Thursday, March 22, 2012

Charm and Harm of the Health Reform Law

There is no charm equal to the tenderness of heart.

Jane Austin (1775-1817), Emma

As to diseases, make a habit of two things-to help, or at least, to do no harm.

Hippocrates (460-377 BC), Epidemics

March 22, 2012 - Tomorrow is the 2nd anniversary of the Affordable Care Act (ACA). This is a good time to analyze its charm and its harm.

Brace yourself. You are going to hear a lot about the law’s charm by government officials. Critics will cite the harm of its intertwined proposals. It’s a massive sprawling law with plenty of cannon fodder and food for thought for both sides.

Tomorrow’s “celebration” and “condemnation,” depending on your point of view, will pit positive spin against negative spin. The spin will carry over until March 26, when the Supreme Court begins its six hours of hearings on the health law. The length of these hearings is unprecedented in the history of the Court. The hearings and speculation about their outcome will be the talk of the town from now to late June, when the decision will be announced.

The Charm of the Law

For progressives, the law’s charm is undeniable. It shows the tenderheartedness of government. The message goes: Trust your government. It will protect you against all eventualities. Its leader, President Obama, is undeniably a charmer. Personal charm is his most endearing, enduring , and, perhaps, his winning trait.

Some say the health reform law is the work of dreamy “bleeding heart” liberals. I do not agree. It is the work of stout-hearted pragmatic charmers. They see it as a sure path to political power. This is especially true when one can make more citizens dependent on government than not, and when one can define, dictate, measure, and enforce the rules of patient-doctor engagement and payment.

The health law offers concrete provisions that will protect certain segments of the population against the slings and arrows of disease and economic misfortune and makes them dependent on government.

The uninsured, These include 32 million who will now qualify for Medicaid. It may also include an estimated 5 million to 20 million more as employers drop coverage due to the expense of meeting the conditions of government-regulated plans. These formerly insured people may land in Medicaid.

Those with pre-existing illness – 129 million Americans have at least one disease. Government estimates 50,000 Americans will sign up for plans covering pre-existing illness, although only 20,000 have so far.

• Seniors falling into the “doughnut hole.” These individuals are unable to afford the cost of brand name drugs and have reached a certain threshold of expense They number perhaps 3-5 million out of 45 million Medicare recipients.

Seniors who want to take advantage of “free” preventive screening tests - The precise number desiring to do so is not known, although 5.5 million is one government estimate.

Young adults up to age 26 who will now be covered under their parents’ plans. The government puts the number of young people affected at 2. 5 million.

All told, as of now and by 2014, as many as 50 million Americans may directly benefit from the Affordable Care Act. The exact number is evolving and will depend on the success of government marketing of the health reform act, the number of people who become aware of its benefits, the bureaucratic complexities of qualifying for its provisions, and, ultimately, on trust of people in their government and quality and convenience of the benefits.

I have seen estimates of as many as 100 million on Medicaid and 70 million on Medicare by 2020. This means, I suppose , that we could then make a Declaration of Dependence and abandon the Declaration of Independence.

So far, the health law shows no sign of delivering on its three major promises: 1) to provide health insurance coverage for all Americans ( the Congessional business office says 27 million Americans will remain uninsured in 2022); 2) to redue costs for individuals, businesses, and government (the converse seems to be true); 3) to increase quality and value for each government dollar spent (this is very much in doubt, but it's still early).

The Harm of the Law

Conservative and independent critics have their lists of potential harm of the ACA. Some of this harm is theoretical and imagined, such as loss of individual freedom and bureaucratic malfeasance, and some parts of it real, such as soaring costs and losing one’s health plan.

These “harms” include:

Loss of health insurance by employed Americans, due to uncertainty of employers, who are fearful of costs of government regulated plans. Estimates of these victims of health reform vary from 5 million to 80 million, with most projections in the 20 million range.

Loss of control to federal bureaucrats in 159 new ACA agencies and boards in Washington, D.C. This may be more of an emotional rather than a real threat.

Physician shortages, now pegged at 50,000 by most, but some project 160,000 more physicians will be needed when the 32 million new Medicaid and 78 million Medicare-eligible baby boomers hit the entitlement streets..

Long waiting lines to see, or even to find, a doctor, already the case in Massachusetts, which ironically has the 2nd highest number of physicians per capita after Washington, D.C., but the nation’s longest wait times.

Increased insurance premiums, up 9% in 2010, another 9% in 2011, where it stops no one knows.

Loss of privacy. Health and Human Services has ruled that all private insurers must send their data to a central data bank in the nation’s capital – without patients’ permissions.

• Medicare cuts of $575 billion for seniors and provides to pay for the younger have-nots and uninsured joining Medicaid.

Loss of specialists in many fields secondary to systematic cuts in Medicare reimbursement.

Higher taxes on medical device makers, drug firms, and health plans which will be passed on to consumers and which may discourage innovation.

Staggering increases in the national debt. The debt now nears $16 trillion. The Office of Management and Budget has just announced the true cost of ACA will be $1.76 trillion rather than the $940 billion originally projected.

Federal rules, regulations, and protocols which will dictate what insurance to purchase, what insurance will pay for, what medical specialists will be paid, what treatments and diagnostic tests will be allowed, what tests will be permitted, who can own and operate hospitals, and what taxes will be imposed on individuals, businesses, and participants in the medical industrial complex

Tweet: The health reform law has its 2nd anniversary tomorrow; its advocates have a list of its charms. Its critics have their list of its harms.

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