A Word to the Wise: Expert Analysis of Health Care Reform

As part of our Prescription for Reform Series---running now through August 7---we asked several experts to give an insider's perspective on the questions we've got about health care reform. This week, Jonathan Oberlander, Ph. D., weighed in. Dr. Oberlander is associate professor of Social Medicine and Health Policy and Administration at the University of North Carolina. He has written The Political Life of Medicare and co-edited a series entitled The Social Medicine Reader. He has done extensive research in Medicare policy, health care reform, and health care policy and politics. TakePart: What single word best describes our health care system as it currently exists? Jonathan Oberlander: Dysfunctional. Non-system comes in a close second. TP: What component of the proposed health care bill would make the most significant improvement to our system? JO: The insurance expansions that have the potential to significantly reduce the number of uninsured Americans. The legislation before Congress is far from perfect, but many persons who don't have access to affordable coverage would gain that access if health reform passes. TP: Two weeks ago, Ezra Klein, writing on WashingtonPost.com, said that one problem with the proposals being considered in Congress is "they do not do enough to cut costs, because they do not do enough to change the fundamental nature of the employer-based health-care system." Do you agree? What weaknesses do you see in the proposals? JO: Cost control is a real Achilles Heel. The Obama administration has proposed significant savings in Medicare. But the legislation does not have reliable controls on system-wide health spending. Another problem is that that under the House bill, the coverage expansions would not go into effect until 2014. That is a big political risk and it means many uninsured Americans wont get the medical care they need in the intervening years. TP: How would the current proposal change the way people obtain health insurance? JO: Most Americans--those with employer-based insurance and Medicare, for example--would keep their current insurance. Medicaid would be significantly expanded to enable more low-income Americans to enroll. Workers in firms that don't provide insurance and others without insurance would receive insurance from health insurance exchanges--a regulated market that would offer a menu of different private plans as well as a public plan option (if the latter survives the legislative process). People would get subsidies depending on their income to help them afford insurance. And there would be a requirement that all Americans would have to be insured, except in the case of financial hardship. TP: On March 5 at the White House Forum on Health Reform, President Obama called healthcare reform a "fiscal imperative" saying, "We can all agree that if we want to bring down skyrocketing costs, we'll need to modernize our system and invest in prevention." Do you think the proposals, if passed, will incentivize people to seek preventative care? JO: We certainly could benefit from health reform that lowers our obesity rate and encourages other healthy behaviors. But prevention that is medical in nature--where people seek preventive services from doctors and other health professionals--usually doesnt produce health care savings, though it is well worth doing for other reasons.