NEJM: Getting the Facts Straight on Health Care Reform (Dr. Jonathan Gruber)

Dr. Gruber doesn't understand why anybody would oppose health care reform bills. He argues that they a) over universal coverage b) control costs c) do not represent a government takeover of the health industry. Sounds pretty good to me. He addresses the major criticisms of health care reform in this article, which I will summarize as follows.

Criticism #1: Reform represents a government takeover of health care.
Dr. Gruber refutes this criticism by saying that the role of government in health care reform is "as a financier of the tax credits that individuals will use to purchase health insurance from private companies through state-organized exchanges." I had to read that a couple of times before understanding, but I think it means that the government will give people money to buy health insurance from insurance companies. I can't really imagine how that's going to reduce the deficit, but essentially his point is that the government doesn't want to run health care for everyone but just to help pay it for everyone. Sounds great, almost too great to be true. I'll have to do some more research to see where the government is getting money to do this.

Criticism #2: The bills cost too much money.
Too this, Dr. Gruber says this is simply incorrect. "Both bills are completely paid for — indeed, both would reduce the deficit by more than $100 billion over the coming decade. And the CBO estimates that both would reduce the deficit even more in the long run, particularly the Senate bill with its strong cost-containment measures." Again my question is where is where is the government finding money to pay for all this extra health care coverage? The next criticism starts shedding some light on that issue...

Criticism #3: The bills will cut medicare spending.
Dr. Gruber calls it reducing overpayments to hospitals and private insurers. So it seems this is how the senate and health bill pay for some its promises, by reducing medicare payouts. Dr. Gruber emphasizes that this will not negatively affect medicare patients, just the "pocketbooks of those who profit from them" which I suppose are the hospital administrators and insurance executives? Reform is intending on using market bidding to reset the reimbursement rate for medicare and tie payment to hospitals to outcome measures rather than the current method of reimbursing based on medical procedures performed. The takeaway from that bit is that it seems the next few years, hospitals will see a transformation in the way and amount of government funding they receive. I am not completely aware of all the implications of this, but they could be pretty significant and include things like physician salaries, available resources, and types of medical procedures performed.

Needless to say, it should be interesting to see how everything pans out.

Getting the Facts Straight on Health Care Reform