Reflections on the House health bill
March 22, 2010
Below is the response from Physicians for a National Health Program on yesterday’s House vote. But first, my comments:
Yesterday, the House of Representatives took a huge step in embracing the principle of health care reform. Much of the language used resembles the rhetoric that would sound like single payer (“universal coverage”, “health care is a right”, “no longer would people be denied coverage”, etc.). Unfortunately, the promise is better than the reality and the plan fundamentally relies on the for-profit, private insurance industry to rely on providing this coverage.
Given their track record and their demand for shareholder profits, we should be very cautious.
If you want an idea of how much this will cost and whether you will get a subsidy to fund health care, go to the Kaiser Family Foundation subsidy calculator to get an idea of how much insurance will cost you. (Look up the reconciliation bill version which is what passed last night). You may be surprised at the cost.
Frankly, we will still have the most expensive health care system in the world, by far, (http://blogs.ngm.com/.a/6a00e0098226918833012876a6070f970c-800wi) because we are unwilling to face the reality that the feared “government takeover” of health care is the bitter medicine that we need to control costs. We would like to believe that a competitive private insurance industry can lower costs, but we have 50 years of evidence that this belief is misguided. Within that framework, we have asked the insurance industry to stop excluding people with preexisting conditions, no more recissions, no lifetime caps, no medical underwriting, etc. This is good, but insurers are unlikely to do all this without raising premiums or cutting benefits and AHIP’s statement essentially assures they will do just that.
We should note that America’s Health Insurance Plans have released a one sentence statement about the reform plan which basically assures us that there will be increases in premiums:
AHIP Statement on Health Care Reform Legislation
We will never control costs and preserve access without taking a step toward single payer health care, perhaps by expanding Medicare. This was not our step yesterday. But in the global economy, we have to start moving this way or employers will find themselves stuck with unaffordable insurance premiums. I am willing to support candidates who clearly understand this and are willing to support single payer, while still getting people health insurance using our flawed private insurance model right now. But eventually, we will have to make the really tough decision which we avoided with this legislation.
So today, I rejoice that we made a step toward the idea that we need to fix our health care system, but we have not made the tough choice to move us toward single payer that we have to make to control health care costs and that will position our country to be competitive in a global economy. For those who don’t want to wait until 2014 to see insurance expansion, we have a chance to prove the benefits of single payer in Pennsylvania with the passage of SB 400/HB 1660, the Family and Business Health Security Act. Walter
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Physicians for a National Health Program
News release
March 22, 2010
A False Promise of Reform
The following statement was released today by leaders of Physicians for a National Health Program, www.pnhp.org. Their signatures appear below.
As much as we would like to join the celebration of the House’s passage of the health bill last night, in good conscience we cannot. We take no comfort in seeing aspirin dispensed for the treatment of cancer.
Instead of eliminating the root of the problem – the profit-driven, private health insurance industry – this costly new legislation will enrich and further entrench these firms. The bill would require millions of Americans to buy private insurers’ defective products, and turn over to them vast amounts of public money.
The hype surrounding the new health bill is belied by the facts:
* About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.
* Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.
* Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.
* The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.
* People with employer-based coverage will be locked into their plan’s limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.
* Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.
* The much-vaunted insurance regulations – e.g. ending denials on the basis of pre-existing conditions – are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.
* Women’s reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.
It didn’t have to be like this. Whatever salutary measures are contained in this bill, e.g. additional funding for community health centers, could have been enacted on a stand-alone basis.
Similarly, the expansion of Medicaid – a woefully underfunded program that provides substandard care for the poor – could have been done separately, along with an increase in federal appropriations to upgrade its quality.
But instead the Congress and the Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers’ health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.
This bill’s passage reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities. We seek evidence-based remedies that will truly help our patients, not placebos.
A genuine remedy is in plain sight. Sooner rather than later, our nation will have to adopt a single-payer national health insurance program, an improved Medicare for all. Only a single-payer plan can assure truly universal, comprehensive and affordable care to all.
By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually in unnecessary, wasteful administrative costs. 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 penny.
Moreover, only a single-payer system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning.
Polls show nearly two-thirds of the public supports such an approach, and a recent survey shows 59 percent of U.S. physicians support government action to establish national health insurance. All that is required to achieve it is the political will.
The major provisions of the present bill do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we cannot wait, nor can our patients. The stakes are too high.
We pledge to continue our work for the only equitable, financially responsible and humane remedy for our health care mess: single-payer national health insurance, an expanded and improved Medicare for All.
Oliver Fein, M.D.
President
Garrett Adams, M.D.
President-elect
Claudia Fegan, M.D.
Past President
Margaret Flowers, M.D.
Congressional Fellow
David Himmelstein, M.D.
Co-founder
Steffie Woolhandler, M.D.
Co-founder
Quentin Young, M.D.
National Coordinator
Don McCanne, M.D.
Senior Health Policy Fellow
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