Source: The Dallas Morning News
And you thought getting Congress to pass a major health care bill was hard. The next phase involves implementing the bill, and it could prove even more difficult. Points turned to health care expert John Goodman, head of the National Center for Policy Analysis in Dallas, to discuss what's likely to happen to insurers, patients and providers. He also shares his views on the politics of this legislation, which are in play in November's elections.
You say that the White House and leaders of both parties offer little more than sound bites. Why do you think that?
There has been no real attempt by either party's leaders to explain to Americans what this bill really does. From the White House, we hear only about the benefits. You hear nothing about the costs. From the critics, you hear about the costs, but nothing about the benefits.
Let's start with the benefits. What do you see as some of them?
We will insure about 32 million more Americans. We will make it easier for people with health problems to get insurance. Millions will get more generous health insurance. And most people will get access to preventive care. They will be entitled to it with lower out-of-pocket costs.
OK, what about the costs?
This bill does not create any new doctors, nurses or paramedics, and that will be a big problem. This is what happened in Massachusetts after they passed a health bill. They cut their uninsured rate in half, but they didn't create any new doctors. Now the waiting time in Boston to see a new doctor is twice as long as that in any American city. There are more people in Massachusetts going to emergency rooms for non-emergency care than ever before.
You think this will be replicated nationally?
It will be worse. Massachusetts didn't have that many uninsured people to begin with. Across the country, the uninsured rate is higher. In Texas, about one in four people lack insurance.
But why will they end up at emergency rooms?
We won't have enough doctors. The demand for care will outstrip the ability to provide it. People will go to the emergency room as a last resort.
You've said "grandfathered-in" health plans could be few and far between. Why?
Every time they make a substantial change, they lose grandfather status. This could particularly affect small businesses. Even large companies will lose it if they create more cost-sharing. One survey shows that 90 percent of large businesses will lose their grandfathered status in the next few years.
Why is there an anxiety among some seniors?
More than half the cost of health reform is paid for through reducing payments to Medicare. Unless there is a change, Medicare payments to doctors will drop by 30 percent over the next two years. And payments to doctors and hospitals will keep falling. By the end of the next decade, Medicare fees will be lower than Medicaid fees. Right now, Medicaid recipients have a hard time finding doctors to see them. They go to community health centers and safety net hospitals. In 10 years, seniors could be in the same position.
So, which triumphs: the costs or benefits?
This is a terrible bill.
No. 1, it requires you to buy insurance whose costs are growing at twice the rate of growth of your income. It has a bizarre system of subsidies that will encourage employers not to provide insurance. It creates a health insurance exchange that will create perverse incentives for health plans to overprovide to the healthy and underprovide to the sick.
Should Congress repeal it?
Congress will open it up and reform it. It may get opened up even with Democrats in charge. A lot are bragging that they voted against the bill.
But don't we open up a big Pandora's box if some start to repeal this bill? Both parties would start shooting at each other's pet laws. When would it end?
This bill represents what happens when you only have Democratic votes. If President Barack Obama had reached across the aisle and gotten 20 to 30 Republicans, it would have been a much better bill. In order to get every last vote, the White House made ugly deals with Democrats.
But where would this stop?
One of two things will happen. Either Obama will reach out to Republicans and make a better bill. And many in the White House would like a better bill. Or he won't reach out, and we will have guerrilla warfare for two years. Republicans will try to defund and delay many things in this bill.
What happens to health care if Republicans gain control of Congress?
I would hope that everyone would recognize you can't overhaul the health care system without major buy-in from both parties.