The New Health Dialogue

She checked in with three health-care policy experts to hear what they have to say about the “five biggest myths” of health reform.

 

Far from it.

 

Stephen Zuckerman, a health economist at the Urban Institute’s Health Policy Center, explains that people don’t always understand the difference between “who’s delivering health care” and “who’s paying for health care.” Sure, the scope of public programs has increased during the recession -- the government has served as a safety net for many newly uninsured Americans. But health reform does not mean we're heading for government-run health care.

 

“Government run health care would be if the government employed the providers and they were all paid a salary and you had no choice but to be treated by them,” explains Len Nichols, director of the health policy program at the New America Foundation.

 

Instead, “More care is going to be financed by government, but more care is not going to be provided by government,” Zuckerman clarifies. We will still have a mixed public private system.

 

Many Americans shudder when they hear this word.  It’s really just an evocative word.

 

If Americans are going to throw out the term, they have to acknowledge that, in a sense, it already exists. “The American public is quite accepting of rationing in the softer sense, that if you can’t afford it, you can’t have it,” Henry Aaron, senior fellow at the Brookings Institution in Washington argues, “Pushing back that frontier is part of the objective of the legislation. The main thrust is to reduce rationing in terms of price rationing.”

 

While Zuckerman acknowledges that there might be a strain on the demand for medical services once millions more Americans are insured, “there’s a very high volume of care that’s provided in the U.S., and there’s very little in the bill that would likely change that. Rationing is one of the more inflammatory words that gets used that has no basis beyond what currently happens.”

 

Cost-containment, plain and simple, is just not sexy. Rhetoric gets all the attention.

 

“The single biggest myth is that no one is thinking about cost-growth containment,” Nichols states. “In fact, most of us think about little else. Lawmakers don’t talk about it as much as they’re working on it because frankly the rationing rhetoric has been so effective. The people who on the one hand historically have been in favor of fiscal rectitude who are now screaming rationing are making it very difficult to have an adult conversation about cost-growth containment.” Nichols argues that the bills will "change payment incentives so that patients receive high value care for the first time" -- it will start with Medicare and then the rest of the country will follow suit.

 

Zuckerman is more circumspect about how strong the cost-containment provisions would be in the near-term. But he emphasizes that cost measures are in the bill, it's just not true to say they aren't.

 

And chances are you will be able to keep it.

 

Health care costs are spiraling out of control, and, as Gerencher explains, there is a chance that “employers may decide for them [employees] if they wager they’d be better served to drop coverage and let their workers shop for policies in the new insurance marketplaces the bills envision.”

 

But the bottom line, is “employers may choose to change or drop cover in the next few years with or without health reform,” Zuckerman argues. That's been happening for years.

 

The rule of the land will be a bit different with health reform, but the penalties are there to safeguard what you have now -- not make it more attractive to drop it. “In practice, the vast majority of people covered by private insurance will end up keeping their private insurance and won’t notice any material change,” Aaron says.

 

Nothing’s perfect. But baby steps just won't be as constructive. Incrementalism is ... incremental.

 

“It’s got to be done as a package," Nichols explains. He stresses that there are too many moving parts and they all need to “work in unison to achieve the desired results.” As an example -- insurance companies cannot be forced to accept all enrollees if there is no mandate for coverage or penalty for those who drop out.