‘Obamacare won’t solve the problems’
Experts agree on that, but not on alternatives
To understand why the Patient Protection and Affordable Care Act has fallen short of what President Obama envisioned for health-care reform, consider the story of Billy Tauzin, as told by Dr. Jeff Lobosky.
Lobosky, a Chico neurosurgeon and the author of a new book, The Doctor Won’t See You Now: The Failure of American Health Care and a Prescription for the Cure, was one of four health-care professionals who participated in a forum titled “Health Care Reform: Mission Accomplished?” last Wednesday (March 9) at the Enloe Conference Center.
The others were Mike Wiltermood, CEO of Enloe Medical Center; Dr. Henry Abrons, board president of the California Chapter of Physicians for a National Health Program; and Dr. Richard Thorp, a Paradise internist and former president of the Butte-Glenn Medical Association.
Tauzin, Lobosky related, was a Democratic congressman from Louisiana who, after the Republican takeover of Congress in 1994, switched parties. As chairman of the committee that oversees the drug industry, in 2005 Tauzin played a central role in creating President Bush’s Medicare Prescription Drug Bill, or Medicare Part D, which included a provision that Medicare could not use its massive buying power to negotiate drug prices—a prohibition worth many billions to the pharmaceutical industry.
Two months later, Tauzin resigned and took a job, at a salary of $2 million, as chief lobbyist for PhRMA, a powerful drug industry trade group. In that role, in 2009, he cut a backroom deal with the Obama administration during health-care-reform negotiations that traded industry support for the bill and $80 billion in other savings in return for keeping the ban on negotiating drug prices.
But, as Lobosky said, Obama had campaigned on a health-care-reform platform that included ending the ban on Medicare drug-price negotiations, among other worthy goals, such as a public option to compete with private insurers. No sooner did he try to implement these goals, however, than the “special interests raised their ugly heads” and screamed about “socialized medicine.”
To get a bill through, Obama was forced to abandon an open process and start making backroom deals, including the one he cut with Tauzin.
A major problem with the bill, Lobosky said, is that, while it will expand access to Medicaid, it will decrease access to care. That’s because it will pay for that expansion by reducing Medicaid and Medicare reimbursements to providers. In turn, fewer doctors will accept Medicaid and Medicare patients. As many Medicaid patients already know, having insurance means nothing if they don’t have access to care.
Abrons, a pulmonologist and clinical-care doctor by training, sought to refocus the discussion. Before we talk about services and costs, he said, we need to talk about morality and what kind of society we want to be.
Do we hold the free-market view that each individual is responsible for his or her own health care, or do we recognize—as all other advanced nations do—that health care is a right, not a product?
The market view of health care ignores a fundamental aspect of the transaction: The buyer doesn’t have a choice. A sick person can’t just walk away.
The current system is money-driven, he said, but most providers are primarily service-driven. They went into medicine because they care. Only a single-payer system—essentially an expansion and upgrading of Medicare—has the simplicity of design that would free them from the stranglehold of the money-driven system.
Obama’s Affordable Care Act is an improvement, Abrons said, but it “will achieve only mediocre, expensive health care for some.” About 25 million people will remain uninsured; it will foster under-insurance; fail to provide financial security; have high deductibles; and continue the burdensome administrative waste and paperwork that now costs about $400 billion a year.
And the requirement that people buy insurance, he said, “is a mandate to purchase a defective corporate product.”
From his perspective as a hospital CEO, Wiltermood doesn’t have high hopes for the Affordable Care Act. It’s “just rearranging the chairs on the Titanic,” he said.
His biggest concern is that it will reduce reimbursement rates. “As payments become squeezed, it drives the best and the brightest from health care.”
It also forces hospitals to charge private insurers more—“cost shifting,” it’s called—leading insurance premiums to go up.
Nor is Wiltermood optimistic about single-payer. His experience with Medicare is that lawmakers are constantly rewriting the codes, and “now we have thousands and thousands of codes.” Every time a new code is written, he said, a “cottage industry of former Medicare employees springs up to teach hospitals how to deal with the change.”
Americans now pay 18 percent of their gross domestic product to health care, twice as much as any other country, “and that’s wrong,” Wiltermood said. “We have to do something.”
But he offered no direction, other than to say that “We have to work together locally.” With state budget cuts and the downturn in the economy, the hospital’s charity care has gone from an average of $10 million per year to nearly $20 million, and bad debt has risen, too. “The next four years are going to be tough. … We need the community’s support.”
Thorp devoted most of his talk to showing charts and graphs that illustrated the country’s finances from a business perspective. His goal was to illustrate something he said at the beginning of his talk: “It concerns me when they talk about Medicare-for-everyone when the Medicare program is going broke.”
Sure enough, the charts showed that we’re spending more on Medicare than we’re taking in from Medicare taxes, an unsustainable situation.
“We’re going to have difficult decisions to make,” Thorp said. “As a society we can’t afford to give everyone everything.”
He stopped short of endorsing any particular approach to solving the problem, though he did say, during the question-and-answer period, that he would like to see all insurance providers become nonprofits.
Responding to a question about single-payer, Abrons stressed that it wouldn’t cost more than the present system and could cost less. “We don’t have all the answers, but we have learned a lot from other countries. … Right now it’s a game of ‘get the money any way you can.’ ”