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When health insurance isn’t enough

Salon.com, 7/7/11

By:  David Sirota
Wednesday, Jul 6, 2011 13:01 ET

New studies suggest that coverage doesn't protect Americans from going bankrupt over medical costs
        
While the contest for the 2012 Republican presidential nomination is already revolving around conservative-themed attacks on "Obamacare," back when the healthcare bill was being legislated, the most important debate was within the Democratic Party, which held large majorities in both houses of Congress. On one side were the drug companies, the insurance companies and President Obama -- the latter who had not only disowned his prior support  of single-payer healthcare but had also worked with his corporate allies to actively undermine a modest public insurance option. On the other side were progressives who opposed any bill which further cemented the private insurance industry as the primary mediator between doctors and patients.

Ultimately, Obama and his corporate-backed allies organized enough conservative Democrats in Congress to win, effectively turning healthcare "reform" into a blank-check TARP-style bailout for the health industry. But, of course, to even whisper that last truism is to now run the risk of being labeled a blasphemer in a conversation that can only tolerate misleading red-versus-blue analyses. In today's national political debate, there are Republicans who insist "Obamacare" is a Canadian-style "takeover" of America's healthcare system, and there are Democrats who insist that the health bill is a major Medicare-like achievement -- any other argument, no matter how valid, has been vaporized by election-season pressure to fall in ideological line.

Unfortunately for the political class, however, reality doesn't take orders from partisans -- it persists irrespective of talking points, press releases and Twitter mobs. And on healthcare, the original progressive criticism is now being validated in a new study from Arizona. Going beneath the superficial rhetoric about health insurance and to the reality of actual health care and health costs, the study published by the American Journal of Public Health found:

Health insurance is not protecting Arizonans from having problems paying medical bills, and having bill problems is keeping families from getting needed medical care and prescription medicines, a new study has found... After taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications. In addition, says University of Arizona College of Pharmacy research scientist Patricia M. Herman, ND, PhD, who directed the study, medical debt is a separate and better predictor of whether people will delay or forgo needed medical care than their insurance status.

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt," Herman says. "From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."

With 60 percent of all bankruptcies related to medical costs; with many of those medical-related bankruptcies occurring among those who have private insurance; and with the fear of medical bankruptcy encouraging the insured to unduly skimp on medical services, the Obama healthcare bill did purport to address the issue via caps on out-of-pocket expenses. But those weak caps  -- and the bill's failure to achieve universal coverage -- promise to allow the medical debt problem to continue, just as they have in the state whose "reforms" most closely mimic Obama's bill.

As the Los Angeles Times recently reported:

Studying medical bankruptcies in Massachusetts, whose recent healthcare reform was a model for national reform, researchers found that while new insurance rules increased the number of people who had coverage, those rules did not improve coverage -- leaving many still struggling with medical debt... Proponents of the national healthcare reform passed into law last year have claimed that it would reduce medical bankruptcy in the United States by helping more Americans get insurance. This new study, which was published Tuesday in the American Journal of Medicine, suggests that a reduction in bankruptcies is unlikely.

Add to all of this a new Center for Public Integrity report about how American wages are still being eaten up by private health insurance premium increases, and the trajectory is clear: Events are proving that "real reform" and strengthening insurance industry power are mutually exclusive goals. That is, they are proving the veracity of progressives' original criticism of President Obama's healthcare legislation. This is, to be sure, a politically inconvenient truth to both parties and their insurance industry benefactors -- but alas, it is the truth. The longer we simply stare at it -- or pretend it doesn't exist -- the longer the healthcare crisis will continue.

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