By Steven Findlay, Consumers Union, Washington DC (published in USA Today, 1/13/2010)

Polls show that about half the country is still opposed to or skeptical of the health reform legislation entering the endgame in Congress. This could threaten final passage or undermine sustained support if the legislation becomes law. Those of us fighting for passage must face this fact and do a better job of convincing you doubters that the bill is, on balance, worth it.

Here's my shot at that, focused on the biggest and most persistent fears.

First, it's not a government takeover of health care. Yes, the legislation expands Medicaid, and new rules and regulations will affect insurers. But by and large, it not only preserves but also strengthens the private health sector by funneling millions of people and about $430 billion over the first 10 years to private insurers. Those insurers, in turn, pay private hospitals, doctors, drug companies and pharmacies.

At the same time, the existing private system where most people get coverage at work is preserved, with a few new rules. And new shopping marts for health insurance are created; in them, people who do not have access to job-based coverage can choose among a range of mostly private plans and policies.

Second, it's highly unlikely (but not impossible, I admit) that your existing coverage is going to cost more under this legislation than it would otherwise over the next 10 years. The annual average cost of family coverage more than doubled between 1999 and 2009, from $5,800 to $13,400. And it's on course to double again by 2019. The bill takes dozens of initial steps to help lower medical costs so premiums can follow.

Does it do enough on cost control? We'll see. But tracking on that front will be meticulous in coming years. The bills require that, and the health industry knows it'll be watched more closely than ever. If the rate of increase in costs doesn't start to come down based on what's in the bill, Congress will have no choice but to get tougher. That's because sometime between 2016 and 2020, health costs become the major force driving the long-term deficit and national debt.

Remember, it's a delicate balance. You can't ask for a mostly private, for-profit health system without government price controls and then complain that the bill doesn't do enough to control costs. The bill threads the needle, testing many new ways to prod doctors and hospitals to become more efficient and paying them on the basis of the quality of care they deliver, not just the quantity.

Third and related, the legislation is not going to bust the budget. You've heard the refrain: "It costs a trillion dollars!" Three points: (a) Even if the official estimators in Congress are off by 10%, the revenue sources being proposed would cover the $871 billion to $1 trillion cost over 10 years; (b) that trillion dollar expense is cited out of context. We'll spend as a nation a projected $35 trillion on health care from 2010 through 2019. One trillion adds 3% to that. And the non-partisan number crunchers at the federal Centers for Medicare & Medicaid Services estimated last week that the legislation would actually increase national health spending over the next decade by just 0.6% because it reduces wasteful spending, mostly in Medicare.

And (c): 90% of the $1 trillion is allocated to expanding Medicaid and directly helping people buy private insurance. It's not money for new bureaucracies and regulations, or to bail out businesses. It's your tax dollars being used to help 30 million to 36 million Americans (and you could be one someday) get the security that health insurance provides.

Fourth, Medicare is not being sacrificed on the altar of coverage expansions for the under-65 folks. And the program is most certainly not being "cut." If the legislation becomes law, Medicare spending will still rise from an estimated $517 billion in 2010 to $896 billion in 2019.

Yes, that'll be an estimated 10% less than if the legislation does not become law. But this is not a gutting of Medicare. It is the government taking the lead in a public insurance program whose costs are rising too fast and where an estimated 20% of expenditures are wasted on inefficient or ineffective medical services.

After more than 60 years of failed attempts, the U.S. is poised at last to join the community of industrialized nations that offer its citizens guaranteed access to health insurance. The United States is the only nation that does not. This is beyond shameful for the wealthiest country on earth.

As imperfect as this legislation may be, is waiting 15 more years to tackle this problem really an option? Will we fiddle as Rome burns? Fear of health reform legislation's unintended consequences is understandable. But make no mistake, failure to pass it carries far greater risks.

comments (21)

Comments

1 Posted by William Freeman at 01/14/10 07:28 PM

If this is really reform and everyone supports it except the majority of Americans, why is it being done behind closed doors?

Why have so many sweetheart deals already been cut and how many more are being promised?

Where is the tort reform that will lower cost?

How do all of the proponents of the bill know what is being decided behind those closed doors or what is in it for them?

2 Posted by Robert M. Gangawer at 01/15/10 07:19 AM

Consumers Union is non-partisan, my butt.
1) The "few new rules" that make it cheaper for my employer to drop coverage than keep it helps me how?
2) Of course my coverage is going to cost more, nothing is being done to rein in the cost of nuisance lawsuits (tort reform) meaning doctors are going to continue practicing defensive medicine and ordering every test possible. This helps me how?
3) Of course it'll bust the budget. Name one government program that has been done at the price we were told it was going to cost! And since the people working in it will belong to the same unions that still get raises and better benefits than the rest of us despite the current economic conditions this statement is disengenuous at best!
4) What do you say we "reduce the wasteful spending in medicare" first, and then see what needs to be done?
Please give a little thought to how this piece of crap legislation that is being twisted and contorted in innumerable ways to disguise it's true effects can be fixed BEFORE we're stuck under in the mess it's going to make!

3 Posted by Robert Peterson at 01/21/10 04:27 PM

CU writes:

"But by and large, it not only preserves but also strengthens the private health sector by funneling millions of people and about $430 billion over the first 10 years to private insurers. Those insurers, in turn, pay private hospitals, doctors, drug companies and pharmacies."

"Funneling"? Dishonest word. You're taking about compulsion. Compelled consumers are, by definition, not part of a free market system.

CU writes:

"Remember, it's a delicate balance. You can't ask for a mostly private, for-profit health system without government price controls and then complain that the bill doesn't do enough to control costs. The bill threads the needle, testing many new ways to prod doctors and hospitals to become more efficient and paying them on the basis of the quality of care they deliver, not just the quantity."

In a market system, government role is to enforce contracts. Costs are controled by competition.

CU writes:

"Even if the official estimators in Congress are off by 10%..."

1. Is CU the only organization in the US that does not understand that these figures are cooked to begin with? That they assume things -- like cuts in Medicare -- that will never happen? Or is CU simply dishonest?

2. Is CU aware that the "official estimators" projected in 1967 that Medicare would cost $12 billion in 1990, when in fact, it wound up costing $110 billion? Is CU aware that the "official estimators" almost always greatly underestimate the cost? Is CU aware that if the projections were off by only 10% it would be an occasion for a ticker tape parade?

CU writes:

"Second, it's highly unlikely (but not impossible, I admit) that your existing coverage is going to cost more under this legislation than it would otherwise over the next 10 years."

Price Waterhouse Coopers, not an "official estimator," but a private firm whose livelihood depends on the accuracy of its projections projects that, in the next 10 years, premiums will increase of 79% under the current system and 111% under the Democratic proposal. Why does CU belief that those figures are incorrect? Indeed, upon what basis does CU opine that premiums will be less? Or is this simply wishful thinking?

4 Posted by Tracy Miller at 01/22/10 04:50 PM

THIS HEALTH CARE REFORE BILL WILL DESTROY THE QUALITY OF HEALTH CARE IN THIS COUNTRY! YOU FOOLS! REFORM DOESN'T IMPLY IMPROVEMENT! HAVING AFFORDABLE HEALTH CARE DOEN'T GUARANTEE IT'S QUALITY. READ BETWEEN THE LINES! THAT'S ASSUMING YOU CAN READ. IT YOU SUPPORT THIS HEALTH CARE REFORM, MY GUESS IS YOU CAN'T READ!

5 Posted by KENNETH DEVORE at 01/22/10 04:58 PM

I AM NOT IN FAVOR OF THE HEALTH CARE BILL THAT IS IN EITHER THE HOUSE OR THE SENATE. I DO NOT WANT YOUR EMAILS ON THIS SUBJECT!

6 Posted by K Welch at 01/22/10 07:32 PM

I usually agree with CU on the consumer rights they advocate, but you guys are way off-base on this health care reform thing. I used your form letter to send to my legislators to tell them NOT to pass it.

7 Posted by Health Care Not insurance care at 01/22/10 09:16 PM

It's simple, just eliminate Insurance. Insurance Companies are in the business to deny health care not provide it.
They have priced themselves out of the heath care business.

Pass a bill that will:
* Save money and not increase any more spending
* Enforce existing laws that prevent medical care from being practiced Illegally; without a license. How are Insurance companies allowed to make medical decisions without a license??? Eliminate insurance from making health care choices. Insurance is in the business to deny health care not provide it.
* Eliminate premiums, Co-Pays, and deductibles. Without Insurance, health care would be affordable to ALL. Money would go to health care not to the monopoly on health care.
* Eliminate the corruption in the FDA and AMA. They will not approve any "Cures"! Cure is not in their vocabulary. They approve only treatments that perpetuates more spending.
* Help improving the Doctor/Patient relationship. I feel like I'm going through a divorce with my Dr. I have to go through my Attorney=Insurance Co to have anything approved.
* Give me health care that I will always have access to no matter what happens with my job;
* Health care would be competitive if Insurance didn't have a monopoly on the national market to prevent better health care.

Health care is affordable without insurance. Quit paying premiums and taxes our owners could no longer tell us what is best for us.

8 Posted by Disappointed Reader at 01/25/10 12:49 AM

I do NOT support the proposed senate/house/POTUS "health care overhaul" bills. And, I am very disappointed in CU's support of these bills. Despite the title, forcing individuals to buy health insurance does NOT protect the consumer, does NOTHING to reduce health care costs, and does NOTHING to improve health care. HI is an unnecessary health care overhead! The insurance companies currently stand as a cost buffer between the patient & medical care (i.e., the patient does not know the health care cost, content, or outcome until after the service/product is provided). This is unacceptable! We don't take our cars in for service & hand over our bank account to the service dept. We ask for an estimate before diagnosis & correction of the problem. Our bodies are no different. Until insurance companies are removed as cost buffers & consumers can get health care costs, content, outcome PRIOR to service so consumers can shop for the most cost effective care, health care costs will continue to go up. And until the supply of medical staff is increased, health care costs will continue to increase. In addition, limiting medical/drug patents to no more than 10 years with NO extension would help reduce drug costs. The current bills are nothing but a congressional/POTUS spending excursion designed to keep them in office. By supporting these bills, CU certainly isn't looking out for us consumers in this instance!

9 Posted by Steve Findlay at 01/25/10 06:46 PM

Thanks much for these comments on my oped piece. This has been an emotional debate over quite complex legislation...legislation that is now in limbo. Most of you appear to oppose the Senate and House bills, or at least have very serious reservations. We'll have to agree to disagree for now on what the end result would be if either bill became law. After a lot of close examination and analysis, we concluded that the legislation would benefit consumers and make health care in America better than it is today. We endorsed the House bill in November for that reason. We remain convinced that if people look carefully at lists of actual provisions in the bills instead of listening to platitudes on either side of the debate, they'll reach a similiar conclusion. I agree with several of you that we can't know exactly how this legislation would play out...say, for example, in terms of how it affects health care costs. But most independent policy experts have concluded that there's more chance it'll help control costs than add to them or end up increasing your insurance premiums. That said, to be sure, there are lots of uncertainties.

10 Posted by Ken at 01/29/10 02:09 AM

Well folks what it really comes down to is this:
If you have really read the legislation and understand it and still think Government control is the wrong way to go then as a American you should demand that State and federal control over Medicare,Medicaid and utility rates should be abolished and by the way do away with The Federal Trade Commission which I am sure you know safeguards Citizens from price fixing,monopolies etc.. Oh and by the way health Insurers unlike your Auto and Home Insurance carriers are not under FTC regulations thanks to their tremendous campaign dollars.
I know these facts because I sell Insurance including some health and just this week I have seen the arrogance of Insurers as 3 policy holders (2 policies were for a husband and wife 50 years old and one single female 26 years old)recieved their renewals with price increases over $150.00 per month and 2 of these policies which had been in effect for several years and never had one single cent paid out on them.
All of these policies carry a $ 2,500 deductible.
The health insurance industry has done a great job in using scare tactics and lies to discourage any reform with a public option while at the same time wanting to see a requirement that all Americans have health insurance thus increasing profits and allowing them to charge whatever they want and now they feel that they have won this battle and now the screw the public agenda has begun for 2 reasons
1.Increase profits
2.Anger the public by blaming supporters of reform for the increase in rates.
I know that I have not changed the mind of anyone who is against reform but i guarantee you one thing and that is that within 1 year if reform WITH a public option is not passed and you have either an Individual policy or a group policy you will be screaming because of your inability to pay your premiums.
Now for those of you who say well why did these customers not go to another carrier?
The answer is that all just happened to take rate increase effective 03/01/2010.Strange isn't it! but legal,remember no FTC control.
(5 companies raising rates at the same time)
Good Luck with your Insurance-I really hope your relationship is great in the future after all they really care about you!

11 Posted by at 02/02/10 03:20 PM

i notice most of the raving positive comments you posted are pre massachusetts. this plan to socialize the US medical deivery system (the best in the world) is designed to buy votes for democrats, protect tort lawyers and expand the federal government big time. Doctors and insurance companies are subjected to the howitzer style control of the feds--the ones who gave us the postal system-while tort lawyers chase ambulances and siphon off more hundreds of billions. Get serious, the anti free enterprise CU immediately laps up any socialist scraps tossed out by the leftist democrat party. The people of Massachusetts flunked the program--hopefully the rest of America will flunk the dems, tort lawyers and CU this year.

12 Posted by Torry Edwards at 02/06/10 09:18 PM

Consumers Union, Non Partisan? After reading your health care pluggs for Obama I'll never believe that! 1/6 of our economy being wrenched away to cover some giant government project that will just become another turd like all the rest. Govenment get the hell out of the way and let the American people and free enterprise fine the answers. CU....You guys need to go back to studying washing machines!

13 Posted by Henry Murdoch at 02/08/10 07:43 PM

CU, I urge you to keep up the good work. Do not let the name-calling and abuse that is so widespread today prevent you from telling the truth as you know it. Many people are scared and angry and do not want to consider anything other than what has been incessantly drummed into their heads. It's such a pity. America deserves better than this.

14 Posted by f. chard at 02/11/10 02:17 PM

This "reform" is pure crap. It is akin to the Medicare Part D prescription coverge. This "reform" is a dressed-up fraud, written by and designed to enrich health insurance companies. C.U. should hang it's head in shame for supporting this garbage.

15 Posted by carol at 02/11/10 11:14 PM

I am in favor of a nonprofit or government option because I do not trust insurance companies, period. It is a conflict of interest for insurance companies who are interested in profits to fairly and honestly manage health care. They and the drug companies are pocketing billions at the expense of tne public. I am 62 years old and one millisecond after I turn 65 I will be glad to be on Medicare.

I feel the biggest barrier to implementing health reform is cost. The public cannot believe we can insure millions more people without costing us more money. Congress has to itemize the sources of revenue for this program openly and honestly. We have already seen the backlash from political wheeling and dealing by Reid and others.

Remember that USA is the only industrial country without universal health care. We can afford it more than other countries. Comments about the Canadian system being bad are simply wrong. We have relatives in Canada who have undergone heart surgery with no problems. They don't have to change health insurance when they change jobs. Our whole system needs to be rebuilt. But the Democrats are screwing it up by using old fashioned politics.

Why can't Obama appoint a nonpartisan commission to study the health care system and recommend changes? We might get a balanced, intelligent, believable analysis. Take the process away from the politicians. They are bought by insurance and drug companies. Look at Lieberman; he is owned by insurance companies.

16 Posted by Marion at 02/12/10 01:16 PM

I agree that health care needs to be reformed. However, there is no such thing as a "free lunch". We taxpayers will be paying for it.

And what about all of those earmarks we keep hearing about written into the house and senate bills.

I suspect that the drug companies and insurance companies will benefit the most from both bills.

Time to go back to the drawing board and start from scratch.

17 Posted by IBEWDan at 02/23/10 11:24 PM

I have been a reader of Consumer Reports for decades and respect your track record and the work you do for consumers.
I have noticed with some concerned amusement how CU has lowered it's expectations for this health-care reform bill as it has mutated over the last year. If it was a year ago I doubt CU would be supporting the proposed bill.
I just went through on the White House website.
While this bill would make health insurance available to all Americans and indeed mandate coverage for all, it does not make it affordable for the people we are targeting.
Who on unemployment can afford 8% of their last year's gross income on health insurance?
The tax penalty for individuals and business' who don't have or don't offer health-care is far less then the expense of actually having coverage, even with the proposed financial aid.
This is good because this proposed bill doesn't make health-care coverage affordable for many lower income workers or unemployed Americans living out there in the real world.
Is this bill better then nothing? Yes. Is it as good as we envisioned it during the Presidential campaign? Not even close!
I salute CU on your ability to lower your expectations and standards on this proposed bill. It still has four years to continue to mutate before the important parts kick-in in 2014. Given the past year, who knows what it will look like then.

18 Posted by Kathy at 02/24/10 12:38 PM

RE 2/23 11:24
Indeed the final bill doesn't have everything we wanted. But it really does help people losing their jobs and their health care. There are very specific provisions designed to make sure that someone who loses their job can quickly qualify for help paying those premiums based on the much lower income level they project to have after filing for unemployment.

In general, eligibility for discounts will be based on last year's income for people who still have the same job. But Section 1412 of the Senate bill anticipates that people will have “changes in circumstances” and directs the Secretary to establish alternate procedures. Among them:

"allowing an individual claiming a decrease of 20 percent or more in income, or filing an application for unemployment benefits, to have eligibility for the credit determined on the basis of household income for a later period or on the basis of the individual’s estimate of such income for the taxable year" (p. 290)

19 Posted by IBEWDan at 02/24/10 05:04 PM

Thanks Kathy.
It is great to know that they made an allowance for an unexpected income reduction or unemployment. I Hope they remind the unemployed of this. I also hope that this doesn't just lead a person to the yearly deductible and co-pays he thought he could afford back when he was working. With the exception of the yearly exam, which will have no extra cost.
When I think of how simple and easy this plan could have been with a single, all-inclusive plan for everyone and a single, fair income source that automatically and immediately adjusted to your income level.
We all could have been in one big shared boat instead of each on our own trying to figure how seaworthy a boat we can afford for ourselves without any real need to care about the other guy, who probably has the budget basement leaky dingy.

20 Posted by Brad Thibodaux at 08/20/10 09:28 PM

Kathy, Obama Care may not be the takeover of health care now, but you know that if they could have had their way, the Democrats would have passed a public option which would have been a takeover of the healthcare system. The rules and regs of Obama Care will make it difficult for insurance companies to remain in business and eventually there will be a complete takeover of health care. doctors will be limited on how much they can charge and doctors will be told not to provide certain lifesaving procedures if a Senior is over a certain age. Obama's poll numbers are at 42% because of unemployment and because of the sagging economy. When insurance companies are forced to shut their doors and when health insurance agencies go out of business, their will be millions added to the unemployment rolls and depending on the gov't handout. That's where we are headed and you are too damn blind or dumb to see it.