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NAVIGATION PNHP RESOURCES
Posted on July 29, 2009

Discard this health plan

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Congress is bowing to special interests

Ray Bellamy
Tallahassee Democrat
July 29, 2009

I supported Barack Obama when he ran for president. Still do. But he made a fatal mistake allowing Congress to generate his health care reform bill. Congress invited affected industry groups to the table and excluded us regular taxpayers from the sausage-making.

Proposals were generated in the House and Senate that protect industry profits and expand their markets but soak us and future generations. The result is awful. Unsustainable, unaffordable, doomed to fail. Little or no cost-control measures and little reform. Most of the current health system’s flaws remain. Perhaps one or two minor features of the proposal are worth saving, but in general both the House and Senate proposals must be completely discarded. Let me elaborate.

I confess to not having read the more-than-1,000-page House bill or studied emerging details of what the Senate has ginned up. But I have followed the process for months with increasing alarm. Now a very worthwhile executive summary of the impact of the House bill is available (http://www.pnhp.org/news/2009/july/more_of_the_same_is_.php), “More of the Same is not Health Care Reform, It’s a Placebo” by Leonard Rodberg, a professor of urban studies in New York. If you were inclined to support this attempt to cover the health care needs of all Americans, you need to read this short explanation of why you should not.

  • The massive wasted administrative expense in the present system, estimated at 31 percent, remains intact. The journal Health Affairs published a May article estimating each physician wastes two hours a week just wrestling with the many insurers. That waste remains, perhaps increases, with Congress’ proposal.
  • No serious cost-control measures. The Med Pac feature and some effort to deal with disparity between reimbursement in Medicare between rural and urban areas are minor exceptions.
  • Employers must either provide insurance, likely to be more expensive, or pay a fee. Everyone is required to have insurance, and if your employer offers insurance you must take the plan offered unless you cannot afford it. The only access to the insurance exchange is to people who are not covered by their employer; they cannot choose the public option.
  • The public option, originally envisioned by Jacob Hatcher of Berkeley, was to cover 130 million of us at affordable rates and lead to single payer, eventually. To assuage critics’ concerns, it would now be available only to the uninsured on a limited basis, expected to cover about 10 million of us, and we are assured by Obama Health Secretary Kathleen Sibelius that the public option will not be allowed to eventuate in single payer.
  • Medicaid is to be expanded to those who earn less than 133 percent of the federal poverty level. States should take note, as Florida currently pays $17 billion as its share of Medicaid, the largest item in our state budget.
  • Subsidies to help the poor pay insurance premiums are inadequate and, although there is a mandate to purchase insurance, there are no limits on the cost of premiums or the amount of deductibles or copays or on drug prices.

The House bill is patterned after the Massachusetts Plan, which was apparently authored in large part by Blue Cross. Like all other state plans with goals to cover all their citizens, it seems to be failing in its third year because of cost overruns. Some 45,000 taxpaying Massachusetts citizens were cut from the insured rolls in the last 10 days to save $117 million in the stressed state budget. Since much of the safety net infrastructure of neighborhood health clinics has been dismantled in that state, those unfortunately dropped from coverage will have to go to the ER for care.

The proposal out of Congress does not meet Obama’s goals, which I share, of universality (at least 10 million would not be covered), does not meet the affordability goal, and does not meet the guaranteed choice goal, since employees must take the plan offered to them at work.

The scrambling about in Congress to “find some more savings” should ring alarm bells. Already, in order to gain the endorsement of the American Medical Association, a $245 billion fix of the Sustainable Growth Rate for Medicare has been promised, with the entire $245 billion not to be counted in calculations of cost for the “deficit-neutral” aspect of this plan.

(The Medicare Sustainable Growth Rate formula is an annual sticking point and has been for years, and sometimes nearly shuts down government and stops payment to MDs for a few weeks causing cash flow problems.)

It appears the pharmaceutical industry also has garnered promises that it will not be subjected to demands for volume discounts in return for nonbinding promises by Big Pharma of $80 billion in savings.

Perhaps we are faced with something akin to the situation when a massive sports stadium is being sold to taxpayers. The cost of the project is low-balled, then, when the stadium is half-built and the money has run out, the taxpayers find they must finish the project by coming up with more money or leave the unfinished stadium as an eyesore.

I agree with the Congressional Budget Office analysis that there are few cost controls and no savings in the proposal. My fellow physicians would predict massive cost increases just as in Massachusetts, and eventual failure of the plan.

I agree with Obama’s goals and with his observation that doing nothing is not an option, as we have reached a crisis in this country with unsustainable costs in health care. Let’s be honest with the American people; rationing will be necessary.

Major restructuring of our delivery system is urgently needed. However, the proposals churned out by Congress, with only affected industries providing input, are indeed only placebo. A very expensive placebo. Taxpayers deserve much better.

In my dreams, I imagine an America where politicians are immune to the need to constantly raise funds for re-election. That is not likely to happen in my lifetime. But just maybe, when legislators have tried everything else and realized that all of their proposals to “build on the present system” are unaffordable, they will reluctantly come to the realization that the only affordable and sustainable pathway to universal health coverage is a single-payer system, a variation of what almost all industrialized countries have adopted.

Cost controls, reasonable decisions about rationing, most of the money spent on health care going to help people rather than to wrestle with insurance companies, universal coverage from the day of birth, no medical bankruptcies — then we will have arrived. This would actually be the most fiscally responsible position.

Sorry, Rush and Sean Hannity, I had to say it.


ABOUT THE AUTHOR: Ray Bellamy is a physician practicing in Tallahassee. Contact him at ray.bellamy@med.fsu.edu.