The narrow survival of the Affordable Care Act last week was certainly cause for celebration. But as the jubilation subsides, it's important to realize that having avoided what would have been a giant step backward doesn't mean we've taken a giant step forward. Because the law as it now stands is only the first step toward health care reform.
On Sunday's This Week, Vicki Kennedy (Ted Kennedy's widow) spoke movingly of how "health care reform was the cause" of her husband's life. "He believed that it was a moral issue," she said, "that it defined the character of who we were as a society, who we were as a country, and that decent, quality, affordable health care should be a fundamental right and not a privilege." She went on to say, "Families can go to sleep relaxed and happy knowing that their children who have asthma or diabetes or allergies are covered by insurance and aren't barred because they have a pre-existing condition."
But in fact we are a long way from that rosy description. Beyond the problems of implementation and whether this state or that governor will set up the required exchanges by 2014 or accept money for Medicaid expansion, the Act mostly extends a flawed system to more people. And while this is certainly a very good first step -- leaving 50 million people without insurance is unconscionable -- we quickly need to get to work improving it.
"All but lost in the commentary" about the decision, writes Eugene Robinson, "is that the Affordable Care Act was intended as just a beginning." Or, as Cornell's Robert H. Frank put it, "The point worth celebrating is that last week's ruling will at last enable our distinctly dysfunctional health care system to evolve into something better."
Primary among the next steps to continue that evolution is the need to focus on cost containment and prevention -- neither of which the Act adequately addresses.
"With or without Obamacare, the American health system will continue to unravel -- quickly if Romney is elected, slowly if Obama is re-elected," writes Dr. Marcia Angell of Harvard Medical School. And this is because the law doesn't actually reverse the unsustainable trend line of skyrocketing health care costs. "[Obama] also did nothing to rein in the profit-oriented delivery system that rewards providers on a piecework basis for doing tests and procedures," writes Angell. "So with all the new dollars flowing into the system and no restraints on the way medicine is practiced, the law is inherently inflationary."
As one health care lobbyist told Angell, if the Act cuts into the industry's profits, they'll just raise premiums -- something the new law doesn't prevent. When this happens, more and more people will opt out of the system, choosing to pay the meager penalty -- sorry, Chief Justice Roberts, I mean tax. This will lead to even higher premiums, and the vicious cycle will continue, albeit a tad more slowly than before.
This is because, writes Angell, "Obama gutted the law before it even passed." Aside from keeping most of the current system in place and simply extending it, there were the deals to not allow drug reimportation and the deals that prevent the government from negotiating for lower drug prices. In 2008, then-candidate Obama took on the latter provision being left out of the Medicare Part D bill: "That's an example of the same old game playing in Washington," he said. "You know, I don't want to learn how to play the game better. I want to put an end to the game playing." He clearly didn't.
Beyond the continuing problems of how to cover treatment once people are sick is the escalating problem that comes one step before that: dealing with efforts to prevent people from getting sick in the first place. Given current obesity and diabetes trends -- and the myriad medical problems associated with them -- it's not enough to focus on coverage. Any plan that doesn't aggressively tackle preventive care can't contain enough costs to be sustainable.
And though the Act has modest preventive care provisions, they're mostly about screenings for various conditions -- which is great, but not nearly enough to reverse the alarming trend lines. And even among those provisions, there are, as many patients -- and insurers -- have already found out, numerous loopholes.
"Perhaps the most pressing public health challenge for the United States today is the epidemic of... obesity," writes Ross A. Hammond of the Center on Social Dynamics and Policy, "which is linked to an array of costly and debilitating health consequences." Since 1960, obesity has risen nearly 35 percent. Looking just at children, nearly one-third of whom are obese or overweight, obesity is associated with over $14 billion in direct medical spending; overall, more than 20 percent of U.S. medical costs are now attributable in some way to obesity.
This obesity epidemic is also helping to fuel the diabetes epidemic (in addition to heart disease, cancer, asthma and a host of other conditions). As Hammond notes, a shocking one-third of all children born in America will develop type 2 diabetes at some point. "Even if the epidemic does not worsen," he writes, "these costs are likely to prove an unsustainable burden on the health system given the long-term growth of the federal debt." On the other hand, just a five percent decrease in diabetes could save an estimated $25 billion every year.
In response to the Supreme Court ruling, President Obama said that "with today's announcement, it's time for us to move forward -- to implement and, where necessary, improve on this law." The "where necessary" implies that it's just a matter of tweaking a few things here and there. But it's not about tweaks. We need to continue to think big. Among the many important aspects of passing the Act was simply putting to rest the notion that nothing can be done. Well, something was done -- but much more, especially on preventive care, still needs to be done.
In the weeks leading up to the ruling, we read a lot about the sense of urgency and alarm and resolve that health care advocates would have if the Affordable Care Act were struck down. Now that it's been largely upheld, we need to keep -- and build upon -- that sense of urgency.
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I was told our lower life expectancy was a result of our HC system during the HC debate, I claimed our low life expectancy was a result of our lifestyle choices.
People think that mandating everyone pay the same creates equality in the system when in reality it creates a path for continued irresponsibility from the abusers of our system.
I just got my bill from Kaiser Physical Therapy. My bill was 100.00 dollars for 15 minutes. That equates to 400.00 per hour so someone could flex my shoulder. I did not receive any ice or electric stimulation just some flexing and stretching. 400.00 per hour for physical therapy. True.
I'll take the government....thanks
And why should we spontaneously believe HC lobbyists .... ?
First of all, a CBO report has shown that the profits of health insurance companies will neither go up nor go down.
Secondly, Obamacare CLEARLY contains EXPLICIT mechanisms to prevent costs from rising. An example: from now on companies are mandates to spend 80% of what their receive in premiums on reimbursements.
If you know that many companies today are engaged in a "race to the bottom", with some of them spending only 70% on care, AND if you know that the main driver of this process was the fact that Wall Street gives them a LOT of money when they can show that they lowered the % of care, then you'll easily understand that MANDATING them to pay 80% ENDS it. They will no longer be able to increase their profits simply by increasing premiums or trying to get rid of even more sick Americans.
More broadly, imo the biggest mistake we can make is to imagine that REAL reform still has to begin. What the entire Obamacare battle has shown - and continues to show - is why it has taken us more than half a century to obtain a bill that keeps a 100% private sector system but that optimizes it in such a way that hundreds of thousands of lives will be saved during the next decade alone, all while creating almost universal HC: it's because a LOT of extremely powerful HC lobbyists STRONGLY oppose the smallest change to the status quo.
Today, Romney has become the champion of defending the status quo. The most important question during the next months will be whether we as a people can succeed to keep Obamacare, or whether we'll lose it even before having experienced its benefits.
I absolutely want single payer, but we will never get there if we don't take EVERY single battle that we have to fight in order to get there seriously.
Electing a supermajority that wants single payer already in Nov. is totally IMPOSSIBLE.
That means that we URGENTLY need more articles explaining what Obamacare will do and debunking the many Myths the GOP is spreading about it.
The same goes for jobs.
By focusing on our ultimate goals on, we risk to lose the most important battles of our generation.
So a person on $20,000 would contribute $4,000 per year; a person on $40,000 would contribute $8,000 per year and a person on $100,000 would contribute $20,000 per year. Finally a person making $200,000 would pay $30,000 and a person making $1million would pay $110,000.
If you ask people to do it when they are younger they will usually sign up to it and be less resistant as they are not wealthy AND they are usually healthy. As they get older and earn more the reward to the HMO is counterweighted by their higher income.
If you consider your average premium is $8,000 and you have 240 million people living in the States. Then that makes $2 trillion. Wow isn't that what the US spends already!!! Crazy and everyone gets insured!!
And if you take a look at Romney's superPACs, you'll see that HC lobbyists are paying him MILLIONS in order to repeal Obamacare.
Why?
Precisely BECAUSE the new law makes it impossible to suddenly arbitrarily raise premiums by 40%, only because that allows the insurer to lower the % of care reimbursed compared to what he receives in premiums, and when he does that, he wins a LOT of money on Wall Street.
From now on, insurers HAVE to spend 80% of premiums on care. As a consequence, premiums can still rise, but only if insurers reimburse MORE. And if you can't afford the new premiums, the biggest HC tax credits in history are there to help you.
I'm not saying that Obamacare is perfect. It isn't, of course, and sweeping overhauls like that always will have to adjust to changing realities during and after their implementation. Moreover, I'm a strong single payer supporter.
But we shouldn't criticize the bill based on rumors only. A lot of studies have ALREADY been done. To know what effect Obamacare will have, you first have to READ those studies. You can't just isolate one fact and then draw conclusions about the entire bill.
There was one other point I was trying to express. That IF Obamacare is NOT a plus for the corporate sector, then the claims that the Supreme Court is owned by those corporate interests is simply false. How many people have you seen express the opinion that they are bought and paid for by corporations? I've seen it thousands of times and this decision flies in the face of that belief.... unless it actually does benefit the corporate sector.
But my main point was not so much
Though I'm a Democrat, and I accept the Patient Protection and Affordable Care Act as a better way than we currently have of approaching the health care problem, I do also feel that it was not the right solution to the problem. Forcing Americans to purchase health care from corporations is simply unconscionable. It will, I think, in the LONG run, increase insurance costs.
The only morally correct way of approaching health care is on a non-profit system. Companies that provide health care insurance must not be owned by shareholders (public nor private) seeking to maximise profits.
The highly trained doctors and nurses, and overburdened hospitals (that currently rely so greatly on large donations from high profile individuals with oversized egos) are the ones that should benefit from every single penny of Americans hard-earned money -- not insurance companies who spend so much of that money seeking to circumvent the care they are contractually obligated to pay for for the sake of higher ROI for investors.
We needed single payer- not forced large monthly health insurance premiums to cut throat ins co's.
F&F!
Which is why, ultimately, we need to adopt a single-payer system--Medicare for all--in this country. The wider the pool, the greater the benefits for all and the more power for all. Let's strive to get for-profit insurers out of the health care business, period.
You LOVE the existing system in the US!
What do you propose then? have you been to Europe and seen with your own eyes how public health costs and how it works?
So even though the complete text of the Patient Protection and Affordable Care Act is 974 pages long, I was compelled to read it in its entirety in order to find out for myself what it Really says and does. The reader can find it in .pdf format here: http://housedocs.house.gov/energycommerce/ppacacon.pdf
Insurance companies' profits are now limited under the law to 15-20% of total premiums; the balance must be paid out in benefits, or the company will be obligated to send out rebate checks to everyone. As a result, the business model for maximizing the bottom line is simple: Pay out as much as possible in benefits. This is a radical departure from the pre-ACA business model of "Pay out as little as possible, because what you don't pay out in benefits is profit."
I urge the reader to take the time to read the Act before making judgments, to separate the hype and propaganda from reality. For more information on how the ACA might actually BE tweaked: http://americanprogressive.org/2011/08/28/a-social-capitalist-approach-to-health-care-delivery/
On substance: I couldn't agree more.
Normally a "fundamental right" would not be paid for by someone else against their will Who will pay for this "fundamental right"? Universal health care is a worthy goal but it is not a right or privilege. It is charity.
Note also: Healthcare costs can be made more efficient but they will continue to go up forever. This is one case where success leads to higher costs. Example: I am cured of cancer and live 20 years longer. That is 20 additional years of yet more expensive healthcare (since I am older) - and - I will still die of something! The "end of life costs" are postponed but not eliminated. Still, the 20 years of extra life are worth it to me - especially if someone else is picking up the tab!
Not only that, but health care is a service provided by people. If that health care is deemed a right, that means that others "deserve" the work and services provided by the doctors and nurses, etc.
Freedom of speech is a fundamental right. Demanding the work of another human for your own benefit is not a fundamental right.