A Doctor's View -- We're Heading for Disaster As Number of Uninsured Rises

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Obamacare is getting more customers than it ever anticipated.

More than 50 million Americans now lack health insurance, according to a new U.S. Census Bureau report out this week. The report reveals that the rate of uninsured Americans rose to 16.7 percent last year from 15.4 percent in 2008.

This disturbing new trend is partly due to the U.S. unemployment rate continuing at close to 10%, while employers continue to drop health coverage (only 56% were insured through their jobs, the lowest on record). Meanwhile, the U.S. poverty rate last year rose close to fifteen percent.

On the surface all of this bad news would appear to be an argument for Obamacare, based on the claim that those without insurance are less likely to obtain adequate care unless the government mandates coverage, but in fact adding people to the insurance coffers does not guarantee access to care at all.

Not only that, but research, including a recent study in the Journal of the American Medical Association demonstrates that overuse of insurance by patients who aren't really sick clogs the medical turnstiles and interferes with access for all while leading to spiraling costs and premiums. We lack the E.R.s (down by 10% in the past decade) or the doctors (a 160,000 shortage is anticipated by 2025 by the Association of American Medical Colleges), to take care of these newly insured patients.

Now it turns out that the costs of extending health insurance to an ever growing number of uninsured will likely be well beyond $1 trillion. Much of this coverage will come directly from the government entitlement programs Medicare, Medicaid and CHIP. The federal government simply can't afford it.

The U.S. Census report also revealed that last year the number of people with private health insurance dropped from 201 million to 194 million, while those covered under these government programs rose from 87 million to 93 million. The percentage of people with private coverage is 64%, the lowest since 1987, while the percent of patients covered by government programs is 30%, the highest since 1987.

As the uninsured join the ranks of the insured, it is more and more likely that it will be government insurance they will be receiving. Many features of the health care law will be implemented by 2014, and by that time many employers will likely decide they can only stay in business by dropping their employee health coverage and paying a penalty. People will flock to the state exchanges to buy individual policies, and those who can't afford it, even with the federal subsidies offered, will go on Medicaid.

The amount of government spending this will require is not sustainable. This trend towards government-run insurance amid an ever-expanding insurance pool is also bad news for the hospitals, who routinely compensate for Medicare and Medicaid payments of less than 90 cents on the dollar by charging private insurers more.

The overwhelming numbers of people without insurance is not the reason that the new health reform law is essential, it is the very reason it won't work, as it mandates and provides the kind of insurance that is too expensive, too comprehensive, and has no disincentive for overuse. In fact, the only way to control costs with this kind of low co-pay, low deductible insurance is to deny expensive services (such as our latest targeted cancer treatment or coated cardiac stent) or to pay doctors and other providers less.

A far better solution than this insurance scheme -- which is destined to bankrupt the federal treasury -- would be the kind of insurance which makes a patient pay something out of their own pocket; either a deductible, co-pay, or cash payment. Over 10 million Americans now have Health Savings Accounts, but the incentive for them to make use of them will diminish greatly as more and more Americans end up with the kind of insurance that discourages or restricts a patient from paying out of pocket. In 2011, patients will also no longer be able to pay for over-the-counter medications with HSAs.

We are heading into a health insurance future we can't possibly sustain. If health care were really the issue instead of politics, our leaders would have anticipated this debacle and gone in an entirely different direction.

Marc Siegel MD is an associate professor of medicine and the medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical Contributor.

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