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Steve Heilig

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Health Care Reform: Sorting Out the Scaremongers

Posted: 03/26/2012 5:01 pm

The Patient Protection and Affordable Care Act, aka healthcare reform, is now two years old, and still an infant. As noted by the local Public Health Institute, a very respective advocate for better health, this 'infant' is thriving, to the benefit of many people thus far:

"Because of the Affordable Care Act:

  • 2.5 million young adults under the age of 26 have health insurance because they could stay on their parents' plan.
  • 105 million Americans no longer have lifetime dollar limits on their coverage.
  • More than 17.6 million children with pre-existing conditions can no longer be denied coverage.
  • Insurers now must cover a range of evidence-based preventive health services without charging co-pays or deductibles."

Yet as everybody should know by now, the ACA is under severe attack, with one result being historic Supreme Court hearings next week that will determine its future.

My own newspaper, the San Francisco Chronicle, recently and I think lamentably, published an attack on national health reform by the local "Pacific Research Institute" (quotes added as they are not really any such thing). As the New York Times put it, with the Supreme Court taking up the future of ACA, it's open season from all sides.

The unfortunate aspect of this local article is not only that the PRI is really just a corporate lobby, but that there are so many expert, objective authors, including local ones, who could have filled that limited print space with much more, er, fair and balanced factual information. Instead, the PRI piece presents biased, silly propaganda. Their "research" has no credibility in qualified health policy circles -- it doesn't even register. It's easy to see why they favor the status quo, for as one online comment put it nicely:

Bear in mind that the Pacific Research Institute is an industry front group that used to shill for the tobacco companies and is now doing the same for the insurance, energy, and pharmaceutical industries. Funding comes from PhRMA, Pfizer, Lilly, and various right wing sources, including the Schaife family and (surprise!) both the Koch Brothers. Not mentioned in the article: health insurance companies skim 15 to 20 cents of each healthcare dollar before anything is paid to actual healthcare providers.

Well said; groups like the American Enterprise Institute, the Competitive Enterprise Institute, the Cato Institute, the PRI, and many others, like the tobacco industry-funded "Tobacco Institute" years ago, are just modern corporate twists on the world's oldest profession. Newspapers who run their propaganda should at least benefit by charging them for the privilege, as they are simply advertisers, once removed from their "clients."

The current barrage of anti-reform articles and op-eds are all part of a well-funded ongoing partisan attack on health reform; as noted this week in the Los Angeles Times, critics of the overhaul have outspent supporters by about three-to-one on advertising related to the reform law in the two years since the law was enacted; 410 advertisers have spent $204 million to air 1,018 advertisements critical of the health reform law, while 48 advertisers have spent $58 million on 90 positive ads. Thus, it's hardly surprising that support for the ACA has stagnated over the two years since adoption.

Nobel prize-winning economist and New York Times columnist Paul Krugman this week, after reviewing what is really known about the ACA thus far, concluded "Given this evidence, what's a virulent opponent of reform to do? The answer is, make stuff up."

But enough about propaganda. What's a concerned reader who wants real information to do?

For a quick summary of the legal questions to be addressed by the Supreme Court next week, see, click here.

For key components of the ACA itself, click here.

For an explication of how "patient-centered" focus and quality incentives are central to the ACA, by a longtime expert, click here.

For ongoing true expertise in depth on all manner of health policy issues, lately of course with a focus on health reform, the New England Journal of Medicine's health policy section sets a standard.

For an insightful look at two long-term pioneers in exposing commercialism in the American health system and trying to do something about that, see this new piece on Arnold Relman MD and Marcia Angel MD (both former editors of the New England Journal of Medicine. A briefer video interview with them is here.)

For Krugman's most recent take on this topic, titled "Hurray for Health Reform," click here.

A few observations:

1. For most of us, the main message regarding current reform at this point is still "wait and see." The reforms contained in the ACA are really just underway, with some positive patient benefits and protections already implemented, and much more coming. Much of this was going to have to occur anyway -- and still will, regardless of how the Supreme Court rules on the mandate for coverage and other aspects of the ACA. Having heard high-level consultants telling hospitals, doctors, and health systems how to survive and even prosper with the new reforms, I can say that many people are working very hard at making this work for everybody. It's setting up a more competitive field, based on both quality and cost, such has not existed before. There will be winners and loser, as always. One big question, the biggest for many, is that it's far too soon to know if all this will translate into cost savings -- but compared to the status quo projections, that is very possible. But that might require some other tough medicine, including reducing a lot of waste, improving how we deal with end-of-life care, cutting administrative costs, and taxing the external costs of health-damaging products like alcohol, tobacco, and sugar, as I noted here.

2. If somebody calls the ACA "Obamacare," that almost always means they don't like it -- or Obama, for that matter. And they are not likely to be objective. Likewise, if they say the ACA has had all sorts of negative impacts already, they are jiving -- that's too soon to know, too. Yes, health care providers, businesses, and insurers are confused about the new rules and regulations rolling out -- but that was already true, and things like rate controls on insurers seem to be popular with just about everybody other than the insurers themselves (and, again, their front groups).

2. I think anybody knowledgeable must admit that, for all its length and detail, there are some serious unknowns regarding the eventual impact of the ACA. One serious concern is how all the millions of newly-covered people will access care given that we have a large and growing shortage of primary care physicians (something the "market" for specialties continues to make worse). But as Krugman notes, "The perfect is the enemy of the good." The ACA was hashed out via lobbying and politics and could have been a lot better, and probably simpler. But too many critiques of it seem to assume that the status quo is good, and there is massive evidence that it is not, from your local hospital to your local health department to the loftiest policy wonks. We pay more than any other nation for worse outcomes overall. And many people suffer for that. So any reform must be measured against the status quo, not some pipe dream of a "free market" -- which has never existed in healthcare anyway.

3. The "good old days" weren't. The health of Americans and access to care was much worse before Medicare and Medicaid were instituted in the 1960s, and don't let any (affluent) historical revisionists tell you otherwise.

4. If you have insurance now, and like it, chances are very good, like 95 percent, that you won't notice health reform at all, other than in new clinical guidelines for prevention and such, most of which have been recommended for years. Much of the opposition to the ACA, again, fueled by intentional scaremongering, comes from frightened Medicare patients who have been told they will lose insurance, or benefits. Not true.

5. This week, veteran health policy guru Stuart Altman, a health official under Nixon, Reagan, Clinton, Bush #1, and Obama, spoke at the University of California, San Francisco medical center about the history of efforts to improve health access and quality in America. He knows this field firsthand. Such distinguished professors tend to be circumspect about their feelings, and choose their words carefully, even blandly. But here's what Altman said about the "PR wars" regarding reform now underway: "When I read and hear all the accusations of this current attempt at reform being 'socialism' or a "government takeover' I can't help but be a little sick to my stomach," he said. "Those of us who have worked and lived with these issues for decades just wonder "What are they talking about?' This is an incremental attempt; it's not a revolution, it's just evolution."

But we know how some people nowadays are even opposed to that.