Today marks one of the most pivotal moments in American health care history. The 2010 Affordable Care Act (ACA), signed by President Obama, is coming under the judicial scrutiny of the Supreme Court, whose decision will change the course of health care and its sister industries for the coming years. With one swift decision, the Supreme Court can undo years of collaborative work from the government, physicians, patients, and insurance companies to make health care in America affordable and available for all.
Health care reform came about from the trouble with the 49 million uninsured Americans in 2009. Uninsured patients who use medical services in the US end up siphoning tax money meant for other purposes. That is to say, everyone who pays taxes ends up taking care of those who couldn’t pay into insurance plans like Blue Cross or Aetna. A number of reasons may explain why these patients couldn’t get insurance, but the conclusion is that the system wasn’t sustainable. The system before the ACA basically allowed people to piggyback on others’ wallets. But that’s all about to change.
The ACA enacts three major changes to health care that you should know about (CNN’s Elizabeth Cohen has a good video summing up the reform that you can find by clicking here). First off, it forces insurance companies to cover children and adults with pre-existing conditions. If an adult or child with cancer or asthma signs up for insurance, it will be illegal for the insurance company to deny them coverage. Secondly, children are able to stay on their parents’ insurance plan until they are 26 years old. This puts a lot of stress off college graduates who are still trying to find a stable job in this miserable economy. Thirdly, and most importantly, everyone will be forced to have at least a basic government or private insurance plan by 2016 or face a yearly penalty ($350 per child, $750 per adult). This third provision is what has many states trying to convince the Supreme Court of the ACA’s unconstitutionality. If you’re curious or don’t want to take my word for it, here’s a link to the law’s actual text.
The legality of this legislation is up for debate and I won’t make any specific point about it here. Nine very wise judges will make that decision within the coming months. Rather, I want to focus on how we got here on the first place and why this system is broken. Understanding the philosophical implications of our older system can help clarify why Congress is making these proposed changes. This is not the last change that will happen though. Ultimately, I believe the final evolution of health care will be decidedly “un-American” – socialized medicine. I’ll explain why in a bit.
Insurance plans originated in the 2nd and 3rd millenniums BC. Traders looking to protect their wares against thieves would redistribute goods among many vessels to ensure that the loss of any one vessel did not equate with a large loss of goods. The advent of the first accident policy in the US was in 1850 through the Franklin Health Assurance Company based in Massachusetts. The 20th century saw the development of a veritable alphabet soup of insurance schemes – PPO, EPO, HMO, SHIP, PACE, PFFS, HDHP, SPAP, and more abbreviations that make it sound like you’re trying (and failing) to beat box – from both government and private companies. Insurance corporations seemed to have won the upper hand by providing access to drugs and services that the overburdened government insurance pool couldn’t.
Medicine has had its mission rooted in helping others since its inception. Whether it was the shaman-healers of African tribes, the midwives of industrial England, or the physician-scientists who discovered cures for epidemics, all the work done was always for the betterment of another. There are few physicians today who will tell you that they are solely motivated by money. Becoming a physician today is increasingly difficult, expensive, and the fiscal rewards are meager compared to the altruistic honor of simply doing good. Whether a physician, physician assistant, nurse practitioner, or physical therapist, their work is always in service to another.
Only in America could we see corporations flourish on the Darwinian survival instinct by pandering to patient fears and gridlocking care through cash flow control. Adapted to insurance, the common saying goes “Hope for the best, pay for the worst.” With thousands of patients funneling their hard-earned money into these schemes, insurance companies took 20% off premiums to pad their profits, bolster their stock market presence, and splash their corporate executives with bonuses. Contrast this with the goal of medicine. We hear of not-for-profit clinics that provide care for the uninsured and are barely scraping by, let alone the families they help. These clinics are the epitome of selfless service that define medicine’s core. Even in state-of-the-art hospitals, physicians will do everything they can, regardless of cost, to preserve their patient’s life (barring any DNR orders or advanced directives).
What we face here is a fundamental incompatibility of core values. We have patients dependent upon a corporation that’s trying to grow itself, first and foremost, for the benefit of its shareholders. Money is the life blood of any corporation. Try to siphon that away and a commercial survival instinct will kick in – fewer people get coverage, premiums go up, and quality of care plummets because physicians can’t get the money they need. When patients need money, they have to break through bureaucratic red tape to get to what was theirs in the first place. Show me a selfless corporate conglomerate and I’ll show you a bovine that sprouts wings.
Trapping an altruistic profession in a capitalistic framework makes little sense to me and has historically proven ineffective. America spends the most amount of money on health care (16% of GDP compared to the average 9% of GDP other nations spend) and ranks 42nd in life expectancy. You would think we could do a little better.
As we realize that our personal health is equally dependent on environmental factors, private insurance will become woefully inadequate. That is to say, if everyone is not healthy, the chances of us being healthy decrease substantially. Humans are social animals that tend to concentrate where other people live. This makes contagious transmission a potent threat. If even a single person, who did not buy into coverage, is sick within a pool of healthy insured patients, everyone gets sick. One bad apple spoils the bunch. Even with the ACA, there is the chance that a few holdouts will opt to pay the yearly penalty instead, come down with the next H1N1 flu, fail to receive adequate care, and spread this new pandemic to rest of us. Why? Because the hospital couldn’t help; insurance purse strings restrained its actions.
How do we solve this problem? By adopting the system so many other developed nations, like Canada, Australia, and England have long used - socialized medicine. Perhaps its America’s deeply imbedded phobia of anything communist that makes the term “socialized medicine” seem so abhorrent. For those who think socialized medicine is a terrible anti-American idea, call it a “single payer system” instead. If you want to find out more about the single payer system, click here.
Sure, the single payer system has its drawbacks, as does any system, but it’s worked for other nations. They spend less on their healthcare and get more bang for their buck. To defend our current insurance state by claiming American livelihood is somewhat different is a rather elitist view, I think. In a single payer system, the people look out for each other instead of a company “looking out for” its customers. This makes much more philosophical sense to me than our current insurance framework. It allows us to reconcile our personal and environmental health by providing health care, however basic, to all people in the state. A major complaint about the single payer system is that it takes a very long time for anybody to actually receive treatment. Perhaps that will promote healthy lifestyles so patients don’t have to wait to see the doctor in the first place!
Physicians often look for treatment options labelled “best practices”. Best practices are techniques that have shown to repeatedly produce superior results across a spectrum of patients. Hospitals advertise best practices as a point of pride and quality assurance for prospective patients. If nations are patients, the single payer system has become the best practice that America has yet to adopt. Canada, Australia, England, Spain, France, and the majority of the European Union all implement the single payer system with great results. Isn’t time America does the same?
Update: The New York Times has a pretty interesting video on the conservative origins of health care reform. You can find it here. Oh, the things politicians say to get elected.
This was a first attempt at tackling the complicated issue of health care in the U.S.. I look forward to developing my stance further and improving my familiarity with insurance and health care. Expect to see more of these kinds of posts in the future.
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