Tuesday, December 29, 2009

Your Taxes or Your Health!

Bob Herbert at the NYT has an excellent piece on one hidden cost of health care reform for middle-class Americans. I mentioned it in a post I wrote a couple of days ago (the tax on so-called "Cadillac plans") but Herbert does a bang-up job explaining where the catch is.

There are many troublesome truths in Herbert's piece, but this is the one that sent my blood boiling: "Proponents say [taxing "Cadillac plans"] is a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services." (Emphasis added.)

I find that deceitful and offensive. The assumption is that the high cost of insurance is due, to some unspecified extent (leading many to think it is THE problem to address), to the wasteful ways of policyholders. It is possible that there is a number of hypochondriac policyholders who go to the doctor way too much and who demand an excessive number of exams, even unnecessary ones. But this is a way to shift the blame from where it squarely lies: on the shoulders of providers and insurance companies.

I have never gone to the doctor expecting an MRI or X-rays or blood-work, much less demanding any of it. I trust my doctor to do the right thing (which is why, above all reform measures, I favor a system in which your PHCP acts as a gatekeeper--you get to see a specialist only if your family doctor says so; if s/he does not, you are free to go a specialist and pay out of pocket.) You know, the sacred relationship between Americans and their doctors? So for anyone to suggest that the best way (or an effective one) to control costs is to tax "Cadillac" plans, without mentioning that doing so will affect an increasing number of Americans as time goes by and may result in a loss of good health for many people is a despicable thing to do.

Think about it this way: I go to the doctor as often as I think I need to (which is not often, maybe a couple of times a year) because I know doing so won't break my bank and because my policy covers most (almost all) of the costs. Conversely, I go to the dentist as rarely as possible. Not because I think I don't need to, but because my employer's dental insurance covers only 80% of the costs, in some cases even as little as 50%. The result is that my mouth is probably the part of my body which is in worst shape. That reluctance to go to the dentist in order to save money in the present will probably lead to higher costs when I finally must go. But that is what people of ordinary means do: they postpone expenses as far as they can. Now apply that logic to the rest of your body, and see what that does for ordinary Americans.

Health care reform that leads to higher taxes or less health care for Americans is tantamount to President Obama reneging on his campaign promise not to raise taxes on the middle-class and a way to punish the American people for the greedy conduct, in some cases criminal, of insurers and some providers. It is just another sign of politicians being serfs to moneyed interests and of the fact that what needs reforming is not just our health care system, but our system of government as a whole.

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