If we can hit the pause button on the hagiography associated with the current healthcare bills, it's time to admit there's been way too much myth making around how much the Congressional bills will reduce overall healthcare costs and make healthcare more affordable.
At the top of the list should be all the rhetoric, fanned by too many liberal and progressive wonks and columnists, about how the misnamed tax on supposed "Cadillac" health plans will "lower costs" while ignoring all the consequences.
One effect was exposed in a Mercer consulting firm survey released today of 3,000 employers, up to 19 percent of whom will be hit by the tax in the first year alone.
How will employers respond? As a report in the Kaiser Health News aptly notes:
Their actions would tend to shift more costs to workers
How would they do so?
75 percent would raise deductibles or copayments
The result, more medical bankruptcies, more people skipping needed medical care because of high out of pocket costs.
40 percent would add a lower cost health plan
What might better be called skeletal or junk insurance plans that fail to cover many needed medical services or have such high deductibles or co-insurance that they deliberately discourage those who are "covered" with going to the doctor.
Promoting self-rationing of care is the favored mantra of the experts desperate to come up with an explanation for why our healthcare costs are twice as much per capita as most of those other industrial countries that have the single payer or national healthcare systems that President Obama and Congressional leaders discarded even before negotiating with the Blue Dogs and the Olympia Snows of Capitol Hill.
Ignoring the crucial difference between the U.S. and those other countries that don't chain care delivery to the profit motive, which is the biggest reason for our higher costs.
But if you are not going to effectively curb the price gouging practices and profiteering of the insurance companies, pharmaceutical giants, big hospital chains, medical suppliers, biotech firms and all the others in the medical industry who profit from pain and suffering, you have to find another culprit.
Presto, the explanation that our costs are so high because we, as a nation, love to get those unnecessary colonoscopies, and sit for eight hours in an emergency room for the sniffles.
Thus the solution -- at a time when medical bills already account for 62 percent of personal bankruptcies and half of Americans forgo medical care because of costs -- enact reforms that will encourage less use of needed medical care, not more.
Clearly some people presently uninsured will have access to coverage they did not have before under the proposed legislation. That is laudable.
But there are also others like Jeremy Devor of Salem, Il., whose story is told by Trudy Lieberman in Columbia Journalism Review :
In a good year, Devor’s job at a ten-person engineering firm gives him an income of about $46,000. That’s 32 percent above the poverty line for his family of seven.
By today’s standards, his insurance is generous and more or less comprehensive—unless his carrier, Blue Cross Blue Shield, decides to reject one of the family’s claims. "They reject everything the first time around," he says. The deductible is $500 for each family member and $1,000 for the family—low compared to the enormous deductibles of $3000, $5000, and even $10,000 families face today as employers shift costs to their workers. Copays are light, too—$15 for doctor visits; $30 for specialists; $75 for the ER, and only ten percent of any doctor or hospital bill if he stays in network. The out-of-pocket maximum is $2,000, and he always tops out on it.
For this coverage, his share of the premium is $5,443 a year—more than 12 percent of his income...
He could lower the premium by upping the deductible to $1000 per person, but says he can’t swing the out-of-pocket expenses a higher deductible would require. In fact, he adds, "I don’t make enough money now to cover the deductibles, and we don’t always have the money for the copayments."
For awhile he was hopeful that health reform might help him out. That’s unlikely. Because he has insurance, he’s not eligible for Medicaid or a public plan if one were part of the final health care bill. And he’s not eligible for subsidies unless his employer makes him pay a very large portion of the premium.
Currently the Senate bill says that anyone spending more than eight percent of total income on insurance won’t be penalized if they fail to get coverage. So Devor could drop his policy and pay for all his medical bills out-of-pocket—not exactly something he’s eager to do. It’s an unappealing alternative for someone struggling to pay the deductibles and coinsurance for the coverage he has now.
So where does that leave him—one of several million Americans who will be over the line and perhaps facing another medical bankruptcy down the road, the kind of thing Obama said reform would prevent. "The single biggest issue in my household is health care," Devor told me. "I wouldn’t mind paying the same amount in taxes that I am paying for health care today. I already don’t have that money for our family. And still I have the stress and anxiety of dealing with doctors."
There's going to be a lot of others like Jeremy Devor for whom the promise of reform becomes little more than a mirage, and we'd all best be prepared for the public backlash against the reformers when that happens.
There's still time to raise your voice to support a single payer amendment now introduced by Sen. Bernie Sanders in the Senate, and urge our legislators to do more to protect our families from these crippling costs.