14 Desember 2010

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A repeal that’ll be dangerous to our health

MANY REPUBLICAN lawmakers are saying they will make the repeal of President Obama’s health care law their top priority in the new Congress. And yesterday a lower-court federal judge rejected a key part of the law. But what would Republicans repeal to? They don’t have an answer.
While polls find Americans split on the general question of repeal, few people want to actually kill major individual reforms. A November Kaiser Family Foundation poll found that by margins ranging from nearly 3 to 1 to more than 4 to 1, Americans do not want to repeal such aspects as: tax credits for small businesses offering health care to employees; closing the “doughnut hole’’ to help seniors keep prescription medicine costs down; help for low- and moderate-income Americans to purchase coverage; and a ban on insurance companies denying coverage because of preexisting conditions. Also last month, a McClatchy poll found that 68 percent of Americans want to keep the ability to insure children until age 26, compared with only 29 percent of people who want that aspect repealed. The Republicans say they want to kill health care reform because it costs too much, but the old ways were costing us even more.
As flawed as the law may be to critics on the left and right, going backward is not a reasonable option. More caution against wholesale repeal came in the form of a recentstudy from Columbia University that suggested that US overspending on health might be harming Americans.
Analyzing survival rates for men and women ages 45 and 65, Americans have stunningly fallen behind other large, wealthy nations in life expectancy. That is despite a rate of health care spending that has grown nearly twice as fast as the spending in 12 comparison countries since 1970.
By 2005, the 15-year survival rates of white women were not only lower than in all comparison countries, but they were lower than the 1975 survival rates for women in Switzerland, Sweden, the Netherlands, and Japan. “Many people say health care is just fine and that things like the poor health of African-Americans makes statistics look worse,’’ said study author Peter Muennig, “but when you see how much worse it is for whites, too, you have a problem you cannot run away from.’’
Muennig said the study accounted for factors that many people often say explain why we are behind such nations as the United Kingdom, Canada, Germany, and France. Researchers accounted for population diversity, smoking, obesity, traffic accidents, and homicide. Muennig was still left with the conclusion that rising health care spending “is itself responsible’’ for the relative decline in survival rates in the United States.
He said there are three reasons why this might be true. One is that rising costs mean more inadequately insured people. Another is that rising health spending may be “choking off public funding on more important life-saving programs’’ such as public transit, public safety programs, and community recreation centers. A third is that our current system encourages a level of unneeded, confusing procedures that lead to complications for patients.
In a phone interview, Muennig said, “We don’t really know for sure how much the higher expenditures are driving higher mortality as obviously it can happen in complex ways. But it is clear that other nations are investing in things other than health care and their people are living longer. Could it be that lower health care costs in other countries lead to their governments being able to sell cheaper train and subway tickets and provide more resources for people to get out and lead healthier lives as a normal part of life? In the US, health care costs could be a canary in a coal mine sort of thing.’’
If health care costs are the canary, then Republicans should be persuaded to think twice before squawking for repeal. The Republicans say Obamacare kills jobs. But health care spending prior to health care reform quite possibly was killing people.
Derrick Z. Jackson can be reached at jackson@globe.com.
Opinion of Boston 14 December 2010