Shoving more costs onto patients benefits the politicians and keeps the world safe for doctors, who contribute mightily to the high cost of health care through the drugs, tests, and treatments they prescribe. Those doctors also contribute mightily to politicians. With middle-class people paying some of the freight, the pols won’t have to enact real cost containment measures that would control the price of medical services through global budgets and other means, and doctors will escape from this round of reform without the fee cuts that Congress once had mandated for them. It’s a lot easier to deal with disorganized patients who may not realize what could befall them than to say ‘no’ to the docs who have given them a lot of campaign dough.

Last year The Commonwealth Fund found that some 25 million people were underinsured; that is, they spent more than 10 percent of their income on medical expenses even though they had health insurance. Underinsured families with low incomes are spending five percent of their income on out-of-pocket costs. When The Commonwealth Fund released its report last year, the press picked up the story, and, for a while, the notion of underinsurance floated around. Those stories still need to be told. And that’s especially so now that Congress seems to be willing to trade off more underinsured Americans for more insured Americans who have a policy—however skimpy it may be. It would be great if the media looked into the equities of all this.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.