Be wary of counterfactual assertions about Obamacare, Medicare, Medicaid

vox ocareAs 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.

acaObamacare, Medicaid, Medicare, and employer coverage

  • 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

What about payment innovations and quality measures?

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.

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