Our Sick System Still Needs Triage

Attending a meeting on the new health care law, I had to fight the urge to stand up and beg the experts to stop. They were making the issue too complicated. At this rate, nobody will be able to understand what the law will do. And this may be the fatal flaw of the ambitious program. The law is too complex for the public to understand unless President Barack Obama somehow finds a better way to explain it.

This gathering of detail-loving policy wonks in downtown Los Angeles last month provided an excellent example of the obstacles facing the president and the rest of the Democrats as they campaign in the tough midterm elections.

They are confounded by the difficulty of explaining health and the other new laws and programs enacted in the past productive two years. And this is something they must do before the Republicans win enough seats in November to dismantle what the Democrats have accomplished.

Obama made his own attempt at explanation this week in a video meant to show how to navigate the administration’s health care site, healthcare.gov. It was a good try, but he reminded me of someone from IT explaining a new corporate communications system or, worse yet, a chilly guy from HR walking employees through the next buyout.

When the health care law is fully implemented in 2014, it will cure many of the ills that plague those needing medical care. That, however, may be too long a wait for a troubled country, especially one faced with intractable unemployment and a fruitless, unpopular Afghanistan war.

I attended the health reform meeting, sponsored by the New America Foundation, to find out what’s happening with the program now that it’s the law. Some portions are beginning to take effect, and I wanted to know if it was helping anybody.

Castulo de la Rocha, who heads a community health organization in Los Angeles, said institutions such as his—which provide health care for the poor—are immediately benefiting from an additional $12 billion in funding over five years. This will permit the clinics to reach an additional 20 million patients, making a big improvement in the care of urban and rural poor.

But most of the other speakers were preoccupied with problems the new law will bring.

Hospitals will be measured on performance. Payments will be reduced to those with too many patients making return visits. Doctors will be pushed to abandon charging separate fees for each visit and treatment, which is the way medicine has been practiced for years. Expect the docs to fight back. Already they are spreading negative stories on how the health plan will play out.

Yet, positive things are happening now. High-risk insurance pools with policies for those with pre-existing medical conditions are beginning operation. Children 26 and under are now included in parental health insurance policies. Co-pays for many preventative services are banned in new policies. The law sets up a government program to provide funds for employers to continue insurance for those forced to retire at 55. It gives a $250 rebate to Medicare recipients reaching the “doughnut hole” in drug coverage. Small businesses will be given tax credits for offering employees health insurance. A report from Families USA and Small Business Majority said 4,015,300 small businesses, 83.7 percent of all small businesses in the country, will be eligible this year.

Unfortunately for Obama, the major portion of the law does not take effect until halfway through his second term — if he wins re-election. That phase will involve the opening of insurance exchanges in which individual consumers or small businesses can shop for health insurance policies without most of the restrictions that now confront consumers. Americans would be required to buy health insurance, but the government would subsidize policies for those with low incomes.

Obama knew health reform would be a tough sell. Jonathan Alter in his book “The Promise” quoted the president as saying, “I remember telling Nancy Pelosi that this could end up being so costly for me politically that it would affect my chances if I were to run for reelection.” He went on to say that if it didn’t pass now, “it wasn’t going to be done.”

The Democratic dilemma is this: The administration has accomplished much — health care, a limited toughening of financial regulation and a huge bailout that probably prevented a depression — all of it hard to explain.

A July poll by the Kaiser Family Foundation shows that doubters can be converted. Fifty percent of those surveyed now support health reform, while those looking at it unfavorably have dropped from 41 percent to 35 percent in the past month. But support from the high-voting group of those 65 and older remains weak, with 46 percent viewing the plan unfavorably and 38 percent favorably.

The economy rather than health care will probably decide the election. Health care will be a factor in close races, however, which is why Obama and the other Democrats have to sell it in a strong and simple manner.

The same is true with the administration’s other accomplishments. If the Democrats fail to make that sale, the Republicans will win the Senate and the House and begin their assault on everything Obama and his party have accomplished. That will be the prelude to what has been the Republican goal from the beginning: driving Obama from the White House and reversing what he and Senate and House Democrats have accomplished, including health care reform. And that would return us to where we were — or worse. Remember Sarah Palin?