Who would lose out with health care reform?

We've heard that this time around, the medical associations, pharmaceutical industry and health insurance companies have come to the table to try to make health care reform work. They know the current system is falling apart, and they want some say in what will replace it. So who's leading the opposition? Let's look at who's got something to lose.

One big loser could be print and broadcast media. Look at all the advertising drug companies purchase! And many of these media outlets are in precarious shape financially due to competition from free content on the internet. So it's no surprise Sarah Palin can get away with fear mongering about imaginary "death panels" without getting called on it -- it's more surprising how many news programs and publishers have the integrity to report the facts, even when it runs counter to their own interests.

The hospitality industry could also lose. Without a lot of excess money flowing around, there won't be free dinners and conferences to promote drugs and devices.

The pharmaceutical benefit managers could be left without a business if the federal government requires uniform pricing of drugs to allow supply and demand to control the costs. PBM's exist to secretly negotiate lower prices for their insurer clients, so if everyone paid the same price, no one would need an intermediary.

People who are currently uninsured could be caught in the middle. They will be getting a benefit they didn't have before, but they will have to pay for it when they pay nothing now as long as they don't get sick. Low income people will have subsidized premiums, but many self insured people simply didn't buy insurance because they considered the price unreasonably high -- they could have afforded it, or they could have afforded it if it cost less, but as long as they were healthy, it was not a priority. Of course, if those people become catastrophically ill under the current system, they will eventually get covered by government health insurance programs, but only after they lose their savings and probably their homes.

If you're afraid you will lose out because you're currently happy with the way things are, please understand they won't stay that way, even if congress does nothing. The costs are going up so fast that the quality of insurance coverage is declining for higher and higher income people. You may look at other countries where there are long waits for surgical procedures and say you don't want those waits. Well, plenty of people in the US already have to wait because of where they live or what kind of insurance they have. And no one even gets added to the O.R. schedule at all without advance approval from an insurer. The micromanagement of medical decisions began with the private plans serving medical assistance patients, and it now affects most of the employer-paid plans I deal with, too. Don't imagine the change won't make it as far as you, just because you live in a wealthy suburb.