Health Security: We Can Do Better

"Don't you realize that your body is the temple of the Holy Spirit, who lives in you and was given to you by God? You do not belong to yourself, for God bought you with a high price. So you must honor God with your body." --1 Corinthians 6:19-20

"If you don't take care of your body, where are you going to live?" --Unknown

"If you look at the studies coming out of the Congressional Budget Office, the number one thing that's going to blow a hole in the deficit as we go forward 20, 30 years is government spending on healthcare." --Christina Romer, former Chair of the Council of Economic Advisers

"We have now just enshrined ... the core principle that everybody should have some basic security when it comes to their healthcare." --Barack Obama

Did it seem odd to you that, after the cacophonous debates leading up to it, the Los Angeles Times opened their report -- as we waited for the Supreme Court's ruling on The Affordable Care Act -- saying that "the White House was unusually quiet"? During three days in March, 26 states, individuals and the National Federation of Individual Businesses, among others, challenged the law's constitutionality. Texas filed suit and 25 percent of the population of Texas lacks health insurance -- the nation's highest rate. California was one of 11 states that filed a court brief supporting the law.

Lots of attention had been paid to the individual mandate, which required that most individuals purchase health insurance. Perhaps less focus was put on the expansion of Medicaid, which ended up not being upheld. Regarding Medicaid (for low-income and sick people), states will be granted flexibility not to expand programs without paying the penalties that were in the law. Gordon Deal of the Wall Street Journal had written before the ruling:

"No matter how the Supreme Court rules Thursday on the federal health-care law, states will face huge struggles paying for ballooning health expenses and swelling uninsured populations -- a problem that has prompted some states to draft their own overhaul plans."

The Houston Chronicle stated that "a Republican Supreme Court handed a Democratic president a massive election year victory Thursday by ruling that the sweeping 2010 health-care law is constitutional" (although under Congress' power to tax, not under the Constitution's Commerce Clause). Do we have to accept as inevitable the politicization of this is issue? If so, we get extremes instead of facts, and lose the complexity and sophistication with which we need to solve the huge healthcare issues that impact all of us. David Maris, blogging in Forbes, suggests that couching the healthcare program, de facto, as a tax program may position Republicans to explain to voters that the president's program is a massive new tax with "the potential for not only enlivening the debates, but energizing the Republican fiscal conservative base."

A 5-4 decision doesn't help keep the focus on what should be a shared objective: the common good. We know we need to overhaul healthcare -- which everyone will need during a lifetime and we must pay for -- one way or another. Should the commitment to insure the uninsured be partisan or more effectively be approached as an economic issue of fairness -- not only to the uninsured, but also to those of us who are insured but pay more for those who enter the healthcare system with no coverage? We know that 50 million people lack healthcare and cannot pay all their medical bills. The result is simple: when hospitals and clinics make up the difference, they charge higher rates to insurance companies, who pass them on to policyholders.

The court limited the federal government's power to terminate states' Medicaid funds. Chief Justice Roberts wrote:

"Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."

That will not satisfy people like Virginia's Attorney General Ken Cuccinelli and other health care law opponents, who will continue to argue that the issue is not about how the government chooses to provide health care to those in need but "about liberty." Curiously, some 56 percent of people were against the health care overhaul with 44 percent in favor, according to a Reuters/Ipsos online poll. That suggests that voters were willing to reject reform even though they liked much of what is in it, especially allowing children to stay on their parents' insurance until age 26 and covering pre-existing conditions. The majority polled were against the "individual mandate" requiring all U.S. residents to own health insurance and want the benefits contained in the legislation. The fact is that the mandate is the only way to pay for what they want. Every State that has put such benefits in place without mandated participation has had to close expanded program features like the popular acceptance of adult children until 26 years old or no restrictions on pre-existing medical conditions.

Some health experts say that reform is also good news for women, because they represent more than 19 million of the uninsured. Under current insurance practices, some experts also argue that women are charged more for health care, which the new law rectifies. According to the National Women's Law Center, in states that have not banned such practices, more than 90 percent of the best-selling plans charge women more than men. And with only 3 percent of them covering maternity services, almost a third of plans charge women at least 30 percent more than men for the same coverage. In one plan, 25-year-old women are charged 85 percent more than men. The practice costs women about $1 billion a year.

America spends far more per capita on health care than any other nation with the average American spending about $7,900 per year on health care. Medical problems contributed to many bankruptcies. And we lag behind many other nations, at least according to the World Health Organization, which reports that the United States ranks 37th in health system performance and far behind many other countries with regard to infant mortality, life expectancy and preventable deaths. Not all Americans believe that all of us should have effective health care coverage as a right and see it as a privilege. The World Health Organization's constitution states that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being." If such coverage is the law, then no one should be left out. Then the debate refocuses on how we accomplish that goal affordably and sustainably. With our history of innovation and entrepreneurship, we can do better.

 

Comments

[soma77]

11:58 AM on 07/07/2012

Obamacare is a good start.

[rtx47]

10:04 PM on 07/05/2012

America's healthcare quandary is cost of healthcare delivery - (at least) twice/person and 2-3 times GDP compared to Western economic competitors. ACA attempts to solve this with CER -Comparative Effectiveness Research. Yet there's no disincentives for 30% of unnecessary and inappropriate care that's delivered (Dartmouth Atlas of Healthcare).

President and Congress should appoint two panels to address each side of the coin.

Healthcare payment system addressed with representations from healthcare and tax economists, business groups, labor, insurers, Medicare, Medicaid, and politicians. The group should end cost shifting, which distorts the whole system. And reduce the role and cost of extraneous factors that are not involved in delivery of healthcare.

Cost of delivering care addressed by representations from doctors, nurses, hospitals, pharmaceutical, nursing homes, ambulance service, equipment manufactures and others in healthcare delivery. Over- and inappropriate-treatment along with over- and repetitive-use of high technology tests and treatments have high-jacked the costs of healthcare without significant additional benefit. We have to end the 'medical arms race' across America.

Both panels should be staffed by biostatisticians with the stipulation (as in other Western economic countries) to come up with ONE healthcare coin, with both sides "matched for circumference, diameter and area". This need not be a national coin; and likely more workable on a state or regional basis. This is not difficult. Other countries have done it; and some regions / states across US have it. Governors could implement as they so choose as healthcare is a state issue.