This post is Part One of a planned series about healthcare reform in the United States. The series covers detailed problems with the current healthcare system, including specific issues and obstacles to reform; the type of healthcare system needed to benefit every American citizen, justifications for healthcare as a fundamental human right and short and long term goals for implementation; and how to pay for healthcare, including specific sources and revenues.
This series contains both fact and opinion. Every effort has been made to verify statements represented as fact. Due to widely varying statistics, some facts are followed by a website citation, where the fact may be referenced. Facts lacking citations indicate that the information is widely available. Any portion of the series, up to and including the whole, may be reproduced or linked for purposes of education and advocacy.
PART ONE: THE PROBLEM
Very few Americans would disagree that there are big problems with the current US healthcare system. However, the difference between what the people and the politicians believe to be the answer may prove to be a vast, unconquerable divide. Finding the solution should always begin with a decent grasp of the facts.
The US is the only developed nation without a single-payer universal healthcare system. As a result, 47 million Americans are uninsured (census.gov), and millions more are underinsured. The US spends much more per capita (per person) on healthcare spending than any other nation in the world, including those who have universal healthcare systems. So much more, in fact, that the World Heath Organization (WHO) brought attention to the issue in a 2008 report, calling the US healthcare system exceptional for being a system with “singularly high additional private expenditure” that persistently underperforms “across domains of health outcomes, quality, access, efficiency and equity.” (pnhp.org) 22K Americans die every year because they don’t have health insurance, approximately one death every 24 minutes(independent collegian.com), and lack of health insurance coverage is reported to be the third leading cause of death among adults aged 55-64. (aarp.org)
Estimates of the uninsured vary widely, from 35-55 million people. For these Americans, health insurance is out of reach, either because it is not offered through their employer, or because the cost of such insurance is prohibitive. The issue for many is an income too great for Medicaid, yet too small for private health insurance. Private health insurance premiums can easily total 15-20% of income or more. Even people in middle-class jobs once considered to be fairly well paying have problems paying for health insurance at those levels; with the rise in costs in just about every area, people just don’t have the money. For those who are generally healthy, paying $100-200 for a sick visit and the least expensive antibiotic once or twice a year is preferable.
Medicaid, the health insurance “for the poor” is more difficult to qualify for than people might think. Federal law prohibits extending Medicaid benefits to adults--no matter how poor--unless they are disabled, elderly or have children (states may waive this restriction, though few choose to do so). Medicaid eligibility income guidelines are greater ($2400 more in New York State) than the federal poverty guidelines for a single person, meaning that even a person considered to be poverty-stricken by the federal government is not eligible for the government’s medical program that is intended to serve those living in poverty. Greater than half of the uninsured poor adult population are ineligible for Medicaid, ranging from young adults to people in their 60’s not yet eligible for Medicare. The majority of these adults are white, and 4 out of 5 are employed US citizens. Tens of thousands of elderly are forced to divorce in order to obtain Medicaid coverage.
Of those who do receive Medicaid, 65% are employed. 55% of AIDS patients receive Medicaid coverage. (aids.org) Although Medicaid is criticized for its high costs, Medicaid growth per capita has consistently stayed at about half the rate of growth of private insurance premiums, and Medicaid administrative costs are lower than that of private insurers. Cuts to Medicaid reimbursement directly result in higher medical costs for everyone.
Those who are privately insured still face the potential for huge bills and bankruptcy if they are diagnosed with an expensive medical condition; private insurance has annual and lifetime benefit limits. Insurers dictate what care patients may receive, as most medical providers and facilities will not perform expensive procedures--even if the procedure may be life-saving--if the insurer refuses to pay for it. People with “good” health insurance have been known to borrow money to pay for procedures their insurer refused to authorize. And even the largest private insurers have been found to target subscribers with diagnoses requiring expensive medical treatment for cancellation.
The practices of private insurers have resulted in profit explosion of over 400% from 2000-2007 and a decrease in the quality of medical care for everyone else. Specific coverage limitations, denied claims, preauthorization requirements, slow payments, reduced payments, “allowed amounts” and enormous amounts of paperwork for providers and facilities to complete have resulted in higher costs, longer wait times for shorter appointments, higher rate of medical errors, and drastic changes to the way medicine is practiced. Premiums rise annually and to a greater extent than wage growth and inflation. Employers are passing on more and more premium costs to employees, giving them less buying power every year despite wage increases, so private health insurance even affects the economy to some degree.
Proposals to reform healthcare are currently being discussed by lawmakers, but politics, lack of knowledge, pressure from special interest groups and the White House’s timetable appear to be preventing the development of a real solution.
Simply reforming healthcare isn’t enough. Any healthcare reform is going to be expensive, and the price of reform that doesn’t work will include the eventual cost of reform that does. We need the best plan at the lowest cost, which means that we need to thoroughly examine each individual issue and decide how to best overcome each obstacle. Healthcare reform is a life-and-death issue for 22,000 Americans annually, and a quality-of-life issue for millions more. It is not an issue that should be hastily legislated without debate; we need to abandon the normal politics and the habits of this administration and pass bipartisan healthcare legislation that guarantees every American their fundamental human right to healthcare.
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