The Health Care Reform
Content
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The Health Care Reform
A Brief Understanding of the Pros and Cons
By Rishi Das Towne Meadow Elementary Carmel, IN
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Introduction
On March 23, 2010, President Barack Obama signed the new law “The Patient Protection and Affordable Care Act”, popularly known as the Health Care Bill, and jokingly called “Obamacare”. As we have heard often on the news for the past few months, the democrats almost unanimously supported the bill, whereas every republican voted against it. So how much do you really know about Obama’s health care reform? This paper will give a summary of what has happened, what is happening, and what will happen. I will also explain how the reform could help many people, as well as anger, confuse, and tax many of us.
Background and History The U.S. is the only developed and industrialized nation that does not have a universal health care system. In comparison, most European nations have government controlled health care systems, even though they may not be perfect. Currently, the US spends more than $2 trillion every year behind health care (Tumulty, Pickert, & Park, America, the doctor will see you now, 2010), which is way more than any other nation. We also have the most modern hospital facilities, the newest medical innovations and the best technology in the world, and a fairly large number of well trained doctors, nurses, and other healthcare workers. Yet the US population is among the unhealthiest and has a shorter life expectancy compared to other developed and industrialized nations, and more than one-third of our population does not have any health insurance coverage (Tumulty, Pickert, & Park, America, the doctor will see you now, 2010). Therefore, there is something wrong about the current overall status of our heath care system, and there is no doubt that something needs to be done to correct it.
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The health care issue appears to be highly political. It is to be noted that President Obama is not the first to attempt healthcare reform in the US. One of the early successes happened during the presidency of Lyndon Johnson in 1965, when Medicare and Medicaid were created to take care of our old, disabled and poor people (New York Times, 2010). The last major push for health care reform came during the Clinton presidency in 1993, when Mrs. Hillary Clinton brought forth a health care bill (New York Times, 2010). This bill died in 1994 due to stiff opposition by the Republican Party (Reuters). One thing that became clear to me during my research was that the democratic presidents have more often promoted health related issues, while the republicans have opposed all proposed reforms. As a child growing up in a staunch democratic household, I therefore think it is a good thing that we finally have something happening for healthcare issues. However, is the health care reform bill, in its present scope, the best answer to our problems? In my opinion, NO, and in the next few pages, I will explain my reasons.
Methods The thought of reading and understanding a legislation that is more than 2400 pages long was utterly impossible to me, plus I do not understand lawyer-like language yet. Therefore, I focused on news articles from respected sources such as TIME magazine, CNN Money, New York Times, Reuters and CBS, etc. The majority of my research was conducted over the internet and by reading paper magazine subscriptions available courtesy of my parents. Initially I created an outline of the paper by drafting key questions and preparing a mental map of the paper. My readings answered some of my questions, and the remaining was researched by using appropriate keywords on search engines such as Google. Microsoft Word was used to create the text of the
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paper as well as assemble the bibliography. I used web resources such as Diigo.com as online libraries. Finally, I obtained assistance from my parents, who are both university professors in a health related field, in verifying the authenticity of my resources and in drafting interview questions. I interviewed two professors, Jason Range, JD and Ralph Hatcher, MD at Butler University, College of Pharmacy and Health Sciences, Indianapolis, IN. My mother introduced me to her colleagues and served as my back-up note taker (as I am not a very fast writer), but the interview was conducted completely by me, from the start to finish. I also took as many written notes as I could during the interview. Later I transcribed the notes and showed the script to the two interviewees to make sure they agreed to my written text, and that I did not make mistakes while taking notes.
Results The key positive things proposed in the health care reform bill include 1) medical benefits for adult children until age 26 through their parents, as many college students currently cannot afford health insurance and thus have no coverage, which puts them at great risk, 2) insurance companies cannot refuse people based on pre-existing medical conditions, meaning if they were already sick before they asked for coverage, especially children, and 3) closes a “doughnut hole” for seniors citizens on Medicare, where they have coverage for some amount, then pay out of their pocket up to a certain amount, and then receive aid again, which puts retired people on fixed incomes into a lot of trouble (Barry, 2010) According to Jason Range, Esq., a major component of the program is that it will help 32 million currently uninsured Americans to get insurance; Dr. Hatcher, on the other hand, was concerned about this benefit for several reasons, including potential abuse of the healthcare system and the immense pressure to be put
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on the already stressed healthcare infrastructure of this country. Under the new law, individual states will have to come up with their own plans and resources to provide health benefits to its residents. While Mr. Range emphasized on the tax benefits associated with this clause, Dr. Hatcher was highly critical of it as he considers this to be an “unfunded mandate” (federally) which many economically stressed states will not be able to meet, and thus several states have already brought lawsuits against the proposal. Small businesses, i.e. those with 50 or more employees, will now be forced to provide health insurance to their employees, although there will be tax breaks offered to these companies to reduce the pain to some extent. Since all republicans have voted against the bill, I took interest in finding out what they were bitter about, but I was unable to identify any official document offered by the Republican Party that offers a counterpoint to the proposal. However, news articles quote republican spokespersons, one of them being Dr. Charles Boustany, a heart surgeon, whose chief concern appears to be the financial burden of the reform if it goes into effect. Financially, the supporters of the health care bill claim that it will cost close to $1000 billion over the next 10 years; however, it will reduce budge deficit by about $150 billion during that period and more than $1 trillion over the subsequent 10 years (CBS). Other republicans, such as House Republican Leader John Boehner, have offered alternative middle grounds such as a) let families and businesses buy health insurance across state lines, b) allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do, c) give states the tools to create their own innovative reforms that lower health care costs, and d) end junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it's good medicine, but because they are afraid of being sued (ABC, 2009).
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Table 1: Interview transcript from Rishi Das’s interviews with two university professors on the topic of health care reform.
Interview questions, asked by Rishi Das What do you think the health care law will cost the American people?
Response from Jason Range, JD* (FOR health care reform) Ultimately it will be budget neutral; there will be some gain and some drain, i.e. increased spending in some areas offset by decreases in others. By the target date of 2014 for full implementation of the law it will all even out
Response from Ralph Hatcher, MD** (AGAINST health care reform) Over 2 trillion dollars in projected expense. Worst thing is that it will not even accomplish what we set out for.
How does the law affect our old people, specifically Medicare?
Medicare is for individuals who are 65 or older, or disabled. Healthcare reform will help seniors, specifically prescription drug coverage or Medicare part
Very adversely, because according to President Obama approximately 500 billion dollars will be taken away from the Medicare budget to pay
D, by eliminating the “doughnut hole” as more drugs will for other plans and programs. be covered and to a greater extent. In addition, people who choose to work after age 65 will be helped by the new law
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Who will treat all the patients if we have universal health coverage?
More emphasis will have to placed on basic health promotion, which means more primary care physicians, family doctors, internists, pediatricians, OB-GYN (woman’s) doctors
This one is particularly tough – because when people think medical care is all free, they will be inclined to run in and get as much of it as they can, and ultimately abuse it. Plus there will be tremendous increased demand on the healthcare system as more than 30 million people, who currently do not have coverage, will be covered and supply will not be able to keep up with demand. Additionally, enrolment in medical schools is dropping around the country so we will be making far less physicians than will be necessary
How will the individual states be affected by this law? Will it affect Indiana?
The law will affect each state differently, based on population and demographics, e.g. Florida has a large proportion of senior citizens among its population and will be affected differently from, let’s say Indiana. The
States will be hurting badly as they have to meet unfunded mandates. They are left on their own to generate funds to provide for services that the federal government demands, but is not paying
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law will help Indiana in general because it sets aside funding for public health promotion efforts, such as cutting down on smoking and fighting obesity, which are both bad in Indiana Can the government really monitor the implementation of this law? If yes, how? If no, why? Yes, by creating electronic medical records. This will help doctors access and maintain patient records much more efficiently, and allow for better communication of patient medical info between different physicians,
for. Therefore, several states have already sued the government. Some large states such as California simply cannot afford this law.
No. Not in a “normal” way as it is impossible to keep track of the daily activities of the healthcare system, the physicians or the patients. Unless the government enforces
thereby reducing duplication of tests and reducing overall mandatory reporting, i.e. maintaining electronic costs patient records, but that could potentially violate patient privacy issues.
* Jason Range, MBA, MS, JD is a practicing lawyer who joined the faculty of College of Pharmacy and Health Sciences, Butler University, in 2008. Jason is currently pursuing his PhD and teaches on topics related to diversity, health care economics, accounting and health care policies. He is a declared democrat and strongly supports health care reform.
** Ralph Hatcher, MD is a practicing ER physician who also has a family practice in Zionsville, plus teaches anatomy as a faculty in the College of Pharmacy and Health Sciences, Butler University. He is a declared republican and strongly opposes health care reform.
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Discussion On March 1, 2010, the billionaire investor Mr. Warren Buffet said during an interview on CNBC news that “the current healthcare system is like a tapeworm eating away at the US economy and American competitiveness”. He emphasized that we have fewer doctors, nurses and hospital beds per one thousand residents compared to other developed nations, yet we spend nearly twice as much on healthcare. According to Mr. Buffet, this new bill does not do anything to change the basic cost situation of our healthcare industry. He mentioned that we will need more fundamental changes that attack the cost factor, and that we should treat this problem like a national emergency (CNBC, 2010). I have grown up listening to stories about Mr. Warren Buffet and Mr. Bill Gates, as my parents are great fans of these two individuals and their philosophies. In an earlier interview with CNBC at Columbia University, Mr. Gates joined Mr. Buffett in his criticism of the current health care bill – they both welcomed the idea of reform but mentioned several concerns as to why the bill has limited chance of success unless we make changes in places not even discussed in the document (CNBC, Warren Buffet - Bill Gates; Keeping America Great, 2009). After doing my research and listening to individuals such as Mr. Buffett and Mr. Gates, the two university professors I have interviewed, and of course my parents who are both university professors in the medical field, I have formed the opinion that healthcare reform is absolutely necessary in the USA; however, the way the current bill is drafted leaves out many issues unaddressed, which raise questions regarding the feasibility of success of this reform in the long term. On the surface, the healthcare bill seems to take care of our young, old and poor people, which is very good and necessary. The creation of electronic medical records and data sharing
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among various health care providers also appears to be a very positive step despite privacy concerns. However, my main concerns regarding the changes proposed are as follows: 1) Who will pay for the health care reform? Some of the funds will be generated by diverting revenues from other programs, but for the most part, the public will pay for healthcare reform in the form of increased taxes. This prospect has angered and frustrated a lot of people who are already hurting because of the economic downturn. The richer you are, the more you will pay for funding healthcare reform. Insurance premiums for most existing policy holders will increase because insurance companies will need the revenue to cover the 30+ million new entrants into the system. According to Dr. Hatcher, in the short term, funds will be diverted from Medicare to pay for the programs, which may not turn out well. In my opinion, the worst affected individuals will be young, healthy, working professionals, as they will be paying for these programs for many years before they actually need the facilities for themselves. However, when the time comes for them to use the program in their old age or due to ill health, just like the social security system, there will be no guarantee that there will be anything left for them, or even that the programs will sustain that long. In effect, the young folks now may be paying a lot of money and getting nothing in return in the future, which is not fair. Even in the short term, a change in leadership to the Republican Party may mean major changes or even the death of the health care reform, which may mean that a lot of people will have paid up a lot of money short term for nothing in the long term. 2) Basic costs: As it is right now, health care in US hospitals and clinics is simply too expensive. Many unnecessary tests are done, sometimes because the doctor wants documentation and evidence for everything for the fear of being sued. Not all doctors treat the same disease with the same quality of care, for instance, a doctor in state X may not be doing
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enough to treat heart disease, which may result in more cost (or early death) to the patient later, but a doctor in state Y may be doing too much, so much that it may not be doing any further good to the patient after a certain point. There must be concrete policies and mechanisms to reduce such wastage and disparity in care, which the healthcare bill apparently does not contain, and there are no incentives to consciously trim out wastage. Simply asking the hospitals to reduce overall budget every year, which the bill does, may not achieve the desired results as they can choose to cut out some expenses essential to the public but not to the hospital administration, particularly since the bill does not clearly define what must be cut (Tumulty, Pickert, & Park, America, the doctor will see you now, 2010). 3) Infrastructure: Every article I read seems to emphasize that out healthcare system is already stressed to the limit. We do not have enough doctors, nurses, pharmacists, etc., nor do we have enough hospital facilities or space. The bill proposes nothing about changing the current infrastructure, yet it plans to provide insurance to more than 30 million currently uninsured individuals. So, who will take care of them? While I understand that if these individuals receive regular primary care they would not be using emergency medical care services as much as a last resort (which could potentially reduce cost), I feel this is a speculation as we do not know what the true burden on emergency room care will eventually be. I agree with Dr. Hatcher that we as human beings have the tendency to abuse “freebies”, and thus the inclusion of these 32 million individuals for primary care may break the system completely. 4) Growth and recovery of economy: There is pressure being placed upon small business owners, who will now have to provide health insurance to their employees or be asked to pay a fine by the federal government. It costs thousands of dollars per employee to buy insurance, and for small groups, the rates are very high. On one hand, President Obama is talking about small
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businesses being essential to the economic growth and recovery, but with this kind of pressure many small businesses may be forced to close. On the short term there will be tax breaks for these businesses, but in the long run these temporary tax benefits may not be enough. Overall, I feel that the bill arrived at a time when the economy in the country is in very bad shape; therefore, even if some of its key elements are really good, the fear of further stress on the economy because of the new rules is frightening and angering people, and that cannot be good for any country or its government. 5) Control and management problems: The federal government is setting down rules but the individual states are supposed to implement it in their own way through private insurance companies. In my opinion, private companies are in business for profit, not the greater good. Therefore the various states, which already have no money and are making budget cuts in essential services such as education, cannot cope with the mandates and are already suing the federal government. So in this case, the boss wants something done but is not giving his people the ability to carry out the work – simply asking them to get it done, somehow. Perhaps the federal government should have accepted responsibility for implementation of the mandate, financially and personnel wise, only then can they fine or punish people for not listening to them. 6) Education: As mentioned before, we have a shortage of healthcare providers. According to Dr. Hatcher, himself a practicing emergency room physician and university professor, the enrolment numbers in medical schools are at an all time low. There could be two main reasons for this situation; a) our school system is not preparing enough graduates with a strong enough background to be capable of tackling medical school and related fields such as biomedical engineering. It is no secret that US students lag behind their global peers in science and mathematics standards, but nothing much has been done about it. Perhaps the federal as well
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as the state governments should be focusing harder on our middle and high school education and spending resources appropriately such that we can grow our own doctors and engineers for the future; b) perhaps the payback from medical and related professional schools is not enough when compared to the investment in terms of time and money – meaning that a doctor graduates in his/her thirties with a huge tuition debt – may be the earnings and the high risk nature of the work is simply not enough to compensate what the individual has been through – maybe this is a place for change as the government should ensure that these individuals are well compensated and protected such that they feel happy and capable to serve the public. For example, a large number of doctors in Britain work for the government (Harrell, 2009). Last, but not the least, we must educate our citizens in healthy lifestyle habits as it is not enough to provide healthcare simply when they are sick. Preventing a disease is much easier and much more cost effective than treating a disease, even if quality of life issues are not counted. It might be much better use of our limited resources if we can educate people to lead healthy lifestyles from an early age, starting from elementary school itself. For that, fundamental changes will have to happen in the food industry, some of which are already taking place (like posting calorie counts in restaurants, the ban against trans fats, etc.), but not enough. And ultimately, our own citizens must take responsibility of our own health, particularly preventable diseases such as heart disease and diabetes. If I understand the health insurance system correctly, the premiums paid by individuals is not enough to pay for their care when they sick and hospitalized – it is the collective premiums from many other healthy individuals that actually pays for their care. Therefore, there must be penalties against people who willfully choose to be unhealthy – for instance, how do you feel about a person who eats junk food all day, becomes obese and weighs several hundred pounds and then goes and seeks healthcare when heart disease
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and diabetes develop? On the other hand, there could be incentives offered to lead a healthy lifestyle, e.g. reduced health insurance premiums for people who maintain a healthy weight, exercise, eat well and go for annual preventive health checkups. Only then can we begin to become a healthy nation.
Conclusions In this paper, I have researched and summarized the key elements of the health care bill, and outlined some of my concerns regarding the same. There is no doubt that health care reform has been long overdue, because the current health care infrastructure of this country would have simply been unable to meet the increasing demands over the long term and could eventually fail, causing a major crisis. Therefore, there are many reasons to cheer for the current healthcare reform, as it includes crucial benefits for the young, old and poor citizens of this country. President Obama and his team must be complimented for their success in making the health care reform a reality, because other previous presidencies have failed in their efforts. However, it appears that in their hurry to get the bill approved, the team has failed to come up with concrete plans which have the promise of long term success, and as a result the bill has some major flaws and loopholes that could lead to its failure in the future. Opponents of the program cite financial arguments against the bill, particularly the increased tax and insurance premium burdens on the middle to upper class citizens. However, as a young individual I have additional concerns about the program, namely the lack of infrastructure changes, sweeping changes to our education system which would help train more health care professionals, and in general a strong movement of some kind (such as one with consequences for one’s voluntary actions and health decisions – good or bad) to help guide this country into leading a healthier lifestyle and disease prevention
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efforts. Only time will tell if the program will succeed. In the meantime we have to assume that everything will work as proposed, which may not be the case when the law takes full effect by 2014. We must hope for the best that the government and citizens will cooperate, learn from mistakes and make necessary changes as we go along, in order to bring about some positive changes. Hopefully USA will soon catch up to the rest of the developed world in terms of healthcare and maybe someday in the future lead others by its example.
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Bibliography
ABC. (2009, September 9). Louisiana Congressman Delivers GOP Response to President Obama's Health Care Address. Retrieved May 3, 2010, from abcnews.com: http://abcnews.go.com/Politics/HealthCare/charles-boustany-republican-rebuttal-obama-health-carespeech/story?id=8527214 ANI. (2010, April 14). Retrieved April 15, 2010, from 24 World News. Barry, P. (2010, May). A User's Guide to Health Care Reform. AARPBulliten , p. 8. CBS. (n.d.). Retrieved April 23, 2010, from CBS. CNBC. (2010, March 1). Squawkbox-Ask Warren Buffett. Retrieved May 3, 2010, from cnbc.com: http://www.scribd.com/doc/27725494/Ask-Warren-Buffett-Complete-CNBC-Squawk-Box-Transcript2010-03-01 CNBC. (2009, November 22). Warren Buffet - Bill Gates; Keeping America Great. Retrieved May 3, 2010, from cnbc.com: http://www.cnbc.com/id/15840232?video=1335717418&play=1 Curran, B. (2010, April 14). Retrieved April 15, 2010, from The Inkwell. Harrell, E. (2009, August 18). Is Britain's Health-Care System Really That Bad? Retrieved May 3, 2010, from time.com: http://www.time.com/time/health/article/0,8599,1916570,00.html Kiplinger's Personal Finance Magazine. (n.d.). Health Care Reform: 15 Key Questions. Retrieved April 21, 2010, from MSN Money. New York Times. (2010, March 26). Health Care Reform. Retrieved April 20, 2010, from New York Times. Party, R. (n.d.). Retrieved May 2, 2010, from www.GOP.gov: http://www.gop.gov/solutions/healthcare PBS. (n.d.). PBS:Healthcare Crisis:History. Retrieved April 20, 2010, from PBS. Reginer, P. (2010, April 22). The truth about health care reform. Retrieved April 22, 2010, from CNNMoney. Reuters. (n.d.). Retrieved from Reuters.com. Tumulty, K. (2010, March 23). Making History:House Passes Health Care Reform. TIME . Tumulty, K., Pickert, K., & Park, A. (2010, April 5). America, the doctor will see you now. TIME , pp. 24-32.
The Health Care Reform
A Brief Understanding of the Pros and Cons
By Rishi Das Towne Meadow Elementary Carmel, IN
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Introduction
On March 23, 2010, President Barack Obama signed the new law “The Patient Protection and Affordable Care Act”, popularly known as the Health Care Bill, and jokingly called “Obamacare”. As we have heard often on the news for the past few months, the democrats almost unanimously supported the bill, whereas every republican voted against it. So how much do you really know about Obama’s health care reform? This paper will give a summary of what has happened, what is happening, and what will happen. I will also explain how the reform could help many people, as well as anger, confuse, and tax many of us.
Background and History The U.S. is the only developed and industrialized nation that does not have a universal health care system. In comparison, most European nations have government controlled health care systems, even though they may not be perfect. Currently, the US spends more than $2 trillion every year behind health care (Tumulty, Pickert, & Park, America, the doctor will see you now, 2010), which is way more than any other nation. We also have the most modern hospital facilities, the newest medical innovations and the best technology in the world, and a fairly large number of well trained doctors, nurses, and other healthcare workers. Yet the US population is among the unhealthiest and has a shorter life expectancy compared to other developed and industrialized nations, and more than one-third of our population does not have any health insurance coverage (Tumulty, Pickert, & Park, America, the doctor will see you now, 2010). Therefore, there is something wrong about the current overall status of our heath care system, and there is no doubt that something needs to be done to correct it.
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The health care issue appears to be highly political. It is to be noted that President Obama is not the first to attempt healthcare reform in the US. One of the early successes happened during the presidency of Lyndon Johnson in 1965, when Medicare and Medicaid were created to take care of our old, disabled and poor people (New York Times, 2010). The last major push for health care reform came during the Clinton presidency in 1993, when Mrs. Hillary Clinton brought forth a health care bill (New York Times, 2010). This bill died in 1994 due to stiff opposition by the Republican Party (Reuters). One thing that became clear to me during my research was that the democratic presidents have more often promoted health related issues, while the republicans have opposed all proposed reforms. As a child growing up in a staunch democratic household, I therefore think it is a good thing that we finally have something happening for healthcare issues. However, is the health care reform bill, in its present scope, the best answer to our problems? In my opinion, NO, and in the next few pages, I will explain my reasons.
Methods The thought of reading and understanding a legislation that is more than 2400 pages long was utterly impossible to me, plus I do not understand lawyer-like language yet. Therefore, I focused on news articles from respected sources such as TIME magazine, CNN Money, New York Times, Reuters and CBS, etc. The majority of my research was conducted over the internet and by reading paper magazine subscriptions available courtesy of my parents. Initially I created an outline of the paper by drafting key questions and preparing a mental map of the paper. My readings answered some of my questions, and the remaining was researched by using appropriate keywords on search engines such as Google. Microsoft Word was used to create the text of the
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paper as well as assemble the bibliography. I used web resources such as Diigo.com as online libraries. Finally, I obtained assistance from my parents, who are both university professors in a health related field, in verifying the authenticity of my resources and in drafting interview questions. I interviewed two professors, Jason Range, JD and Ralph Hatcher, MD at Butler University, College of Pharmacy and Health Sciences, Indianapolis, IN. My mother introduced me to her colleagues and served as my back-up note taker (as I am not a very fast writer), but the interview was conducted completely by me, from the start to finish. I also took as many written notes as I could during the interview. Later I transcribed the notes and showed the script to the two interviewees to make sure they agreed to my written text, and that I did not make mistakes while taking notes.
Results The key positive things proposed in the health care reform bill include 1) medical benefits for adult children until age 26 through their parents, as many college students currently cannot afford health insurance and thus have no coverage, which puts them at great risk, 2) insurance companies cannot refuse people based on pre-existing medical conditions, meaning if they were already sick before they asked for coverage, especially children, and 3) closes a “doughnut hole” for seniors citizens on Medicare, where they have coverage for some amount, then pay out of their pocket up to a certain amount, and then receive aid again, which puts retired people on fixed incomes into a lot of trouble (Barry, 2010) According to Jason Range, Esq., a major component of the program is that it will help 32 million currently uninsured Americans to get insurance; Dr. Hatcher, on the other hand, was concerned about this benefit for several reasons, including potential abuse of the healthcare system and the immense pressure to be put
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on the already stressed healthcare infrastructure of this country. Under the new law, individual states will have to come up with their own plans and resources to provide health benefits to its residents. While Mr. Range emphasized on the tax benefits associated with this clause, Dr. Hatcher was highly critical of it as he considers this to be an “unfunded mandate” (federally) which many economically stressed states will not be able to meet, and thus several states have already brought lawsuits against the proposal. Small businesses, i.e. those with 50 or more employees, will now be forced to provide health insurance to their employees, although there will be tax breaks offered to these companies to reduce the pain to some extent. Since all republicans have voted against the bill, I took interest in finding out what they were bitter about, but I was unable to identify any official document offered by the Republican Party that offers a counterpoint to the proposal. However, news articles quote republican spokespersons, one of them being Dr. Charles Boustany, a heart surgeon, whose chief concern appears to be the financial burden of the reform if it goes into effect. Financially, the supporters of the health care bill claim that it will cost close to $1000 billion over the next 10 years; however, it will reduce budge deficit by about $150 billion during that period and more than $1 trillion over the subsequent 10 years (CBS). Other republicans, such as House Republican Leader John Boehner, have offered alternative middle grounds such as a) let families and businesses buy health insurance across state lines, b) allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do, c) give states the tools to create their own innovative reforms that lower health care costs, and d) end junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it's good medicine, but because they are afraid of being sued (ABC, 2009).
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Table 1: Interview transcript from Rishi Das’s interviews with two university professors on the topic of health care reform.
Interview questions, asked by Rishi Das What do you think the health care law will cost the American people?
Response from Jason Range, JD* (FOR health care reform) Ultimately it will be budget neutral; there will be some gain and some drain, i.e. increased spending in some areas offset by decreases in others. By the target date of 2014 for full implementation of the law it will all even out
Response from Ralph Hatcher, MD** (AGAINST health care reform) Over 2 trillion dollars in projected expense. Worst thing is that it will not even accomplish what we set out for.
How does the law affect our old people, specifically Medicare?
Medicare is for individuals who are 65 or older, or disabled. Healthcare reform will help seniors, specifically prescription drug coverage or Medicare part
Very adversely, because according to President Obama approximately 500 billion dollars will be taken away from the Medicare budget to pay
D, by eliminating the “doughnut hole” as more drugs will for other plans and programs. be covered and to a greater extent. In addition, people who choose to work after age 65 will be helped by the new law
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Who will treat all the patients if we have universal health coverage?
More emphasis will have to placed on basic health promotion, which means more primary care physicians, family doctors, internists, pediatricians, OB-GYN (woman’s) doctors
This one is particularly tough – because when people think medical care is all free, they will be inclined to run in and get as much of it as they can, and ultimately abuse it. Plus there will be tremendous increased demand on the healthcare system as more than 30 million people, who currently do not have coverage, will be covered and supply will not be able to keep up with demand. Additionally, enrolment in medical schools is dropping around the country so we will be making far less physicians than will be necessary
How will the individual states be affected by this law? Will it affect Indiana?
The law will affect each state differently, based on population and demographics, e.g. Florida has a large proportion of senior citizens among its population and will be affected differently from, let’s say Indiana. The
States will be hurting badly as they have to meet unfunded mandates. They are left on their own to generate funds to provide for services that the federal government demands, but is not paying
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law will help Indiana in general because it sets aside funding for public health promotion efforts, such as cutting down on smoking and fighting obesity, which are both bad in Indiana Can the government really monitor the implementation of this law? If yes, how? If no, why? Yes, by creating electronic medical records. This will help doctors access and maintain patient records much more efficiently, and allow for better communication of patient medical info between different physicians,
for. Therefore, several states have already sued the government. Some large states such as California simply cannot afford this law.
No. Not in a “normal” way as it is impossible to keep track of the daily activities of the healthcare system, the physicians or the patients. Unless the government enforces
thereby reducing duplication of tests and reducing overall mandatory reporting, i.e. maintaining electronic costs patient records, but that could potentially violate patient privacy issues.
* Jason Range, MBA, MS, JD is a practicing lawyer who joined the faculty of College of Pharmacy and Health Sciences, Butler University, in 2008. Jason is currently pursuing his PhD and teaches on topics related to diversity, health care economics, accounting and health care policies. He is a declared democrat and strongly supports health care reform.
** Ralph Hatcher, MD is a practicing ER physician who also has a family practice in Zionsville, plus teaches anatomy as a faculty in the College of Pharmacy and Health Sciences, Butler University. He is a declared republican and strongly opposes health care reform.
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Discussion On March 1, 2010, the billionaire investor Mr. Warren Buffet said during an interview on CNBC news that “the current healthcare system is like a tapeworm eating away at the US economy and American competitiveness”. He emphasized that we have fewer doctors, nurses and hospital beds per one thousand residents compared to other developed nations, yet we spend nearly twice as much on healthcare. According to Mr. Buffet, this new bill does not do anything to change the basic cost situation of our healthcare industry. He mentioned that we will need more fundamental changes that attack the cost factor, and that we should treat this problem like a national emergency (CNBC, 2010). I have grown up listening to stories about Mr. Warren Buffet and Mr. Bill Gates, as my parents are great fans of these two individuals and their philosophies. In an earlier interview with CNBC at Columbia University, Mr. Gates joined Mr. Buffett in his criticism of the current health care bill – they both welcomed the idea of reform but mentioned several concerns as to why the bill has limited chance of success unless we make changes in places not even discussed in the document (CNBC, Warren Buffet - Bill Gates; Keeping America Great, 2009). After doing my research and listening to individuals such as Mr. Buffett and Mr. Gates, the two university professors I have interviewed, and of course my parents who are both university professors in the medical field, I have formed the opinion that healthcare reform is absolutely necessary in the USA; however, the way the current bill is drafted leaves out many issues unaddressed, which raise questions regarding the feasibility of success of this reform in the long term. On the surface, the healthcare bill seems to take care of our young, old and poor people, which is very good and necessary. The creation of electronic medical records and data sharing
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among various health care providers also appears to be a very positive step despite privacy concerns. However, my main concerns regarding the changes proposed are as follows: 1) Who will pay for the health care reform? Some of the funds will be generated by diverting revenues from other programs, but for the most part, the public will pay for healthcare reform in the form of increased taxes. This prospect has angered and frustrated a lot of people who are already hurting because of the economic downturn. The richer you are, the more you will pay for funding healthcare reform. Insurance premiums for most existing policy holders will increase because insurance companies will need the revenue to cover the 30+ million new entrants into the system. According to Dr. Hatcher, in the short term, funds will be diverted from Medicare to pay for the programs, which may not turn out well. In my opinion, the worst affected individuals will be young, healthy, working professionals, as they will be paying for these programs for many years before they actually need the facilities for themselves. However, when the time comes for them to use the program in their old age or due to ill health, just like the social security system, there will be no guarantee that there will be anything left for them, or even that the programs will sustain that long. In effect, the young folks now may be paying a lot of money and getting nothing in return in the future, which is not fair. Even in the short term, a change in leadership to the Republican Party may mean major changes or even the death of the health care reform, which may mean that a lot of people will have paid up a lot of money short term for nothing in the long term. 2) Basic costs: As it is right now, health care in US hospitals and clinics is simply too expensive. Many unnecessary tests are done, sometimes because the doctor wants documentation and evidence for everything for the fear of being sued. Not all doctors treat the same disease with the same quality of care, for instance, a doctor in state X may not be doing
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enough to treat heart disease, which may result in more cost (or early death) to the patient later, but a doctor in state Y may be doing too much, so much that it may not be doing any further good to the patient after a certain point. There must be concrete policies and mechanisms to reduce such wastage and disparity in care, which the healthcare bill apparently does not contain, and there are no incentives to consciously trim out wastage. Simply asking the hospitals to reduce overall budget every year, which the bill does, may not achieve the desired results as they can choose to cut out some expenses essential to the public but not to the hospital administration, particularly since the bill does not clearly define what must be cut (Tumulty, Pickert, & Park, America, the doctor will see you now, 2010). 3) Infrastructure: Every article I read seems to emphasize that out healthcare system is already stressed to the limit. We do not have enough doctors, nurses, pharmacists, etc., nor do we have enough hospital facilities or space. The bill proposes nothing about changing the current infrastructure, yet it plans to provide insurance to more than 30 million currently uninsured individuals. So, who will take care of them? While I understand that if these individuals receive regular primary care they would not be using emergency medical care services as much as a last resort (which could potentially reduce cost), I feel this is a speculation as we do not know what the true burden on emergency room care will eventually be. I agree with Dr. Hatcher that we as human beings have the tendency to abuse “freebies”, and thus the inclusion of these 32 million individuals for primary care may break the system completely. 4) Growth and recovery of economy: There is pressure being placed upon small business owners, who will now have to provide health insurance to their employees or be asked to pay a fine by the federal government. It costs thousands of dollars per employee to buy insurance, and for small groups, the rates are very high. On one hand, President Obama is talking about small
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businesses being essential to the economic growth and recovery, but with this kind of pressure many small businesses may be forced to close. On the short term there will be tax breaks for these businesses, but in the long run these temporary tax benefits may not be enough. Overall, I feel that the bill arrived at a time when the economy in the country is in very bad shape; therefore, even if some of its key elements are really good, the fear of further stress on the economy because of the new rules is frightening and angering people, and that cannot be good for any country or its government. 5) Control and management problems: The federal government is setting down rules but the individual states are supposed to implement it in their own way through private insurance companies. In my opinion, private companies are in business for profit, not the greater good. Therefore the various states, which already have no money and are making budget cuts in essential services such as education, cannot cope with the mandates and are already suing the federal government. So in this case, the boss wants something done but is not giving his people the ability to carry out the work – simply asking them to get it done, somehow. Perhaps the federal government should have accepted responsibility for implementation of the mandate, financially and personnel wise, only then can they fine or punish people for not listening to them. 6) Education: As mentioned before, we have a shortage of healthcare providers. According to Dr. Hatcher, himself a practicing emergency room physician and university professor, the enrolment numbers in medical schools are at an all time low. There could be two main reasons for this situation; a) our school system is not preparing enough graduates with a strong enough background to be capable of tackling medical school and related fields such as biomedical engineering. It is no secret that US students lag behind their global peers in science and mathematics standards, but nothing much has been done about it. Perhaps the federal as well
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as the state governments should be focusing harder on our middle and high school education and spending resources appropriately such that we can grow our own doctors and engineers for the future; b) perhaps the payback from medical and related professional schools is not enough when compared to the investment in terms of time and money – meaning that a doctor graduates in his/her thirties with a huge tuition debt – may be the earnings and the high risk nature of the work is simply not enough to compensate what the individual has been through – maybe this is a place for change as the government should ensure that these individuals are well compensated and protected such that they feel happy and capable to serve the public. For example, a large number of doctors in Britain work for the government (Harrell, 2009). Last, but not the least, we must educate our citizens in healthy lifestyle habits as it is not enough to provide healthcare simply when they are sick. Preventing a disease is much easier and much more cost effective than treating a disease, even if quality of life issues are not counted. It might be much better use of our limited resources if we can educate people to lead healthy lifestyles from an early age, starting from elementary school itself. For that, fundamental changes will have to happen in the food industry, some of which are already taking place (like posting calorie counts in restaurants, the ban against trans fats, etc.), but not enough. And ultimately, our own citizens must take responsibility of our own health, particularly preventable diseases such as heart disease and diabetes. If I understand the health insurance system correctly, the premiums paid by individuals is not enough to pay for their care when they sick and hospitalized – it is the collective premiums from many other healthy individuals that actually pays for their care. Therefore, there must be penalties against people who willfully choose to be unhealthy – for instance, how do you feel about a person who eats junk food all day, becomes obese and weighs several hundred pounds and then goes and seeks healthcare when heart disease
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and diabetes develop? On the other hand, there could be incentives offered to lead a healthy lifestyle, e.g. reduced health insurance premiums for people who maintain a healthy weight, exercise, eat well and go for annual preventive health checkups. Only then can we begin to become a healthy nation.
Conclusions In this paper, I have researched and summarized the key elements of the health care bill, and outlined some of my concerns regarding the same. There is no doubt that health care reform has been long overdue, because the current health care infrastructure of this country would have simply been unable to meet the increasing demands over the long term and could eventually fail, causing a major crisis. Therefore, there are many reasons to cheer for the current healthcare reform, as it includes crucial benefits for the young, old and poor citizens of this country. President Obama and his team must be complimented for their success in making the health care reform a reality, because other previous presidencies have failed in their efforts. However, it appears that in their hurry to get the bill approved, the team has failed to come up with concrete plans which have the promise of long term success, and as a result the bill has some major flaws and loopholes that could lead to its failure in the future. Opponents of the program cite financial arguments against the bill, particularly the increased tax and insurance premium burdens on the middle to upper class citizens. However, as a young individual I have additional concerns about the program, namely the lack of infrastructure changes, sweeping changes to our education system which would help train more health care professionals, and in general a strong movement of some kind (such as one with consequences for one’s voluntary actions and health decisions – good or bad) to help guide this country into leading a healthier lifestyle and disease prevention
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efforts. Only time will tell if the program will succeed. In the meantime we have to assume that everything will work as proposed, which may not be the case when the law takes full effect by 2014. We must hope for the best that the government and citizens will cooperate, learn from mistakes and make necessary changes as we go along, in order to bring about some positive changes. Hopefully USA will soon catch up to the rest of the developed world in terms of healthcare and maybe someday in the future lead others by its example.
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