Volume 8  Number 1  February 23, 2011
Second Opinions

What's So Wrong with the Health Care Bill? — I

"Just because you do not take an interest in politics doesn't mean politics won't take an interest in you!"

Pericles (430 B.C.)

In a country with millions of uninsured and underinsured citizens, health care has become more a privilege than a right. Indeed, the United States remains the only industrialized country in the world that doesn't guarantee health care to all its citizens. Who could have predicted how few Americans would bother to learn about the stunning new reforms introduced under the Patient Protection and Affordable Care Act? Otherwise, how explain the unexpected uproar over the legislation erupting a few weeks after it was signed into law March 23, 2010.

How indeed is it possible for almost half the American public to be drowned in a sea of misinformation, distortions and limitless malice? The usual explanation is that most people are too busy with children, working (or looking for work), taking care of the house, shopping, etc. But whose pronouncements are manipulating the supinely acquiescent media with the loudest voices and the biggest lobbying budgets? And, more important, do they have anything to offer other than sheer opposition to health care legislation?

It has been clear since the introduction and passage of the health care reform bill, H.R. 3590, that new reforms under the legislation will bring to an end some of the worst abuses of the insurance industry. These reforms will give Americans new rights and benefits, including helping more children get health coverage, ending lifetime and most annual limits on care, and providing access to preventive services without cost-sharing. "These reforms will apply to all new health plans and many existing health plans as they are renewed. Many other new benefits of the law have already taken effect, including rebate checks for seniors in the Medicare donut hole and tax credits for small businesses. And more rights, protections and benefits for Americans are on the way now through 2014."

Brief Guide to the Health Care Reform Bill

If it's "just the facts, ma'am," here are a few specifics to ponder. Under the present Act:

  • 32 million uninsured Americans will gain access to health coverage.

  • Insurers will no longer be allowed to deny coverage to patients based on pre-existing conditions, and patients will no longer face lifetime caps on coverage or be threatened with cancellation of coverage.

  • Children can remain on their parents' policies until the age of 26.

  • Competition will enter the insurance marketplace since health insurance exchanges and co-ops will be created allowing pooling of coverage for individuals and small businesses. High risk insurance pools will be created.

  • The bill leaves medical decisions in the hands of you and your doctor. Subsidies will help low-income individuals and families buy health insurance.

  • Immediate tax credits will be extended to small businesses for purchase of health insurance for employees.

  • Insurance claims processing will be standardized and streamlined, helping lower health provider overhead costs.

  • The widely despised Medicare Part D Coverage Gap (donut hole) that haunts millions of seniors will be closed.

According to estimates by the Congressional Budget Office, the new bill will keep Medicare financially sound for 10 years by cutting rates of increase in health care costs. This should help cut the U.S. deficit by $143 billion.

Positive and Negative Reactions

Corporate America generally supports the Patient Protection and Affordable Care Act with 4,700 firms and unions having signed up for federal help paying for coverage for early retirees, and taking advantage of tax credits. According to the New York Times, (Oct. 17, 2011) insurers, eager to have millions of new private customers, the big private plans and their lobby are against repeal. Still, they spent tens of millions of dollars supporting anti-reform candidates and are fighting key consumer protections and cost controls. Can you be for and against at the same time? Go figure.

Doctors, hospitals, and the drug industry remain firmly in support of the law-not altogether surprising, given that they cut deals with the administration to protect their bottom lines. There's much more outlined by the AMA, the AARP, and others. The AMA Statement of Support 25, 2011 by Cecil B. Wilson, MD, President, American Medical Association can be seen here. One of the most incisive opinions on the current budget debate and health care legislations is contained in an Op Ed piece by the Nobel Laureate, Paul Krugman, columnist for the New York Times.

Support and opposition to the Health Care Act divides mostly along party lines, with the Democrats almost unanimously in favor (in the senate, not one Democrats voted for attempted repeal). The Republican mantra remains almost overwhelmingly, "repeal and replace," but so far they have offered no alternatives. The divided, if delayed public reaction to the Act following its passage was certainly an unpredictable development. The negative political reaction suggests blind partisanship or rejection of the whole idea of health care legislation. Yet the latest CBS poll (Feb. 2011) found that the majority of Americans disapprove of the GOP's plan to cut off funding for health care reform. 55% do not want the funding eliminated, while just 35 percent said they approve of the Republican idea.

The Strange Case of FEHB

While over 46 million Americans remain uninsured and millions more underinsured, members of Congress receive health-related services that many in the U.S. can only dream about. Members of the U.S. Congress. Representatives and Senators alike enjoy some of the best health care benefits in the country, much of it paid for with taxpayer dollars. Yet these same members seem unable or unwilling to extend similar protections to the rest of America. As soon as members of Congress are sworn in, they may participate in the Federal Employees Health Benefits Program (FEHB). The program offers an assortment of health plans from which to choose, including fee-for-service, point-of-service, and health maintenance organizations (HMOs). In addition, Congress members can also insure their spouses and their dependents.

Rep. Phil Gigrey R-GA, astounded a lot of people by declaring on the House floor the health-care overhaul law was the "worst bill that has ever been passed in the history of Congress." To quote Michael Lewis, author of The Big Short, originally referring to bankers, "We still have socialism for the capitalists" (read legislators) "and capitalism for everybody else."

Martin F. Sturman, MD, FACP

Copyright 2010, Mathemedics, Inc.

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