September 2 2009

What a Government-Run Plan Will Mean for Children

Nicole Kurokawa Neily

Expanding the government's role in the health care market won't help American children. Worse, it will hurt them, both physically and financially.

The president's main objectives in health reform are to expand coverage and cut costs. Unfortunately, these are essentially mutually exclusive goals.

Keep one thing in mind: when a bureaucrat says "cutting costs," that's code for "cutting care." You can't please all the people all the time, and you can't give them all the doctor's visits they want while saving money. It's mathematically impossible.

One way the government plans to cut costs is to cap payments, as they currently do with Medicare and Medicaid. Doctors, hospitals, specialists, and pharmaceutical companies are reimbursed for services and products at below market rates - creating a disincentive to provide care to government patients. Some providers have simply stopped accepting these patients at all.

This can have tragic consequences. Consider the case of Deamonte Driver, a twelve-year-old boy from Maryland who suffered from a toothache and died in 2007. His family was covered by Medicaid. Unfortunately, only about 900 of the state's 5,500 dentists accept Medicaid, according to the Washington Post. Finding a dentist and scheduling treatment took months- a delay that ultimately cost Driver his life. Why on earth would we want to expand a program like that?

Doctors that do opt to accept government patients at a financial loss will not be able to sustain themselves indefinitely. Just to break even, they will have to charge higher rates to customers covered by private insurance plans - penalizing other children unintentionally.

In the face of a more expensive private plan versus a government (read: taxpayer) financed public option or co-op, employers that provide insurance for their employees will abandon the private market in droves. The Lewin Group estimates that up to 114 million Americans will lose their current coverage under the bill. That's mostly because of companies dropping coverage, but many Americans will lose more than just their insurance - they'll lose their jobs as well. According to a model developed by Christina Romer, chairwoman of the President's Council of Economic Advisors, 5.5 million Americans could lose their jobs as a result of the taxes that will be imposed on businesses that cannot afford to provide health insurance.

If the only patients available are covered by a government plan, doctors will have to accept them, despite the financial hit. However, in the long run, many doctors may decide to stop practicing medicine, and bright young students will decide to take their talents elsewhere instead of enduring the rigors of medical school and training, with little potential payoff. Fewer doctors to pay may be better for the government's budget, but it's certainly not in the best interest of the country.

It's not just quality of care that will be sacrificed in a government-run system, but the loss of control. Congress has proposed that a Health Benefits Advisory Committee determine the types of health plans that individuals must purchase. Presently, parents are able to determine the care that their children receive; for example, some parents choose to not vaccinate their children. That is their prerogative. But for how long? One can easily imagine that government recommendations could become government mandates. After all, he who pays the piper calls the tune. So if the government is picking up the tab for healthcare costs, they may decide that they should decide if you should vaccinate your children, or circumcise, or use antibiotics liberally, or engage in any one of a number of specific treatments.

Our children, and our children's children, will also ultimately be saddled with tremendous debt as the result of a move toward government-run healthcare. The proposed plans will create additional spending on an unprecedented scale, with no signs of abatement. Ever. The Congressional Budget Office says the president's plan will cost $1.6 trillion over the next ten years and add another $239 billion to the deficit; Health Systems Innovations, a health care consulting firm, puts the cost of the bill at $4.1 trillion over ten years.

Nobody is arguing that the poor and indigent be denied care; on the contrary, they should have access to quality providers in a timely fashion. But this can be done in innovative ways without impacting the three-fourths of Americans that are happy with their coverage. Let's assist the truly needy, but target assistance without restricting choice through providing health care vouchers to the very poor that can be taken to any doctor, expanded state high-risk pools, and subsidized catastrophic insurance for families that are truly in poverty. Existing programs have failed our most vulnerable populations for years. It's time to try something new.

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