Since Wednesday, I have asked folks to chime in with their thoughts on the content of Obama’s health reform press conference. I have received just a handful of comments, mostly tangential to the actual presser, but relevant nonetheless. The comments I got serve two purposes: First, they provide evidence in direct support of Wright’s Law of the E-Death Spiral, which I wrote about earlier. Second, they shed some light on the very common fears many Americans have about health reform and allow me the opportunity to allay these concerns by clarifying some of the more widely held misunderstandings. This is the first in a two-part series.
Fear # 1 – The Public Insurance Option is the Only Option
As I wrote in my “Lies, Damned Lies, and Scare Tactics” post, misinformation regarding the future of private health insurance is being widely circulated online. In fact, many sources claim that private health insurance will be no more—made illegal—in the wake of health reform. My own analysis of the actual text of the House bill finds this completely untrue. Still, an anonymous comment I received reads:
No, it doesn’t say “illegal.” But the lack of choice comes from if you do not have a provider the year this goes into effect, you WILL HAVE the public ins[urance]. Where’s the choice in that? And forget about changing anything in your current policy. You are stuck with that coverage you have on day 1 of year 1 of this plan.
Facts: Having a “provider” is not the issue. Having an insurer is. The legislation, as written, would let you keep your current coverage if you wish, and your current policy could be changed, it just couldn’t be changed in ways that would harm you. That is, your private insurer couldn’t suddenly start cutting benefits and jacking up premiums. If, on the other hand, they decided to become more generous, nothing in the legislation would prevent them from doing so. Put simply, these are consumer protections for the good of the public. The strong opposition here comes from insurers whose ability to earn outrageous profits is being handcuffed.
While there is talk of a personal insurance mandate, nothing requires that you “WILL HAVE the public insurance.” Private insurers must simply participate in the health insurance exchange, which again is a way to make insurers compete with each other on the basis of price and quality (i.e., scope of benefits), which will again benefit the consumer by making insurers more transparent.
Fear # 2 – Government is Going to Start Playing Doctor & Denying Care
There seems to be a very strong sense that government involvement in health care means long waits, rationing, denied benefits, and poorer quality. An anonymous poster writes:
In the press conf last night he said the American people will no longer pay for tests that do not make us better. Since when does a test make us better? The test provides the info needed to take a course of action to make us better. How are we going to know what to do to make us better if we can’t have the tests!!? Yes, they may be costly, but is our lives not worth it? Well some of us may not be, but the govt will decide that issue as well…Why do we need MORE govt in our lives? What does the govt know about my health and what I need? Since when can the govt do a better job than my doctor? Where’s their Medical Degrees?
And from Joel:
Anyone that’s ever spent time at the DMV has a pretty good idea of what state provided healthcare will be like. Or if you’re really curious, ask a Canadian.
Facts: First of all, the Canadian system is single-payer, but that’s not “state provided.” All of the healthcare delivery in Canada is delivered by private providers just like it is here in the U.S. Second, absolutely no one in government is talking about playing the role of doctor. A system like the National Health Service in England, where the government owns the hospitals and employs all of the providers, is not even up for discussion.
What is being talked about is comparative effectiveness research, which involves using empirical data to make sure Americans have access to the best care, which may or may not necessarily be the most expensive care. In all other areas of our lives, we expect to get what we pay for. Why should medicine be any different? It should also be noted that “government” is not going to be deciding what benefits to offer. As Obama noted, there would be an independent commission made up of physicians and consumers that would make those decisions. In other words, you have doctors playing the role of doctor.
The other point made was about the need for care coordination, which includes such things as using electronic medical records to avoid multiple providers running duplicative tests. I’d think people would support that unless they’re just partial to being stuck with needles.
Stay tuned for Part II, and if you have other fears or concerns, let me know, and I’ll do my best to help you get a good night’s sleep….