Mark Twain stated in the June 2, 1897 issue of the New York Journal American after a journalist was sent to inquire about his health, thinking he was near death's door, "The report of my death is an exaggeration" (the quote is popularly said to be, "The rumors of my death have been greatly exaggerated"). Fast-forward 113 years later to when President Obama signed into law last March the new health care law, the Patient Protection and Affordable Care Act ("PPACA"). As sure as the new Congress was sworn in on January 5, 2011, attempts will be undertaken to unravel PPACA, spearheaded by the new Republican majority in the House. However, as with a prognostication on Mark Twain's death, PPACA on death's door is greatly exaggerated.
A distinguished news editor/colleague of mine, Joyce Frieden of MedPage Today, recently brought to my attention an article written in Bloomberg Businessweek by Boston University Economics Professor Laurence Kotlikoff, "Health Law's Demise May Permit Better Plan." While he forecasts as well an effort to dismantle PPACA either through lack of congressional funding for various of its parts or with a Supreme Court ruling within a year or so, he believes that health care needs to be provided for America's citizens but that PPACA, "adds another expensive entitlement -- federally subsidized health exchanges," with no solid cost controls -- to Uncle Sam's continually skyrocketing Medicare and Medicaid obligations." He also prognosticates that the way PPACA is structured, the feds will be picking up the tab for the entire American population. Such "the sky is falling" mentality is surely not comforting to read or hear, though it must be viewed within a proper context.
As I have opined in prior HuffPost editions, Kotlikoff agrees that we need a health-care system that, as he says, "insures us all at reasonable cost." Yea for Motherhood and apple pie too. PPACA is a start -- just like Medicare was when first signed into law in 1965 -- but PPACA is only half a loaf. It addresses the accessibility side of providing health care without shoring up affordability for it. Sure, PPACA, for example, now covers our kids to age 26; precludes dropping those of us and our children with a preexisting condition; provides for state-run health insurance exchanges in 2014; and shores up some exposures for our seniors in Medicare who require expensive pharmaceuticals. But with all these type benefits, hasn't anyone asked the question, what precludes insurers from including these federally mandated features in increased premiums on an on-going basis? The answer: not really anything. This was so, because there was not, and still is not, a competitive force in the marketplace to keep insurers' pricing of their product in line with what, as Kotlikoff says, is reasonable. Remember what happened to the so-called "public option" that Obama promised before he allowed it to go to the trash-bin? Ditto for doing away with the antitrust exemption for insurers. Even state insurance honchos in general cannot preclude insurers from jacking up insurance premium rates as they see fit, yet the states are being looked to now to fix our health care woes. Note, too, that at the end of last year, HHS announced its implementation of a PPACA provision mandating that most of what insurers take in from premium dollars (80%) will, indeed, go to pay for medical care provided through insurance plans.
I have written in the past that health care should be a right for all Americans, as it is viewed in other industrialized nations. That has attracted considerable comments from readers, overwhelmingly favorable I might add. To get there, though, requires more than what PPACA offers. Again, no doubt the Republican-led House will pound its collective chest in overturning the new health care law, reported now to be later this month. This will be for show, since it knows the Senate will not concur, and there is also the president's veto pen. Moreover, it knows that something is better than nothing that can then be amended, modified, and built upon (ask if any of our seniors want to give up Medicare even 46 years after it becoming law?). To be sure, taking away social entitlement benefits is not politically popular, particularly as the 2012 election cycle approaches. To have PPACA thrown out legislatively or by judicial fiat is to also return us to a health-care system that has previously been declared beyond fail-safe. That would only also add fuel to the present state of the economy---recently, the CBO has preliminarily figured that throwing out PPACA will add $230B to the federal deficit and, after 2019, another 0.5% of GDP to it.
Now is most definitely the time to make health care a right for all, and affordable at the same time. Kotlikoff makes suggestions in his article to do the latter; I have made mine known in the past, as has countless other knowledgeable folks. One of them should not be to start over from scratch. If history is any guide, that will take decades to do -- our country cannot afford that. So, to all who recall Mark Twain's comment on his own premature demise, the death of PPACA should be viewed through the same lens.
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