Telling the Truth about Reform
1. Will adding people to the health care system drive up the costs of health care?
We won't be adding people to the health care system; everyone is already in the system one way or another. Some have good coverage, enjoy preventive and diagnostic care, and see a doctor regularly if they have a chronic condition. Others have bad coverage, get their medical care in the emergency room, and see a doctor only after they are very sick.
According to a health economist at the University of Pennsylvania, for every $1 we currently spend on people with coverage, we already spend $0.75 on people without coverage. After nearly everyone is covered, additional medical care would be provided (4 percent more across the system).
Over time, by being smart about how we structure and provide health care, we would recover that incremental growth and bring the ruinous medical inflation rate under control. How? By studying what are the most cost-effective treatments and encouraging health care providers to apply those treatments, avoiding waste, emphasizing prevention, managing chronic diseases according to best medical practices, and paying providers for bundles of care rather than a fee for each item.
2. Will health reform drive up the costs of health insurance?
No, it will not.
Currently 15-20 percent of the population does not have health insurance. But those people still get sick, and when they can not afford to pay their own medical bills, those costs get passed along to those of us who have health insurance. So in our current system, we pay a "hidden health tax" of 8-10 percent for the uninsured.
Under national health reform, nearly everyone will be covered and nearly everyone will be contributing dollars to the system. So the cost of health insurance is likely to come down.
3. Is the "public option" a government take-over of health care?
No, it is not.
Under the House bill, the "public option" would be a government-backed health insurance plan that is available to individuals who are uninsured and to businesses that currently do not offer a health plan to their employees. Most of us would not be able to buy it because we have health insurance now. Under the House bill, during the first three years of operation (2013-2016), the Congressional Budget Office estimates that around 10 million people will be enrolled in the public option. That's only 3 percent of the U.S. population.
Longer term, the number of people who choose the public option could grow if it offers a better product, if the private insurers fail to improve their prices and customer service, and if the Congress opens up the public option to more people.
But getting everyone into the public option is not the goal. The goal is for the entire system (including the private health insurers) to offer better coverage at a lower price. The public option, by adding more competition to the insurance market, would nudge the system in that direction.
Under our current system, the government has a variety of roles: regulator, funder, and for the elderly - provider of a government-run health program (Medicare). Each of those roles would continue under health reform.
As for "government-run health care", most people enrolled in Medicare are highly appreciative of their health care plan.
4. Will the government tell us what insurance we must buy?
No, it will not. We will have a range of policies to consider at different prices. We will be able to choose from a variety of companies from whom to buy.
What will change is that all policies will need to meet certain standards and will be rated according to a standard rating system. No policy will be permitted to exclude pre-existing illnesses or injuries. Every policy will have a rating that tells us what portion of medical costs that policy is expected to pay on average across a large group of people. It will be easier to shop for health insurance and easier to compare prices because the quality of each policy will be reflected in the rating.
This regulatory framework is basic consumer-protection. It has long been in place for various kinds of insurance products, such as Medicare supplemental policies.
5. Under health reform, will a government bureaucrat decide whether I live or die?
No, that won't happen.
The opponents are trying to scare people with such talk. They say that because health reformers want to bring costs under control, we will be denied the care we need. They say that because once every five years Medicare will pay doctors to discuss end-of-life care with their patients, that health reform will introduce euthanasia into our health care system.
These are lies used to confuse people.
Health care costs are growing at an unsustainable rate. If we do nothing, eventually the system will collapse. Then the bad things we fear - like rationing - would become a real possibility.
But if we act wisely now to bring costs in line with the usual rate of inflation, then we can avoid rationing and the denial of care. The proposals under consideration in Congress attempt to do that. All of them leave basic health care decisions to us and our doctors. No bureaucrats in Washington would be involved in decisions about our care.
6. Will health reform cause my taxes to go up?
Yes, for some of us.
For example, under the House bill, taxes will go up for the 1.0 percent highest income households. For the other 99 percent, taxes will not go up.
The Senate bills may have other ways of financing the cost of getting everyone covered. In each case, we will need to carefully study the plan and find out who would be affected.
7. Will small businesses be put out of business by health reform?
Most employers want to offer coverage because it enables them to attract higher quality applicants and to avoid turnover among their experienced and productive employees. And most employers recognize that if nearly all employers offer coverage, then not offering coverage becomes a competitive disadvantage.
So the key question is whether health reform helps employers without health insurance to gradually make the transition to a system where every employer is expected to provide coverage. Again, we need to look at each bill carefully to answer this question.
In the House bill, the requirement that employers provide coverage would not start until 2013. Even then, employers with annual payrolls under $500,000 would not be required to offer health coverage to their employers. And small employers that decide to start offering coverage could offset the cost with tax credits from the federal government.
8. Will health reform expand coverage of abortion?
Currently, federally-funded health plans, such as Medicaid and the federal employee health plan, do not cover abortion services. And currently, some private health insurance policies cover abortion services and others do not.
The bills under consideration in Congress are designed to leave this basic pattern in place. That is, publicly-funded plans would not pay for abortion services, some private plans would pay, and some private plans would not. The "basic benefits package" that the House bill would require all but the smallest employers to make available to employees would not include the coverage of abortion services.