Harry Reid Wrong on History and Wrong on Health Reform

Michelle D. Bernard

american health-care debate in Congress (c) Dick Locher

If he continues on his present course, he may have a mutiny on his hands

Michelle D. Bernard is president and CEO of the Independent Women's Forum and an MSNBC political analyst.

I am black. I am a woman. And, with all due respect, I think Harry Reid has lost his mind.

Yesterday, on the Senate floor, Majority Leader Reid compared those who oppose his healthcare reform package to those who opposed ending slavery, fought against women's suffrage, and thwarted civil rights. What's next, Holocaust comparisons?

Many assume that given my race and gender, I would support the Senate health reform bill as a savior of the masses. I do not. And thousands, if not millions, of blacks, Hispanics, women, low-income, and at-risk communities feel the same.

There are many reasons why I don't support the proposed healthcare legislation. I worry about how Congress's regulations will drive up insurance premiums, a "public" option might strangle private health insurance, employer mandates might exacerbate the job crisis, and that ultimately this program will add to our already exploding debt.

Yet my reasons to oppose this bill are also personal: In 2005, I found a mass in one of my breasts. I was four months pregnant. I've never forgotten my doctor telling me that "cancer starts small." I had a biopsy and my doctor found a second mass. Two years later, I found a mass and my doctor found another. Thankfully, all four masses were benign. But I know I have an elevated risk for breast cancer, so I'm taking many precautions. Following the advice of my doctor, I do a monthly breast exam; I have a breast MRI every six months, and an annual mammogram.

I firmly believe that decisions about my care should be left between me and doctor. I worry that for millions of American women, these kinds of personal choices will increasingly become influenced by government bureaucrats.

We recently got a glimpse into the role that the government could play in making healthcare decisions. A federal task force recommended against annual mammogram exams and regular breast self-exams for women under age 50. They calculated that the costs of all of the false-positives that are created by screening women (like me) in their forties aren't worth the number of lives saved. The calculation goes like this: Every 2,000 mammograms for women between 39 and 49 prevent one cancer death. It takes only 1,300 for women between 50 and 59 to save a life, and just 337 for those between 60 and 69. From the government's standpoint, it's worth reducing the number of false-positive and unnecessary tests of women in their 40s even if that means sacrificing the lives of some women.

Many doctors were alarmed by the recommendations. An impassioned Dr. Daniel Kopans at Harvard Medical School said: "Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it. It's crazy--unethical, really." And beyond the effects of the change in policy, doctors worry about the confusing messages that recommendations like these send. Robert M. Goldberg at the Center for Medicine in the Public Interest warns of "the impact of telling women to simply go away. It took years to build up screening rates to where new drugs could have an impact on mortality. Now all that could be undone."

This is particularly true for minority communities. African-American women are nearly 40 percent more likely than white women to die of the disease. The mortality rate for black women under 50 is 77 percent higher than for white women. Shockingly, breast cancer deaths of African-American women are up 13 percent since 1974, even though the deaths of white women dropped 11 percent over the same period.

They are many reasons for these differences in mortality, but a primary cause is that African-American women are more likely to be diagnosed later. The single most important way to save more lives is earlier detection. Studies suggest that when black women follow the same preventive practices, most notably regular mammograms, as white women, their death rates are similar.

There was a public outcry about the mammogram recommendations, and the Senate has amended its legislation specifically to protect and encourage the use of women's preventative services. Yet this should be little comfort to those concerned about the potential consequences of more government involvement in healthcare. The government will have to limit services as it assumes responsibility for providing healthcare to a larger and larger segment of the population. Less politically popular diseases and treatments are sure to be on the chopping block.

Those familiar with the Medicaid program, a joint federal-state program that serves low-income communities across the country, know the other ways that care can become restricted under government healthcare programs. In general, Medicaid is a second tier healthcare system, with fewer benefits and less flexibility. Many doctors and specialists just won't accept Medicaid, since payment rates are set below the cost of providing care. The Senate bill would expand Medicaid and many will be surprised to find themselves stuck in Medicaid's morass.

Proposed cuts to the Medicare Advantage program similarly will disproportionately affect minority communities. Currently, about one in five of all seniors--but one in four African-Americans and one in three Hispanics--participates in Medicare Advantage plans, which tend to cost less and provide superior benefits to traditional "fee-for-service" Medicare. Seniors who don't have the money to purchase supplemental private insurance will be particularly hard hit as they are pushed out of Medicare Advantage. Low-income seniors--again, who disproportionately come from minority communities--will also bear the brunt of the massive cuts to all Medicare services, since they don't have the money to buy care outside of the system.

We do need healthcare reform, particularly to help low-income and minority communities that today often don't have access to the quality care they need. But those reforms should focus on preserving what's best about our current system--its high quality and medical innovation--while fixing the system's flaws. There are many ways to improve the system without a massive expansion of government: allowing for the purchase of insurance across state lines and giving those who purchase insurance themselves the same tax advantages enjoyed by employers who provide insurance would both drive down prices and make insurance more affordable and accessible. Direct subsidies to help those who can't afford insurance themselves would be a better policy than forcing them into a one-size-fits-all, government-run program.

Americans want a better healthcare system--but they don't want government bureaucrats dictating care options and restricting the availability of certain treatments.

If comparisons to slavery are now fair game, Majority Leader Reid should consider this one. In 1839, slaves being transported on the ship La Amistad revolted and killed many of those holding them captive; when the matter was eventually taken up by the Supreme Court, the would-be slaves were found not guilty of wrongdoing and were freed. Today, Reid and members of Congress are steering America toward a land of government-run healthcare, in spite of the fact that polls consistently show that most Americans don't want to go in that direction. Just 27 percent of Americans polled have a favorable view of Congress, and just about 40 percent of Reid's constituents plan to vote for him again.

It's not a perfect analogy, but I hope it gets a point across: If Reid and his fellow congressman continue on their present course, they may be facing a mutiny of their own.

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Healthcare - Harry Reid Wrong on History and Wrong on Health Reform