Health Care Reform

With all of the media, politicians, and pundits out there spinning the health care reform debate in opposite directions, making one side out to be unfeeling and merciless and the other to be socialist, pinko commies, how do we really come to understand Barack Obama's proposed reform and its implications for our country?  It's a question that I am certainly not qualified to answer completely, but for my own peace of mind, I've decided to do some research to begin to sort out the arguments and the truth from the lies.

Reasons Why We Need Reform?

Our health care system is a mess.  I've compiled a list of problems (with links to the sources) that our health care system, and thus, the American citizen is facing under today's health care status quo.  I was really taken aback to learn that:

• Most everyone agrees...President Obama, Republican and Democratic members of Congress, the American Medical Association and America's Health Insurance Plans, which represents the insurance industry, all have agreed the system needs to be changed. How to do it is the question.
  
• Latest Census Bureau estimates show that the overall number of the uninsured rose from 45.7 million in 2007 to 46.3 million in 2008.  More than one in four adults between ages 18 and 34 were without health insurance in 2008. They account for 55.1 percent of uninsured Americans, and the percentage is growing, up from 53.8 percent a year earlier. 
• Rising health care costs are the single biggest economic concern facing American businesses, according to a survey of businesses by Business Forward.  Nearly 90% of those polled cite health care costs as a major concern, more than taxes, government regulation, labor costs or energy costs. If costs continue to rise as expected, nearly 9 out of 10 business leaders expect to raise their employees' deductibles and copayments. Nearly 8 out of 10 expect to cut benefits. And nearly one in three expects to lay off employees.
• In the United States, total health care spending was $2.4 trillion in 2007--or $7,900 per person -- according to an analysis published in the journal Health Affairs. National health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of the gross domestic product (GDP). By 2018, national health care expenditures are expected to reach $4.4 trillion—more than double 2007 spending.The United States spends 52 percent more per person than the next most costly nation, Norway, according to the Kaiser Family Foundation. Just to give you some idea of what other countries are spending: United Kingdom $2,760 per person, France is $3,449 per person, Canada $3,678 per person, according to the Organisation for Economic Co-operation and Development. 
• While some would argue that medical care is better in the United States than in these other countries, others would say the opposite is true. For example, the United States ranks 50th in life expectancy, and 180th infant mortality (meaning 179 countries have higher infant mortality rates such as Angola and Turkey and 43 countries have lower infant mortality rates such as France and Sweden) according to the CIA World Factbook.
• Most individual insurance policies are discriminatory against women.  Most individual insurance policies are permitted to exclude maternity care. Most states permit insurance companies to set premiums based on gender and generally charge women more than men for individual policies. Women are more likely than men to face limits or restrictions in prescription drugs, mental health or other care.

Proposed Reform?

Obama has proposed a Health Care Reform Plan to begin to mitigate the outrageous cost of health care for the country and for its citizens.  I'll try to talk about some of its important points, but you can read all about the plan here.

• $900,000,000,000.00 over the next 10 years--Let's get this out of the way right now, the costs of this reform plan will be around 900 billion dollars over the next ten years.  However, Obama promises to not increase the deficit by even a dime (his words).  He claims that savings from reforming the health system combined with fees collected from insurance companies offering expensive policies will more than pay for his plan.   If the savings don't materialize, Obama promises to cut other areas of govt to pay for it.
  
• Putting restraints on the way that insurance companies do business/make money--Insurance companies make money by gambling that those they insure will remain healthy, and they will do (and should do, in the current system) everything in their power to reduce their risk.  This means, in essence, that your money, not you, is what they care about.  Obama says, sure, we're in a free market system, but, just like in other industries, we need to put some regulations on insurance companies to protect society.  Here's what he came up with:
  
• Under the President’s plan, it will be against the law for insurance companies to deny coverage for health reasons or risks. 
• The President’s plan will end insurers’ practice of charging different premiums or denying coverage based on gender, and will limit premium variation based on age. 
• The President’s plan prohibits insurance companies from rescinding coverage that has already been purchased except in cases of fraud (in other words, insurance agencies can't cancel your plan because you are costing them too munch money.) 
• The President’s plan will cap out-of-pocket expenses and will prohibit insurance companies from imposing annual or lifetime caps on benefit payments. 
• The President’s plan ensures that all Americans have access to free preventive services under their health insurance plans.
• Streamline Medicare overhead costs and provide prescription drug benefits to the elderly
  
• The Exchange--The administration will create a new insurance marketplace that allows people without insurance and small businesses to compare plans and buy private insurance at competitive prices.  In other words, insurance companies that meet the policy requirements of the Exchange will become part of an online market place, where people who aren't offered insurance through their employment or small business owners can literally shop around for the best insurance policy to fit their needs.  It reminds me of how we shopped around for our car insurance. This is important, experts claim, because right now insurance companies are mega-giants and each state has very few of these companies operating within it.  For example, in Alabama, Blue Cross Blue Shield controls 75-90% of the private insurance market.  Hospitals and doctors say they have little to no wiggle room in negotiating rates. Small businesses say they are held hostage to whatever price increases Blue Cross demands. As the exchange develops and grows, more and more insurance companies will move to this insurance marketplace, increasing competition and driving down premiums.  
• Making insurance and medical care more affordable--The President’s plan will provide new tax credits on a sliding scale to individuals, families, and small businesses (larger business won't qualify) that will limit how much of their income can be spent on premiums.  If you pay a lot for insurance and medical bills, the govt will give you a credit to help mitigate your cost.
  
• Offers a public health insurance option to the uninsured and those who can’t find affordable coverage-- Here's the part that so many people are really worried about, the public option.  Barack Obama proposes to create a govt owned, non-profit health insurance company that will offer insurance to people who can't afford private plans.  This public insurance company will not be run by tax dollars, but like private insurance companies, by premiums collected from its customers.  According to Obama, "It would only be an option for those who don't have insurance.  No one would be forced to choose it, and it would not impact those of you who already have insurance.  In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up...By avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities."
• Immediately offers new,  low-cost coverage through a national "high rish" pool to protect people with preexisting conditions from financial ruin until the new Exchange is created in 2013. 
• Implements a number of delivery system reforms that begin to rein in the health care costs and align incentive for hospitals, physicians, and others to improve quality.  Obama mentions reforming the health care system to be more like Intermountain Health Care in Utah and a couple other stand out hospitals.  Utah's total health care costs per capita are the lowest in the country. The state is efficient even by international standards, its costs ranking below countries such as Norway, Denmark and France. Statisticians explain that low costs are not only explained by Utah's healthy life style, but by IHC's efficient practice standards. Here's an example of what makes IHC better, that may blow your mind: In the mid-1990s, only about 40 percent of heart surgery patients nationally were going home with the right medications -- beta blockers, anticoagulants and other potentially lifesaving drugs. Intermountain Healthcare's numbers were better, but not by much. So, in 1997, a research team at the Salt Lake City-based nonprofit health system developed a low-tech solution: a mandatory two-page checklist to help doctors ensure discharged patients get exactly what they need.  It was a simple innovation, yet one that yielded impressive results. Within a year, more than 90 percent of patients were getting appropriate medications. Readmission rates at its hospitals went down. Survival rates went up.  Making evidence-based medicine easy to practice is Intermountain's modus operandi. Do that, its top managers and clinicians say, and health care gets better -- and cheaper. Intermountain Health Care collects a lot of data and the uses that data to develop best practices that doctors follow, revolutionary.  Using Intermountain as a benchmark, the 2008 Dartmouth report says, the nation could reduce health care spending on acute and chronic illnesses by as much as 40 percent. 
• Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine--Medical malpractice reform is something that Republicans have fought for years.  Many economists are skeptical that malpractice insurance premiums paid by doctors — or even the practice of defensive medicine to avoid litigation — are major reasons for soaring health care costs. But the issue looms large politically because many conservatives in both parties are convinced that doctors routinely order tests their patients don't need because they're afraid of getting sued.  So this will help doctors feel more comfortable practicing medicine and it could reduce costs. 
  

So, there are some of the points of the plan as I understand them.  Jonathan is going to write a comment in response to this post that will explain why many people, like him, can't support much of  this plan for reform.   Please feel free to add your enlightened comments as well, since we are all trying to learn more about what this reform will mean for us.