The generated uproar over the health reform efforts has been remarkable in its ability to completely miss the point. We the people were told that “Obamacare” would insert the government between us and our doctors. We the people were told that “Obamacare” was a government takeover of a free market. We the people were told, again, that the market could take of itself with the help of tax cuts. As the implementation of the Affordable Care Act continues, and as the rhetoric of the midterm elections escalates, it is time for a reminder of the facts of the medical marketplace.
Currently, insurance companies come between most patients and their doctors. Insurance companies dictate what treatments and which drugs a patient can receive, and they do it on the basis of financial calculation rather than patient need. The only way to change that paradigm, is to force insurance companies to compete for patients on a low-margin, high-volume basis. Such a competition will encourage improvements in service and cost. The principle structures created by the Act are the insurance exchanges that will come into being in 2014. The broad investment controls of the Act (companies must spend at least 80% of premiums on their customers), along with the bans on preexisting conditions and rescission, are designed to compress the operating margins of these firms. To maintain the same net revenue, insurance companies will have to find and get more customers.
In the summer of 2008, better than 75% of Americans wanted something done about the medical marketplace in our country. By overwhelming margins, Americans believed it an embarrassment that this country lacked the capacity to care for its citizens. The explosion in costs for average working Americans was also a driver in public opinion, as well as the knowledge that our country ranked behind most of the industrialized world in most key health statistics.
The winter of 2009/2010 has not seen a change in public opinion on the keys for health care reform, but it has seen the success of the most ambitious and well orchestrated branding campaign in political history. In poll after poll, Americans say that they favor a repeal of the anti-trust exemption for insurance carriers, some form of publicly administered plan to provide low cost competition, and the prohibition of pre-existing conditions and rescission. All of the plans proposed, including the two that passed the House and Senate, contain these remedies in some degree. All of the plans proposed have also become universally unpopular.
Glenn Beck went on the morning show on Fox News last week and got off a shot against the President. It really wasn’t newsworthy, as much of his commentary is not newsworthy. Mr. Beck will admit to as much when pressed; he is, in his words, an entertainer and not a newsman. He feels no responsibility to check his facts before he makes an attack. Last summer Mr. Beck famously attacked Democrats for their lack of support for clean coal technology, then went on the offensive in February against the stimulus bill for its inclusion of billions for…clean coal technology.
I feel comfortable bringing this up because I understand Glenn Beck’s problem. He suffers from a previously undiagnosed problem that afflicts millions of Americans…including me. Mr. Beck suffers from Glennbeck Syndrome; the uncontrollable urge to overreact to anything seen in the news or an email combined with overpowering “knowitallness” and a strong dose of bad attitude. Those who suffer from this disease take information from emails and news programs as gospel, and recirculate the information before checking the facts. Unfortunately, I have looked for years for a twelve-step program; but to no avail.
The debate over health care is fast reaching a fever pitch of sloganeering and circular arguments. A screaming collection of cowboys driving herds of mooing cattle over the landscape have come close to derailing any real action that seemed probable just a few months ago. On the right, a phalanx of insurance companies, big pharma, and the AMA; on the left, a scrum of typically weak Democratic senators. The rational middle is, at the moment, looking for cover in the crossfire. I think it is time to step into the body armor and state a few facts.