Will the Greatest Fear Win Out?

Different stakeholders are battling to protect their different interests, in the reform of an industry that is responsible for $2.5 trillion annually, 1/5th of our total economy. The New York Times in its News of the Week in Review, lays it out nicely in its lead article, Following the Money in the Health Care Debate. But each interest group and each of their arguments they make preys upon a different set of fears in the public. Those fears will not be explicit, but they are likely to be what determines the outcome.

Doctors fear a government-run insurance program that looks like Medicare will pay like Medicare, said Robert Laszewski, a health policy consultant in Alexandria, Va. “Medicare pays doctors 80 percent of what an insurance company pays,” he said. “If you get a public plan, the doctors are going to get a 20 percent pay cut.” The AMA has already staked out its opposition.

So doctors will argue to the public that low pay will degrade the profession and lead to fewer, less qualified doctors and inadequate care. Yes, you can have government insurance, but your health will suffer.

Insurance companies may get some new customers, but their trade association fears its members would be driven out of business as the government uses its purchasing power to demand much lower prices.

The insurers will argue that government insurance is inefficient, full of gaps. The public, they suggest, will be not get the care it needs when it needs it. The fear: you will be neglected, forced to wait, maybe even overlooked.

The hospitals’ concern is that, like the doctors, they will be paid less. The fear they will arouse in the minds of the public is that hospitals will be overcrowded, inadequate, poorly staffed. Do we want that?

The nation’s drug makers are afraid of the government’s ability to demand lower prices for their products. “The more government intervention you have, the less payment you have,” said one analyst. These companies also fear that the government will play a greater role in determining the effectiveness of different drugs and medical devices and use that information to control costs. (The Times points out that insurers, not surprisingly, support the government’s intervening with drug and medical device makers so they don’t have to.)

There are real issues and real complexities at stake here, and clearly some plans will be better than others – and some worse. But we all are easy prey to anxiety, especially as we all fear sickness and disability so profoundly. And we are not likely to be conscious of having our fears manipulated.

It will be tough for legislators, besieged by lobbyists and anxious constituents, to thread their way to a logical and effective plan. But the hidden role of anxiety will make it even tougher.