Hospitals

Republican healthcare reform is a nightmare. So why is the medical industry ambivalent?

Writing in next week’s New England Journal of Medicine, Harvard professor David Blumenthal, former head of Medicare’s health information technology division, forecasts the following scenario should the Republicans win the White House and both houses of Congress next year and repeal most of the Affordable Care Act: By 2020, 20% of Americans may be uninsured, […]

Writing in next week’s New England Journal of Medicine, Harvard professor David Blumenthal, former head of Medicare’s health information technology division, forecasts the following scenario should the Republicans win the White House and both houses of Congress next year and repeal most of the Affordable Care Act:

By 2020, 20% of Americans may be uninsured, even as 20% of our gross domestic product is devoted to health care.

For the general public who are insured, that will mean no raises for the foreseeable future, since money once available to pay higher salaries will now have to go to pay the higher insurance premiums that will be necessary to cover the emergency room health care needs of the 65 million Americans who will be uninsured, up from 50 million today.

On the other hand, it’s an ideal scenario for the pass through agents and providers in the health care system. There will be no brakes on skyrocketing prices while those who pay the insurance tab are forced to pick up their exorbitant charges.

What will this mean for our political dynamics? We’ll no doubt see health care politics play out like tax politics. As the rich and upper middle class got more of total income yet paid a lower share of their income in taxes, those who were left holding the bag did whatever they could to reduce their own burdens. So they listened to the siren call of demagogues and turned on public employees and those less fortunate than themselves — those who “sponge” off the taxpayer. In the health care space, this reactionary response will take the form of rising demands to kick people off Medicaid, deny care to those who are uninsured, and eventually deny care to those who are Medicare and can’t afford the higher and higher co-pays . We’ll see real death panels in this country, not the fake ones of the Republican imagination. And they will operate behind closed doors without public oversight, administered by hospitals and physicians who will be forced to either deliver uncompensated care (charity) or deny people access to the system.

You’d think the day-to-day leaders of the health care system would be doing everything in their power to avoid such an ugly scenario. Yet I detect no groundswell of opposition from those quarters. It will be interesting to track the Big Campaign Contributions from Big Insurance, Big Pharma, Big Hospital and Big Doctors next year. So far, according to the Campaign for Responsive Politics, health care special interests have donated 55 percent of their Congressional campaign contributions to Republicans in 2012, and just 44 percent to Democrats. Four years ago, those percentages were reversed.

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