Columns » Ernest Dumas

Winners and losers



It is time that someone separated the winners from the losers in national health-care reform if something approximating the bills circulating in Congress becomes law.

You can't tell from all the media commercials, business and medical forums, town-hall ragings or the big bus rallies like the one organized this week at the Capitol by former Congressman Asa Hutchinson and Americans for Prosperity, the right-wing lobby financed by the tobacco companies and polluting industries, which has added health insurance reform to its agenda of killing clean-indoor-air laws and climate-change legislation.

You can't distinguish the winners because in those forums everyone is a loser since they claim that the government would start running all health care. It is provable nonsense. The only government-run health care under any of the bills would continue to be the current government programs, principally Medicare and veterans medicine, which happen to be the best run and best liked insurance programs in the world. Medicare, which was designed by the great socialist Wilbur D. Mills of Kensett, Ark., is government-run only in the sense that it pays the bills. The government makes far fewer decisions about care than under any private plan in the country.

So here at, we have prepared an objective primer on the winners and losers.

You can identify the biggest winners yourself by locating the loudest whiners. Some of them were at the table at Little Rock Monday complaining about how health-care reform would bankrupt insurance companies and drive doctors out of the profession because of the puny pay they would get.

For the big insurance companies it depends on whether the legislation passes with or without people having the option of buying a low-cost government-sponsored plan. With a government option, the bills would be merely a bonanza for the insurers, without highway robbery. They will get 20 to 40 million new customers in one fell swoop without having to run an ad or mail a circular, and the government will help millions of people pay for policies from Blue Cross, UnitedHealthcare, Aetna or Cigna.

Tom Hamburger, formerly a Little Rock boy now part of a crack team that marks the sparrow's fall on political money for the Los Angeles Times, reported this week that the insurance companies, thanks to $35 million spent lobbying Washington during the first six months of this year alone, were poised to reap a financial windfall, regardless of what happens to the public option. They bitterly oppose the public option, but you can't blame them for wanting to count their margins in the billions rather than millions.

Physicians? Big, big winners. Even the conservative docs at the American Medical Association, who fought Medicare for years and then got rich from it, support the House bills. More patients, better compensation (especially for primary-care doctors), no more uncompensated care for indigents and those who lose their insurance or coverage for pre-existing conditions, and ultimately less paperwork. If it works right, in a few years they'll be paid for successful care and not for pointless procedures. Doctors who won't treat poor people or Medicare or Medicaid patients anyway — well, they may not get any fatter from Obamacare. You can feel sorry for them if you like.

What about everyone else? How would they fare?

Small businesses:  Winners. They will be able to provide insurance for their workers or help them buy it at the same rates that big companies do now, which are typically 20 to 30 percent lower than for small companies, entrepreneurs and individuals. They'll no longer lose valuable employees to competitors with health coverage either.

Big corporations:  Winners and they know it. Wal-Mart is for it. Does anything else need to be said? Manufacturers like steel and automobile companies would get a leg up. They compete with nations that provide health care for everyone, where health-care spending is a third less than the United States. General Motors makes good money in Europe, but not in the United States.

The uninsured: Winners and losers. Unless they are poor enough to qualify for Medicaid, they would be required to buy an insurance policy with some help from Uncle Sam until their incomes reach $60,000 to $85,000 a year depending on their family size. No more stiffing hospitals and doctors and people who do have insurance for the cost of their care.

The insured:  Winners. They're losing coverage in droves now as their employers drop or reduce coverage or the insurance companies cut them off. Their premiums are going up 8 percent a year and their copays are rising. Cost savings cultivated in the legislation over time will stabilize their coverage. If universal coverage and regulation can drive costs down to that of even the next highest nation, France, they would reap savings over time of more than 30 percent.

Hospitals: Giant winners. Uncompensated treatment for people who get their medical care in emergency rooms and surgical wards and never pay would be virtually eliminated. Those patients would carry insurance.

Drug companies: Big, big winners, as always. Many more customers, all with insurance, and no stifling government price controls.

Rich people: Losers. If the House bill passes, their income taxes would rise to half the rate that Herbert Hoover set in 1932 and a little more than a third of the rate in the grand days of Dwight Eisenhower. Pity them if you must.

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