As speculation explodes about what the GOP and the president-elect will or won’t do with the Affordable Health Care Act (aka Obamacare), Medicare, and Medicaid, skeptical citizens would be well-served to learn as much as they can about critical policy concerns. Ask tough questions and be wary of counterfactual contentions. Here are a few prime subjects:
Debunking so-called ‘tort reform’
- A tip of the hat to the Center for Justice and Democracy at New York University for providing research that debunks what may be a component of the multi-pronged attack on Obamacare: the falsehood that one way to contain rising medical costs is to enact so-called “tort reforms,” especially those that target medical malpractice lawsuits. I’ve written about this canard. These bad policy measures: strip patients of invaluable rights to sue; impose arbitrary, cruel, and unsupported caps on what they can recover from doctors and hospitals that harm them significantly; and fail to curb rising medical costs, no matter how partisans shill to sell them. The center’s new research points out that insurers play a huge role in creating malpractice liability crises. Although they blame malpractice lawsuits for driving up coverage costs and causing physicians to practice “defensive” over-testing and other negative medical practices, insurers, the center’s research shows, actually are at the root of many cost explosions due to their own avaricious practices. That’s because insurers rely on market investments to pump up their premium and capital reserve revenues. They have sent coverage costs skyrocketing in good times and bad to ensure they have money to invest and profit more with Wall Street, or to supplement their reserves when their stock losses mount. Meantime, medical malpractice claims and premiums are at historic lows—certainly nowhere near levels to justify hype about how the health care system would benefit from so-called tort reforms.
- Obamacare has affected all health insurance: It has forced large employers to cover their full-time workers, and it eliminated insurers’ sweeping coverage exceptions for those with preexisting conditions. It barred insurers from charging women more than men, and provided preventive screenings and treatments for women. It prohibited insurers from setting yearly or lifetime dollar limits on essential benefits. It expanded Medicaid health care for the poor, where, after a U.S. Supreme Court ruling, states agreed to join the expansion. It has slashed the number of uninsured Americans to record lows, helping tens of millions to get health coverage, partly by sparking the creation of insurance exchanges and subsidies to those who need and qualify for them. It is not causing Medicare to go broke—and widespread dislike or mistrust of Obamacare isn’t a reason in itself to attack one of the key ways that older Americans get health coverage, shifting it so it becomes what critics have called a privatized and “voucher-ized” program. Obamacare also is not jacking up the costs of employer-sponsored health coverage, just the opposite. The preponderance of Americans get their health insurance at work, not under Obamacare and its insurance exchanges. In most states, premium growth in employer provided insurance has slowed for the last five years, as did the amounts that workers contributed to the costs of their health plans. But employers also have shifted more costs to workers, especially by creating incentives for them to take high-deductible coverage that lowers their monthly payments but leaves them with big bills to pay out of pocket. (I’ve written about this issue). A lack of wage gains and economic growth in select states, particularly in the South and Southwest, have fueled antipathy toward U.S. health care. Partisans have successfully targeted this anger at Obamacare, but the facts don’t mesh with the anger.
The sick, poor, and the safety net
- The sick and the poor aren’t going away, no matter how much partisans attack safety net programs in health care. Even the harshest health care critics, and the most outspoken opponents of government, aren’t for now floating the harsh notion of repealing federal laws that require hospitals and other caregivers to provide emergency medical care almost without exception. But where will poor, ailing children, the feeble old, and single moms—to name a few groups of people—magically go for treatment, particularly if they are uninsured, can’t afford basics much less health services, and the nation rolls back not only Obamacare but also Medicaid, as the GOP has proclaimed it will do? So-called “populist” politicos blithely assert that they will retain Obamacare’s popular features, while gutting it as they have wanted to do for almost a decade now. Pragmatists point out just how difficult this will be, even illustrating key reasons why in cartoon form or in clarifying information graphics to assist the reality-challenged (see above —with all credit and thanks to Vox and Modern Health Care for their excellent work). Besides the harms to patients, hostile and hasty changes to American health care could create huge disturbance in a big sector of the U.S. economy, which now comprises 17.5% of the nation’s GDP. It could cause fiscal chaos in state government budgets.
What about payment innovations and quality measures?
- Obamacare also sparked innovations in health care, and what will happen with these if it is repealed? How would these be replaced? What incentives will there be, for example, for providers to unhook themselves from their cost-busting practices of charging fees for individual services, as opposed to bundled medical payments? For example, instead of charging one price for everything connected with a hip replacement surgery, will U.S. health care revert to trying to up-charge for every associated test, procedure, exam and etc for such operations? What will happen to all the pushes and prods to doctors, labs, and hospitals to improve the quality of their work and care, especially because their reimbursements were tied to the them under Obamacare?
Stay tuned. A massive failure in the election process the American people just put themselves through was that the major parties and candidates, as well as the media, generated enormous heat but little light about the plans, policies, and practices that will affect our lives, finances, health, and well-being. If anyone wasn’t paying attention before to critical issues, the time is long past due. So, too, is it time now to bring a screeching halt to “truth decay,” especially when it comes to our health.