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Healthcare Reform - Reject or Perfect?
Healthcare Reform - Reject or Perfect?
What is the state of U.S. health care now that the dust has settled following the healthcare reform battle of 2009 and early 2010? The opposing sides have vastly contrary views regarding this matter mostly formed to uphold their point of view. Nobody received everything they wanted during this process. Most received some acceptable compromises and some disappointments. Hand wringing over the process has been rampant on both sides.
I would like to offer a more sober and clear eyed examination of the state of our healthcare system. I will begin with a summary of the evolution and resulting state of U.S. health care prior to this reform bill's passage. Then I will give my synopsis of how the bill began, evolved, and finished during the 14 month battle. Finally I will give my views on the positives and negatives of this new law as well as the changes and additions I would like to see implemented to improve it. Health care is too vital to our country to allow to remain stagnant and unresponsive to our needs.
How did our health care system get to this point? For most of our history there were no high tech diagnostic machines or high cost prescription drugs. People were treated with common therapies and either recovered relatively quickly or died if the illness was serious enough. Medical bills were not onerous for the most part. Therefore health care insurance was not necessary.
Some life insurance companies started to offer healthcare insurance plans in the 1930s and 1940s. Non-profit companies such as Blue Cross Blue Shield also formed to provide healthcare insurance. Companies first began offering plans during the World War II years because of government imposed wage freezes. These companies used the plans to recruit and retain workers in lieu of higher wages. These plans grew in popularity after the war due to their success in attracting employees.
These plans were fee for service plans until the 1980s when health care costs began exploding. Company health care plans quickly and steadily moved to managed care plans to control costs. Ever since costs have continued to rapidly spiral out of control with benefits being curtailed and premiums rising. The vast majority of people in the United States now receive their health care insurance through company sponsored plans. Government sponsored plans such as Medicare cover individuals over 65 and SCHIP covers poor children. Approximately 50 million Americans have no health care insurance at all.
Now we turn to the debate over the HealthCare Reform bill that occurred during 2009-2010 and the resulting law that Congress passed and the President signed. The House of Representatives and the Senate began introducing health care reform bills early in 2009 after President Obama's inauguration. He had vowed during the presidential campaign to make health care reform a priority and convinced the Democratic leadership in Congress to proceed promptly.
The Republicans initially decided to have some dialogue about making some minor changes to the health care system but were intent on leaving the bulk of the system intact. Eventually special interest groups worked behind the scenes to derail the entire effort. They enlisted a group of followers to attend congressional Town Hall meetings regarding the proposed healthcare reform bills. These followers bombarded the representatives with accusations and catcalls ruining the informational purposes of the meetings. The Republicans saw the potential political damage of going against the wishes of this group and ceased negotiations with the Democrats. They also saw the potential political gain of these attacks and attached themselves to this opposition group. They proceeded to oppose every action the Democrats tried from that point on. The Democrats needed 60 votes for cloture every time the Republicans filibustered a significant action attempted by the Democrats. This allowed the bill to be watered down each time by Senators seeking special advatages for their constituents in exchange for their vote.
Finally on March 23, 2010 President Obama was able to sign the Healthcare Reform bill that was passed and reconciled by both houses. Several key provisions have already taken effect. Insurance companies are now barred from dropping coverage to individuals when they get sick or injured. Young adults are able to remain on their parents health insurance plan until they reach the age of 26. The medicare drug benefit gap that has proven to be very expensive to seniors has been eased with an annual $250 rebate. This gap will eventually be eliminated. Small businesses have been given a tax credit to provide their employees with health care insurance. The rest of the provisions of this bill will be implemented on a rolling basis through 2018. The most important and controversial aspects will be introduced in 2014.
The biggest of these is the opening of state health insurance exchanges for individuals and small businesses. Most people will be required to obtain health care insurance or be forced to pay a tax. Individuals with income up to 133% of the federal poverty line will qualify for Medicaid coverage. Those with incomes up to 400% of this poverty line are eligible for tax credits. Health care insurance companies will no longer be allowed to refuse coverage to persons who have pre-existing conditions. These are the major aspects of the new Healthcare Reform law.
Now that we have examined our health care history and status, allow me to elucidate my views on how we should proceed to improve on this historic Healthcare Reform law. This entire process was one of compromise and no one is totally happy with the result. The Republicans are intent on repealing the bill after the November 2010 election through new legislation. This is a bit unrealistic at least in the short term due to the inevitable President Obama veto. They are also pursuing legal action with appeals in many state courts around the country. The most prevalent appeal they are making is that the law is unconstitutional because it forces individuals to purchase health care insurance. They also argue that the states should not be forced to create and run these state health care insurance exchanges. The United States Supreme Court will probably be the ultimate arbiter of the individual mandate aspect of the law.
I personally feel that the law can survive no matter which way this issue is decided though costs will escalate if it is struck down. I also feel it should be upheld as constitutional. We mandate automobile drivers to have insurance if they drive. Why not mandate health care insurance? Why should taxpayers foot the bill for those who roll the dice and refuse to insure themselves? Young healthy individuals could purchase a "bare bones" policy which would cover doctors visits and hospitalization costs with higher deductibles and higher out of pocket expenses. This way the taxpayer is not left footing the bill and the individual is able to purchase a less expensive policy that matches his lower risk of illness and injury. We require those that work to pay for social security and other social safety net programs. Why not also require them to pay for health care insurance as part of our shared social compact?
I feel the state health care insurance exchanges will be the most important aspect of the new reform law. They are the compromise that Congress reached when they realized that they did not have the votes to pass a true public option. These exchanges will be the vehicles used to ensure that every United States citizen has health care coverage. Each state exchange will have the power of numbers to keep rates low and give individuals quality low cost health care coverage.
I believe that every American citizen has a right to have access to affordable health care. The 9th amendment in the United States Constitution states " The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people". Therefore in my view, a right to affordable health care is essential and thus one of the rights not originally enumerated in the Constitution which the 9th amendment refers to. We can already see this in effect in the following de facto manner. Most hospitals refuse to withhold treatment to people who are indigent and cannot pay for it. Public hospitals are required to treat these individuals by law. I am not stating that people have a right to free health care. The right to affordable health care comes with the responsibility to obtain and pay for it if they have the economic means to do so. Those individuals with incomes around and below the poverty line will be given assistance to obtain health care insurance. The state run health care insurance exchanges are a good first step towards ensuring coverage for all individuals.
I feel they are only a start on providing this insurance. Much more work needs to be done. The opportunities for innovations and changes to these exchanges will present themselves as the exchanges are rolled out in 2014 and begin to mature. Lower costs should develop through streamlined systems and lessened paperwork. Proposed preventative health care measures should also lower costs in the long run and make these plans very attractive. For too long our health care system has incentivized medical procedures to maximize profits. We now have the opportunity to convert the system into one of rewarding quality of health care in terms of wellness, successful medical outcomes, and patient satisfaction.
Companies will be watching all of these developments very closely. They are by nature attracted to lower costs and higher quality. I would not be surprised to see many companies gradually begin to drop their company sponsored health care insurance plans and simply pay the tax to the U.S. government to provide health care insurance to their employees. We could see a large growth in these exchanges as a result. This growth should accelerate if these exchanges continue lowering costs while keeping quality high. Some state health care exchanges will be more successful than others due to size and competency. Mergers of some state exchanges are another change that I believe would help the overall system. I hope legislators would consider this option when and if the necessity develops. These mergers could help solve some state exchange problems and also create greater economies of scale. We see this employed in the business world every day so why not with these health care insurance exchanges as well. This could lead to purchasing health care insurance across state lines which is an issue that Republicans have advocated for. I also believe we need serious medical malpractice tort reform to lower costs. This is another Republican issue who's time has come and deserves serious consideration. Medical malpractice lawsuits are out of control and this must be corrected.
These are the major changes that I would like to see our new health care reform system take in the next few years. Medical professionals, administrators, and politicians must constantly examine how this new health care system is working. Successful innovations should be adopted nationwide. Processes that do not work correctly should be changed or phased out. Vigilance and innovation are necessary to allow this new health care system to work correctly. I am hopeful these steps will be taken so we can develop the fairer and more efficient health care system we deserve and need. Health care is now the largest part of our economy and growing. The prosperity and quality of life of all Americans is at stake here. We need to get together and make our health care system work. Failure is not an option