By C.V. Allen, M.D.
The Modesto Bee, Dec. 3, 2016
Don’t look now, but our president-elect is on track to preside over the premature and preventable deaths of 16,000 Americans – each year.
Sound extreme? Read on.
Among Donald Trump’s “What I will do Day One” promises was his pledge to repeal Obamacare, a program to insure all the uninsured Americans who at one time numbered nearly 50 million. Though Trump has mildly backed down and now says he might keep the “good parts of the law,” his original intent remains unchanged.
Rising costs, low pay to providers and financial loses have caused insurance companies to withdraw from many regional markets, especially in rural areas, giving the Affordable Care Act a negative image. In more urban areas, where these things have not occurred, the program remains more popular.
But the major cause of failure is due to what is known by its technical term, “adverse selection.” That means the sickest people sign onto insurance while the younger, healthier people opt out, convinced they are going to live forever. The basic tenet of all insurance – auto, life or health – is that those who don’t use the services must outnumber those who do by a margin wide enough to lower the cost for all. Failure to have more non-users than users guarantees financial failure. For Obamacare, this was predicted by many.
Unrecognized by public and (often insured) critics is one of Obamacare’s stunning achievement – the numbers of uninsured dropped 40 percent, from 50 million to about 30 million. That was the largest decrease in our nation’s history. Twenty million people – a number equal to the combined populations of Norway, Denmark and Sweden – can now start each day reasonably certain that health care services will be available when needed and they won’t go bankrupt paying for them.
What will replace Obamacare?
Here the picture gets a bit vague. President-elect Trump has a few vague suggestions:
* “Let insurance work cross state lines” – but that will no effect on cost or availability;
* Issue “block grants to states” – same problem, it won’t increase availability or drive down costs for consumers.
More likely to be offered are yet-to-be-detailed “reforms” based on market forces and the assumption that providing health care is like selling cars. It isn’t.
Selling more Fords is good for Ford. Providing more health care is bad for insurers. In fact, the easiest way for those who sell health insurance to make money is to avoid as much as possible selling policies to the 10 percent of the population responsible for 90 percent of the costs – older Americans and those who are already sick. This is common practice in today’s commercial health insurance industry.
Those 16,000 deaths? It has long been known that those with access to health care lived longer than those without, but details remained scarce until a properly designed comparative study by the American Journal of Public Health showed us just how important health insurance really is. Two large groups of subjects – similar in gender, age, health status and all other factors except one – were compared over time. The only difference was that one group had health care insurance and the other did not. The end point was clear.
Applying the results of this study to the soon-to-be 20 million uninsured, it can be predicted about 16,000 Americans would die, unnecessarily, each year because they do not have health insurance.
Pulling the insurance rug from under 20 million people is risky for any politician, even Donald Trump. Clearly, some mix of vague “reforms” will be offered to fill the void, but most experts see the uninsured numbers and the deaths that inevitably will follow and continue to climb. True reform – universal health care – must wait for another day.
Dr. C.V. Allen is a semiretired Modesto physician active in health care reform issues. He wrote this for The Modesto Bee. Send comments or questions to firstname.lastname@example.org.