By Dr. James C. Mitchiner
AnnArbor.com, April 4, 2010
In the weeks and months ahead, Americans will learn the true details about the health care reform bill passed by the U.S. House on March 21 and signed into law by President Obama two days later. They may not like what they see. If ever there was March Madness, this surely must be it.
Lost in all the hype and self-congratulatory rhetoric repeated by Speaker Nancy Pelosi and her Democratic colleagues are the facts that brought us to the passage of this flawed legislation.
Here are a few:
• Of the 32 million Americans who will gain coverage under this law, about 16 million will be covered by Medicaid. Here in financially strapped Michigan, with the recent 8 percent reduction in Medicaid reimbursement to doctors and the looming possibility of an additional 11 percent cut, the already dwindling Medicaid participation rate among physicians will decrease further. The result will confirm what we have learned from health reform in Massachusetts: access to health insurance in no way guarantees access to actual health care. Waits to see a physician will increase, and emergency rooms will become jammed more than they already are.
• Millions of middle-income citizens will be herded into buying private health insurance policies costing up to 9.5 percent of their annual income while covering on average only 70 percent of their medical expenses, leaving them responsible for high co-pays and deductibles. Such a “benefit” will not provide them with the necessary financial security should they fall victim to a catastrophic illness or injury.
• Health insurance firms are likely to garner over $400 billion in federal assistance, courtesy of American taxpayers, to subsidize the purchase of their defective products. Moreover, since the newly insured are likely to be young and healthy, and therefore less risky to insure, private insurers will be guaranteed continued profits which will be used to extend their political clout and inhibit future reforms.
• Workers who currently receive coverage from their employer will be restricted to using their plan’s limited network of providers. As the cost of their insurance climbs, many will eventually be taxed on the value of their benefits.
• Optimistic projections that the reform law will reduce the federal deficit are based on wishful thinking and untested theories. As the experience with the Massachusetts reform plan (the model for this bill) has amply demonstrated, health care costs will continue to escalate.
• The much-ballyhooed regulatory reforms in commercial insurance, such as prohibiting denials on the basis of pre-existing conditions, were crafted with the assistance of the insurers themselves, casting doubt on their true effectiveness. Older people, for example, can be charged up to three times more than their younger counterparts, and female employees can be charged higher rates at least until 2017.
This bill’s passage is grounded on base political pragmatism rather than sound health care policy. It leaves intact the fragmented and unsustainable system that is wreaking havoc on our health and economy today, a system that generates up to $400 billion annually in wasteful administrative costs. According to Physicians for a National Health Program, an organization representing over 17,000 single-payer physician advocates, that’s enough to cover all the uninsured and to upgrade everyone else’s coverage without having to increase overall U.S. health spending by one dollar.
So, in the coming years, we will be forced to muddle through the dysfunctional mess that epitomizes American health care. But it is only a matter of time before future legislators will survey the damage done and conclude that only the adoption of a single-payer national health insurance program – an expanded and improved Medicare-for-All – will guarantee coverage for Americans that is universal, portable, affordable, and equitable for all.
Dr. James Mitchiner is an Ann Arbor emergency physician and is the former president of the Washtenaw County Medical Society.