Saul Loeb/AFP/Getty Images
During a summer tour to drum up support for a health care overhaul, President Obama often spoke of wanting to improve the way care is delivered. His trip included a visit to a Kroger's grocery store in Bristol, Va., in July.
During a summer tour to drum up support for a health care overhaul, President Obama often spoke of wanting to improve the way care is delivered. His trip included a visit to a Kroger's grocery store in Bristol, Va., in July. Saul Loeb/AFP/Getty Images
When President Obama and congressional Democrats began their drive this year to revamp health policies, they promised to expand health care coverage and to make it more affordable.
The health bill passed by the House — and a similar measure pending in the Senate — boost the number of people covered by health insurance. But critics from across the political spectrum say the legislation does little to rein in runaway health care costs.
Rules Change For Payers — Not Chargers
There's been a significant rhetorical shift in the way President Obama and his congressional allies refer to their health care overhaul. This summer, when President Obama was still talking about what he then called "health care reform," he promised to bend the rising cost curve of health care downward.
"Our proposals would change incentives so that providers will give patients the best care, not just the most expensive care," Obama said in July. "Which will mean big savings over time. This is what we mean when we say that we need delivery system reform."
Fast-forward to the day after the House passed its health care bill earlier this month. Notice how President Obama, in praising that action, no longer called it either delivery system reform or health care reform:
"It brought us closer than we have ever been to comprehensive health insurance reform in America," the president said of the bill in a Rose Garden address.
"Health insurance reform" is the same label other Democratic leaders are now using — a phenomenon that coincides with the insurance industry having turned against the Democrats' health care proposals, which force insurers to drop highly unpopular policies, such as denying coverage because of pre-existing conditions.
A Shrinking Effort At Reform?
Paul Ginsburg, head of the nonpartisan Center for Studying Health System Change, says he thinks the health care makeover has ended up being largely about putting the squeeze on insurance companies:
"Insurance reform is a much more accurate label," Ginsburg said. "So we can praise that for the accuracy of labeling, but lament the fact that there's a lot of health care reform that needs doing, and our insurance reform will get us only so far."
Even as they're taking on the highly unpopular insurance companies, lawmakers are not requiring big changes in the way health care is delivered by doctors and hospitals. In turn, those providers are backing the health care plans moving through Congress.
But the providers' ever-increasing fees, many experts say, are driving health care costs up for everyone.
Sen. Susan Collins (R-ME) says those constantly rising costs are the biggest worry for people in her state.
"I'm very concerned that the bill passed by the House does not do enough to lower health care costs in general," Collins said. "In fact, it does virtually nothing to lower health care costs."
Critics Seize On Rising Costs
The absence of clear measures to rein in costs is being seized on by opponents of the legislation.
A TV ad sponsored by business groups calling themselves Employers for a Healthy Economy targets Maine and nine other states.
In the ad, a narrator states that the new bill does nothing to address rising costs: "Health insurance costs will skyrocket. Call Congress. Tell them the new health care bill is a bill America can't afford to pay."
Even some longtime supporters of health care overhaul are dismayed. The National Coalition on Health Care is running newspaper ads that proclaim that enacting "national health care reform without cost control is like moving furniture into a burning house."
Ralph Neas, the lobbying group's CEO, explains the logic behind the ad.
"Because if you have coverage, if you have other things that are very important — and the bill does — but you don't have cost containment, then you're not going to have a bill that's sustainable," Neas said.
Another critic of the bill, Georgetown University health economist Jean Mitchell, says the legislation perpetuates a flaw in the current system: "The way the system is, the more you do, the more money you make."
Mitchell finds little in the legislation before Congress that would compel doctors to stop charging for every procedure they perform, a practice known as fee-for-service.
"It's almost as though patients have become like ATM machines," Mitchell said. "You know, you put them in, and you try to extract as much revenue as you can."
AMA Backs Democrats' Plan
James Rohack, head of the American Medical Association, doesn't agree.
"We believe that fee-for-service is a good mechanism, because it recognizes what a physician does," Rohack said.
Though he defends the fee-for-service model, Rohack, a cardiologist, also acknowledges that the system gives him and his fellow doctors perverse incentives to perform more procedures than are needed.
"As long as there's fixed costs and a physician isn't able to really get paid for the true cost of care, it's created this horrible problem where physicians are pressured to increase volume just to make ends meet," Rohack said.
The AMA has endorsed the health care bill passed by the House. In turn, House members will vote this week on removing scheduled cuts in Medicare reimbursements — cuts that are meant to curb the exploding volume of services doctors perform.
Congress has enforced such cuts only once in the past seven years — and it now seems unlikely to get tough on the costly practices of doctors, who are, after all, more highly regarded than the insurance companies.