Health Care Reform Could Harm More Than It Helps

Horace Cooper

6/30/2009 11:57:25 AM - Horace Cooper

Congress has started in earnest its effort to enact President Obama’s promise for universal health care. Many in the mainstream media repeat the meme that this effort will finally ensure quality health care for all Americans, but the truth is that enactment will bring profound changes for the average insured person -- changes that will more likely lower the quality of coverage particularly for those individuals reliant on advanced medicines.

Besides creating a federally run insurance network to compete with existing private sector insurance, the main bill introduced by Senator Edward Kennedy (D-MA) requires the federal government to subsidize insurance premiums for families of four with incomes up to $100,000. It creates a national mandate for every American to obtain health insurance with penalties on as many as 5 million Americans who don’t have coverage (although the bill does include an “exceptional financial hardship” exemption for a few). Not leaving employers out of the picture, the bill places a similar mandate on all medium and large businesses forcing them to provide coverage and it expands Medicaid to cover people with incomes up to 150 percent of the poverty level ($16,245 for an individual and $33,075 for a family of four). The end result is that the already ballooning deficit will expand beyond any comprehensible level and private insurance will be crowded to the periphery.

Perhaps the most consequential change will be the additional cost controls the Kennedy bill places on the existing insurance sector including eliminating nearly all options for insurers to either deny or price different applicants according to their health needs. Taken together with the expansions in the government sector, these changes will lead to radically different treatment tomorrow for patients who already have coverage. For these individuals the changes could be deadly.

One particular area of concern is the potential changes in access to life saving statins - a class of drugs that lowers cholesterol levels for those at risk of heart disease - that will come as a result of this bill. Heart disease is the number one killer in the United States and any changes to our health care system should improve this situation, not exacerbate it.

Unfortunately Senator Kennedy’s bill will likely limit or reduce access to life saving statins for existing patients which is likely to lead to more deaths, not fewer. Why? The cost sharing and non-discrimination mandate which will herd high risk and already ill patients into the pre-existing insurance pool provided in Kennedy’s bill will force insurers to reduce coverage and spend less per patient. This means that on top of the existing pressures being pushed by today's insurance providers, tomorrow's patients will face an even greater array of restrictions on the choices of doctors and medical care they receive.

Like many pharmaceuticals, there are a variety of cholesterol-lowering statin medications and they each have different benefits and uses. Different patients with different risk factors require different medications. It is those attributes – gender, race, family history, age – and other medical risk factors which have traditionally been the primary decision drivers for prescribing statins.

But because Kennedy’s bill requires rationing to achieve its goals, the cost of statin medications will drive health care decisions, not patient needs. Many critics of the existing insurance network rightly recognize the existing pressures by the insurance industry to try to lower costs by limiting patients pharmaceuticals, the Kennedy bill would dramatically exacerbate this phenomenon.

Getting all patients including existing covered patients to meet or exceed their cholesterol goals should be the priority, not assuming that the cheapest statin medication is the best.

Just as night follows day, the health sector will respond to these federal mandates by requiring the lowest priced statin to be used regardless of applicability and this will have deadly consequences. There simply is no good reason for this kind of cost containment experimentation, particularly for the high risk populations that rely on statins. In the long run it won’t be more cost effective, and it will cost lives.

The costs for brand name medications and insurance formularies are constantly changing and today most boomers have access to the most effective heart disease medications without realizing it. Before rushing headlong into a system of government controlled health care layered on top of an already over-regulated industry patients should determine what the impact on their own personal health care needs will occur with these proposed changes. Unless dramatic changes are made, this health care bill could prove to be a major bust for existing patients.