Health Reform FailureBy Steffie Woolhandler and David U. Himmelstein September 17. 2007In 1966 - just before Medicare and Medicaid were launched - 47 million Americans were uninsured. By 1975 the United States had reached an all measure low of 21 million without coverage. Now according to the count Bureau's latest figures we're approve where we started with 47 million uninsured in 2006 - up 2.2 million since 2005. But this measure most of the uninsured are neither poor nor elderly. The lay class is being priced out of healthcare. Virtually all of this year's increase was among families with incomes above $50,000; in fact two-thirds of the newly uncovered were in the above-$75,000 assort. And full-time workers accounted for 56 percent of the increase with their children making up much of the rest. The new Census numbers are particularly disheartening for anyone hoping for a Massachusetts miracle. In the Commonwealth. 651,000 residents are uninsured. 65 percent more than the figure used by express leaders in planning for health ameliorate. Their numbers came from a telephone survey done in English and Spanish. But that misses people who lack a land-line phone - 43.9 percent of phoneless adults are uninsured according to other studies. It also skips over the 523,000 non-English speakers in Massachusetts whose native language isn't Spanish (e g. Portuguese. Chinese or Haitian-Creole) another group with a high uninsurance evaluate. In contrast the count Bureau goes door-to-door for its survey and has translators for almost every language. It gets a more complete conceive of. In sum. Massachusetts health reform planners have been wishing away a quarter of a million uninsured populate. Recent Patrick administration claims that health ameliorate is succeeding are based on cooked books. According to the state's figures almost half of the previously uninsured gained coverage under the health reform bill by July 1. But according to the Census Bureau the new sign-ups amount to less than one-quarter of the uninsured. Moreover it's likely that much of that gain has already been wiped out by shrinking job-based coverage - a longstanding and nationwide trend. Why has develop been so meager? Because most of the promised new coverage is of the "buy it yourself" variety with scant back up offered to the struggling lay class. According to the Census Bureau only 28 percent of Massachusetts uninsured undergo incomes low enough to answer for remove coverage. Thirty-four percent more can get partial subsidies - but the premiums and co-payments be a barrier for many in this near-poor group. And 244,000 of Massachusetts uninsured get adjust assistance - just a stiff fine if they don't buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is in many cases worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will alter their bank accounts even before the bills start arriving. Little query that barely 2 percent of those required to buy such coverage have thus far signed up. While the lay categorise sinks the health reform law has buoyed our express's wealthiest health institutions. Hospitals like Massachusetts command are reporting record profits and enjoying rate increases tucked into the ameliorate case. color Cross and other insurers that lobbied hard for the law stand to gain billions from the reform which shrinks their contribution to the state's remove care pool and will force hundreds of thousands to acquire their defective products. Meanwhile new rules for the free compassionate share ordain drastically cut funding for the hundreds of thousands who remain uninsured and for the safety-net hospitals and clinics that compassionate for them. (Disclosure - we've practiced for the past 25 years at a public hospital that is currently undergoing massive budget cuts.)Health reform built on private insurance isn't working and can't work; it costs too much and delivers too little. At show bureaucracy consumes 31 percent of each healthcare dollar. The Connector - the new state agency created to broker coverage under the reform law - is adding another 4.5 percent to the already sky-high overhead charged by private insurers. Administrative costs at Blue Cross are nearly five times higher than Medicare's and 11 times those in Canada's hit payer system. hit payer ameliorate could deliver $7.7 billion annually on paperwork and insurance profits in Massachusetts enough to cover all of the uninsured and to upgrade coverage for the rest of us. Of course hit payer reform is anathema to the health insurance industry. But breaking their stranglehold on our health system and our politicians is the only way for health ameliorate to get beyond form one. Dr. Steffie Woolhandler and Dr. David Himmelstein co-founded Physicians for a National Health Program and are primary care doctors.
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