Year in Review: Healthcare Reform and You

Photo: Urban News

The state of healthcare reform this season is mixed.

The good news is that, if reform is enacted along the lines of current House and Senate proposals, the number of uninsured people, including the poor and those with pre-existing conditions, will decrease. According to the Congressional Budget Office, the Senate bill would reduce the number by 31 million. Also:

•    Medicare services would be unchanged for seniors. Some younger people might be able to buy into the program.. However, federal subsidies for Medicare Advantage insurance plans might end. People with such policies could pay more for them in the future.

•    People with health insurance through their work may not experience much difference in current cost and coverage trends.

•    Modest income Americans who buy their own insurance may receive some government help with the cost.

•    Most uninsured people who don’t qualify for Medicaid will be forced to either buy private coverage or pay an income tax fine.

•    Some other people would pay more under reform as well. Depending on the bill, these may include higher income Americans who purchase their own insurance, employees with high-cost health insurance plans, individuals with adjusted incomes exceeding $500,000 per year and families with adjusted incomes in excess of $1 million per year.

We can count on the bickering herald angels of politics to sing the
praises of reform and damn it to hell throughout the holidays. No final
congressional action is likely until next year. But bill or no bill, we
needn’t sneak a peak at the gifts under the tree to know that, with
regard to run-away costs, we’re all getting lumps of coal.

Let’s look at where we are today and then focus on two consumer issues: cost and coverage.

The Current Situation

Though some assume – wrongly – that reform legislation has
already been enacted, only the House has passed a bill. Publicly the
Senate is “debating” its plan — while in the back rooms Democrats are
watering down provisions for a public insurance option in the vain hope
of finding enough votes to overcome a Republican filibuster. If the
Senate passes a bill, House and Senate leaders must merge their
different versions into a single piece of legislation that must pass
both chambers — against more watering down and filibustering.

Meanwhile, the health insurance and pharmaceutical industries
are rushing to hike prices and lock in ever-rising profits. Wholesale
prices for brand name drugs rose by 9 percent from September 2008 to
September 2009, while the Consumer Price Index actually fell.

A recent Harvard study estimated that 45,000 Americans die each
year because they lack health insurance. In the absence of effective
controls on healthcare costs, Medicare is expected to become insolvent
in 2017. By 2018, one dollar of every five spent in the United States
is projected to go for a health-related expense.

Kitchen Table Finance

Other developed countries keep expenses relatively low with
single-payer systems covering all their people. Here, single-payer was
eliminated from discussion before the debate started. Industry
interests are now working to prevent competition from any
government-sponsored insurance option. The health of Americans may lag
behind other countries, but robust corporate profits and warm hearths
seem assured whatever happens.

If reform is enacted, older and sicker Americans might pay lower
premiums. More Americans may be enrolled in Medicaid. An influx of
money from taxpayers and a new pool of young, healthy private-insurance
customers are expected to pick up the tab for the costs of insuring
people with pre-existing conditions.

An “individual mandate” requiring most people not eligible for
Medicaid or Medicare to purchase private health insurance especially
warms the heart of the insurance industry. Government subsidies would
help people and families with incomes below some multiple of the
federal poverty level. Those who don’t buy health insurance would be
fined, probably with a tax penalty. As the Urban News goes to press,
the Senate is considering allowing uninsured Americans as young as 55
to buy into Medicare. Details of proposed subsidies, fines and other
comparisons of the House and Senate bills are available at the very
informative Kaiser Family Foundation website.

The Mammogram-gate Lesson

The U.S. Preventative Services Task Force (USPSTF), in
operation for 25 years, has a solid reputation in the medical community
for scientific rigor. Last month it sparked a medical and political
furor by recommending that women under 50 without risk factors for
breast cancer shouldn’t be routinely advised to get any mammograms.

The American Cancer Society hasn’t endorsed the recommendations
and the American College of Radiology is outraged; other professional
societies are split on the subject. Errington Thompson, a surgeon and
fellow writer for the Urban News, says he believes in more screening,
not less. But, he says, “the earlier you start screening the more
likely it is that you’re going to have something found on mammography,
which will lead to a biopsy, which most likely will be negative. Once
women understand this and want to accept this risk then there should be
no argument.”

The task force doesn’t make coverage decisions for either
government or private industry payers, but conservatives immediate
demagogued the USPSTF recommendations as government healthcare
rationing. They refuse to admit that, in the real world, insurance
companies ration healthcare, because their profits increase when
coverage decreases.

On the other hand, medical providers and patients regularly ask
insurers to cover procedures that are unnecessary, needlessly
expensive, or of questionable benefit, adding up to 10 percent of all
healthcare costs, according to some estimates. Healthcare reform
legislation proposes comparative effectiveness research panels to
evaluate various treatments for diseases. Demagogues have attacked them
as “death panels.”

Here, too, as the House and Senate bills are written, the panels
have no power to enforce recommendations, let alone make decisions
about individual cases. Good healthcare needs reliable data interpreted
by competent experts with no financial interest in the outcome. In our
market-driven culture, none of this is guaranteed, or even likely.
Patients and doctors should always be on the alert.

Bottom Lines in a Reformed World

Whether or not a healthcare reform bill passes before the
end of the year, or even in this session of congress, insurance and
pharmaceutical corporations are already big winners. They’ve raised
their prices to ensure that their profits will continue, and continue
to grow, no matter what happens. It will be a sobering Christmas for
those who had visions of universal healthcare dancing in their heads.