Recent surveys show that support for health reform is waning.
A recent New York Times/CBS News Poll found that about half of those surveyed believe the federal government should guarantee health insurance for all Americans, which is down slightly since July and more than a 10% drop since June.
Those numbers are even worse when survey respondents are told to consider that reform could increase their health insurance premiums and/or taxes. The figures are worse than that if health reform were to increase the federal budget deficit.
Similar to any other political issues, as more specifics have emerged about health reform, fewer people are behind it. The possibility of a large health reform bill getting approved this year grows dimmer by the week—even though President Barack Obama is pushing the reform as a major administration initiative.
There are four major reasons why large-scale health reform is unlikely to happen this year:
There aren't enough uninsured
Studies show that there are about 47 million uninsured Americans. Yes, that number is huge, but look at it another way: There are more than 255 million Americans with insurance, which was an increase of nearly two million from 2007 to 2008—coincidently enough, mostly thanks to government programs.
Most of the insured aren't willing to enter into a health reform program that could potentially affect their families' coverage and access to doctors.
In order for most Americans to back major changes, more Americans will have to lose their employer-based coverage and be forced to search for individual coverage. That might come soon enough. The U.S. Census reported that more than 1 million fewer Americans were covered by employer-based insurance in 2007 compared to 2006. If that number continues to grow over the next five years, the U.S. may reach the tipping point when there are enough people to push for major changes.
There aren't enough doctors to care for the 47 million uninsured
If a healthcare reform project is actually approved that insures those without coverage, this could exacerbate the issue of physician shortages in some parts of the country.
On the plus side, this would force the health industry to redesign care through a coordinated care model, such as medical homes. However, the medical home model, which puts the patient at the center of care with a doctor (such as a primary care physician) helping to coordinate care, has not been tested enough and there are many specifics that need to be worked out. In other words, don't expect widespread utilization of the medical home to become a reality for several years.
Experts are already sounding the physician shortage alarm. Bringing 47 million into the healthcare system will affect wait times to see physicians and will not win the support of the American public.
Public option will pay docs less
There has been much discussion about how much a public insurance option would pay doctors and hospitals. Though the amount is unknown, one thing is for sure—the government will not pay as much as private insurers.
A major reform would at the start likely result in more pay than Medicare, but less than private insurers. But as the federal government needs to invest more in healthcare reform and other domestic programs and foreign affairs wrestle for federal funds, Congress will likely need to find new funding sources and ways to reduce costs. Physician payments at rates that are greater than what Medicare pays would likely rise to the list of possible cost cuts. Doctors and hospitals will be asked to share in the pain along with taxpayers and employers.
The public won't support taxes to pay for reform
A comprehensive health reform package will likely cost at least $700 billion—and more likely closer to $1 trillion. Though the president has pointed to fraud prevention and reducing unneeded procedures and utilization as ways to pay for health reform, expect taxes to play a key role in the eventual health reform package. Most Americans don't want to pay more taxes in order to cover more Americans.
Without that funding avenue, Congress will be hard pressed to create a meaningful reform plan that actually covers most of the uninsured.
These are four fairly large barriers to meaningful health reform. Significant change will require plenty of sacrifice by the American people, a request Obama has made. But with so many Americans with coverage and physicians and hospitals worried what lower payments would mean to their already problematic bottom lines, I can't see any way that meaningful health reform will happen in 2009.