Congress has prescribed aspirin for the treatment of cancer. Decades of experience have shown that private health insurers can neither control costs, nor provide American families with the coverage they need. Yet the law leaves private insurers at the center of the health care system. It's quite true that the system was tweaked rather than overhauled. But aren't there positive points in the reform, like no more excluding pre-existing conditions and millions more individuals who will now have health insurance?
The ban on pre-existing condition exclusions (which goes into effect in 2014) will be very useful for the 3% of Americans who purchase private health insurance in the individual market, that is, those who are under 65 and not part of an job-based group. Unfortunately, even this ban is full of loopholes: for instance, people over the age of 55 can be charged 3 times more than young adults.
Perhaps the best aspect of the bill is the expansion of Medicaid to 16 million Americans with incomes up to 138% of poverty. However, if middle-class Americans want to tax themselves to fund health care for the poor, (and I think we should) we could have passed the Medicaid expansions on their own, without the other parts of the bill such as the $447 billion dollars in taxpayer subsidies to the private insurance industry.
The Massachusetts law has helped some people and hurt some others in the state. What is clear is that Massachusetts' reform is no solution. In the first two years after the reforms' passage, Massachusetts's health care costs rose by 15% (according to our Attorney General), much faster than cost increases nationally. Surveys find that many people in the state still go without needed health care because they cannot afford it.
So, according to your press release, you are not confident that costs will be contained. Is that inherent in any money-driven system or is it the manipulations of the insurance companies themselves? Can you talk about this a bit?
Let's be clear. There is nothing in the law that has been proven to reduce health costs.
Profit-seeking corporations raise costs in two ways. First, the insurance industry generates tremendous administrative costs. To society, those costs are waste; to them it is their business. The private insurance industry adds no value to health care yet consumes, on average 14% of premium. In the case of the leading insurers, they consume up to 22% of premium for their paperwork and profit. Second, a profit-driven system undermines real health planning, i.e. making sure health resources are there where they are needed, and not duplicated where they are redundant, unnecessary, or even harmful.
Well, we've definitely left the foxes in charge of the hen house. There seems to be a disconnect between what the people want and what the politicians are willing to fight for. Especially with the Supreme Court decision that unleashed corporate campaign donations, how do the people get what they want and deserve?
We need to build a movement demanding a reform based on improving and expanding Medicare to cover all Americans.
Corporate control of Washington is a major barrier to progress, not just for health care, but for bank regulation, the environment and most of the really important issues we face as a nation. The private insurance industry donated tens of millions of dollars to the Obama Democrats, then donated tens of millions more to the Republican opposition. The framework on which the law was built (the so-called Baucus Framework for the Senate Finance Committee) was written by Liz Fowler, whose previous job was as vice-president of Wellpoint, the nation's largest private insurance company. The insurance and pharmaceutical hijacked the health reform process.
But in the end, we can throw politicians out of office; we have the power to hold their feet to the fire and make them put the health of the American people above the interests of the insurance and drug industries.
It's getting harder and harder to hold politicians accountable. That infamous Supreme Court decision is no help, to say the least. And complacency among legislators - now that something, anything has been passed - won't help either. In September, the Harvard study you directed released its findings that 45,000 Americans die every year because of our health care system. How will that change under the new legislation? Surely, there will be a big improvement, or at least some improvement.
The most literal interpretation of our study on deaths due to lack of insurance is that for every 1 million uninsured people, there are approximately 1,000 premature deaths annually. According to the Congressional Budget Office, the new law will leave 23 million Americans uninsured in 2019, so we can expect about 23,000 premature deaths due to lack of health insurance in that year. To me as a physician, this is unacceptable.
23,000 premature deaths each year are, indeed, a bitter pill to swallow. You prefer the single-payer system. How do we get there, given the political climate where even something moderate, at best, is smeared by the right as "socialism"? What strategy does PNHP have up its sleeve to move things toward expanded Medicare for all Americans?
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