Healthcare is a human must. A sustainable high-quality health care system is the mark of a great society.
There is a lot of heated chatter these days about the Affordable Care Act (ACA) and its troubled implementation. Instead of coming together to make this critically important law work, the focus is on technical website issues, services not fully functional yet (like easy comparison of plans and determination of eligibility for subsidies), and the argument that anything and everything that ails us is “obviously” the fault of President Obama, ACA and Government. In addition, the great “horror of our existence” is that some plans in the individual market (under 5% of those with insurance) are being canceled by the insurance companies, most replaced with better plans to comply with ACA. (I found good options and with a little effort your will too.) Speaker of the house John Boehner declared last week that “We have the best health care delivery system in the world.” That is an inaccurate statement at best and I would urge him to read The Commonwealth Fund Commission on a High Performance Health System that outlines why we do not and how we can get there.
To put things in perspective, let’s evaluate our health care related standing in the world in the following categories:
1. Life Expectancy – America is 51st in the world with 78.62 years life expectancy. The 50 countries ahead of us with higher life expectancy include Japan #3 – 84.19 years, Canada #13 – 81.57 years, Israel #18 – 81.17 years, UK #30 – 80.29 years and European Union #37 – 79.86 years, all with some form of single payer organized health care system.
2. Infant Mortality – This is defined as number of deaths of infants under 1 year old per 1000 live births. America is 50th in the world with 5.9.
3. Teenage Pregnancy – Developed World – This is defined as number of births to women ages 15-19. In the US it accounts for 18.4% of all non-marital births and 8.4% of all births, making it higher than most industrialized nations.
4. Spending on Health Care – The US spends more on healthcare per person at 18% of GDP than any other country, yet lack of health insurance is estimated to contribute to 45,000 deaths per year as well as a factor in our shorter life span.
As a participant in the individual insurance market for over 5 years now, I have, like many others, put up with ever increasing pricing, confusing/complicated terms and conditions, escalating out-of-pockets and deductibles and ever changing benefits and restrictions. Being healthy, I luckily did not end up like the hundreds of thousands of Americans (most with health insurance) in bankruptcy due to medical bills not covered by their sub-par plans, although I always have to pay for care in addition to and above my health insurance premiums. The Affordable Care Act was designed to reform that system and provides for minimum standards like:
1. Health Insurance Marketplace for people and small business to get competitive health care coverage.
2. No denial of coverage for pre-existing conditions.
3. Simplify and clarify what you are buying.
4. No arbitrary cancellation of insurance if you get sick.
5. Protect choice of doctors.
6. Cover kids till age 26 on your policy.
7. Include preventative care in all policies.
8. End lifetime and yearly dollar limits.
9. Guarantee right to appeal.
With those health care benefits, clearly some existing plans that come up wanting will be canceled. It was also clear that to maintain our health insurance system, we need to increase the pool of the insured with the young and those healthy of all ages, paying in substantially more than they take out. (That is how private insurance always worked and always will.) Meanwhile, the uninsured (numbered around 48 million people), now have the opportunity to acquire such protection and mitigate, with good coverage, the risk of losing it all due to lack of proper insurance or any insurance at all.
Why are we then laser focused on a small sliver of the US population that had policies canceled by insurance companies? And why is it that we fail to mention that those people who were always stuck in a “wild west” unpredictable market, now have the option to go on the exchanges (phone, mail and in person pending website fix) and find better and mostly cheaper insurance plans? For reference, California has already close to 60,000 people signed up, will meet its 2014 enrollment goal and just happens to be the largest economy and most populated state. (I guess, strong political will and appropriate allocation of resources and funding works!)
Let’s not forget that we have a for-profit insurance system that must pay out less than they take in to guarantee shareholder return. That requires both more “healthy” than “non-healthy” insured, as well as sub-par “catastrophic” policies that cost less but cover very little, if anything. With high deductibles and out-of-pockets and minimal coverage, most of those premiums are left safely in the pockets of the insurance companies. This also creates a chilling effect (preventing people from seeking early ongoing preventative care), which later forces them into emergency care (the single most expensive type of health care), at great waste of treasure and high cost of human suffering.
This is about Health Care, not Health Insurance. We all need health care on an ongoing basis and more of it as we age. We need to get the uninsured into the system and make sure we all have good health insurance, freeing us from living at the arbitrary mercy of the for-profit insurance industry. This will also curb the out-of-control escalation of health care as percentage of GDP.
A Public Option, of course, would capture the uninsured and incentivize the insurance companies to match or better the public option plans (capitalism and market competition at its best.) To go completely bonkers for a moment, I would argue that if we had some version of a Single Payer System, we would be able to deliver good health care to all Americans (focusing on prevention) at a reasonable price while reducing overall health care costs, as most modern industrialized nations do.
What is particularly disheartening with ACA (a compromise that did not make the Right or the Left happy), is the complete unwillingness to do any work on this in the House of Representative except repealing it (unlike Medicare Part “D” under the Bush 2 administration when all, Republicans and Democrats, joined forces to make it work), focusing instead on cheap politics and ideological fantasies that have nothing to do with the issue at hand.
Mitt Romney (and I am not a big fan), while campaigning for President famously praised the Israeli healthcare system, which provides high quality inclusive health care at a cost of 8% of GDP, compared to the inefficient and much less inclusive US health insurance system that costs a staggering 18% of GDP. (The basis of ACA is a Heritage Foundation plan, created to counter the Hillary Clinton initiative in the Clinton presidency and later implemented with great success in Massachusetts by Mitt Romney.)
There is no reason we cannot create a great Health Care System in America, except for lack of will. The first step to fixing our health care system is to fix the ACA implementation. What is needed is focus, motivation and leadership — right, left and center — putting people and country first and solving this critical national security issue that is the lack of high quality, affordable and cost-controlled healthcare for the American people. Congress and the political players and pundits should worry less about the “demise of the Obama presidency and its competence and credibility” (way premature and false), and more about making the Affordable Care Act work.
John F. Kennedy, who’s life we are celebrating at the 50th anniversary of his assassination, famously said: “Ask not what your country can do for you, ask what you can do for your country.” We should heed those wise words, take them to heart and take action to fix the implementation of ACA and provide affordable, high-quality and sustainable health care for all.