Come on now. We’ve heard enough about the political horserace of health reform—way too much of Nancy, Max, and Olympia. No doubt we’ll be overfed on the theatrics of the coming Joe and Harry Show; but that’s not where the story is.
The real story is how reform will affect millions of people who will have to live with the financial consequences of the deals made by Baucus, Pelosi, Snowe, Lieberman, and Reid—and so far we’ve blown it. As readers of Campaign Desk know, stories about how reform affects ordinary folks have been missing since the campaign. And there’s a real danger reform will pass without families knowing what’s in store for them, financially speaking.
A recent Gallup poll shows that forty-one percent of Americans believe they will be better off after reform, while forty percent think they will be worse off. The numbers drop when pollsters ask how reform will affect their own situation. Twenty-six percent say they would be better off; thirty-six percent say they would do worse; and about one-third said reform wouldn’t make much of a difference. “Americans have moved in a more negative direction on the basic issue of whether a new bill should be passed into law,” Gallup concluded.
Those numbers are something to think about. Are people basing their opinions on good media explanatory pieces, or on rhetoric from stakeholder groups using the media as their mouthpiece? “What people want is a Consumer Reports 101—how will the bill make things better for me,” says Harvard pollster Robert Blendon. “Nobody has explained why people should be thrilled by the passage of this bill.”
For the most part, there have been few stories focusing on how much people will pay for health insurance after reform—a big concern on the mind of the electorate during the campaign. It’s affordability, stupid! But for the most part, interest groups from the White House on down haven’t been keen to address that one, because for many voters health reform won’t make premiums more affordable. It might even increase them, and few pols want to expose the emperor without any clothes.
Oregon Sen. Ron Wyden is an exception. He says “this town continues to miss what is going to be the real issue—premiums, premiums premiums.” Earlier this year, he told Congressional Quarterly that “If middle class people have to pay more than they’re paying today…I don’t think that is going to pass the smell test as being affordable.” A good story, no?
Politico journeyed into the White House’s territory last week by examining the rhetoric of the president’s campaign pledge and today’s reality, namely that the lack of serious cost controls might indeed make premiums unaffordable. It started its story this way:
Barack Obama ran for president on a promise of saving the typical family $2,500 a year in lower health care premiums. But that was then. No one in the White House is making such a pledge now.
Politico made another important point that the MSM should examine pronto—that no independent group has looked at how the bills would affect the premiums for 170 million workers with coverage from their employers. Remember, that’s the group the president said could keep what they have, since they are happy with their coverage. This is the group that is being offered policies with higher and higher deductibles and more cost-sharing.
The media have talked about affordability mostly in the context of whether the country can afford reform, not whether individuals can afford it. It’s easier for a reporter to write about humongous numbers like $900 billion or $1 trillion, and give the arguments that those sums will or won’t add to the federal deficit, than it is to spend several hours with the Joneses in Peoria finding out where in the family budget they will find $8,000 to pay for health insurance. And the advocates—reform’s uber-cheerleaders—who see victory at hand aren’t terribly eager to point out that mandatory insurance might be unaffordable after all. Making that too transparent might undermine all the work they’ve done to advance legislation this far.
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As always, readers are very much in Ms. Lieberman's debt for her sober and informed work.
#1 Posted by Norman Birnbaum, CJR on Tue 17 Nov 2009 at 12:11 PM
Here is a good case study that could be used for comparison: http://www.guardian.co.uk/lifeandstyle/2009/nov/03/brain-abscess-surgery. It's about an editor from the Guardian who wrote about his recent and sudden health emergency from a brain abscess. He is an otherwise healthy 41 yr old man who had no reason to suspect that he might experience a health crisis that would require emergency brain surgery and 5 months recovery. He describes his treatment by the British NHS, including home visits from his doctor, and his aftercare experience. He is not writing to complain or celebrate his treatment, just matter of factly describing what happened to him and that he's happy to be back at work. An American's story would likely include dramas about insurance coverage and would likely be focused on the financial catastrophe caused by treatment and losing 5 mos from the job. An upcoming beef-and-beer fundraiser would likely be a reason for an American to write about the crisis. So I would like to know how this man would experience his emergency in America under the reforms on offer.
#2 Posted by MB, CJR on Tue 17 Nov 2009 at 01:06 PM
Excellent perspective for the "common man." Now the poverty stricken who receive Medicaid will be increased by 7,000,000, placing them in competition with those already on Medicaid, who can't find a doctor to see them even now. So, if the common man suffers, the more unfortunate are merely herded into a larger stockade, that much farther from the feeding trough of actual medical care. As a newcomer to these informative articles, I may have missed a reference to William Hsiao's "First Question:" Is health care a human right? Until we answer that question in the affirmative, we will be applying bandaids at the cost of reconstructive surgery, with all the expense nd none of the results.
#3 Posted by Laurence Lewin, M.D., CJR on Tue 17 Nov 2009 at 10:51 PM
There seems to be no interest in addressing the cost curve associated with healthcare. If this was of any concern, the members of Congress would look at the idea of establishing state Medical PSC's. State Medical PSC's have the power to make healthcare affordable for the average citizen.
A Medical PSC would set the price for each Medical Charge Code used to bill insurance. Prices would be set on a fair and reasonable basis based on actual provider costs plus a reasonable mark-up (profit margin). The mark-up could be matched against the average profit margin of the state insurance companies (now about 6%). Under this arrangement, as the annual profit of the insurance companies goes down due to the over-use of medical services, the doctors mark-up (profit margin) is reduced accordingly. This ties the profitability of the medical providers to the profitability of the insurers. This "check and balance" mechanism will encourage doctors to consider the impact of how they provide services.
The state insurance commissioner can monitor the profit margins of the state healthcare insurers to ascertain adequate competition to keep profit margins reasonable.
Under a Medical PSC there is no provider network or provider service contracts. All insurers provide state-wide coverage and all providers are paid the same for identical services. State Medical PSC's will minimize healthcare costs, but keep them fair and reasonable. Then Washington can change the laws to extend healthcare and subsidize the disadvantaged. And the states via their Medical PSC's can insure that the money made available for healthcare is stretched to the limit. This is how the American healthcare system should work.
All who read this should contact their congressional representatives and demand that state Medical PSC's be considered!! This is the REAL solution to controlling costs!!
#4 Posted by Dan Smith, CJR on Thu 19 Nov 2009 at 10:16 AM