Much has already been said and written about the impact of US healthcare reform on medical tourism... a sprinkling of fact, pure fiction and plenty of wishful thinking. Ian Youngman from IMTJ puts US healthcare reform in perspective and separates myth from reality.
In this article he deals with ten aspects of healthcare reform. More myth and reality to come next week in Part 2.
The problem with “industry comment” on any major issue is that initial “sound bites” can often become unquestioned truths. Every industry commentator has an agenda and he or she will reflect an issue in the way that best suits their political and business interests. That’s the way it is. By pinning down the main myths early, with help from experts who really know what they are talking about, we can stimulate serious discussion and analysis of the real issues from a more accurate starting point.
So, let’s look at what is fact and fiction in the debate so far.
Myth One: Early comment on healthcare reform was based on facts.
Early comment was based on pre-conceptions, newspaper headlines and the “sales message” that the individual commentator wanted to promote. There are 3,000 pages of regulation; the real experts are still combing through it weeks later.
Congress approved major health care legislation in the form of two pieces of legislation: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 which made a number of changes to provisions of the first act. Many misleading comments were made before the final legislation was published
Myth Two: We know how healthcare reform will work.
“ As hospitals, clinics and doctors prepare for the coming changes, little is certain except that it will be a process of discovery for all.” - LA Times
Weeks after the new healthcare law was enacted, people are still scouring it to figure out precisely what it allows. Many of the details are unknown until government officials translate the legislative language into specific regulations.
The key is that this is not long complex legislation that details everything. It is enabling legislation that allows government to get through hundreds of bits of legislation in the future without having to argue the need for healthcare reform every time.
Myth Three: Legal challenges will kill healthcare reform.
“ Unless some 70 years of U.S. Supreme Court rulings are reversed, the new health-care-reform legislation is unquestionably constitutional. Congress decides whether the plan is in the national interest, not a court. In scores of cases, the Supreme Court has upheld broad congressional power to deal with economic issues affecting the nation through its powers of taxation, spending and control of interstate commerce. Federal insurance mandates are not new. In 1937, the Supreme Court approved Social Security and federal unemployment compensation, both funded by taxes on employers and employees. Social Security also insures against disability. Medicare is not voluntary — it forces people to buy health insurance. Congress also has passed many laws regulating health care, employee benefits and insurance. The new law uses the same constitutional means that support these long-standing measures.”
Stewart Jay, professor of constitutional law at the University of Washington School of Law.
Myth Four: If the Republicans get in, they will reverse the law.
Even the Republican Party is divided on health care reform. Only extremists believe they could stop it in future years. Many welcome it and will work to amend it to a more workable system.
Myth Five: Last year, more than one million Americans traveled overseas for medical treatment.
Deloitte says outbound US medical tourist numbers declined to 540,000 in 2008, and have no 2009 figures. Others argue that Deloitte underestimated the fall-out from the recession. Josef Woodman, author of the Patients Beyond Borders series, estimates that only 240,000 Americans traveled for medical procedures in 2009, although numbers are growing.
Myth Six: By 2012, there will be 5 million American medical tourists, and by 2017, 17 or 23 million.
Pure fiction, worthy of a literary prize for imagination. This kind of hype actually does considerable damage to the industry. New and existing businesses enter the medical tourism sector pursuing the promised pot of gold at the end of the rainbow….to be disappointed when they discover the reality.
Myth Seven: Increased pressure on healthcare services will cause treatment delays and waiting lists, as in the UK
- There are few queues in the UK.
- Some medical tourism destinations promote the number of American trained doctors they have. Increased demand in the US could be bad news for them and increase US recruitment from overseas.
- The legislation offers encouraging steps to accommodate demand, and 28 states are considering expanding the authority of nurse practitioners- nurses with advanced degrees who practise without a doctor's watchful eye.
Myth Eight:Medical tourism can still target the 17 million uninsured
The Congressional Budget Office says that by 2019, legislation will reduce the number of non-elderly people who are uninsured by about 32 million, leaving about 23 million non-elderly residents uninsured. Americans who remain outside the health care system includes those who opt out, who don't know how to enroll, or who are exempted from the health insurance requirement because they can't afford the premiums, even with a subsidy.
By 2017, only 8% of the population will be uninsured. 3% are 11 million illegals with no passport and who cannot become medical tourists. Most of the remaining 5% are too poor to buy subsidized insurance, have no money to pay for travel or care overseas, rarely travel, and have no passport.
Myth Nine: There will still be millions who are underinsured who will be key medical tourism targets.
Only one in five Americans has a passport. Both in the exchanges and privately bought personal and small business health policies, there will be restrictions on exclusions and co-payments, plus controls on what covers must be included and price controls. This will greatly reduce the number of under-insured Americans.
Myth Ten: Forcing almost everyone to have health insurance will make costs rocket for all.
Those suggesting this have no grasp of how insurance pricing works. Robert Stover at Liberty Mutual Insurance Company explains:
“Unless we have mandatory coverage for all citizens it will have a hugely negative impact on prices if companies are allowed to decline coverage to people with pre-existing conditions. If the young and relatively healthy are simply allowed to drop out the system, a larger pool of sick people will increase costs for all. Most people don't understand that insurance is merely an agreement for risk sharing among policyholders. It is never based on one individual's claim experience alone. What makes insurance work is that low risk people and entities pool their money with high-risk people and entities in sufficient quantifies to cover the claims of all insured persons or entities in the event of a claim. Mandatory coverage, whether in a group plan, individual plan, health care cooperative or other arrangement is necessary to make health insurance work. We think nothing of a government system that mandates that everyone has car insurance, yet we balk at the notion of a government that is thinking of requiring mandatory health insurance coverage.”
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