What Happens If Reform Fails

Whenever I saw a policy getting demonized, I used to joke that opponents were claiming it would steal your lunch money, put a dent in your car and not leave a note, and punch your grandmother in the face.  So it’s a little surreal to be living in a time where opponents from reform are literally saying it will kill your grandmother.  The strategy of the opposition neatly encapsulated as “Just Say No.”  It’s probably worth considering what actually happens if “No” wins the day.  What happens if nothing changes?

Let’s start with what we go through with our broken system today.  Reuters covered the July 24-26 Remote Area Medical Volunteer Corp event in Wise, VA.  For those three days, doctors, nurses and other health care workers volunteered their time and their labor for free care for Americans who have no access to affordable care.  This is not some hypothesis of a possible future.  This just happened last week.

Attending a similar RAM event convinced Wendell Potter that the business practices of the insurance industry which he had spent his career in were performing a fundamental betrayal of its customers and our country.  If we change nothing, we’ll still live in a world where the only option medical care for some is a fairground in Appalachia, and people are willing to sleep in their cars overnight because nothing else is affordable.

It’s fair to say that if the president and Congress get stopped here, they won’t have the stomach to attempt bold reform on this issue for the duration of his presidency.  That’s what happened with Bill Clinton in the 1990s.  So what happens if nothing is changed in the entirety of the Obama presidency?

This week, the Robert Wood Johnson Foundation released a report by the nonpartisan Urban Institute entitled “Health Reform:  The Cost of Failure.” (Before we start hearing about bias, let me just mention that Karen Ignagni of America’s Health Insurance Plans was also there to second the economic imperative for reform).  Here’s their best estimates of what the future looks like 10 years from now:

• Premium and out-of-pocket expenses for medical care going up at least 46 and as much as 68%.  If your individual insurance plan costs you $411 per month now, imagine it at $700.
• We hear a lot of whining about Medicare rates, and not enough about uncompensated care for hospitals – which the American Hospital Association pegged as $43 billion in 2008.  This picture gets substantially worse.  The early estimates for 2009 are already $62 billion.  Urban Institute predicts a range of $107 to $141 billion by 2019.  Yes, that’s per year.  And yes, that means many hospitals will go under.
• Why?  We’re due for a dramatic increase of the uninsured.  53 million is the “best case” scenario.  68 million is the worst.

Here’s food for thought – we’re more or less maxed out for low-income Americans who are uninsured.  The only way that number will increase is if state and federal governments start cutting Medicaid and SCHIP.  That means most of this growth comes from the middle class:  “The report makes clear that the biggest effects of not having health reform would be felt by families with moderate incomes, who have less access to public coverage. Under the model, the number of middle-income earners without insurance would increase sharply from 12.5 million in 2009 to as many as 18.2 million in 2019.”

So you can imagine all the scary futures if health care passes that you want.  If your family is uninsured, or if you lost your benefits with your job, the present is at least as scary enough.  The future looks like more of the same.