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States are look­ing to put freeze on health re­form to ap­pease the few

Modern Healthcare - - Opinions Editorials - NEIL MCLAUGH­LIN Man­ag­ing Edi­tor

Notes on the news: Here’s the lat­est ev­i­dence of the bound­less ca­pac­ity of many Amer­i­can politi­cians to sac­ri­fice the pub­lic in­ter­est for po­lit­i­cal gain. As of last week, of­fi­cials in 33 states—mostly Repub­li­cans—were mount­ing le­gal and leg­isla­tive chal­lenges to a key por­tion of the re­cently en­acted na­tional health­care re­form law. They are fo­cus­ing on the pro­vi­sion that re­quires most Amer­i­cans to buy health in­surance or pay a tax penalty. They ar­gue that such a re­quire­ment is a vi­o­la­tion of con­sti­tu­tional rights and a usurpa­tion of state power by the fed­eral govern­ment.

Back­ers of the law say that with­out a penalty, many peo­ple might forgo buy­ing cov­er­age. Be­cause in­sur­ers will be pro­hib­ited from ex­clud­ing peo­ple with pre-ex­ist­ing con­di­tions, the in­surance pool would be skewed with large num­bers of sick pa­tients tak­ing ad­van­tage of the law.

Strik­ing down the re­quire­ment would un­ravel the pro­gram. The ob­ject­ing politi­cians know that, but they want to curry fa­vor with a small but vo­cal con­stituency that op­poses so­cial in­surance of any kind—or at least any kind that doesn’t ben­e­fit them per­son­ally. (Try tak­ing away their Medi­care, for in­stance.)

In Mas­sachusetts, where a re­form law mir­rors the na­tional leg­is­la­tion, polls show cit­i­zens over­whelm­ingly want to keep the sys­tem. The naysay­ers don’t want that kind of thing catch­ing on na­tion­ally.

It’s no co­in­ci­dence that we didn’t see a sim­i­lar flurry of ac­tiv­ity by these of­fi­cials on be­half of pa­tients and providers when the num­ber of unin­sured was grow­ing like an oil spill in the Gulf of Mex­ico. They serve those who make the most noise and who con­trib­ute the most money to their cam­paigns.

One of the states in the van­guard of the de­stroy-the-re­form-law move­ment is Florida. You would think that state has other busi­ness to at­tend to, like a dev­as­tated hous­ing mar­ket, un­em­ploy­ment, sag­ging state fi­nances or the threat of oil spills. It also is No. 3 among the top five unin­sured states when it comes to health­care, ac­cord­ing to the U.S. Cen­sus Bureau. It ought to wel­come na­tional help with that last plague.

Let’s hope that providers in Florida and other states reg­is­ter some com­plaints against the ob­struc­tion­ists on be­half of their pa­tients and them­selves. And re­mem­ber who did and didn’t try to help.

Politi­cians bam­boo­zle the pub­lic so of­ten be­cause many Amer­i­cans are, to put it nicely, un­aware. The lat­est ev­i­dence comes in the third an­nual Deloitte Cen­ter for Health So­lu­tions Sur­vey of Health Care Con­sumers. For ex­am­ple, only 23% of con­sumers sur­veyed said they un­der­stand how the health­care sys­tem works.

Maybe that’s an un­fair ques­tion. As we have ob­served, this coun­try has had more of a crazy quilt than a sys­tem.

Some 57% of peo­ple were sat­is­fied with their health plan, but only 46% said they un­der­stood their cov­er­age and one in four didn’t know how much they are pay­ing for health in­surance. Some 88% of the con­sumers said they were in good or ex­cel­lent health, yet more than half have been di­ag­nosed with chronic con­di­tions or take pre­scrip­tion med­i­ca­tions.

The Deloitte sur­vey is only one of sev­eral that show Amer­i­cans, de­spite the del­uge of health re­form cov­er­age, are wan­der­ing in a fog. For ex­am­ple, a Pew Re­search Cen­ter poll in Jan­uary found that only 32% of re­spon­dents knew that the Se­nate passed its re­form bill with­out a sin­gle Repub­li­can vote. A Kaiser Fam­ily Foun­da­tion poll showed that 58% of re­spon­dents didn’t know that pend­ing bills would bar in­surance com­pa­nies from set­ting life­time cov­er­age caps.

Many providers to­day worry about health lit­er­acy, but maybe the prob­lem is even broader—ba­sic lit­er­acy.

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