As a psychiatrist, I've observed that people generally make bad decisions when they're rushed and in crisis. Politicians, unfortunately, often fail to recognize this aspect of human nature. Clearly, we are in an economic crisis, which makes me immediately fearful of politicians' proposed cures.In rushing to stimulate the economy - a supportable though debatable action - Congress may find a way to include a few programs that won't stimulate anything and which may even make the situation worse. This seems to be the case with two proposals hidden within the stimulus package ostensibly designed to help the unemployed maintain health coverage. One such provision would offer Medicaid, a government healthcare funding program for the poor, to the unemployed or those to be unemployed by 2011, regardless of how much money one has or makes. Thus, we soon may all be paying for millionaires' medical care. Another provision is to have the government cover 65 percent of COBRA payments for those who lose their jobs. COBRA is a program that helps people maintain the insurance coverage that they had while employed for 18 months after the end of employment. The problem is that it is expensive, because an individual has to pay not only his own share of the premium, but also the previously hidden employer's portion of the premium, which is usually about three times more. It's not clear how either of these provisions will stimulate the economy, though I do understand the desire to help the unemployed maintain health coverage. I am concerned that both provisions will add to the growing mountain of government debt for which my children will ultimately be responsible and that we will further damage the health care system. There is actually a simpler, less costly, and more beneficial way of helping the growing number of unemployed maintain coverage. Allow people to purchase insurance policies free of mandates for non-catastrophic services, such as naturopathic care, massage therapists, acupuncture, and any number of other discretionary services. In 2008, the Council for Affordable Health Insurance estimated that such mandates comprised 20-50 percent of the cost of premiums, depending on the number and type of mandates in the various states. What people really need when unemployed is an inexpensive policy that covers them in the event of a catastrophic illness until they are able to find another job. Massage therapy isn't a primary medical need at that point. Nor do I think that it makes sense for the rest of us to pay for anybody's massage therapy through federally subsidized COBRA payments. In terms of extending Medicaid benefits, I have worked in government hospitals with Medicaid recipients for more than 20 years. Much of the care is poor, rationed, and inaccessible, and I only see it as a means of last resort. Americans used to good quality health care through private insurance are going to be less than enthusiastic sitting around for hours in a Medicaid clinic. We shouldn't be trying to force them into that clinic, particularly at our expense. Instead, we need to help them pay for their own insurance coverage. Unemployment is a serious and growing problem, but our short-term focus should be on finding a way to help those who either lose their insurance or will have difficulty affording the expensive policies they had while employed. It would be prudent to help without further deepening the federal deficit. Amending COBRA to permit people to opt for mandate-free, catastrophic coverage would be a simple, direct solution. Mark Schiller, M.D., is a psychiatrist and a fellow in health care studies at the Pacific Research Institute.
********** Published: April 24, 2009 - Volume 8 - Issue 1