Tuesday, September 21, 2010

Health Care Reform's Six Month Mark

As we mark six months since the Patient Protection and Affordable Care Act (the health care reform law derided by its opponents as "Obamacare") I think is is reasonable to review the problems the law was intended to fix as well as honestly assessing support for the law's reforms. 

At this six month mark, the following changes will go into effect: insurance companies will no longer be able to set lifetime limits on your health benefits, and adult children up to age 26 will be able to stay on parents' insurance policies (so long as the coverage is paid for by the family in some way, of course).   For any new insurance plans or plans that change enough that they are no longer considered "grandfathered" (and therefore exempt for now), there are additional benefits: preventive services such as cholesterol checks and breast cancer screenings will be be available without deductibles or co-pays, recommended vaccines will be provided at no-cost, and patients can see obstetricians and pediatricians (when applicable) without needing referrals.  At the same time, small businesses with 25 or fewer full-time employees who earn an average yearly salary of $50,000 will qualify for a tax credit up to 35% of the cost of premiums in order to encourage small businesses to provide health insurance to their employees. 

Insurance companies also face new regulations affecting how they can operate: new policies for children up to age 19 cannot be denied coverage for pre-existing conditions, and the heinous practice of rescissions (canceling coverage once a policy-holder got sick) will be ended except for cases of fraud. 

Medicare benefits will NOT be affected, despite what the plan's opponents claim.  Meanwhile, the law has already started working on reducing the harm imposed by Medicare Part D's "doughnut hole" in providing drug coverage.

Opponents of the law imply that these changes, and the entire law, are deeply unpopular among the public.  This is contradicted by poll indicating that more than 70% of the public support the guaranteed issue of policies for children, tax credits to small businesses and the provision of preventive services without cost-sharing; more than 60% support prohibiting rescissions except in the case of fraud and closing the Medicare Part D "doughnut hole"; and more than 50% support eliminating the lifetime caps on benefits and extending dependent coverage until age 26.  This clearly indicates public support for this law's reforms so long as the public is not manipulated by those decrying it as "Obamacare" while misrepresenting the law's benefits and inventing supposed harms.

Meanwhile, a recent study highlighted the nature of the uninsured in the US.  The number of the uninsured reached 50 million people--approximately 1/6 of the nation's population.  Most of these people are low- or moderate-income and would struggle to pay for a premium without employer contributions.  More than 3/4 of the uninsured are in a working family, and approximately 1/4 of uninsured adults defer care (including preventive care and care for major health problems) because of cost.  When the uninsured access care, they face higher costs than insured people and the bills can escalate rapidly.  These issues are at the heart of why the Affordable Care Act was enacted: providing care to Americans who need it stands to provide significant benefits to those who most need it.

So, six months and and now the real changes begin.  The law will still have opponents, but I hope that we can recognize the falsehoods they put forward.  This law is not a socialist take-over, it is not government-run medicine, and its reforms are not unpopular when the political vitriol is stripped away.  This is a good law, making sensible changes and enacting meaningful reform.  Do not let anyone convince you otherwise.


Xris Roberts said...

They simply could not charge more than what could reasonably be collected. It is govt regulation, insurance companies, and frivolous law suits, that have helped to drive prices up, not doctors.

mark said...


As much as I would like to absolve us of the blame, I think doctors (and the health care system overall) have had a big role in driving up costs.

Our current system reimburses us for the amount of care we provide, not for the type of care we provide. The more people we see, the more tests we order, the more money changes hands. Add to that the fact that face-to-face visits are undervalued in our current payment system and you have multiple incentives for doctors to provide ever more care. The use of high tech equipment and tests (MRIs, surgical robots, etc) raises costs even further, despite the fact that many of these technologies are used in ways that do not necessarily provide any better outcomes for patients. 15-minute appointment schedules push us to work ever faster, and it is quicker to send patients for a test than to spend 30 minutes on a thorough history and physical exam. Patients expect use to use the newest, fanciest technology. As a result, physicians definitely help push up health care costs.

I do think that insurance has raised costs, Frivolous lawsuits might have raised some costs, but I have seen mixed reports regarding how much of a difference they made and whether tort reform will do much to reduce costs. Government regulation may have raised costs, but I'm not sure how much--remember that Medicare is the most cost-effective insurance around.

There is plenty of blame to go around. Doctors need to be accountable for our share of it. If we work to reduce the use of costly but unproven technology, and if our health care payment system actually valued patient-centered care, then we could also be part of the solution.