unless its paradoxes are resolved.

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Each additional uninsured American - and there will be tens of millions more in coming years without reform now - ends up driving overall health costs higher. Lacking any preventive care, the uninsured overwhelm emergency rooms - which are obligated by law to treat anyone who shows up, but where care is the costliest. That cost is not borne by the uninsured. Those with insurance bear the price in higher premiums.

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The above taken from an article reproduced in full below:

. . . . . . .

President Barack Obama's health-reform package faces a life-or-death moment

Konrad Yakabuski, Washington
Wednesday, Feb. 24, 2010

For some people, pain medication actually makes them hurt more. For others, sedatives turn them into insomniacs. So-called "paradoxical reactions" are rare, but they seem to pop up with every new drug on the market.

In the $2.5-trillion American health-care system, paradoxical reactions are neither uncommon nor inexplicable. They proliferate for entirely understandable reasons. A system that so skews the incentives faced by doctors, hospitals, workers, employers, insurers and patients is bound to produce unhealthy results - and not just for the almost 50 million Americans without coverage.

The U.S. health-care system is about to become dramatically sicker, unless President Barack Obama can find a defibrillator for his health- reform package.

This is a life-or-death moment for Mr. Obama's initiative, which would extend health coverage to 31 million more Americans. Its fate depends on how the President performs at a televised summit tomorrow, where Republican and Democratic leaders will jockey for position in the public-opinion sweepstakes.

Republicans will argue that with record deficits and an economy struggling to create jobs, now is hardly the time to pass sweeping social legislation that will cost almost $1-trillion in its first decade - paid for out of new taxes and cuts to seniors care. Forget for now about extending coverage to the uninsured. Tackle costs first.

The White House whizzes who put together the administration's blueprint for reform, released Monday, insist you cannot "bend the cost curve" without achieving something close to universal health coverage for all Americans. To work, health-care reform must, by definition, be comprehensive. The weight of expert opinion is on their side.

"You can't do incremental reform because there is a connection between all of the problems in the system," explains Judith Solomon, a senior fellow at the Washington-based Center on Budget Policy and Priorities. "With comprehensive reform, you make it more likely that people will get the right care when they need it, and not wait for the most expensive option."

Each additional uninsured American - and there will be tens of millions more in coming years without reform now - ends up driving overall health costs higher. Lacking any preventive care, the uninsured overwhelm emergency rooms - which are obligated by law to treat anyone who shows up, but where care is the costliest. That cost is not borne by the uninsured. Those with insurance bear the price in higher premiums.

Spiralling premiums lead more and more Americans to drop their coverage altogether or wind up with inadequate insurance. That reinforces the same vicious circle. Having more and more uninsured Americans results in higher and higher costs for those who have insurance, and that leads more and more individuals or their employers to drop their coverage. The projections, based on the status quo in health care, are terrifying.

The poorest Americans can always turn to Medicaid, a joint federal-state program that provides basic care. But they pretty much have to be indigent in most states to qualify for it, and reimbursement rates to doctors are so low it's becoming increasingly difficult to find physicians who will take Medicaid patients at all. Cash-strapped states, meanwhile, keep cutting the list of services covered by Medicaid.

Critics of the Canadian system argue that it could benefit from more market discipline. And Newfoundland Premier Danny Williams, who chose to get heart surgery south of the border, has not exactly been a billboard here for the merits of the Canadian model. Yet, no system does perverse incentives like the supposedly market-driven U.S. model.

One compelling example was raised at last weekend's gathering of state governors in Washington by Atul Gawande, a Harvard University health policy professor. Doctors at Children's Hospital in Boston, Dr. Gawande explained, developed a simple "checklist" for asthma patients that included calling parents to make sure kids were using their inhalers and even handing out vacuum cleaners to their families to reduce dust at home.

The checklist helped cut asthma-related admissions and ER visits by an astonishing 87 per cent. Hospital administrators weren't so thrilled. Young asthma patients were Boston Children's biggest single source of revenue and not even a non-profit institution could afford to lose them.

When health-care providers have a paradoxical reaction to helping patients, there is a fundamental problem with the system.

When employer-provided health benefits are treated as non-taxable income, prompting Americans who have such Cadillac insurance to bargain for more benefits instead of higher salaries, there is another. It not only leads to an oversupply of health care for the lucky, but a drop in government tax revenues needed to fund health care for the elderly.

And, contrary to what most Americans and Canadians think, governments are by far the biggest single players in America's "private" health-care system. Federal and state governments already account for almost half of all U.S. health-care spending. (The government share in Canada's "socialized" system was 70.2 per cent in 2009.) Governments' share of U.S. health expenditures is projected to surpass the 50-per-cent mark for the first time in 2011 as spending explodes on Medicare, the federal health plan for Americans 65 and up, and Medicaid. Indeed, without reform now, those programs are the biggest drivers of the debilitating and chronic deficits the country faces in the next decade and beyond.

Americans who spend most or all of their lives without health insurance usually end up being disproportionate drains on Medicare once they hit 65. They have more chronic conditions that might have been held in check, or never developed at all, with basic preventive care or years of regular visits to a family doctor.

Despite the evidence, Americans may still side with the Republicans after tomorrow's summit. It would be the ultimate in paradoxical reactions.

http://www.theglobeandmail.com/news/world/americas/us-health-care-system-to-get-much-sicker-unless-its-paradoxes-are-resolved/article1479226/