Backgrounder
During the heated health reform debate, separate fact from fiction
The Detroit News, this month, published the following commentary by Herbert Smitherman, Jr., M.D.
I see the urgency for federal health care reform every day in my urban practice.
Take the case of a 29-year-old woman who was diagnosed with cervical cancer. The cancer was caught early enough to be treated with surgery, but she couldn't afford it. Her company didn't offer insurance along with her low-paying job. She couldn't afford insurance herself and made too much in income to qualify for government assistance.
Our office eventually got her the medical care she needed, but the time she needed to take off to have the surgery and recover caused her to lose her job. Now she can't afford to pay her mounting medical bills.
This story, which I see repeated in many different ways, shows that the United States provides the best medical care in the world, but has the worst way of paying for it. Unless the system is reformed, phys icians like myself and other health care providers will continue to see the numbers of such hardship cases rise. The status quo is unsustainable and unaffordable for the health and economic future of this country.
The problem is critical, and President Barack Obama's health care proposals offer a solution. But scare tactics about the reform plans are steering the country away from having a reasonable debate. Americans should let facts, not fiction, drive the discussion so we can reach a social consensus.
The United States spends $2.5 trillion per year on health care -- about 50 percent more than Europe or Canada, but with worse health care results. Despite this spending, America still has 47 million uninsured. There are 18,000 deaths each year attributed to the lack of health insurance. About 12.6 million people -- 36 percent of those who tried to buy insurance on the private market -- are denied health insurance because of pre-existing illnesses. Many denied patients have cancer.
Between 2000-07, the profits of the 10 largest U.S. health insurance companies soared 529 percent, according to Securities and Exchange Commission filings, while the number of U.S. uninsured rose 30 percent.
For those who are insured and feel that this issue does not affect them, they are terribly wrong. They pay a high price for the uninsured -- through higher premiums for employees and employers.
When the uninsured get sick or terribly ill, they end up in emergency rooms. Avoidable ER visits and hospitalizations cost the health care system 10 to 20 times more than if they would have had access to basic primary care early on. It would be less expensive to cover the uninsured -- giving them access to primary care and preventive services that are more cost-effective than hospitals and emergency rooms.
We proved this premise in a study done by the Wayne State University School of Medicine, four Detroit health systems and a federally qualified health center. The project was called the Voice of Detroit Initiative and was funded by the Kellogg Foundation. It was later published by Wayne State University Press as "Taking Care of the Uninsured: A Path to Reform."
This initiative enrolled and tracked the care of 33,000 people who were without health insurance over five years. The college was able to transition 55 percent of the patients out of preventable ER and hospitalizations visits into affordable primary care medical home settings. The result was a 42 percent savings in overall care.
The initiative achieved these savings by expanding primary care capacity and reorganizing the delivery system, better aligning health care services to the patient's immediate clinical needs. In other words, we got the patient to the right place at the right time for the right level of care.
Massachusetts has learned this same lesson as a result of its mandate to provide universal insurance coverage to about 439,000 additional Bay State residents. Since its law went into effect in 2006, however, the costs in Massachusetts are 33 percent higher than national average and growing faster than the rest of the country.
The reason is that although people now have an insurance card, there are not enough primary care doctors to absorb 439,000 newly insured people. So the new patients are ending up in high-cost settings such as ERs and hospitals. What we learned from the Massachusetts plan is that covering everyone without fixing the delivery system and expanding primary care capacity leads to higher health care costs.
The current House legislation, HR 3200, sponsored by U.S. Rep. John Dingell, D-Dearborn, is a step in the right direction to fixing this situation. It builds on the current system and doesn't change what works, including leaving the private insurance market in place. It keeps Medicare intact, covers all Americans and expands Medicaid to more low- and moderate-income Americans. It increases federal reimbursement to primary care physicians. It establishes a public option for low- and moderate-income Americans who make 133 percent to 400 percent of the federal poverty level with federal subsidies for families where necessary to help make insurance affordable.
This approach would cover more than 95 percent of the uninsured.
HR 3200 also ends the practice of denying insurance because of pre-existing conditions and does not allow termination of insurance if you become seriously ill. It precludes exorbitant out-of-pocket expenses, deductibles or co-pays. And it ends annual or lifetime caps on health care coverage while allowing people to keep their doctor and their current plan.
To correct other misperceptions, the House legislation does not cover noncitizens or abortions. It does not lead to "death panels" or government-sponsored euthanasia.
For that matter, the public option that the Obama administration has promoted is not a government takeover of the U.S. health care system, but creates more choices by providing a competitive and affordable alternative to commercial plans.
A health care reform bill that simply adds 47 million people to the private insurance market without a public option represents a huge system of federal taxpayer subsidies to the insurance industry with no mechanisms to control costs. It would be a formula for fiscal disaster.
Much has been made of the nonpartisan Congressional Budget Office's estimate that the House proposal would increase the budget deficit $1 trillion during the next 10 years -- an annual increase of 2 percent in the federal budget. But the CBO did not take into account parts of the proposal that would raise taxes, produce savings or reduce other spending to offset implementing the legislation.
Some experts put savings as high as $200 billion a year.
While few organizations have more respect in Washington than the CBO, it isn't infallible. In each of the past three decades, when assessing major changes in Medicare, the CBO has substantially underestimated the savings of the reforms.
While paying for health reform, the House plan ensures that about 96 percent of small businesses will pay no additional fees. Small businesses are now paying 18 percent more than big businesses for the same policy; this bill will stop this unfair practice.
Authentic, fact-based debate can help lead the country toward a consensus on health reform that increases access while keeping costs in check. But when politicians such as Sen. Chuck Grassley, R-Iowa, make statements such as "We should not have a government program that determines we are going to pull the plug on Grandma," they are discouraging the constructive dialogue we need to move America forward.
Spreading false statements to scare folks into opposing reform is not the way to proceed on such a life-and-death subject. We need to get real solutions from their elected leaders.
