The new House bill for health care reform (HR 3962), unveiled by Speaker Nancy Pelosi on October 29th, will not fundamentally reform U.S. health care.
If you were to believe the hype that accompanied its release, you might think that it would be as important as Medicare and Social Security. The New York Times concluded that "This bill will take a long stride toward universal coverage while remaining fiscally responsible." Nobel laureate economist Paul Krugman added: "The political environment is as favorable for reform as it's likely to get. The legislation on the table isn't perfect, but it's as good as anyone could reasonably have expected."
But this bill is not good enough to pass. It will not make a big enough difference in addressing the three main problems requiring reform--containing the spiraling costs of health care, providing universal access to affordable health care, and improving its quality. If we look at the provisions of this 1,990-page bill concerning just the first two of these three goals, we see that it will fail to deliver real reform.
After all of the political compromises along the way that have led to the introduction of the new bill (HR 3962), on the positive side we can say that it will introduce some limited reforms to the health insurance market, expand health insurance to some of the uninsured (primarily by expansion of Medicaid and by often-inadequate government subsidies to individuals and small employers for the purchase of private insurance); and help to address some other problems, such as the growing shortage of primary care providers.
But the negative side far outweighs the positive:
• Although supporters of the new House bill claim that it would expand coverage for as many as 30 million uninsured, we are actually likely to see an increase in the number of uninsured in coming years for these kinds of reasons--as costs keep going up, many Americans will be forced to drop
their present coverage because of inability to afford rapidly rising costs of premiums, deductibles and co-payments; there is no guarantee that the uninsured will be able to afford new private coverage (even with subsidies, which won't kick in for another four years); and expansion of Medicaid will
not take place until 2013 (many states are already pushing back with concerns that the their recession-strained budgets will not allow them to pay their share in adding to their Medicaid programs, potentially leaving millions of the poorest Americans uninsured.
• There are no effective cost containment mechanisms built into the bill, either for the costs of health insurance or for health care itself. As it whines about weakening of the individual mandate that will likely limit some of its big increase in the insurance market, the health insurance industry is already warning that sharp premium increases will result. The most the bill will do is to require disclosure and review of premium increases, without any regulatory teeth. Although the bill would set up a Health Benefits Advisory Committee to recommend a minimal essential benefits package (with four tiers), insurance industry lobbyists will argue for the most minimal levels of coverage, and we can anticipate an exponential growth in underinsurance. Moreover, there are no price controls to be applied anywhere in the system, except perhaps in authorizing the government to negotiate drug prices with manufacturers. But that provision will almost certainly not clear the Senate, where we can expect even less concern for affordability and prices.
• Although the public option has been the target of intense controversy, it will play a negligible role in health care reform. The CBO has concluded that it would cover no more than 6 million Americans, just two percent of the population, in 2013, and will cost more than private programs, mostly due to adverse selection in attracting sicker individuals and its inability to set reimbursement rates for physicians and hospitals as is done by Medicare. Moreover, middle-income families may be required to spend 15 to 18 percent of their income on insurance premiums and co-payments.
• HR 3962 will not result in making health care more affordable, despite allocating some $605 billion over ten years for subsidies to low- and middle-income Americans to buy insurance on Exchanges. We can count on continued increases in the cost of health insurance as far as the eye can see, together with less actuarial value of coverage.
• Buried in the fine print of this monster bill are many provisions that will benefit corporate stakeholders in the medical industrial complex on the backs of patients and their families. These examples make the point:
• Although medical loss ratios (MLR) (the proportion of premium revenue actually spent on medical care) are specified at a minimum of 85 percent, this loophole has been added--"while making sure that such a change doesn't further destabilize the current individual health insurance market." By way of comparison, the Senate Commerce Committee has found that the average MLR for the largest insurers in the individual market is only 74 percent, with 26 percent of premium revenue going to marketing, administrative overhead and profits.
• Although the bill would create a much-needed Center for Comparative Effectiveness Research, it would have no say over reimbursement and coverage policies. As the bill says, it "contains protections to ensure that research findings are not construed to mandate coverage, reimbursement or other policies to any public or private payer."
In sum, this $1.055 trillion plan over ten years will not fix the major problems of cost and affordable access to health care in our deteriorating system, will add new layers of bureaucracy and complexity to the present system, is not fiscally responsible, and is not sustainable.
What to do now? Rather than accept an unworkable bill that is politically expedient, we would be better off to make a major course change. That vote could take place as early as tomorrow.
If that fails, shelving this bill would be the best option. Until a few days ago, I would have added that lawmakers should be pressed to retain the amendment proposed by Dennis Kucinich (D-Ohio) to allow states to experiment with single-payer plans, as a number of states would like to do (e.g. California, Colorado, Illinois, Maine, New Mexico, New York and Pennsylvania). Although that amendment had already been passed by a rare bipartisan vote of 27-19 in the House Education and Labor Committee, it has been stripped from the bill.
The best first option would be to call for a floor vote, as originally promised by the House Speaker Pelosi, for the amendment proposed by Anthony Weiner (D-NY) to substitute HR 676, a single-payer proposal, for HR 3962. If that fails, shelving this bill would be the best option, but if that is not possible, lawmakers should be pressed to retain the amendment proposed by Dennis Kucinich (D-OH) to allow states to experiment with single-payer plans, as a number of states would like to do (eg. California, Colorado, Illinois, Maine, New Mexico, New York and Pennsylvania).
That amendment has already been passed by a rare bipartisan vote of 27-19 in the House Education and Labor Committee. Whether a health care bill survives the end game in both chambers of Congress in this session is still up in the air. If a bill is finally enacted into law, however, it will be ineffective in remedying the big problems of cost and access to health care. We should be gearing up for an intense effort in 2010 to push for real health care reform--Medicare for All.
Dr. John Geyman is professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, a past president of Physicians for a National Health Program and author of "Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It." Buy John Geyman's Books at: www.commoncouragepress.com
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What will happen if nothing is passed? Things will get much much worse. The insurance companies will cause an enormous amount of suffering and many more people will die for their profits. Then, only after an onslaught of public outcry, will real change happen.
Now, let's consider what happens when the Obama administra
If you read my 3 part post that just preceeds this you will understand why I say that. In the end the same thing will happen. A massive public outcry will demmand a Single Payer system replace the criminal institutio
That's still not a reason to force tens of millions of people to buy for-profit insurance at extortion level rates with heavy tax penalty if they don't, with no access to a robust public option.
Only the tiniest fraction of people may access it and that leaves tens of millions of people the victims of extortion.
It's utterly immoral to force tens of millions of people who cannot afford health care now to buy for profit insurance as a form of trillions of dollars of corporate welfare.
The gist is they lied to portray the prices PRIOR TO NEGOTIATIO
Everyone knows that bills that pass can be amended, changed, repealed, etc, etc.
I say better to move forward with something to see if it will start progress in saving our people and saving some money and adjust it as needed to serve the people.
Politician
They want it their way and the way that causes them to avoid work.
It sounds to me like they don't want to pass it because dealing with in and legislatin
None of them have cancelled their own government insurance but will go to "Tea Parties" and protest their own healthcare
If any of these individual
Put your money where your mouth is and cancel your government insurance.
Not one of the critics will do so in any political office.
Radiologis
In this comment, I'd like to address two of your "fine-prin
As to your complaint about the fine print on the MLR spec -- (1) there is no loophole with respect to the group market; (2) the "loophole" can only be exercised by HHS; it's not a freebie for the industry. Again, we all still have to continue to pay attention.
Sadly, your points about the absence of meaningful cost-conta
I appreciate your thoughtful evaluation of Geyman's article. I'd like to address a point on cost's. Currently we have a skewed perception on what something costs. For example, a standard medical X-ray of the chest to check for lung cancer, rib fx, Pot's disease, or what have you. The actual cost of the film (if it isn't digital) is a few bucks, and nothing if it is digital, or near nothing as pixels are bought in bulk these days. We could go into the cost of the old style chemical developers
More coming-
Then you mention, sort of in passing, that it will "introduce some reforms to the health insurance market, expand coverage by about 36 million to health insurance by several means...".
Among those "some reforms" are some pretty big items: prohibitin
As far as universal coverage goes, I don't see any excluded class except for aliens not lawfully present. To the 36 million folks who are now NOT insured, but who will be if HR3962 survives, it'll look a lot like universal coverage. (And, BTW, I fully understand that the millions of undocument
With no mechanism in place to regulate costs, the insurance industry will simply raise their rates ever higher to make up any losses from these "reforms".
For that reason, I would prefer to see an amendment that would allow states to experiment with any variation of "universal
My idea of single payer is that everyone is basically in one big insurance pool (like Medicare, but for everyone). Everyone has to pay in in their lifetime (like SSI and Medicare.)
I downloaded the whole document, but it is way too complicate
So, we have a terd for a reform bill that will bankrupt more people to add billions to the coffers of corporatio
Corporatio
Health insurance companies add NOTHING to healthcare while stealing money to do it. They should not exist.
Okay, I'm done. I just had to let that out.
Thanks.
We should either abolish health insurance companies completely
So many seem to be willing to accept a bad bill only because it is a political victory rather than what is best for the American people.
Something so important, that has taken this long to get this far should not be rushed. It should be done right. Otherwise, this quick political victory could eventually become a political liability down the road.
Here's why: IF it's true that it will raise costs, then it will clearly have failed, and it might actually wake people up to realize we need single payer. In the interim, hopefully we don't all go broke!
Also, once a bill is in place, it's easier to adapt it. We can add to it more easily than recreated it all over again.
Well, at least that's where I stand now. I'm open to being persuaded otherwise.
I truly hoped for single payer, medicare for all. Wishful thinking I guess.
Health insurance companies that are for-profit should be ABOLISHED.
I'd even be open to forcing existing insurance to be run not-for-pr