The Tea Partiers predict disaster: the Affordable Care Act (dubbed Obamacare) will plunge the nation down the road to socialism, or cataclysm, or, if you heed the more prophetic ranters, to Hell. This road is not paved with good intentions, but with government fiats, designed to strip all Constitution-Loving patriots of money and power. Beware! Repent! Repeal! Lets walk those steps to doom.
Step one: Prevention. Health plans will now have to include some preventive services and tests, with no co-pays. A research arm of the government (yes, Big Brothers research arm, not that of a private sector entity that markets the tests, or the insurers that will foot the bill) has compiled a list. The list includes routine pediatric visits, immunizations, vision and health screenings in children, screenings for diabetes, high cholesterol, high blood pressure in adults. Medicare will have to include an intake baseline physical examination. Some of the services will save money. But cost-effectiveness aside (analysts compute the costs of treating a small number of sick people versus the costs of widespread immunization), the services will lead to a healthier citizenry. Astoundingly, many health plans today lack these basics of health.
Step two: Family planning. To date, 22 states Medicaid programs (including Texas, California and South Carolina) have expanded family planning under the decade-old codicil allowing temporary experiments. The Affordable Care Act will make it easier for the other 28 states to launch their programs, as well as allow the current states to expand their outreach. Uncle Sam is not dictating to women the number of children to bear, but is giving poor women the same options middle and upper-income women take for granted. The Tea Partiers should cheer this simplification of a government program unless of course the Tea Partiers would like to nix family planning for poor women.
Step three: Subsidies for small businesses. Today businesses that employ fewer than 25 people face high premiums if they insure their workers. Not surprisingly, many small firms dont. So Uncle Sam wants to offer incentives: tax credits of up to 35% of the employers contribution. The incentives may not work: they may be too meager to change firms calculations, particularly in this recessionary time. But surely this step is worth the effort. Without any government intervention, small businesses wont insure more workers. Ironically, the Tea Partiers who fear a single-government insurance plan (like Medicare) should welcome this public-private partnership.
Step Four: A ceiling on extravagant insurance profits in health care jargon, the medical loss ratio. Companies must spend 85% of premiums on care for enrollees or issue rebates. That might translate into lower executive salaries (they now soar into the millions), lower perks, lower shareholder returns. But the enrollees would see lower co-payments, fewer denials, more access to more physicians, more treatments.
Step five: No more exclusions for pre-existing conditions. Insurance honchos have argued that they must, absolutely must, exclude treatment of illnesses that beset new enrollees, at least for 6 months. Solvency demands it. But Tea Partiers must recognize the cruel lunacy of denying treatment for illness. Certainly new enrollees who receive a rejection letter from their insurers recognize the cruel lunacy.
Last step: Provisions for more people to have insurance. I bet that all the Tea Partiers are insured. (Those over age 65 have Medicare.) Yet as many as 20% of working-age Americans have no insurance, and most of these people work. The Affordable Care Act promises to expand coverage. The Tea Partiers construe this as dreadful; after all, the Constitution didnt mention compassion. And this step will surely plunge the country into a dreadful hell.
Facing the prospect of health reform, the Tea Partiers implicitly embrace the status quo. They offer no genuine legislative alternatives to the Affordable Care Act. Yet the status quo is also a road one that leads to a truly bleak place: more people with no insurance, more people with abysmally inadequate insurance, more people facing medical bankruptcy as they struggle to pay for the care that keeps them alive. This is the road to cataclysm.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, March 1, 2011
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