What the health?!?!? (Revisited)

Well, that was quite an exciting weekend to say the least! 48 NCAA tournament games and health care reform. What will this weekend bring? Forecast calls for a flurry of basketball activity ending by Sunday and continuing fronts of Republican anger. So either because I work in the healthcare industry or because I'm viewed as a super-being of awesome intellect (I'm sure it's the former but I like to pretend that it's the latter) people have been asking for my take on the newly enacted healthcare legislation. My take on it has pretty much been consistent and was well articulated by last week's Economist: it was worth passing, but only just barely.

The positives that the bill does are very real. An additional 32 million people getting insurance, an end to lifetime caps, and an end to denial due to pre-existing conditions. Now the negatives. It does pretty much nothing to bring down the skyrocketing costs of healthcare apart from the fact that providers shouldn't have to worry nearly as much about the uninsured not paying since, in theory, almost everyone will be insured. But offset that against a lot of these newly insured now consuming more health products than they did before and I'm not sure you have a gain. Then there's the suspect claim that it's going to be partially paid for by cuts in Medicare and to that I'll just say this: I'll believe it when I see it.

It also does nothing to address medical malpractice reform. In fact, probably the thing that sticks out most and the biggest overall negative are the things that this bill doesn't do. For all the fury and threats from the bill's opponents you'd think that we had just taken a bulldozer to the entire healthcare industry. But what's remarkable is that very very little has changed. The insurance industry basically just gained 32 million more members thanks to the new quasi-mandate that everyone has to buy health insurance. It's a bit of a double-edged sword though since insurers can't deny people and can no longer place lifetime caps. That makes pricing policies a great deal trickier. The hope is that the increased membership spreads the extra costs around enough to not drive up premiums. We'll see if that pans out.

And that's pretty much the extent of it. We've decided to spread out our health costs over a wider base in exchange for less people being without coverage. That's all well and good except that the health care costs, along with Social Security, are going to beyond bankrupt us and, while I don't believe that this bill hurts us in that regard, it really doesn't help us either. And given the shitstorm the country went through to get it passed it's extremely unlikely that this issue gets touched again for a long long time (with the exception that Republicans are certainly going to run on a platform to repeal it).

One long-term effect that I do see is that this in fact *could* be the beginning of the end for private insurance in this country and the first step towards single payer. Not that I think that's a bad thing, mind you (other than the unfortunate side effect of me losing gainful employment). Here's why. It has to do with the combination of insurers not being allowed to deny for a pre-existing condition and the penalty on consumers for not buying insurance. The key will be the dollar amount they put the penalty at, and the correct amount would be whatever the cheapest insurance policy is. Otherwise you've basically taken away any incentive for anyone to buy insurance. Think about it. You don't carry insurance and maybe pay out of pocket for seeing a doctor a couple times of year when you get sick (which is still much cheaper than insurance). Then something catastrophic like a heart attack happens to you. Well, you just have a family member fill out an insurance application on your way to the hospital: the insurer can't deny you for a pre-existing condition and can't charge you more for being higher risk. Then of course once you recover you instantly cancel your policy again, because why would you carry it when you can just get it again if/when you need it later? It doesn't take a whole of this happening before it quickly becomes an unprofitable model for the insurance industry. Now maybe there's something else in this bill that prevents the situation I've described from happening, but I haven't seen it. The strength of the mandate to buy insurance will be absolutely key.

Oh, and I was a bit amused when I got an e-mail from John McCain right after the legislation passed. He had this to say: "The fact remains that by a two-to-one margin, Americans do not want this bill to become law. " Boy, the Republicans and Fox News sure do love their polls lately. I remember when polls were nothing more than just, like, a puff of air. But apparently they're quite important now, since the Republicans agree with them. But probably not for long considering that now that the bill became law the opinion has changed again and is now favorable. Allow me to just state unequivocally that a poll should never be a reason to do or not do anything. It should only be used as an indicator to tell you how good of a job you're doing at getting your message out. The poll itself should not be the message. The tactic of endlessly repeating one poll that favors your position so that the next time it's taken it favors your position even more is a stupid human trick worthy of Letterman and should be treated as such.