The topic has been thoroughly thrashed over the last year. Health care reform, of course. Now it’s the law of the land. Or about to be.
I share the hope of those who supported it, but none of their confidence. And I share the fear of those who opposed it, for many of the same reasons.
But mostly I just have worries.
First, I have a tough time believing that such an enormous expense will somehow result in a decrease in the deficit. In my math-challenged mind, that just doesn’t make sense. And even if it somehow did, the numbers still are all projected figures, estimates, and guesstimates about countless variables that the government can’t possibly control. Talk about fuzzy math. I’d like to see you get a small business loan with math like that.
One of the scariest things for me is knowing that some of the so-called savings are supposed to come from cuts to Medicare Advantage. MA is sort of a supplemental policy for Medicare participants. It’s administered by private insurance companies that in most cases get government subsidies for doing so. It figures that if those subsidies are reduced or eliminated, the companies may decide it’s no longer worthwhile to sell the policies. My company, I think, does not take such subsidies and will not be affected by the cuts. But I’m not sure. And even if I’m not affected, millions of senior citizens will be. Like your parents or grandparents or dear old Mrs. Jones next door. You know … real people. In the age group with more health problems than any other.
Then there’s that doughnut hole you keep hearing about. Eliminating that would be a very, very good thing. But don’t fool yourself into thinking it disappears this year. It’s one of those phased-in parts of the bill. I think seniors just get a small rebate this year.
My biggest concern, as I’ve mentioned before, is that this bill effectively hands insurance cards to 32 million more people without doing anything to bolster the already seriously overburdened delivery system. Nobody’s building more clinics or medical schools or nursing schools. Nobody can force more medical graduates to choose primary care over the specialties.
And that reminds me of another problem. Medicare payments to a lot of doctors are going to be reduced. So why should those doctors keep seeing Medicare patients? It’s hard enough to find a good doctor these days; many aren’t taking new patients and some already refuse to take Medicare patients. Can you blame them?
There are some good things in the bill. No more annual or lifetime caps on insurance. A phasing out of preexisting conditions. Kids being covered longer under their parents’ insurance. I can’t argue with those. And I hope there’s more good stuff coming that I’m just not remembering right now.
I do wonder why, after the nasty experience with banks and the new credit card regs, the bill didn’t make all the new regs on insurance companies effective immediately. Instead, the companies have years to figure out new ways to gouge patients, limit payments, increase premiums, and find ingenious new ways to offset the losses they see coming. Maybe 32 million new customers will take care of that, but rest assured the insurance giants will be up late nights thinking of ways to save their profits.
And that little thing about requiring people to buy insurance … can they do that? What if I’m young and healthy and jolly well don’t want to buy it? How will you know I haven’t bought it? Will you send the Gestapo in the middle of the night to haul me off to jail for not buying it?
As for small businesses providing insurance for employees … hasn’t that always been a decision for the employers (free enterprise and all that)? An expense to incur or not, as their business sense dictates? And, in my own experience, hasn’t it always been up to the employee to shop for a job that has the desired benefits?
Lastly, no one has talked much about the incredible amount of new bureaucracy that will be needed to administer/enforce all these new measures. But I suppose that’s one way to reduce unemployment.
P.S. President Obama, best get back to Washington and tend to the country’s business. No need to be out there campaigning for a bill that’s already passed.