Monday, May 10, 2010

What Healthcare Reform Misunderstands

So it is finally done. Healthcare reform has not only passed, but it has seemingly survived the first round of amended bills and cries of unconstitutionality. Most importantly, some of it is now in effect. But before the new healthcare bill can take hold and show us what it can do for us, it will have to cut through all the rants and raves about it.

You have the pure Obama Democrat on one hand, who has believed from the very beginning that healthcare was doomed without reform, and that the bill endorsed by the President was the way to solve our problems. These are the blinded, forgetting that it is the goal of every administration to leave a legacy. And given a very rare Democratic majority in both legislative houses, it was clearly the time to create that legacy. So what they did is scare everyone first with overly simplified statements regarding the ensuing failure of the healthcare system. Then they wheeled and dealed to get their bill passed with a once in a lifetime Congressional majority. The rest will be history. This is not how the Obama fanatics see things. The see a President that represents their views in a time when significant policy changes are needed.

On the other hand, you have the hard Republican, who has mistaken democracy for socialism. Anything that forces him to give something for the public good is heresy. The President could repeal all the taxes and still there would be something wrong and Democratically evil about it. They see a President trying to make them pay for something they cannot hold or do not want.

And then you have the rest us, all mixed in somewhere in between. But this is not about whether the healthcare reform was the right thing to do or if it was all smoke and mirrors. This is about the single fact that it unfortunately did not take into account. That fact is that people want more healthcare. They want more tests available to them. They want more drugs available to them. They want more healthcare providers available to them. Seems a simple enough answer—after all, who does not like to have more options? (This is not about whether we do better with more options—that is another post.) But everything with healthcare reform and the debate talks only about an irrelevant fact—that people do not want to pay more for healthcare. Of course they do not. But shifting the cost to the consumer, and trying to make them “see” how much things cost does not dampen the desire for more healthcare. While it may slow the consumption of healthcare, inevitably, there will be a change on the other side, and people will have more money to spend on healthcare. And they will. You can change the price, but one day the income side will change and things will be different again.

You might say that the bill has taken this into account, with the so-called Cadillac tax. This tax is imposed upon high cost policies on the incorrect presumption that these policies carry more benefits and therefore keep the healthcare consumer in the dark as to how wasteful he is of said resources. Aside from the obvious specious reasoning linking cost to overall benefits, the creators of the bill failed to understand that the people who hold these high cost policies tend to be healthy people. The same people you need paying high cost policies, since they also consume the least amount of healthcare. You end up taxing the rich and healthy for what, the poor and sick? Sounds like a twisted version of Robin Hood and Harrison Bergeron.

Another way to look at this overlooked fact is the simple infection. With the reform the patients will see more of the cost of drugs, including antibiotics. That means that penicillin will still be cheaper than Levaquin, but that Zyvox will be essentially unaffordable to most people. (Zyvox is an antibiotic often used for treating MRSA, or resistant staphylococcus.) Though you would think this would steer people towards cheaper antibiotics, it will also steer them towards more ineffective antibiotics. Over time that will lead to more infectious complications and more resistant organisms. But even more likely, it sets up a system where the richer get better treatment for lesser problems than before. You think that open heart surgery will be more available to everyone? Sure, it will be covered. But not the drugs you will need afterwards. Shifting cost to the consumer may curb spending, but it only exaggerates the lack of healthcare when Joe the plumber needs five new medicines after heart surgery to protect his heart, but can only afford two because the costs have been shifted farther over to him.

A lot of people believe that Congress will never have the Republican numbers it needs to repeal the healthcare reform bill. It seems more likely that if healthcare reform is received poorly by the public, we will see a dual Republican majority in the Senate and House, much the same way the current Democratic majorities arose with the policies of the last Republican administration. But as long as you can still get medicines from Canada and surgery in Europe, you can wait it out.