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Wednesday, Apr 01, 2015

Reiniers: Health care reform - forget the politics


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Long before Obamacare was a gleam in President Barack Obama's eyes, state legislators and opinion writers - myself included - expressed concern about the complex issues of health care reform.

My argument was to focus first on health care costs and not on the lofty goals of eliminating underwriting protocols. This would only add more cost to a reformed health care system and force significant premium hikes, which would trigger subsidies paid for by insured taxpayers. Then factor in higher co-pays and deductibles, and the government would be offering an unaffordable product for the very low-income uninsured they pledged to subsidize.

Before Obamacare became law, research revealed - and I had written about - the $600 to $800 billion of costs attributed by experts to fraud and overutilization (waste). Getting that astonishing number under control should have been the first order of business. This would take years, but it would give actuaries a baseline number for legislators to figure out just how affordable the Affordable Care Act would be.

The numbers thus far have been disappointing. For example, Obamacare established The Pre-existing Condition Insurance Program in 2013 and allocated $5 billion to pay the medical costs for the uninsured with pre-existing conditions. The government quickly ran out of money and closed enrollment for the very people who need the most help and to whom promises were made (another promise broken). The average annual cost per enrollee in 2012 was $32,108. One state had a high average of $171,909. Co-pays have been increased to $6,250 a year. In other words, rationing already has begun.

This virtually was ignored by the traditional media.

There is also the exploding cost of subsidies, estimates of which range from a low of $458 billion to $1.2 trillion. The harsh reality of numbers like this is problematical for the Obama administration because it desperately wants to keep the total cost of Obamacare below $1 trillion. (Americans have been getting used to that number in recent years - a mere bagatelle.) Keep an eye out for unannounced administrative fixes.

Perhaps now it should be more obvious that step one for the administration should have been to tackle the astonishing $600 to $800 billion cost of waste and fraud.

Big government never starts at the logical beginning; it always starts by handing out money, because that's how its politicians stay in power.

The second step should have been what every big business does: run a pilot program to see if the plan is feasible and, if so, work out the bugs. (That wasn't in the cards because the administration was, and still is, targeting an end goal of European single-payer health care.)

Massachusetts was an ideal pilot (Romneycare), because it already had a track record. With a GDP of $414 billion, Massachusetts ranks higher than Denmark, and slightly less than Norway. It has a median income of $65,850, and state and local taxes rank it sixth highest nationally. It is America's version of a European social democracy in that its citizens are willing to pay for aggressive social programs. It was a credible pilot then and is now.

Massachusetts has had Romneycare since 2006 - an "Act Providing Access to Affordable Quality Accountable Health Care," and, lo and behold, six years later the legislature passed an "Act Improving the Quality of Health Care and Reducing Costs" . So Massachusetts also forgot to put first things first - the operative words being "reduce costs."

Why the new law? Because after a year's study and analysis, the recently created Health Policy Commission determined that between an astonishing 21 percent and 39 percent of all health care spending was wasteful - eight years after the law became effective. It's another work in progress, as is Obamacare. The Legislature has charged the commission with the responsibility of both monitoring and enforcing health care utilization and costs and tying in costs to the growth in the state's economy. Rationing is inevitable as the heavy hand of government bureaucracy regulates away all these annoying wasteful health care practices.

We can be sure that every state, every health care professional and HHS's Kathleen Sebelius will be watching Massachusetts closely.

As luck would have it, the latest Health Policy Commission report says "Spending in Massachusetts is the highest of any state in the U.S. crowding out other priorities for consumers, business and government." Really? Why haven't we heard about this?

On top of this, a recent headline of The Boston Business Journal reads: "With Obamacare changes, state girds for more Medicaid fraud."

And this was the model that Obamacare patterned itself after. It proves the necessity of having first established a pilot to see if a scheme is even feasible.

If government is the answer, arbitrary rationing is a must. That said, consider these facts about Britain's National Health Service (in business since 1948) and a model single-payer system:

In a recent survey, 71 percent of British GP's believed rationing of health care has increased significantly since 2013. The government is seeking a third year of pay freeze for NHS workers. Waiting times are at a five-year high. Long-term care facilities are being shut down. The list goes on.

The Brits have admirably controlled costs, but there have been continuing crisis points over the decades. The money simply isn't there to support the NHS. We've been there with Medicare and Social Security, so now Obamacare will fill out the trifecta of unaffordable government programs. This is a reality check, not a political statement.

It's a tragedy that our country's health care has become a testy partisan political issue. Professionals need to drive the solution - if there is one - not politicians.

John Reiniers is a retired attorney and regular columnist who lives in Spring Hill. Email him at

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