Sam Uretsky

No Returns

The health care overhaul isn’t very popular, and there’s no reason why it should be. Progressives wanted a single-payer plan, were willing to compromise on a public option, and didn’t get either. Conservatives wanted to leave things just the way they were. If you’ve got one group that wants chocolate, and another that wants vanilla, you can’t mix the two and think you’ll please anybody let alone everybody. Significantly, the only clear winners seem to be the insurance and drug companies, while those people who find that “if you like your current plan you can keep it” doesn’t always apply (it doesn’t), haven’t been counted.

The actual public opinion is anybody’s guess. A widely publicized Rasmussen poll shows strong support for repeal — but Rasmussen polls always seem to be skewed to the right. The most recent Gallop poll has a small plurality of people favoring the reforms. John Zogby, chairman of the polling company that bears his name, wrote an op-ed piece for BBC News projecting increasing approval for the new law, but this conclusion was based on a sort of vector analysis: as Republicans increase the intensity, people who favor the reforms will become more fervent in their approval.

Regardless, it appears that the Republican Party plans to run their midterm election strategy on Repeal and Replace. Repeal brings us back to the status quo ante, and there was no doubt it was a disaster. The replacement hasn’t been presented, although Todd Harris, billed on MSNBC as a Republican strategist, said that a Republican plan would be “market based.” It’s impossible to tell if this is good politics, but it’s terrible economics. Free market theory works, but only in the presence of free markets. It seems like a contradiction, but we can’t have free markets without lots of regulation. Market-based systems work when all the information is available to buyer and seller, both understand the information, and both can negotiate freely. The market for automobiles is a relatively good example — the buyer has a good idea what she’s after, checked the April issue of Consumer’s, knows what she can afford to pay and can go from dealership to dealership. The dealer knows how low he can go on price, so that both can negotiate.

Healthcare is more complex. The buyer and seller aren’t negotiating on equal terms. If the patient is the buyer, the seller always has the upper hand. While the medical literature since the 1990s has given lip service to POEMS, Patient-Oriented Evidence-Based Medicine, a type of practice that depends on rational analysis of the published literature and application of information based on clinical experience and familiarity with the patient, a lot of practitioners simply conclude that it doesn’t work in the “real world.” There are some good medical references available to consumers, but nothing that can be used as a buyer’s guide.

If the consumer is at a disadvantage buying medical services, it’s a lot worse trying to understand an insurance policy. Consider what Congressman Randy Forbes (R-Va.) has to say about the new law: “in its current form (it), would require all Americans to have a health insurance plan that includes ‘essential benefits’ that are determined by a bureaucratic committee in Washington rather than doctors who know what is best.” You can trust the insurers. Ron Williams, the CEO of Aetna, made $24,300,112 in 2008 (total compensation, including use of the company jet). Angela Brady, CEO of Wellpoint, made $9,844,212 (she also gets use of a plane). These are the people, not local physicians, who decide what goes into the policies.

Finally, even the insurance companies don’t have that much discretion, because market forces, in this case stock-market forces, demand that they make the same sort of profits as other companies in the industry. Hospitals and physicians get report cards — reports issued by state health departments on the percentage of patients who survived open heart surgery. Insurance companies are ranked by how well their shares performed, dividends plus appreciation in stock price as compared with similar companies, and they can deal with anything except a “sell” rating from Morningstar or Goldman Sachs. Perhaps the “doctors who know best” have an on-line Ph.D. in accounting.

Arguing for repeal is fair enough — there’s a lot not to like in the reform bill — but do check the proposed replacement. So far, the closest thing offered to an alternative looks immeasurably worse.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, May 1, 2010