healthcare reform

Recently President Obama proposed new health care reform that would include some government control or participation. One of President Obama’s proposals is the creation of a government insurance company that will compete with private insurers. This suggests that a government insurance option will drive private health insurance premiums down by creating competition. Responses from legislators have been emotionally charged and influenced strongly by large lobbying groups. Senator Richard Shelby stated that acting on the President’s proposal would be “the first step in destroying the best health-care system the world has ever known," while other pundits have lamented that it would put bureaucrats between patients and their doctors.

While I don’t dispute that the United States offers the finest health care in the world, it does not do so for every citizen. The slogan of those that seek to protect the status quo should be modified to say “the United States offers the finest healthcare in the world to those who can afford it.”

The current system is fatally flawed as each year it is capable of providing health care coverage to fewer and fewer Americans. Health insurance premiums have been rising at 5 times the rate of inflation. It is a system that is regulated by corporate profit margins not by science and compassion. This system places unnecessary stress on caregivers by allowing third party payers to shake down doctors, hospitals and patients under the guise of managing healthcare. And finally, it is a system that depends upon other programs such as Medicaid and Medicare to care for those that can’t afford its lofty premiums. In the current health insurance system almost 45% of poor adults are uninsured (poor being defined as those who earn <200% of the poverty level).

In a compromise the President suggests that we not throw the baby out with the bathwater. He proposes, and I believe rightfully so, that by maintaining the current system and infusing some government control in the form of a government based insurance option we can transition towards a more equitable system which allows all US citizens to have access to basic health services. Some would say that healthcare is not a right but is a privilege which must be paid for. In the past this was true but as healthcare has progressed towards certain scientific certainties members of our population are all too frequently presented with the dilemma, “If you can pay for this procedure or medication you will live and if you cannot you will die.” As our society evolves, so do our perceptions of fairness. I believe that at this stage in our societal evolution the expectation of basic medical services should be as much a right as the right to vote. For those that seek elevated levels of coverage above what the national discussion determines to be basic, private insurances will no doubt provide options. The current stratified system is insufficient and unfair. Those who fall below a preset poverty level receive Medicaid (a service which varies from state to state), those who work lower paying jobs but whose incomes exceed the poverty set point often have no coverage and those with higher paying jobs enjoy the security of more comprehensive insurance. In addition, those with pre-existing injuries and diseases often lose coverage when changing jobs.

There is no perfect system and countries in Europe and Canada that have nationalized healthcare have learned that their systems are also flawed but at least medical care is available to all citizens. Current estimates put the number of uninsured Americans at approximately 50 million, a number that is sure to rise as unemployment rates increase across the country.
The real question when it comes to healthcare is, do we want a system that supplies top notch healthcare to only 65% of citizens, or do we want a system that insures all citizens at a basic level and allows for higher level coverage for those that wish to purchase it? It’s still a stratified system but at least there is no layer of non-coverage.

The ranks of the insured are reducing as small business owners choose to go without insurance because they can’t afford it, employers with shrinking bottom lines put more and more financial responsibility to pay for health insurance on their employees, and as the weakened economy stretches the unemployment roles many unemployed individuals must choose between making their rent or mortgage payments and paying for COBRA plans which exceed their unemployment benefits.

I don’t know if the time for change is now. Given our current economic woes, the housing crisis, the collapse of the financial system, our role in two foreign wars, impending double digit unemployment and a national debt that recently exceeded the number of available digits on the Times Square clock designed to measure it, it seems an inopportune time. But as so often occurs, difficult decisions are often thrust upon us when we least want to deal with them. I do not know where the money will come from. I am not sure how to structure a system that would provide quality care without exclusion that would still properly compensate doctors, nurses, and other healthcare providers. I do not know… But I do know that we cannot continue to allow a dwindling few to utilize healthcare resources while friends and neighbors wallow in the unknowns of being uninsured. I do know that debating this can’t be anything but good. I do know that we have intelligent actuaries, statisticians, healthcare providers, administrators, and politicians who can solve this problem.

The president’s proposal, while no doubt a stop-gap measure on what is likely a slow march toward nationalized healthcare is a reasonable point to begin the national debate. As evidenced by Congressional Budget Office estimates the Obama plan would be costly and it most certainly could not be implemented without breaking Obama’s pledge to not raise taxes on the middle class. So let the debate begin.

It has been said that the truest measure of a society is how it treats those in the most need. What does it say about the country with the “greatest healthcare system the world has ever known” when we only allow the wealthiest and most privileged to utilize it?

Dr. Michael Raucci