Meiyang Liu

Yes, it could get worse

As a person who staunchly believes that our health care system is in appalling shape, I’ve nevertheless come to the conclusion, especially after observing recent turns in the health care debate, that reform could lead to situations worse than the status-quo. For example,

• An individual mandate passes without ensuring low-cost insurance options exist for poor patients (subsidies might patch up the differences for a while, but costs that must be funded by taxpayers will quickly add up).

• Insurance companies use confusion tactics to take advantage of previously uninsured patients (who are disproportionately less educated, from foreign countries, and have more complex health conditions).

• Without premium caps, insurance companies pass along the increased cost of covering uninsured patients to other consumers.

• Insurance companies pocket increased revenues as a result of the individual mandate instead of being required to pass it along to consumers.

• MEDPAC gets packed with physicians and experts who represent specialist interests, further distorting the reimbursement ratio between primary and specialty care.

• Without a parallel initiative to incentivize physicians to go into primary care, the shortage of PCPs worsens as newly insured patients seek care.

• Nothing is done to bridge the gap between comparative effectiveness research and actual physician prescribing/ordering behavior.

These scenarios, and others even more undesirable, are likely to happen if the health care bills continue to get chipped away to appease various “stakeholders” on their way to the Senate and House floors. Weakened reform can be worse than no reform at all.