This post originally appeared in ProPublica’s Patient Harm Group.

When the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act back in June, members of ProPublica’s Patient Harm Facebook Group had questions about how the law related to patient safety. For answers we turned to Rosemary Gibson, author of “The Battle Over Health Care,” co-written with World Bank economist Janardan Prasad Singh.

 
People are paying more for insurance – even for Medicare – but getting less coverage. Any comments on this?  – Anna Gardiner  
 
Fasten your seat belts because this is the wave of the future whether you have public or private insurance.
 
To pinpoint the root cause, let’s follow the money. At least 15 health care companies are on the Fortune 100 list. They must constantly meet the unforgiving demands of Wall Street for higher revenue and stock prices. 
 
A close look reveals that the health care industry has uncanny similarities to the banks: both have price bubbles, too-big-to-fail syndrome, toxic assets (think Vioxx), privatized gains and socialized losses (think errors and infections), conflicts of interest, you name it. All of this helps companies meet Wall Street demands. But for the people on Main Street, it raises the cost of health care without delivering any value to people when they are sick. 
 
The banks did the same thing: they drove up housing prices with sham mortgages, people had to pay more for housing, and in the end, millions became poorer when they lost their homes and their jobs. Just as the banks messed with peoples’ wealth, the health care industry is messing with peoples’ health. 
 
 
Will universal insurance lead to overtreatment? – Olga Pierce
 
Yes, it will. The health care industry has been given 32 million new customers. The industry mantra is volume and the newly-insured will surely get caught in the treatment trap. You can read about how to avoid it at www.treatmenttrap.org. 

How have caps and immunities in the civil justice system affected patient safety? – Kirpal Singh

These so-called medical malpractice “reforms” aren’t reforms. Real reform is eliminating medical malpractice by making care safe, not limiting lawsuits. In the 1980s, anesthesiologists took the high road and made anesthesia much safer – and med mal premiums in this specialty dropped. That’s real reform we, the public, should demand.  

Will the Patient Protection and Affordable Care Act live up to its name? – Marshall Allen
 
Under the new law, about 16 million people will be able to buy health insurance with subsidies and another 16 million will have access to Medicaid. But the coverage is like a Band-Aid on the BP oil spill. 
Health care reform does nothing to curb the cost of health care and make it affordable. Hospitals, doctors, drug and device companies – and everyone who relies on health care for revenue – can continue to raise prices and bill for more tests and procedures. Health care reform merely transfers the risk of bankruptcy of individuals to the bankruptcy of the federal government.    

A number of members of ProPublica’s patient harm group commented on the fact that poor care and patient harm are tolerated. 
 
The health care industry has an entitlement mentality and expects to be paid no matter whether their products and services help or harm. Thanks to people in this Facebook community, Consumers Union Safe Patient Project, other patient safety advocates, and public interest journalism by outlets such as ProPublica, Medicare now has a no-pay policy for errors such as wrong-site surgery and certain hospital-acquired infections. A merit-based payment system is the right way to go.  Health care reform moves more toward a merit-based approach but we have many miles to go.

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