A number of patients have asked me my opinion of the current healthcare legislation before Congress and so I will take this opportunity to get on my soapbox. I, like President Obama, believe that access to quality healthcare is a right and not a privilege. Anybody who views our current system as excellent is rather uninformed. It is overly expensive for what we , the consumers, get. I, as you doctor, used to be free to order any test I had wanted to and order it as often as I liked even if it were unnecessary. For example, you as a patient, could get an MRI even if it wasn't going to add to the quality of your care. Eventually, that kind of a system runs out of the money needed to pay for the basics. While the perverse incentives of the system aren't going to change much with the current legislation I believe it will be laying the groundwork for such a change in the future.
The Friday Dec. 25 Globe had an excellent table explaining the basic aspects of the Hose and Senate versions of the bills. Here are some important points-
1. Approx. 95% of Americans will be covered (83% now).
2. Insurance will largely be through employers but a public option (House) or national insurance exchanges (Senate) will be available for those without employer availability.
3. Purchasing insurance will be mandatory but there will be subsidies for family of 4 earning less than $88,000.
4. Seniors will eventually have all their medication covered without a 'doughnut hole' (a level at which no drugs are covered).
5. You will not be able to be denied healthcare as a result of a pre-existing condition.
6. Long-term Care insurance will be available on a national level ( a major innovation) and it will be voluntary.
7. Abortions - House bill more restrictive than Senate but neither will change the status quo for those with current insurance.
8. Cost- About $900 billion over 10 years.
9. Funded through various taxes and cuts to some Medicare/Medicaid programs. Seniors will see an improvement in their plans as preventive services will be covered for the first time and there will be elimination of the 'doughnut hole'. The House bill focuses on taxing families earning over $1 million/year whereas the Senate increases Medicare payroll taxes.
Massachusetts already has a plan that covers almost as many people as the proposed plan and indeed was a model for the current plan. There are, of course, aspects of the national plan (esp. those highlighted) that would be an added benefit to us. Employers and some residents masy also get federal tax breaks too.
Eventually, in my opinion, we will need to go to some sort of national system that is similar to Medicare (but more tightly managed). Medicare has approx. 3% in overhead costs compared to 10-20% for private heath insurers. But without controls on services costs will continue to increase in the out-of-contol manner that they have. In short, I believe that the current healthcare reform legislation that has been put forward in the two separate bills in the House and Senate will be a big step forward for the country. It will not bring universal coverage to all Americans but it will get us closer to that goal.
