They Did It!!

So President Obama, the Democrats, and, yes, the American people got their much-awaited Christmas gift–healthcare insurance reform. Oh, sure, the Senate bill has to be reconciled with the House bill, but I’ll bet you my weekly copy of JAMA that’s a no brainer.

So now (or next Monday when the world returns to work) we can expect a slew of criticism and predictions of doom from people unhappy with the bill as passed. I want to head off some of this at the pass by saying this: No, the bill is not perfect. No, the bill will not reform the healthcare system. No, the bill will not save billions of dollars and reduce the amount of GDP (currently at 17 percent) that our country spends on healthcare.

But, as a wise friend once told me, perfect is the enemy of good.

The reality is that the Senate bill is a first step on a very long journey to contain our out-of-control health system. There will be many more such steps before we even get close to stuffing this evil genie back into the bottle. Why? Because we have allowed our system to become the kudzu of our culture. For those who aren’t of Southern roots, kudzu is an evil vine that grows about a mile a day and, left unchecked, can smother a small town within a month. Health care in the United States is pretty much the same. I’ve often compared it to a closed toothpaste tube: you squeeze out some savings at one end and they just pop up somewhere else.

Plus, as with any huge system, once you start messing with it there will be unexpected results. For instance, when Massachusetts required that all its residents have health insurance, it didn’t expect the significant shortage in primary care physicians that resulted as millions of newly insured people rushed to the doctor’s office. Expect similar unintended consequences as we begin manipulating our current healthcare system.

In the meantime, though, we have the first, all important step.

On the plus side, the Senate bill (and, likely, any reconciled bill):

  • Mandates healthcare coverage for most Americans and provides subsidies/low-cost options for such coverage to people who can’t afford to purchase health insurance at full cost
  • Prohibits health insurance companies from discriminating on the basis of preexisting conditions (see my blog about this)
  • Prevents health insurance companies from cancelling your coverage when you get sick

These are just the headlines. I’ve been reading the excellent summary of the bill that the Kaiser Family Foundation provides and, in upcoming blog posts, will be addressing several of the less publicized components of the plan.

For now, though, I’m opening my bottle of champagne early.

7 Responses to “They Did It!!”

  1. Anonymous


    Glad to see you're writing about this. I appreciate that you're cautiously optimistic about this bill. I'd feel better about it if the exchanges were stronger and open to more people and if the subsidies were increased. I'm also not crazy about the idea of paying for it with an excise tax that will increasingly cover most broad based employer provided insurance. I'm cautiously optimistic that some or all of this might happen in committee, so I'm with you. It's real first accomplishment, but we have a long long way to go.

    Case in point is the gorilla in the room. We pay twice the amount per capita or more for health care than any other developed nation. Despite that huge expenditure, we end up with healthcare outcomes significantly below those of countries that spend far less than we do (France, Germany, Japan, Denmark etc come to mind). And there is literally nothing in the current bills that does much other than “try to bend the curve” ie reduce the rate of growth. That's a much harder conversation to have, and we're having enough trouble as it is….

    Josh Harrison

  2. Deb Gordon


    Unfortunately, there's nothing in the bill that prevents companies from raising premiums. However, if the cost-control measures in the bill–and future ones to come–work, then premium increases should slow or stop; that's the goal. More on this in a soon-to-come post.

  3. Deb Gordon

    Susan, there are actually several components of the bill that do move us towards reducing the bureaucracy; the thing is, Medicare administrative costs are MUCH lower than private insurers' costs; the problem with Medicare is that it's not funded properly and the formula for doctor reimbursement is screwed up; the issue will come to a head as, you say, more doctors stop seeing medicare patients. however, since Medicare patients make up the bulk of most doctors' practices, they're kind of in a catch-22.

  4. Deb Gordon

    Actually, there are several components of the bill that provide incentives for preventive care, education and healthier living.

  5. Dr Sergio

    Will this bill really help or will it be like health care itself, which does not cure but only improves people´s immediate needs? What is necessary is a healthier community. But alas fast food companies offer larger quarter pounders and larger soft drinks, which kills efforts for a healthier population. This becomes a vicious cycle of more disease, more treatment and more cost. Do we really need more coverage or less sick people? In 20 years baby boomers will become elderly boomers and they will probably have to overhaul the system again to cover the increasing costs.

  6. Susan Krancer

    You'd better be prepared to pay more… and get less! There's no way to reduce costs unless you reduce bureaucracy (or cut service). Obviously we aren't reducing bureaucracy!
    Here is Williamsburg, doctors are already turning away Medicare patients. By they time we are eligible for Medicare, who knows how far we will have to travel to find a doctor willing to accept the low reimbursements.

  7. Alisa Bowman

    I can't wait to read your more in-depth posts about what is in the bill and what isn't. As a “they passed health insurance reform” gift, my health insurance hiked my premiums by $100/month. I can't wait for this reform to go into effect–even if it's not perfect.


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