Respected health writer Maggie Mahar (“Money-Driven Medicine”) got curious and decided to fact-check the excise tax. – the tax on misleadingly-named “Cadillac plans” (which are really plans that simply cost more, usually for reasons that have little or nothing to do with the benefits offered.) Wisely, she follows the money – which in the world of health care follows the chronically ill. Her findings?
… 75 percent of our health care dollars are spent on patients suffering from serious chronic diseases such as cancer, heart disease, stroke, and chronic obstructive pulmonary disease.
As Merrill Goozner points out: “The idea that taxing those plans will somehow encourage people to reduce their utilization is wishful thinking that ignores who actually makes health care decisions — doctors, hospitals, drug companies, and other providers. It also ignores why most people use health care — it’s because they are sick.
If co-pays for visits to a specialist are high, some chronically ill patients may put off seeking help, but eventually most middle-class Americans will see an oncologist or a cardiologist, even if they have to borrow the money to cover the deductible. “
She provides an excellent overview of the topic and strong rebuttals to the tax’s defenders. Well worth a read.
(Disclaimer: I am working with the Campaign For America’s Future to prevent the tax from becoming law, both because I believe it to be unfair and because I consider to be poorly designed policy.)
The Sentinel Effect 
January 6, 2010 at 12:36 pm
One of the underlying problems not mentioned in the healthcare debate is that medical care has become corporate. The care in healthcare is being rapidly eliminated. Decisions are being made based on the “bottom line.” Instead of having time and patience to sit down and work through problems with patients, doctors feel the pressure (self-induced, insurance driven) to simply follow algorithms. If this is what medicine needs to be, let’s eliminate the triage and go straight to computerized medical problem solving, make all medications over the counter, and train future doctors to be technicians doing procedures. Cut out the liberal arts prerequisites and let the doctors learn a skill (1-2 years of training out of high school) and save ourselves some real money. Open the flood gates to a “medical technician’s” degree and let some real competition start.
Or, we can let primary care doctors actually sit down with patients and think before we expose patients to the corporate assembly line. It is so painful to see the suffering patients always getting lost in the shuffle with no alternatives to our broken system.