By: Dr Barkat A Charania & Chris Ryan
Our basic human rights include Health Care:
As per our constitution there are certain rights of every citizen. As we go by in time we learn from other countries in the world and from our citizen’s wants and desires and as and when needed we add to such rights and facilities enjoyed by our citizens. The basic education and legal defense are accepted as basic needs of all our citizens. Health care is no different. Sickness is unforeseen problem that strikes anyone without any warning. And when necessary health care must be provided to by us all collectively, as we do for safety security, boarder protection, basic education, and state provided legal defense.
Looking at this from another perspective, healthy educated work force can do wonders to our productivity. And hence if we ensure the health of our fellow citizens collectively, we may be eventually doing well to ourselves and our country. This is not only logical but a good common sense that we can use for all of us. This is national need and has nothing to do with any political ideology, as is being sometimes painted.
Hence it will have to be a collective moral and political decision of us all citizenry to ensure that every one of us is provided with all the health care needs from conception to death. Once we decide and agree at this then the modalities of the provision of such health care can be agreed upon and decided around our basic objective.
History of our Health Care efforts for all:
From the time the President FDR left the health care for all out of his New Deal, we have been making efforts to somehow create some measure to fill this big gap in our national policy. Since that time the health care of US citizens is mostly covered by their employers. This unfortunately leaves millions of our fellow citizens without any health cover, because of several reasons. Most important reason of late has been that the health insurance premium is rising consistently more than our inflation. This makes it difficult for the employers to spend that kind of money for their employees. And those employers who used to cover the families of their employees have in most cases been dropped, adding the uncovered number to a frightening number.
An overview of what system we have today: There will be long list of problems and evils in the healthcare system that we have today in USA. Most serious of them are:
· It is not comprehensively covering everyone equally.
· There are many holes in the health care cover provided by insurance companies in the shape of co-pays, deductibles, not covering existing conditions.
· Dental care is not covered.
· Premiums are very expensive.
· Interested vested interests groups like insurance companies, pharmaceuticals and providers have strong lobbies not allowing right and logical decision to be reached.
· Doctors, hospitals and pharmaceutical companies are all strongly profit motivated.
· We have been talking about reforms but have tried and failed many times.
Problems and Evils of present Health Insurance system:
· Insurance companies have profit motive and hence they try and accept the least “expensive” patients who are healthy, and reject those who may turn to be “loosing” patients who are likely to be unfortunately likely to be sick.
· Profits on one side and insured’s care on the other side creates a natural conflict of interest for the insurance companies.
· Insurance companies try and keep on adding the co-pays and keep on increasing deductibles, hence causing general public to pay from their pockets more and more.
· Insurance premiums keep on increasing, because the companies wish to maintain and increase their profits.
· Executives of the insurance companies increase the administrative cost of the program. US spend as much as 20% plus on such administration, whereas countries like UK and Canada has this cost kept around 5% or even less.
· Dental health is very much a part of human body and needs to be fully covered.
· Because the cost of insurance is beyond reach for many citizens, millions of US citizens are without this cover.
· Preventive measures must be more stressed at all ages. Presently these are being used for children and pregnant women in most evident form.
· Well is not rewarded as best as it should.
· Bad habits and factors negatively effecting health of population are not being more severely punished and kept under control.
· Defensive medicine is being practiced because of liabilities associated with loss of life or health is very seriously looked upon by courts and is taken advantage of by many unscrupulous persons and legal profession.
· Over treatment is prevalent, which increases overall cost of health care for all. This should only be allowed in teaching institutions for research.
· There are too many control and not enough choices for patients.
An overview of what and how we need to reform:
There is no harm in learning from those who have been on that path. There is no point in reinventing the wheel. In fact we do not need to go anywhere to learn as to what to do. One of the best programs in USA is Medicare. Everyone likes it and is satisfied from it. There may be some shortcomings, which may be addressed as and when needed, but it is one of the most acceptable programs of healthcare for citizens, and kicks in early 60s.
We only need to replicate Medicare with a little change to the whole population from the time of conception to the time that Medicare kicks in.
Other countries with successful Medical Care by the state may be seen in Canada and UK, which are English speaking countries. Other countries that we are perhaps not very acquainted with, who have successful programs to a major extent are Japan, Switzerland and Taiwan. Many other countries have similar programs that we can learn from. They have been experimenting and changing their system gradually and have arrived at present system. Hence a large experience and experimenting has been already done. We only need to pick and choose what we like the best amongst them and reject those components that we do not like very much.
However, these may all be considered in due course. Today we need to adopt the Medicare for all with a very small minor adjustment and we have one of the times tested and accepted system by ourselves. We may then gradually add or subtract from it taking g lessons from other countries’ successful programs.
Components of successful health care systems around the world:
· Most of them have proper remuneration for all like doctors, hospitals, and pharmaceuticals, but motive of massive profits are kept under control and in abeyance.
· This is done through regular ongoing negotiations between the authorities responsible for payments and those seeking it.
· A sense of competition is inculcated at all levels in the shape of performance and reputation.
· In some countries the hospitals and facilities are owned by the country and people.
· Prices of all procedures, facilities and medicines are kept public and under continuous watch to ensure that they stay as low as possible.
· Legal defense system for the providers is kept available for all at a very reasonable cost, hence avoiding defensive and unnecessary procedures and tests.
· Whether it is single payer system or not, the cost is kept under constant watch and hence the expenses are kept at minimum.
Situation today in Nov 2009:
When we are writing this, the Health care reform bill has narrowly passed in the House under the leadership of Nancy Pelosi. However it has serious limitations. Sometime next week the Senate will start discussing their resolution. Senate majority leader Harry Reid seems confident but has an uphill task to deliver a viable bill with realistic reforms. Saturday, November 21st will go down in history as the day when first vote in Senate, which is really a start of a marathon debate in senate. Having come this far is already a triumph for Obama administration to have brought the reform proposal at least passed in House and being debated in senate. However, from the information about proposal floating around it seems that we may fall short, in fact very short of what we need to achieve to get the meaningful reforms. We hope we are wrong and that the final version of reforms that will go for the President Obama’s signature to become law will be more substantive than what it sounds like today.
Our concern with the bill passed by House and presented in Senate are as follows:
· It seems that President Obama has allowed the single payer to be almost shelved
· House has passed the bill without a good robust public option. House had to even please pro-life conservatives to pass the bill, and that too narrowly.
· Senate may have issues because of the conservative democrats opposing the bill and strong partisan approach.
· Voting on this bill will have a lot of impact on the next year’s mid-term electability of many congressmen and women, which may keep them from voting in favor in final vote.
· Senate proposal does not have a strong public option.
· As the time passes, there is risk of political viewpoints will create internal friction within Democratic Party. Partisan politics will also take its toll on some unforeseen incidences and decisions, like,
o Trying the 9/11 suspects in New York, as decided on 11/13/09
o Decision about surge in Afghanistan, which will need to be made soon
o President Obama’s South Asian tour and its implications will have some indirect effect on internal Democratic thinking, direct opposition of Republican irrespective of what has been done because of partisan thinking, and overall national impact which wil generally be good but some vested interest may represent it differently.
o Economy not yet improving may have its own toll, since it is being seen as more and more present administrations baby instead of its being legacy of past administration
o Unemployment in double difgits with reforms causing budget deficits will= take some proponents away from the supporting the bill.
If the Senate bill is passed with required number of votes, as it seems it will, and then go for conference to include the proposals of the House and Senate both, we need to make sure from right from now to ensure that the final bill after the conference and confluence is the one that is really the answer to our needs of reforms and not more of the same insurance companies ruling us all with their whims and fancies. It is very likely that the reform bill may get diluted a lot by the time it becomes law signed by the president. It is thought that we may perhaps remain and get more stuck with the present system prevalent through insurance companies with the same problems of co pays, deductibles, and being costly.
We all need to influence the bill debated in the Senate and in conferences to ensure that it definitely has following component included to let us have real reform and not only for name sake:
a) Mandatory and compulsory health insurance for all.
b) A watch on insurance companies (if we cannot avoid their big role) so that they cannot reject any patients because of existing condition.
c) Cost must be under ongoing control
d) There must be a strong public option included to give a strong competition to the insurance companies in terms of rates and performance.
A simpler proposal; ADOPT MEDICARE SYSTEM FOR ALL:
Here is a simple suggestion and proposal. We are all well conversant with our Medicare system. We all know it works very well and is liked by all beneficiaries. We have this time tested system already in existence and we can and should use it and build upon it instead of looking for some new experiment. It is simply suggested that the Medicare may be made available to all the people of the US. This will have a lot of advantages as enumerated below.
Advantages of adopting Medicare for all:
· There is no rejection of pre-existing conditions
· There is no picking and choosing of patients, every one without any exception is covered with full and complete benefits that is required
· There is very little difference in programs that Medicare beneficiaries can choose from. These may need to be looked into and ensured that we do not make very large number options available and confuse everyone.
· The co-pays may be removed from it.
· It is One Payer system and works well.
· It is strong Public Option and is accepted and liked by all.
· The administrative cost is perhaps small and by streamlining it may be brought to minimum.
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