Responding to Carol Miller's Op-Ed Criticizing Health Care Reform

Tyler Taylor

This is a guest blog by Tyler Taylor, M.D., who has a solo, patient-focused medical practice in Los Alamos, New Mexico. The piece was written in response to Sunday's op-ed in the Albuquerque Journal North by Carol Miller.

As a member of Physicians for a National Health Plan for over five years, and an enthusiastic Obama supporter, I find Carol Miller's op-ed in the Albuquerque Journal disturbing. When people on the right misrepresent the facts, all of my capacity for surprise has been exhausted. It's more upsetting though when my progressive kin seem to be doing that.

I disagree with several of Carol Miller's main points. For example, there is much more in this bill than "health insurance reform." It also is not accurate to say that the "reference benefit package" will include fewer services than most insured people have today, since the commission that will decide that won't even be created till this bill is passed. I fully agree that waiting till 2013 for most of this bill to take effect is unacceptable, but assuming that's a cynical political ploy by Obama seems unjustified. Is it not more likely this was one of many compromises needed to get some Blue Dog support?

Some of Carol's key criticisms relate to the costs to the public, after health care reform takes effect. Because the proposal offers two types of cost controls on insurance costs for those with incomes at 133-400% of the Federal Poverty Line, the burdens on these folks seem likely to be greatly reduced, by my reckoning. I calculate that a family of four earning $35,000 annually would have health coverage expenses of $1750 for premiums and $1,000 for out of pocket expenses (for deductible and co-pays). Thus all four people would be covered for $2750/yr., about 1/5 of what that insurance would cost now. Also, keep in mind that the cap of $5-10,000 on total out of pocket costs that Carol mentions is for those making $77,000-88,000 a year; that cap is certainly not great protection, but is far better than those folks have now (i.e. NONE!).

Basically I think there are three possible starting points for evaluating the current reform proposals in Congress: a) our current healthcare system, b) the likely healthcare system in 5 to 10 years without serious reform, and c) a single payer (or other radically different) system that could be created over the next 5+ years. Carol has used the latter starting point, not accepting that our current political climate has made a single payer system completely impossible to accomplish. I too wish that had not been true, but the financial crash of 2008, the Depression of 2007-2009, the bailouts, the breadth of the Democratic Party, and 28 years of right-wing empowerment have made Medicare for All much too hard a sell at this critical juncture.

If the House bill is judged based on where we currently are, or where we'll be without a major change, I would say it has at least 10 very positive features. I confess that I haven't taken a week to read the actual 1900+ page bill, but the 10-page "Detailed Summary" (at [HR 3962]) and many months of public discussions, convince me this bill would:

  1. Provide insurance for tens of millions of currently uninsured people
  2. Prevent most of the 44,000 deaths now occurring annually for lack of health insurance (I've always suspected this is a very conservative estimate)
  3. Dramatically reduce the illness-related bankruptcies, and associated fears, crimes, divorces, domestic violence, etc.
  4. Substantially increase the authority for federal regulation of health insurance companies
  5. Eliminate the antitrust special treatment of insurers
  6. Start the process of revising the wasteful incentives in health care, and take a few first steps regarding hospital care incentives
  7. Encourage more training of primary care providers
  8. Encourage more preventive care
  9. Begin systematically evaluating what treatments are/aren't of value
  10. Gradually reduce drug costs for Medicare patients (closing the "donut hole")
  11. Make choosing health insurance a much more rational process, from both a financial and a quality standpoint.

Ultimately, the paradigm shift I keep hoping we can make is to viewing a simplified, quality, universal health care system as something that will require patience, determination and many steps to create over the next decade. I believe that is the long view that the Obama administration is taking. I also truly believe that this issue is the Civil Rights movement of today. As it took multiple Supreme Court decisions, and many landmark laws to gradually establish equality of opportunity for all races, our reshaping of something this huge and this profitable can only be done in steps.

Each step establishes new foundational principles, and shifts power away from the health care profiteers. Also, by taking moderate steps, we set up the dynamic for the next round. In a few years, when the financial cost of the coming reforms is causing even more outrage in the wealthier, "unsubsidized" public, eliminating much more of the waste of private health insurance will be the obvious next step. The right-wing hysteria and exaggerations will have been disproven by then, and I believe further progress will be possible. This has been the way of progress on many issues throughout U.S. history.

We probably all agree that this is an imperfect approach, and will be expensive and complex. But as a transitional step, I think it's the best we can get for now, and does accomplish a great deal. Aren't saving those hundreds of thousands of lives and reducing the fears of tens of millions enough to keep us pushing for this?

This is a guest blog by Tyler Taylor, M.D. Dr. Taylor grew up in Birmingham, AL, and went to college in Virginia, where he returned after his medical training. He was a small town family physician in the Shenandoah Valley for 21 years, and then moved, with his wife and daughter, to New Mexico in 2000. He has a solo, patient-focused practice in Los Alamos, and has gotten seriously involved with health care reform only in the last five months.

More than 20 patients and friends helped Dr. Taylor get a full-page newspaper ad campaign going this summer, explaining the top 14 reasons why reform is a must in 2009. With the sponsorship of Health Action New Mexico, it ran in five New Mexico markets this summer/fall, probably reaching 250,000 or more New Mexicans.

You can find Carol Miller's article here:
We Need Health Care, Not Insurance

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