Afraid of healthcare legislation?

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By Consumers Union on Wednesday, January 13th, 2010

By Steven Findlay, Consumers Union, Washington DC (published in USA Today, 1/13/2010)

Polls show that about half the country is still opposed to or skeptical of the health reform legislation entering the endgame in Congress. This could threaten final passage or undermine sustained support if the legislation becomes law. Those of us fighting for passage must face this fact and do a better job of convincing you doubters that the bill is, on balance, worth it.

Here’s my shot at that, focused on the biggest and most persistent fears.

First, it’s not a government takeover of healthcare. Yes, the legislation expands Medicaid, and new rules and regulations will affect insurers. But by and large, it not only preserves but also strengthens the private health sector by funneling millions of people and about $430 billion over the first 10 years to private insurers. Those insurers, in turn, pay private hospitals, doctors, drug companies and pharmacies.

At the same time, the existing private system where most people get coverage at work is preserved, with a few new rules. And new shopping marts for health insurance are created; in them, people who do not have access to job-based coverage can choose among a range of mostly private plans and policies.

Second, it’s highly unlikely (but not impossible, I admit) that your existing coverage is going to cost more under this legislation than it would otherwise over the next 10 years. The annual average cost of family coverage more than doubled between 1999 and 2009, from $5,800 to $13,400. And it’s on course to double again by 2019. The bill takes dozens of initial steps to help lower medical costs so premiums can follow.

Does it do enough on cost control? We’ll see. But tracking on that front will be meticulous in coming years. The bills require that, and the health industry knows it’ll be watched more closely than ever. If the rate of increase in costs doesn’t start to come down based on what’s in the bill, Congress will have no choice but to get tougher. That’s because sometime between 2016 and 2020, health costs become the major force driving the long-term deficit and national debt.

Remember, it’s a delicate balance. You can’t ask for a mostly private, for-profit health system without government price controls and then complain that the bill doesn’t do enough to control costs. The bill threads the needle, testing many new ways to prod doctors and hospitals to become more efficient and paying them on the basis of the quality of care they deliver, not just the quantity.

Third and related, the legislation is not going to bust the budget. You’ve heard the refrain: “It costs a trillion dollars!” Three points: (a) Even if the official estimators in Congress are off by 10%, the revenue sources being proposed would cover the $871 billion to $1 trillion cost over 10 years; (b) that trillion dollar expense is cited out of context. We’ll spend as a nation a projected $35 trillion on healthcare from 2010 through 2019. One trillion adds 3% to that. And the non-partisan number crunchers at the federal Centers for Medicare & Medicaid Services estimated last week that the legislation would actually increase national health spending over the next decade by just 0.6% because it reduces wasteful spending, mostly in Medicare.

And (c): 90% of the $1 trillion is allocated to expanding Medicaid and directly helping people buy private insurance. It’s not money for new bureaucracies and regulations, or to bail out businesses. It’s your tax dollars being used to help 30 million to 36 million Americans (and you could be one someday) get the security that health insurance provides.

Fourth, Medicare is not being sacrificed on the altar of coverage expansions for the under-65 folks. And the program is most certainly not being “cut.” If the legislation becomes law, Medicare spending will still rise from an estimated $517 billion in 2010 to $896 billion in 2019.

Yes, that’ll be an estimated 10% less than if the legislation does not become law. But this is not a gutting of Medicare. It is the government taking the lead in a public insurance program whose costs are rising too fast and where an estimated 20% of expenditures are wasted on inefficient or ineffective medical services.

After more than 60 years of failed attempts, the U.S. is poised at last to join the community of industrialized nations that offer its citizens guaranteed access to health insurance. The United States is the only nation that does not. This is beyond shameful for the wealthiest country on earth.

As imperfect as this legislation may be, is waiting 15 more years to tackle this problem really an option? Will we fiddle as Rome burns? Fear of health reform legislation’s unintended consequences is understandable. But make no mistake, failure to pass it carries far greater risks.

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