Image: healthcare reform is implemented. Therefore, it is important that he or she is the best person for the job.
Some doubt that President Obama’s nomination of Dr. Donald M. Berwick is the right choice, including the premier industry trade group. America’s Health Insurance Plans declined to sign a letter that supported his selection.
Republicans are also worried that Berwick prefers a government-run National Health Service, similar to the one in Great Britain. They plan to bring up the threat of health plan rationing of care once again during the confirmation hearings.
Unfortunately, health insurance reform does relatively little to reduce the use of often medically unnecessary and less effective–yet expensive–medical care, such as tests. Overuse may make up 10-30% of health care spending in the United States. When some people try to reduce it, they are often accused of rationing.
However, the legislation will eventually do something: starting in 2018, there will be a tax on high-cost health insurance plans. These plans are accused of encouraging consumers to utilize expensive care, especially when they are provided by employers. By transferring more of the cost to patients through higher co-payments and deductibles, they may think twice before demanding a MRI they may not need.
In order to lower their premiums, health insurers may also decide to exclude unnecessary procedures from some of their coverage options. This may make them more competitive in the soon-to-be-launched exchange markets.
How much would you be willing to pay for a couple to screen their child for a rare genetic condition? Would you want your medical insurance pay $4.7 million? That’s the amount it costs to prevent one child from being born with Spinal Muscular Atrophy (SMA). SMA is incurable and cannot be treated; a child born with it will never be able to move at all. There is an accurate test for it, but routine screening would end up costing your health insurance nearly $5 million to save one child from that fate. That’s because the SMA gene is carried by relatively few Americans and has no symptoms, meaning that the general population–as opposed to just those considered high-risk–must be tested. 11,000 women must be tested at $400 a pop to prevent one case (either by terminating the pregnancy, or using donated sperm or embryos to conceive). By contrast, it costs a relatively frugal $260,000 to provide a person with SMA lifetime care.
The idea of a single child being born with that condition is horrifying. Health insurance companies or the government using cost-effectiveness tests and rationing techniques to decide on health care is scary; cold, hard numbers hold a child’s fate in their hands. Decades worth of studies have shown that, perhaps counter-intuitively, the image of one individual’s suffering is more striking than the suffering of untold masses. Our minds find it easier to feel empathy on a smaller scale. A recent study from the American Journal of Public Health estimates that about 45,000 Americans die each year as a result of going without family health insurance, yet fewer people are willing to risk an increase in their medical insurance rates to prevent their deaths. Proponents of healthcare reform have an uphill battle psychologically; President Obama has attempted to give a name and face to the plight of several uninsured Americans in recent speeches, but his specificity appears to have had little impact.