Our health care system is in critical condition. It can be difficult to impossible for Americans in poor health, and even many healthy ones, to find affordable, individual-market coverage. Health-related costs are the leading cause for personal bankruptcy in the United States. Health care reform is an issue that will demand the attention of a new administration and Congress.
Yet true reform efforts—those that will bring affordable coverage to every American—face roadblocks in the form of deceptive conservative myths and faulty policy proposals. We’ve fact-checked six of the most pervasive proposals below, and it’s clear we won’t reach solutions with flat tax credits and caps on malpractice lawsuit payouts, as the fact check illustrates.
Myth: Health care reform is best left to individual states.
Truth: An effective and efficient U.S. health system cannot be constructed one state at a time. The sum of state reform does not equal reform on a national level
It is true that state-level health care reform can show the framework and feasibility of solutions and act as a testing ground for new approaches. But it is no substitute for sorely needed national reform. States alone cannot achieve comprehensive reform. Fiscal concerns, already seen in California to Massachusetts, will make state reform unworkable because of the lack of annual balanced budgets and a high price tag. Without federal support and redistribution, health care will become less equitable from state to state. What’s more, states with a higher percentage of their population living below the poverty line tend to have higher rates of uninsurance.
Without national will and leadership, state-level lessons tend to stay within the single state. Fifty separate reform efforts only complicate the health care system and inhibit attempts to simplify it.
Myth: The federal government should provide a flat tax credit for all Americans who buy insurance, with no qualifying restrictions.
Truth: A badly designed tax credit plan could actually cause costs to rise for most families and increase the number of uninsured by ignoring low-income and high-risk individuals.
The fixed-dollar flat tax credits that conservatives have proposed do not take into account cost variation between insurance plans. Flat credits are also not adjusted for a person’s level of need or income, and so low-income people and people with chronic health problems will end up spending a much higher percentage of their overall incomes on health insurance. Credits will cover the cost of insurance for the young and healthy, but they will not offset the high cost for the older and sicker.
Models and experience show that the effect of a credit on the uninsured is uncertain at best; one analysis suggested that voluntary enrollment in individual-market plans would not reduce the number of uninsured Americans due to a loss of employer coverage or a rise in employer premiums.
Tax credits can be used as part of a broader strategy to reduce the rate of uninsured, but used alone they will not drive down the price of health insurance. The purported benefits of competition among private insurance companies that credits encourage must be weighed against the higher administrative cost of individual-market insurance and a decline in employer involvement. Encouraging tax equity over these other important considerations will do little more than create a larger uninsured population.
Myth: Consumer-driven health plans will reduce costs by giving people more control over their health care choices and encouraging high quality and appropriate use of care.
Fact: Consumer-driver health plans will not control costs. In fact, they will expose people to high deductibles and cost-sharing payments and discourage consumers from seeking important services, like prevention.
Roughly 70 percent of health costs and deaths are attributable to smoking, obesity, and health problems that could be prevented. Conservatives hold up consumer-driven health plans as the answer to encouraging individuals to use preventive services.
Yet enrollees in these plans have inadequate information to make good decisions—and the plans provide no help. Consumers are unlikely to obtain adequate and reliable information on cost and quality and differentiate necessary from unnecessary care. Some studies show that consumers will even choose to underinvest in prevention as they try to be more “cost-conscious.”
The truth is that cost-sharing can discourage people from using preventive care. One study showed that $10 co-pays caused a significant reduction in the use of mammograms among seniors. Other studies suggest that cost sharing, especially for low-income families, people with chronic disease, or families with children with special needs, could deter patients from seeking preventive services.
Myth: Americans have adequate access to health care—everyone has access to emergency care.
Truth: Safety net providers, like emergency rooms, are not a substitute for comprehensive, coordinated, and timely health care services.
Coverage makes a difference. Research indicates that the uninsured population receives less care for necessary medical services compared to the insured population. Uninsured individuals experience delayed diagnoses, are less likely to receive recommended care for chronic conditions, and are less likely to be admitted to a hospital when they experience trauma. Plus, emergency care for the uninsured means longer wait times for everyone.
Other factors restrict and delay access to basic health care services. In rural areas, there are fewer health care professionals, specialists, and less high-tech equipment; in the inner cities, lack of safe transportation is a limiting factor. The socio-demographic studies show that there are growing inequities in life expectancy between the wealthy and the poor. Hispanics and African Americans get more medical services in emergency rooms and are less likely to have a regular primary care provider, further contributing to devastating health disparities.
Myth: Any health reform plan in which the government is involved is “socialized medicine,” which will result in bureaucratic, big-government programs that contradict the American ideals of free market and choice.
Truth: Affordable coverage for all does not equal “socialized medicine.” In fact, public-private hybrid health care plans can be used to achieve a higher degree of universal, high-quality health coverage.
Progressive plans vary in their degree of proposed health care reforms, and government-provided health care is merely one strategy to achieve coverage for everybody. Many health care systems around the world are hybrids that combine public and private insurance elements—and many proposals for health care reform in the United States build upon our current system of shared financing between public insurance programs and private plans.
Critics worry about long lines and “rationing,” but people are already dying and waiting in overcrowded emergency rooms. Americans even wait longer for same-day access to care than most nations with universal coverage. The United States has the highest rate of preventable deaths among 19 industrialized nations due to a lack of timely and effective care—evidence that we already ration care, partly on ability to pay.
“Socialized medicine” is a term that has been embraced, demonized, and misunderstood since the early 20th century in the United States. In fact, two models of government-funded health care in the United States—the Veterans Affairs Health Care system and the Medicare program—represent different and successful public insurance models within our own system.
Myth: Medical malpractice lawsuits are little more than predatory lawyers destroying honest doctors; caps should be set on the amount awarded to accusers.
Truth: Although the malpractice system is deeply flawed, setting caps deflects attention from patient safety and would likely not reduce frivolous lawsuits or costly premiums.
Medical malpractice liability is in need of reform, but claims of a nationwide crisis are overblown. Malpractice claims and insurance premiums vary by specialty and geographic area—doctors in obstetrics or surgery tend to pay higher premiums, for example. What increases occur in malpractice premiums can be linked primarily to a sluggish economy. In fact, malpractice costs represent less than 2 percent of total health care spending. There is little correlation between malpractice claim increases and premium increases.
Enacting caps on awards threatens individual rights to compensation for harm resulting from preventable medical error, mostly because so-called frivolous lawsuits represent only a small portion of claims and awards by juries. Focusing on tort reform deflects attention from patient safety in a system where victims are not fairly compensated and errors are not properly prevented. The solution to rising costs should instead consist of more emphasis on evidence-based medicine, independent screening, immediate disclosure of errors, and even a no-fault system of compensation.