No I haven’t read the 2000 page Healthcare bill so, normally I wouldn’t have a leg to stand on with either criticism or praise but neither have any of the politicians who are running off at the mouth for or against it. If they can shoot their mouths off, so can I.
Enough has been said and written about the bill by the few who have actually read it that one can get some sense of what is good and bad about the bill, what will work and what may crash, so let’s take a look.
First of all the bill exists because something was needed to fill the void in the medical care that exists in this country. The system that existed before Obamacare, if you will, was, agreed by both sides, to be a complete disaster that was leading the country into bankruptcy.
Every president since Kennedy has tried to form some kind of healthcare bill so the idea has to have some value. The fact that all previous champions have failed only shows what a good job Obama did in getting something passed. No it’s not perfect but it’s a good start and if the Republicans weren’t so worried about getting rid of Obama and concentrated a little harder on achieving a functioning healthcare system, we’d be a hell of a lot further along the road then we are now.
The fact is, that the current Republican front-runner instituted a healthcare bill on which, this one seems to be based, when he was governor of Massachusetts. He is trying desperately to sneak out from under his former work, not because it isn’t working, which it is, but because it isn’t favored by the nut case Teabagger base to which, he wants to appeal. The fact is that the Massachusetts healthcare bill is the best one currently working in the country.
The first presumption we have to discard when we speak of healthcare is that any private system will be better and less costly than a public one. This is the lie on which, the right has based its attack on the Obama plan. No private company can deliver anything at less cost than a well-run government plan, because the government doesn’t have to make a profit and private industry does. This is incontrovertible. The problem arises from government bureaucracy’s history of incompetent function… in all areas. I accept this, but the answer is to create function in government not to turn the process over to a profit seeking private contractor because we’re too lazy to get it right on our own.
It is true that Medicare costs have gone up every year, 400% per beneficiary from 1969 to 2009 but private insurance rates have risen much faster, and by much higher percentages, 700% or close to double for the same time period. This alone puts the lie to private insurance being better than public. The only reason the Republicans have attacked the single payer plans is their natural hatred of any increase in government activity, even to the detriment of their constituency.
This by the way, is the problem with most of the government programs that the right would like to eliminate. The answer to saving money is not to cut the program but to make it function efficiently. Private business has learned to do this because it needs to make a profit. The government needs to learn to do this because it needs to continue to exist.
Back to healthcare: The goal of healthcare is to give Americans the care they need at a price the nation can afford, so the first issue that normally comes up for discussion, cutting back the age at which Medicare starts does not fulfill the main goal. Why not? Because people without insurance don’t go to a doctor until they are deathly ill. Dealing with that illness then becomes an extremely expensive process costing the system much more than occasional checkups paid for by Medicare. This is not conjecture but a point of view agreed on by almost all professionals involved in the process. So pushing back the age or eligibility will actually cost the system more in the long run, not less.
The second issue that seems to be floundering around on the table lately, is means testing, which just isn’t viable. Means testing, forcing people over a certain income level to pay their own way, could be accomplished but the additional bureaucracy needed to make it function would only raise the cost past the savings. Better we just raise taxes on those whose income is high enough to place them in a means testing pool. It’s really the same thing. You would pay in taxes, what you would have lost in Medicare remuneration if you had fallen into the rich peoples pool. It’s the same money coming from different places but at a cheaper cost.
As I stated at the beginning, this is not a perfect plan. It has good things and things that need to be fixed. Among the good things are that it will cover nearly 95% of legal US residents and will include preventive care which means longer life, fewer costly medical emergencies, better overall health and lower overall costs. Insurance companies will have to accept everyone, and increased regulation will keep them from rigging premiums, while there will be cheaper prescription costs for seniors.
On the downside, there isn’t a single government agency that runs efficiently. Do we want the organization that developed the tax code to run our healthcare? There is serious conjecture about how much the new plan will actually cost and currently, there is no tort reform included, a really serious deficiency.
A recent study shows that when poor people are given medical insurance they not only find regular doctors and see them more often, they also feel better. The new study, published by The National Bureau of Economic Research showed that in the first year of control the insured spent 25% more on medical procedures but were 40% less likely to say their health had worsened in the past year. They were 25% less likely to have an unpaid medical bill sent to a collection agency and 40% less likely to borrow money or fail to pay other bills because they had to pay medical bills. The message is clear. Poor people don’t spend much money on medical procedures simply because they don’t have much money. The result of this is that easily cured diseases fester and become serious medical problems, which in the end cost society huge sums to deal with. It’s cost effective to create health care for the poor.
Despite Mitt Romney’s abandonment, for political reasons, of the Massachusetts health care plan, the plan is working. 98% of the states residents are covered and payments are unlikely to rise in the current year. Average premiums paid by individuals have actually dropped between 20 & 40% mostly because reform has brought younger and healthier people into the plan spreading the risk on older and sicker ones; the argument for forced inclusion. The rest of the nation needs to watch and learn.
Paul Ryan thought the solution to Medicare was to issue vouchers to senior citizens with which they could pay for their own insurance. It has been estimated that the vouchers would fall about $6000 short of covering the costs of their insurance. The insurance company lobbyists fell in love with this plan, which they had probably suggested to Ryan in the first place.
Of course all this comes with the caveat that healthcare must get serious about cost controls. It has to start saying no to expensive procedures with little or no actual medical benefits. Part of this is tied to tort reform. If doctors are less worried about being sued they will spend more time dealing with the details of their cases and less time ordering expensive tests and procedures just to cover their asses.
Right now Medicare pays for routine colonoscopies in patients over 75 even though the Preventive Services Task Force of the Dept. of Health & Human services advises against them and against any over the age of 85 because there are at that age, dubious benefits from the procedure and risks of serious complications. The task force also recommends against screening for prostate cancer in men over 75 and against screening for cervical cancer in women over 65 who have had a previous normal pap smear; estimated savings, $50 million. Procedures in kyphoplasty and vertebroplasty run to 100,000 yearly at a cost of over $1 billion and they have been found to be almost useless. Unfortunately, when this kind of information was made public, the far right started screaming about death panels as a phony way to attack the bill.
Despite the demagoguery of the right, these and many more savings must be explored and where feasible introduced, all with the view to making our healthcare system function better and more economically for all. The answer is not to eliminate healthcare as the right would have us do, but to make it work for all Americans the way the people would have us do.