Tuesday, July 28, 2009

U.S. Health Care Reform: Continued...

As the debate over U.S. health care reform continues, much of the controversy seems to center on the creation of a "public option" for health care coverage, and the widely-held fear that private plans cannot survive in competition with such an option. Why should private plans survive if they cannot perform in a competitive environment? This question seeks to justify the public plan in the ideological context of its opponents. It is not yet clear whether this logic will be effective in the political process.

In reality, I think that private plans should not survive in their present form as they appropriate either undeserved financial benefits of not-for-profit status - or excessive profits and CEO salaries - while they fail to provide services to American citizens. Other industrialized nations have designed single payer national systems that provide superior care to their citizens at a cost generally half of the per capita cost in the U.S.. (It is interesting to note that neither the Kennedy bill, nor HR 3200, contains reference to a "national system" or "national infrastructure," but the prevailing ideology as well as an essentially "bottom-up" system change process are assumed throughout the text of the legislation.)

Those who doubt the necessity of rapid reform should review the unfolding story of Remote Area Medical Volunteer Corps. While this organization was founded in 1985 by Stan Brock to deploy health care relief services in the developing world - it now has a growing mission in the United States. RAM recently offered free dental and medical services in Wise, Virginia, where as many as 1600 people showed up each day to receive free care, and on August 11-18, a clinic will be open in Los Angeles where as many as 10000 people are expected. (CBS 60 Minutes produced a segment on RAM in March 2008.) The success of RAM in the U.S. is a testament to the suffering of ordinary citizens across the country and a document of third-world America.

On June 15, President Obama made a speech to the American Medical Association in which he pointed out some of the disastrous economic effects of the dysfunctional U.S. health care system:
Our largest companies are suffering as well. A big part of what led General Motors and Chrysler into trouble in recent decades were the huge costs they racked up providing health care for their workers; costs that made them less profitable, and less competitive with automakers around the world. If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke.

According to Obama, not only the health care industry but all of "America may go the way of GM." He is right. He is attempting to convince health-care policy holders that the reform legislation under committee review will improve their coverage in the following ways:
  1. No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
  2. No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  3. No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  4. No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  5. No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
  6. No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  7. Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
  8. Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
    (Source: The Washington Post)

    National Conference of State Legislatures: Federal Health Care Reform:
    Congressional Budget Office - Special Collection on Health
    Commonwealth Fund
    National Academies Press: Health and Medicine

    On July 15, Congressman Kevin Brady (R-TX), the lead House Republican on the Joint Economic Committee, unveiled a detailed flow chart of the complex health care reform proposal by Democratic congressional leaders.

    Kennedy "Affordable Health Choices Act"
    CBO evaluation - Letter to Senator Edward Kennedy (June 15, 2009)

    HR 3200 : ‘‘America’s Affordable Health Choices Act of 2009’’(July 14, 2009)
    CBO Analysis - Letter to Representative Charles Rangel, Chairman: Committee on Ways and Means (July 17, 2009)

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