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The Potential for National Health Care Reform

Health Care ReformIt looks increasingly likely that the new Congress will consider major health care reform legislation upon reconvening in January.

Judging by the proposals that have already been released, the legislation will aim primarily to provide universal insurance coverage. The proposals are modeled after the controversial universal coverage legislation adopted by Massachusetts in 2006.

The Forecast for Change: Renewed Energy at the National Level

Over the past few weeks, Democratic congressional leaders have signaled their intention to make health care reform a top priority as soon as President-elect Barack Obama is inaugurated into office.

Senators Max Baucus (D-Mont) and Edward Kennedy (D-Mass) have taken the lead on the reform efforts.

  • Senator Baucus presented a blueprint to guarantee health insurance for all Americans by expanding Medicaid and Medicare, facilitating the sales of private insurance and requiring employers to provide or pay for health benefits.
  • Upon returning to the Senate for the first time since July, Senate Health, Education, Labor and Pensions Committee Chair Kennedy announced his intention to “lay the ground work for early action by Congress on health reform when President Obama takes office in January.”

But some critics argue that comprehensive reform is still unlikely, due to:

  • The inability of legislators to agree on the particulars of any reform plan, including how it will be financed.
  • The recession, and the limits it will place on the federal government when it comes to program spending.

In response to these concerns, it looks like most democratic lawmakers are lining up behind the Baucus guidelines.

  • Included in this group of supporters is President-elect Obama, who campaigned on a similar plan.

Analysts also suggest that Mr. Obama’s pick of Senator Tom Daschle for secretary of Health and Human Services (HHS) indicates that the President-elect is serious about overhauling the health care system.

  • Mr. Daschle recently published a book called “Critical: What We Can Do About the Health Care Crisis.” Daschle is praised by his peers as someone who can get things done in Congress.

And the conventional wisdom about government spending and the recession is shifting. As the recession deepens, Mr. Obama is said to be considering additional “stimulus spending.”

Rather than just providing a bailout for companies or a tax refund for individuals, the additional stimulus package would be used to fund domestic programs, including a comprehensive health care reform initiative. Such spending would create jobs now and offer a return on investment in the long-run.

Given these indicators, it is safe to say that movement on comprehensive health reform legislation is likely in the near future.

Since we don’t yet know all of the particulars of the reform legislation, including how it will be financed, it is difficult to analyze what the outcome will be and how much it will cost.

We do know that, as of now, lawmakers are considering:

  • Mandating that individuals buy coverage;
  • Expanding Medicare, to allow individuals age 55 to 64 to buy insurance through the program if they are not eligible for insurance through another program or through their place of employment;
  • Expanding the State Children’s Health Insurance Program (SCHIP) to cover children in families with incomes at or below 250 percent of the federal poverty level (FPL) (which is higher than the income level in half of the states with SCHIP);
  • Making Medicaid available to everyone with incomes below the FPL, which would reduce the ranks of the uninsured by 7 million people.
  • Mandating that employers of a certain size carry health insurance for their employees.

In other words, they are considering adopting a plan with many of the same provisions as the Massachusetts’ universal coverage plan.

In this As We See It article, we examine the pros and cons of the Massachusetts’ plan in-depth to find out what we can learn from this state experiment.

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  • Dan January 1, 2009, 7:24 pm

    The following are facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled:

    The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.

    However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned. One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others.

    This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.

    We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.

    Our children.

    Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.

    About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA, according to others.

    Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.

    Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S. Yet considering the hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system, health policy analysts should not be greatly concerned on the steakholders who may be affected by this reform of our health care system that is desperately needed. Tom Daschle leads this Transition’s Health Policy Team. And we also have Ed Kennedy, the committee chair and a prolific legislator. So if the right people have been selected for this reforming team, the urgency and priority regarding our nation’s health care needs should be rather overt to the country’s citizens.
    Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.

    It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes nearly 100 thousand less in income compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system. PCPs manage the chronically ill patients, who would benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly have of the population has at least one chronic illness- with many of those having more than one of these types of illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget.

    The shortage of primary care physicians is due to numerous variables, such as administrative hassles that are quite vexing for these doctors, along with ever increasing patient loads complicated by the progressively increasing cost to provide care for their patients. Many PCPs are retiring early, and most medical school graduates do not strive to become this specialty for obvious reasons. In fact, the number entering family practice residencies has decreased by half over the past decade or so.

    PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers.
    Yet if primary care physicians were increased in number with the populations they serve and are dedicated to their welfare. Studies have shown that mortality rates would decrease due to increased patient outcomes if this increase were to occur. This specialty would also optimize preventative care more for their patients.

    Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if they are numbered correctly to treat and restore others. Also, the quality improves, as well as the outcomes for their patients. Most importantly, the quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase in the years to come. The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.

    Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.

    Health 2.0, a new healthcare social networking innovation, is informing patients about their symptoms and potential if not possessing various disease states- largely based on the testimonies of other people on various websites. This may be an example of how so many others rely now on health concerns from those who likely are not medical specialists, instead of becoming a participant, if not victim, of the U.S. Health Care System.

    Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today, which is why the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially. It should be and likely will be funded by a combination of payroll taxes and general tax revenue:

    Access- citizens do not have the right or ability to make use of this system as we should.

    Efficiency- this system strives on creating much waste and expense as it possibly can.

    Quality- the standard of excellence we deserve as citizens with our health care is missing in action.

    Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.


    Dan Abshear

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