right track. But if we lose the reform law before 2014, we’ll never know. Instead, we’ll go back to the way things used to be. Under that system, my insurance went from $440 per month in 2005 to $1225 per month today. And more and more people were uninsured. Half of all bankruptcies were due to medical debt. The system was unsustainable. We had to do something. Why not try the negotiated solution that the best minds in America have designed and see how it goes, tweak what needs to be tweaked, and keep working on bringing down costs?
In my opinion, the only serious argument against health reform comes from people who prefer small government – period. Even that argument is not credible if those same people want to keep Medicare and Medicaid and the Veteran’s Administration and on and on.
But if you believe we should eliminate all government-funded and/or administered health care because you believe government should be severely limited, then you and I have an honest disagreement over our philosophy of government. I believe that it is the proper role of government to ensure that people who cannot fend for themselves are safe, have a roof over their heads, food to eat, and medical care. If you disagree, then that’s an honest disagreement.
But if you’re against health reform because of the unfounded rumors – lies, really – about what’s in the law and what’s not, then stop criticizing me and educate yourself. After all, when it comes to health care, it’s life and death.