Wednesday, March 24, 2010

Obamacare--The Dark and Unnoticed Corners

by Richard Crews
The new health-care legislation is not a panacea. The U.S. has the most expensive health-care system in the world by any measure. And one of the worst among advanced, industrialized nations by many measures (for example, we in the U.S. have the shortest overall life expectancy; in addition we have relatively high mortality rates for several chronic and curable illnesses). Obamacare notwithstanding, this will continue to be so for many years to come.

On the other hand, the new health-care legislation is not the dawn of Armageddon. Despite Republican predictions, it probably will not bankrupt the nation (though pre-Obamacare trends seemed to be headed in that direction); it will not raise taxes inordinately; and it will not impose a draconian bureaucracy between healers and healees.

By now you have read wonderful lists of the marvelous changes the new health-care legislation will bring about. But there are some important changes that Obamacare will initiate that are not often cited. For example, while it has been widely noted that some 32 million poor people will get health-care insurance, it has not been highlighted that before this new age these people got their basic medical care from emergency rooms. This has been an expensive drain on hospital resources. In the future these poor folks will be able to get better care for less than half the dollar cost to society by using "regular" (middle-class) clinics.

Also largely unnoticed: among these uninsured masses are millions of under-insured people who now pay low premiums for supposed catastrophic health-care insurance but with such large deductibles that they in fact have no real health-care insurance at all. They also routinely go to emergency rooms; since they default on their bills, the hospitals and thus society at large, pays these medical expenses. Anyone who buys health-care insurance in the future will buy "defined benefit packages." (Yes, in a shadow of some of the Republican distortions, their premiums will be higher--paid with the help of government subsidies--but this is because they will now have real health-care insurance.)

In addition, insurance companies will be required to pay for preventive care. Although this does not, statistically, reduce overall health-care costs, it does (statistically) make for a healthier population.

Finally, among the positive "unoticed corners" of the Obamacare legislation, many millions of dollars have been designated for "best practices studies," so that doctors and other health-care providers will have clear evidence about what works and what doesn't work. These findings are not coercive--the law clearly and carefully protects the doctors' and patients' rights to continue to make fools of themselves.

This "best practices studies" is a double-edged sword, however, since it will be driven by traditional Western (alopathic) medicine and thus will not fairly evaluate many alternatives like chiropractics, acupuncture, and homeopathy.

As to hidden corners of the fully negative variety, the new health-care legislation does not cap malpractice awards. Although outlawing runaway multi-million-dollar "pain and suffering" lawsuits was favored by many legislators (including Republicans), trial lawyers--whose fees are usually a percentage of the take--simply had too strong a lobby.

In addition, negotiating prices for generic drugs, including from foreign providers, is still forbidden (although the Veterans Administration is allowed to do this, and saves hundreds of millions of dollars annually thereby). The myth behind forcing Medicare and other plans to buy high-priced meds is that pharmaceutical companies need protected profits in order to encourage research and development of new drugs. The important point missed here is that universities and non-profit organizations should be doing this research into new drugs. This process should not be left to "Big Pharma" with the public advertising and doctor arm-twisting this brings about.

Another problem not solved by the Obamacare legislation is the payment patterns to doctors and other health-care providers. Payments are usually based on episodic illness, rather than on health maintenance (or via simple staff salaries).

And finally, while no damage was done to women's reproductive health care by the Obamacare legislation, no gains were made either. The language remains exactly unchanged--an opportunity missed.

And 12 million illegal aliens in the U.S. are not covered under Obamacare any more than they were before. I consider this a tragic travesty--a violation of fundamental American values.