Support for President Obama's health care reform plan has hit an all-time low. Only 32% of Americans say the president's proposal is a good idea, compared with 47% who now say it's a bad idea, according to a Wall Street Journal/NBC News poll released on Dec. 16. In addition, 44% of those surveyed say they prefer status quo over reform.As I watch my own patients struggle on a daily basis, whether it's fighting with insurers for approval for care or trying to pay bills for services rendered, I find myself wondering, "Where have things gone wrong?"
It's Getting Worse, Not Better
In June, the Kaiser Family Foundation published a public opinion poll, which seems to make the argument for change clear. The survey found that 55% of Americans -- or a member of their households -- had put off needed medical care because of cost. One in four respondents had skipped a recommended test or treatment and a similar number had failed to fill a prescription because it was too expensive.
Just over one-quarter of those surveyed said they or their family had had trouble paying medical bills over the last year. And among those suffering from medical problems, the number rose to 48%. Not surprisingly, 61% of respondents said that reforming health care at the time was more important now than ever before.
Since then, the situation seems to be getting worse. Some jobless patients who took advantage of stimulus money to extend their health care coverage through the program known as COBRA are now facing end of their benefits. Even if they manage to get a job in the next few months, the waiting period prior to insurance becoming available will force many of them to join the ranks of the uninsured.
Other patients who felt safe because they had insurance underestimated the costs of being responsible for 10% or 20% of their medical costs. After having surgery or a baby, they now find themselves in debt. Meanwhile, health insurance premiums continue to rise.
Charity Care Is No Long-term Option
On more than one occasion, patients have asked me for advice that is very difficult to give. For example, a patient with pelvic pain and abnormal Pap smears, an exam used to test for cervical cancer, said she could only pay for one of these problems to be evaluated. She asked me to choose which problem she should treat.
Many doctors, myself included, have dispensed a lot of compassion and free care to help patients, a reminder of why we went into the profession in the first place. But charity and good deeds should not be the long-term solution for providing cost-effective quality care.
Last spring, President Obama made the case that the amount we spend on health care is unsustainable and that we need to provide quality medical care to all Americans. It seemed like a fairly straightforward argument. The administration has fought the good fight. But the president and his advisers must be somewhat dejected by the watering down of the pending legislation and the diminishing hope of truly changing our nation's health-care system.
Small-business owners, physicians and large institutions such as hospital systems are rightfully frightened by the unknowns of the bills, as well as the midnight-hour changes behind closed doors -- and the effect these might have on their livelihoods. During a presentation I attended last week at my own institution, which administered over $60 million in free care to the community in the last year, a hospital administrator bluntly stated that if reform passed in its current form, it would have a devastating effect on hospital revenues.
"Scare Tactics" Have Influenced Opinion
From the Republican perspective, the legislation was too expensive. Republican legislators complained that we -- and our children and grandchildren -- would be paying for it for generations to come. They added that the effect on business would hurt the economy, and in turn, hit the average Joe through further job losses or taxes.
Why isn't the general public more in favor of change? If the nitty-gritty of creating a bill to overhaul the entire health-care system isn't daunting enough, the Republicans threw in a few good scare tactics like the bogus death panels that would supposedly determine whether to continue caring for the elderly. They also used misleading words and phrases like "rationing," "government takeover" and "socialized medicine" to convince those on the fence that the health-care reform bills proposed by Democratic lawmakers needed to be squashed.
The Democrats tried to dispel these myths and countered with their own numbers, reminding the public that many Republican programs such as the Bush-era tax cuts never faced scrutiny over how they would be sustained. But the damage was already done. The public chose to believe the spin by opponents of reform rather than turn to credible sources of information like the fact sheet put out by Families USA entitled 10 Reasons to Support the Health Care Reform Bills.
So here it is December, and people are confused by all the rhetoric, shocked by the huge price tag and scared that the proposed changes will only make the situation worse. Over the last month or so, quarreling among Democrats over the so-called public option (a government-run program to compete with private insurers), cost-containment and abortion has caused dissent within their own party. Republicans, meanwhile, have mostly stayed together in opposition.
The Public Grows More Confused
As we've seen this week, efforts at compromise have meant new proposals and other changes, and the public has become less and less clear on what they are really getting. People are also more fearful about the many concerns some valid, others preposterous, that have been raised.
On one hand, without compromise, nothing will ever get passed. On the other hand, as special interest groups and hold-out legislators, like my home state's Sen. Joe Lieberman, get their way in return for support, the watered-down version of legislation heading toward the finish line seems more likely to appease special interest groups than accomplish the president's goals.
What the final bill will look like is beginning to look disappointing. For example, it probably won't include a public option, serious medical malpractice reform or enough preventive measures. What's more, it doesn't adequately address the broken fee-for-service system, with its excessive testing and treatment -- all of which are necessary to contain long-term health care.
Yet I remain optimistic that before the final bill is voted on, legislators will take a deep breath and fine-tune the bill to approximate the original goals to assure that more Americans will be covered and have access to better medical care in the end.
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