Like much of the opposition to health care reform, Abby Wisse Schachter’s Dec. 23 article “Ready to cheer for Obamacare? Not so fast,” offers fictional statistics to support sarcasm and scare tactics in the guise of analysis.
For example, she cites an unspecified writing by Katrina Anderson for statistics about the cost of health care reform to Pennsylvania. In fact, the numbers referenced by Katrina Anderson and repeated in last week’s column appear to have been taken from a study prepared for the conservative/libertarian “Commonwealth Foundation” that was released Aug. 19. On Aug. 19, there were still numerous versions of health care reform under consideration by Congress. Unless the authors of the study had a crystal ball that could predict the final content of complex and uncertain legislation, the cited numbers are meaningless. On the other hand, those numbers reflect a tactic that has become all too commonplace in supposed political analysis: Make up a number and repeat it enough times to convince people to believe it.
Likewise, other than wishful thinking, there is utterly no basis for Ms. Schachter’s argument that the health insurance mandate, which is essential for any meaningful reform, “may be unconstitutional.” Auto insurance has been mandated for decades and a mandate for health insurance raises no new constitutional issues.
We have no crystal ball, and health care reform will doubtless give rise to new problems providing grist for political rhetoric and fear mongering. On the other hand, we have a pretty good rear view mirror, and it shows we are losing ground. Our present mode of paying for health care is a product of circumstance, not of rational plans, and it is long past due for reform.
There is no doubt that politics is a dirty business, and for the past 60 years no issue has brought out more dirt than health care reform. Since the 1930s, supporters of reform have routinely been labeled Marxists, socialists, communists etc., while the private insurance market has become an increasingly unreliable means for obtaining health care security or containing costs. We now pay nearly twice as much of GDP as other industrialized countries for health care, without better results. Meanwhile, health insurers compete on the basis of patient selection, as profitability depends upon providing coverage only to individuals unlikely to need it. According to a Harvard Medical School study, medical costs are the leading cause of personal bankruptcy in the country, and three-fourths of medical bankruptcies are filed by individuals having health insurance. As one of the authors explained, “unless you’re a Warren Buffett or Bill Gates, you’re one illness away from financial ruin in this country.”
Despite the unambiguous evidence that our system is failing, fear mongering has proven an extraordinarily successful tactic for preserving a failing status quo. Opponents of reform, for example, can create, and cite, surveys indicating that most people are happy with their present coverage. What insurers know, but most people don’t, however, is that study after study has shown that people invariably underestimate both their own risk of suffering a debilitating injury or illness and resulting health care costs. Our brains are hardwired to believe that if things are OK today, they will continue to be OK tomorrow. We think that only others will lose their jobs and insurance coverage (and not be able to obtain new coverage because of pre-existing conditions). We think that only others will suffer from costly medical conditions that won’t be covered, and so on.
As the inevitable result of politics, health care reform will not be perfect or anywhere close. On the other hand, the Senate bill includes funding for programs that have been shown to reduce costs, such as new payment methods and dispute resolution programs. In addition, the Senate bill makes essential changes to the nature of competition in insurance markets. By prohibiting insurers from denying coverage based on pre-existing conditions and from dropping coverage in the face of serious medical issues, health care reform will require insurances to compete on the basis of efficiency and customer service, rather than exclusion of risky individuals. At its core, the purpose of insurance is to spread risk to avoid the debilitating consequences of a serious injury or loss. Our present system of health insurance has promoted the opposite.
So, to answer Ms. Schachter’s question, I will cheer for health care reform. Notwithstanding disgusting political deals and disgraceful politicians who appear to have been bought by industry benefactors (e.g., Sen. Joseph Lieberman), the likely reforms reduce what should be a national disgrace — the insecurity of health care for even those with health insurance — and offers at least some hope that the ever-expanding costs of health care will not bankrupt the country before my kids are grown.
(Gary L. Kaplan, a Pittsburgh attorney and mediator, teaches health law at Carnegie Mellon University.)