By VICENTE NAVARRO
Vicente Navarro, M.D., Ph.D., professor of Health Policy at The Johns Hopkins University and editor-in-chief of the International Journal of Health Services. The opinions expressed here are those of the author and do not necessarily reflect the views of the institutions with which he is affiliated. Dr Navarro can be reached at vnavarro@jhsph.edu
Let me start by saying that I have never been a fan of Barack Obama. Early on, I warned many on the left that his slogan, “Yes, we can,” could not be read as a commitment to the major change this country needs (see “Yes, We Can. Can We? The Next Failure of Health Reform”). Still, I actively supported him against John McCain and was very pleased when he became president – for many reasons, encompassing a broad range of feelings. One reason was that Obama is African-American, and the country needed to have a black president. Another was that his election seemed to signal the end of the Bush era. But, the most important reason was that I saw him as a decent man, surrounded by some good people who could promote change from the center and open up some possibilities for progress, giving the left a chance to influence the administration’s policies. Well, after just over seven months of the Obama White House, I have no reason to doubt that he is a decent man, but I am dismayed by the bad judgment he has shown in the choice of some of his staff and advisors. I really doubt that he is going to be able to make the changes we need. As I said, I never had great expectations about him and his policies, but even the lowest of my expectations have not been met.
Some among the many skeptics on the left might add, “What did you expect?” Well, at least I expected Obama to show the same degree of astuteness that he and his team had shown during the campaign. He seemed to be a brilliant strategist, and his election proves this. But my greatest disappointment is the strategies he is now following in his proposals for health care reform – they could not be worse. I am really concerned that the fiasco of this reform may make Obama a one-term president.
Error number One
One of the two major objectives for health care reform, as emphasized by Obama, is the need to reduce medical care costs. The notion that “the economy cannot afford a medical care system so costly, with the annual increases of medical care running wild” has been repeated over and over – only the tone varies, depending on the audience. An element of this argument is Obama’s emphasis on eliminating the federal deficit. He stresses that most of the government deficit is due to the outrageous growth in costs in federal health programs. Thus, a crucial part of the message he is transmitting is the health care reform objective of reducing costs.
This message, as it reaches the average citizen, seems like a threat to achieve cost reductions by cutting existing benefits. This perception is particularly accentuated among elderly people – which is not unreasonable, given that the president indicates that the funds needed to provide health benefits coverage to the 48 million currently uncovered will come partially from existing programs, such as Medicare, with savings supposedly achieved by increasing efficiency.
To the average citizen (who has developed an enormous skepticism about the political process), this call for savings by increasing efficiency sounds like a code for cutting benefits. Not surprisingly, then, one sector of the population most skeptical about health care reform is seniors – the beneficiaries of Medicare. The comment that “government should keep its hands off my Medicare,” as heard at some of the town hall meetings, is not as paradoxical or ridiculous as the liberal media paint it. It makes a lot of sense. An increasing number of elderly people feel that the uninsured are going to be insured at the expense of seniors’ benefits.
Error Number Two
The second major objective of health care reform as presented by Obama is to provide health benefits coverage for the uncovered: the 48 million people who don’t have any form of health benefits coverage. This is an important and urgently needed intervention. The U.S. cannot claim to be a civilized nation and a defender of human rights around the world unless this major human and moral problem at home is resolved once and for all. But, however important, this is not the largest problem we have in the health care sector. The most widespread problem is not being uninsured but underinsured: the majority of people in the U.S. – 168 million, to be precise – are underinsured. And many (32 per cent) are not even aware of this until they need their health insurance coverage. This undercoverage is an enormous human, social, and economic problem. Among people who are terminally ill, 42 per cent worry about how they or their family will pay for medical care. And most of these people are insured – but their insurance does not cover all of their conditions and necessary interventions. Co-payments, deductibles, and other extra expenses – besides the insurance premiums – can amount to 10 per cent or even higher proportion of disposable income.
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