By David Himmelstein and Steffie Woolhandler
The New York Times, Room for Debate, September 26, 2013
David Himmelstein and Steffie Woolhandler are professors at the City University School of Public Health at Hunter College and visiting professors at Harvard Medical School. They are co-founders of Physicians for a National Health Program.
The Department of Health and Human Services’ breathless report touts the 53 choices and low premiums available through the new health insurance exchanges. But citizens of other developed nations would laugh at this definition of choice, and the rosy rate quotes hide nasty news for those who aren’t forever young.
As The Times reported, the lower than expected rates reflect many insurers’ decisions to pare down their provider networks for plans offered through the exchanges. You may have a choice of insurer, but little choice of doctor or hospital. So in Los Angeles, low cost means you’re not welcome at the top ranked hospitals: Cedars Sinai and U.C.L.A.
In the past the uninsured and Medicaid patients traveled in medical steerage – or not at all; private insurance guaranteed a place in first class care. Much of health law’s new private coverage looks a lot like a Medicaid H.M.O. – coverage that restricts and segregates lower-income patients from the affluent. Top-class care is increasingly reserved for the well-to-do.
Canadians or the French or Germans have little or no choice of who pays their medical bills. But they can choose any hospital and any doctor. And they’re not socked with the enormous uncovered bills that will still afflict insured Americans. Elsewhere, insurance pretty much covers what you need.
In contrast, plans offered through the exchanges will saddle those who gets sick with hefty deductibles and co-payments – $2000 deductibles and 20 percent co-payments thereafter are typical in Massachusetts, the prototype for Obamacare.
If you’re too old to twerk the news is even worse. Health and Human Services’ news release featured premium costs for a 27 year old. At that age you can get a Silver plan in New Jersey for $3,030 annually. But for someone 63 the premium is $8,535.
Instead of a menu of 53 skimpy, restrictive plans, a single payer system would offer Americans unrestricted choice of care and first dollar coverage. By eliminating private insurers’ overhead, and the massive paperwork they inflict on doctors and hospitals, we’d save enough to cover the 31 million who will remain uninsured under the Affordable Care Act.