| OBAMA CARE in Indian Reference:Fight rages to define health care bill to public |
Indian IT poised to gain from US health reforms!
The Bill expands coverage to 32 million more uninsured Americans.
The Healthcare Reforms Bill passed by the US House of Representatives would boost generic drug sales, but may not trigger big business for Indian companies soon.
Further, the provisions in the legislation to allow 12-year exclusivity to new biologics or patented biotech drugs would delay plans of Indian companies to launch generic biologics in the US market, say industry circles and analysts.
The Bill expands coverage to 32 million more uninsured Americans, besides bringing in major changes in the current structure of medical insurance given to the elderly, and promotes use of low-cost medicines.
Analysts say though the generic market in the US will expand with more Americans coming under the health insurance net, this will lead to bigger competition and further squeeze in margins.
"The Bill is an effort by the Obama administration to make health care affordable to all US citizens and Indian companies will need to play a pivotal role in achieving that objective," said Glenn Saldanha, chief executive and managing director of Glenmark Pharmaceuticals.
"The reforms will definitely boost sales of Indian companies targeting the US market, but we will have to wait and watch," he added.
The largest drug market in the world, the US accounts for over half of global drug sales with close to $300 billion every year. Out of this, generics contributed only $60-70 billion, despite 65 per cent of prescriptions generated in the US are for generic drugs.
"It is a reform of the healthcare structure in that country and this does not mean the huge increase in generics business will happen tomorrow for Indian companies. There are also negatives in the Bill, like delay of entry of generic biologics in that market," said D G Shah, secretary general of Indian Pharmaceutical Allianc.
T S Jaishankar, chairman of Confederation of Indian Pharmaceutical Industries, says the US market has already stagnated and most of the leading Indian companies are now concentrating on emerging markets to continue their growth in the past. "The health care reforms will mainly benefit US-based companies, as there are preferences in the Bill for domestic players. Indian companies lack marketing set-up in that country," he said.
"The margins for Indian companies are already minimal, as the companies undertaking marketing in the US enjoy maximum margins," Jaishankar added.
Lupin, ranked eighth, and Dr Reddy's Laboratories at 10th position are the only two Indian generic companies among the top 10 generic players in the US, which is dominated by players like Israel-based Teva Pharmaceuticals and US-based Mylan Pharma.
According to the National Prescriptions Audit for December 2009 by IMS Health, Lupin's share of the generics market in the US is 3.5 per cent and for Dr Reddy's Laboratories, it is 2.7 per cent.
"In the medium- and long-term, the reforms should benefit all low-cost generics manufacturers, including Indian companies, as the whole programme is aimed to reduce healthcare costs," said Ajit Mahadevan, partner, Health Sciences Advisory Services, Ernst & Young.
Sujay Shetty, associate director, Pharma Practice, PricewaterhouseCoopers (PwC), says provisions like 12-year exclusivity for biologics drugs will ruin Indian companies' plans to tap the current $18-billion US biologics market. Companies such as Wockhardt, Biocon, Dr Reddy's, Reliance Life Sciences are building a big portfolio of biotech drugs going off-patent in future for launch in global markets.
Business Standard Reports thus.
The markets opened with a positive gap this morning on firm cues from Asian markets. The US markets too had edged up on Monday, following passage of the US healthcare bill.
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The Sensex opened at 17,423 and surged to a high of 17,531. However, selling pressure in Bharti Airtel and ICICI Bank saw the index shed 174 points from its high to a low of 17,357.
The index recovered in late noon trades as market heavy-weight, Reliance moved up. The Sensex finally ended with a gain of 40 points at 17,451.
The Nifty ended at 5,225. - up 20 points.
The BSE healthcare index surged to a new high of 5,299. The index finally ended up 1.5% at 5,292.
The oil, power and metal sectors also edged up.
Bharti Airtel shed 3% at Rs 307. Tata Motors dropped 2.7% to Rs 739.
DLF slipped 2% to Rs 295. Grasim and ACC dipped 1.3% each to Rs 957 and Rs 2,849, respectively.
ICICI Bank, Wipro and Sun Pharma were down marginally.
However, HDFC Bank added 2.5% to Rs 1,885.
Reliance led the recovery and edged up 1.4% at Rs 1,089. Tata Power has added 1.4% to Rs 1,354.
Tata Steel, NTPC and ONGC advanced 1% each.
The BSE market breadth was marginally negative. Out of 2,879 stocks traded, 1,508 declined while 1,264 advanced.
Tata Motors topped the value chart on the BSE with a turnover of Rs 78.91 crore, followed by SBI (Rs 71.75 crore), Reliance (Rs 68.84 crore), HDIL (Rs 65.91 crore) and Tata Steel (58.60 crore).
The volume chart was led by Syncom Healthcare with trades of over 8.35 million shares, followed by Suven life Sciences (7.17 million), Facor Alloys (6.17 million), Krishna Life (5.56 million) and Alok Industries (4.56 million).
Pranab sticks to 7.2% growth in 2009-10
Finance minister Pranab Mukherjee on Monday said the government was sticking to an estimated 7.2% growth rate for this fiscal (2009-10) and 8.5% for 2010-11.
"I have given some indication in the budget speech and the economic survey. So far as this year is concerned, we are sticking to 7.2% GDP (Gross Domestic Product)growth and 8.5% for 2010-11," Mukherjee said.
The finance minister was talking to reporters on the margins of a workshop on financial
literacy, organised by the Reserve Bank of India and the Organisation for Economic Cooperation and Development, an international body.
House Approves Health Reform Bill After Agreement Reached To Issue Executive Order On Abortion!Although the reform may not result in heavy healthcare technology outsourcing from the US — as it does not talk about any major re-architecturing, re-engineering or system overhauling of the existing platforms — it is expected to bring in windfall benefits to domestic BPO providers who are focussed on insurance and claims processing domains. Indian healthcare IT providers mostly focus on systems integration, application management, maintenance and legacy modernisation.
Minneapolis-based healthcare expert Dr Saji Salam said, ''All existing IT systems including the electronic medical records, patient information systems and other technology platforms are going to stay untouched, barring some minor to medium tweaking, which will mean some additional work for existing providers like IBM, Accenture and EDS (HP). It's possible that minor portions of these might get shifted to India as well, but the sizable opportunity is for BPOs.''
The reform will bring 32 million poor and emigrant Americans under insurance cover. Insurance firms will look at outsourcing partners to help them enrol new members and process their call and claim needs. Rising cost pressures will force insurers and hospitals to concentrate only on a few core functions such as benefit and services design, sales and marketing, while outsourcing back-office functions like member database management, claims processing, support services and enrolment processing.
Sanjiv Kapur, head, Patni BPO, said he saw significant healthcare outsourcing opportunity in BPO and IT areas. "The reform extends coverage to millions of Americans, which means we will see a significant influx of the newly insured into the healthcare system. The additional enrollees will need to beadministered as and when it happens. This means a lot more work in areas of claims processing, enrolments, underwriting support and customer support.''
K Vinayambika, senior V-P, healthcare practice, Cognizant said the company had been benefiting from opportunities spawned by regulatory changes in the US healthcare and life sciences industry, be it HIPAA or ICD-10/5010 in the healthcare and pharma spaces. ''The new bill will create newer opportunities for healthcare players like us,'' she said.
The reform also brings an opportunity for medical transcription providers as electronic health records (EHRs) implementation is likely to undergo some changes. "It will mean a change from paper records to electronic ones, mandatory for all healthcare institutions," said Raman Kumar, CEO, CBay Systems, a medical transcription firm.
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One of the most visibly high-profile and lucrative arms bazaars today happens to be India. The Big Boys of Europe (Russia included) and the United States of America feel happy to see in India a potential market of military equipment worth $50 billion over the next 10 years, and an expected $100 billion in the next 20 years.
The 'mother' of all deals, however, is that for the 126 Multi-Role Combat Aircraft, reportedly worth almost $11 billion. Expectedly, therefore, all top six companies — America's Boeing, France's Dassault Aviation SA (Rafale), America's Lockheed Martin Corporation (F-16), Russia's MiG-35, Sweden's Saab JAS-39 Gripen and the EADS's Eurofighter Typhoon — are competing with one another to clinch the deal.
One can well guess what is there in store for the one 'victor' and the five 'vanquished' once the government of India chooses the type of aircraft for its air force from amongst the six players vying for the deal. There is every possibility of the closure of those plants that fail to get the Indian order, as conventional military hardware markets all over the world have shrunk dramatically. But India being a compulsive big-ticket buyer, all foreign sellers of fighters are camping in New Delhi to woo the potential mega customer.
Perhaps the smartest seller so far has been America's Boeing Company. Reportedly, the Boeing is to reinvest $640 million in India as part of its offset obligations. But many questions remain unanswered — will the Boeing's planned investment upgrade indigenous technology? Or will Boeing remain content with asking Indian entrepreneurs to manufacture and copy a few non-technical and non-sensitive inventories such as the fuselage, doors, windows, galleys and tyres? One is not too sure as yet because if Barack Obama's recent utterances are to be considered, "outsourcing" is anathema to him. And offset programmes of the government of India might be interpreted by American hardliners as outsourcing.
Boeing, however, was reportedly always "confident of securing export orders and the US Navy had sought international partners to share development of P-8A." American companies (especially Boeing), consider India to be an important market — "We are here for the long haul," declared an official of the company.
From India's perspective, however, some puzzles remain. Serious defects had occurred and recurred in the F/A-18 Super Hornet programme. This spells trouble both for India and the USA. If a high-tech aircraft sold to India is found defective, then India — which has till date never produced the likes of F-4, F-5, F-15, F-16, F-18, F-22 and F-35 — certainly cannot be expected to repair or replace an aircraft that even the Americans today find hard to maintain.
It might be useful for India to emulate the Chinese in this regard — "Give us the latest technology first, then only we will take your hardware." India must get the best stuff for itself, and should not be used as a dumping ground for obsolete technology.
The Union defence minister, A.K. Antony, constantly harps on the "need of high level of indigenisation in defence sector". One-way traffic of sale and purchase could be transformed into 'cooperate and produce' between equal partners. The existing imbalance has led to inequalities in India's arms acquisition programme. Choose the best and chase the quality.
ABHIJIT BHATTACHARYYAStupak authored an amendment, approved as part of the House reform bill (HR 3962), that would have prohibited insurance companies receiving federal subsidies from offering abortion coverage, even if paid for with private funds. The Senate bill would allow health plans that receive government subsidies to offer abortion coverage, although no government funds could be used to pay for that coverage. To ensure that only private funds are used to pay for abortion coverage, customers would be required to make two monthly premium payments -- one to pay for abortion coverage and one for all other services. Insurers also would be required to keep funds in separate accounts (Women's Health Policy Report, 3/19).
The House's approval of the Senate bill means that the legislation will become law as soon as Obama signs the measure (New York Times, 3/22). The president will issue the executive order after the legislation is enacted (Benson/Ota, CQ Today, 3/21). The House on Sunday also approved a package (HR 4872) of changes to the Senate bill; the Senate will consider the package this week (New York Times, 3/22).
Details of Executive Order
White House Communications Director Dan Pfeiffer said in a statement that the agreement to issue the executive order "provides additional safeguards to ensure that the status quo [on abortion funding] is upheld and enforced, and that the health care legislation's restrictions against the public funding of abortions cannot be circumvented" (Hall/Fritze, USA Today, 3/22).
Obama's executive order will state that the health reform bill "maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly created health insurance exchanges." It also will state that "longstanding federal laws to protect conscience ... remain intact and new protections prohibit discrimination against health care facilities and health care providers because of an unwillingness to provide, pay for, provide coverage of or refer for abortions" (Benson/Ota, CQ Today, 3/21). The executive order also reaffirms that the Hyde Amendment prohibits community health centers from using federal funds to provide abortion services (Meckler, Wall Street Journal, 3/22).
Agreement Caps Days of Talks
The agreement was reached on Sunday after days of last-minute negotiations (New York Times, 3/21). On Friday, Stupak and his allies demanded a vote on a resolution that would have prohibited anyone who receives a federal subsidy to help pay for health insurance from purchasing a health plan that offers abortion coverage (Levey/Hook, Los Angeles Times, 3/20). The resolution would have required bicameral adoption before it could be added to the Senate health reform bill, and it could have been filibustered in the Senate. CQ Today reports that these issues "rais[ed] questions about whether Senate Republicans might join abortion-rights Democrats in holding up the resolution just to make a procedural mess of the health care debate" (Benson, CQ Today, 3/19).
Democratic abortion-rights supporters agreed to support the executive order if it did not expand current restrictions. Rep. Diana DeGette (D-Colo.), co-chair of the Congressional Pro-Choice Caucus, said, "We said we would compromise to current law in making this a health care bill, not an abortion bill, and that's exactly what the executive order does."
According to CQ Today, Stupak and his supporters agreed to the deal after "[r]ealizing that House Democratic leaders probably had the votes to pass a health care overhaul without them" (Benson/Ota, CQ Today, 3/21). In a Sunday news conference shortly before the House vote, Stupak said he was "pleased to announce that we have an agreement," adding that those involved "were able to come up with an agreement to protect the sanctity of life in the health care reform, that there will be no public funding for abortion in this legislation" (Seabrook, "Morning Edition," NPR, 3/22). Reps. Kathy Dahlkemper (Pa.), Steve Driehaus (Ohio), Marcy Kaptur (Ohio), Alan Mollohan (W.Va.) and Nick Rahall (W.Va.) joined Stupak at the news conference (Benson/Ota, CQ Today, 3/21).
House Dems Defeat GOP Antiabortion Resolution
House Democrats on Sunday also defeated a "last-minute attempt" by Republicans to defeat the health reform bill by adding Stupak's amendment to the bill, Politico's "Live Pulse" reports (O'Connor, "Live Pulse," Politico, 3/21). The Republicans' proposal was rejected 232-199, with 21 Democrats joining 178 GOP members in support of the motion (Kucinich, Roll Call, 3/21). Stupak said the GOP motion was "disingenuous," adding, "This motion is nothing more than an opportunity to continue to deny 32 million Americans health care" ("Live Pulse," Politico, 3/21).
Women's Groups React to Agreement
Several women's and abortion-rights groups reacted to the executive order on Sunday, Politico's "Ben Smith" reports. Planned Parenthood Federation of America President Cecile Richards said that the group "regret[s] that a pro-choice president of a pro-choice nation was forced to sign an executive order that further codifies the proposed anti-choice language in the health care reform bill." However, the group is "grateful" that the bill "does not include the Stupak abortion ban."
In a statement, NARAL Pro-Choice America President Nancy Keenan said that she is "deeply disappointed" that Stupak and his group "would demand the restatement of the Hyde Amendment." Sunday's events are "a stark reminder of why we must repeal this unfair and insulting policy," Keenan said in the statement, adding, "Achieving this goal means increasing the number of lawmakers in Congress who share our pro-choice values. Otherwise, we will continue to see women's reproductive rights used as a bargaining chip" (Smith, "Ben Smith," Politico, 3/21).
In a statement on Sunday, National Organization for Women President Terry O'Neill said Obama's executive order "breaks faith with women" and "suggest[s] that his commitment to reproductive health care is shaky at best." O'Neill added that NOW "has a longstanding objection to Hyde" and "was looking forward to working with this president and Congress to bring an end to these restrictions." However, "[w]e see now that we have our work cut out for us far beyond what we ever anticipated," she said, adding, "The message we have received today is that it is acceptable to negotiate health care on the backs of women, and we couldn't disagree more" (Franke-Ruta, "44," Washington Post, 3/21).
Catholic Bishops Remain Opposed While Other Catholic Groups Endorse
Sister Carol Keehan -- president and CEO of the Catholic Health Association, which endorsed the Senate bill earlier this month -- said, "We are confident that the reform law does not allow federal funding of abortion and that it keeps in place important conscience protections for caregivers and institutions alike," Keenan said. She added, "We are also pleased that the bill includes $250 million to fund counseling, education job training and housing for vulnerable women who are pregnant or parenting" (UPI, 3/22).
The U.S. Conference of Catholic Bishops maintained its opposition. USCCB Secretariat of Pro-Life Activities Richard Doerflinger said that the group's "conclusion has been that an executive order cannot override or change the central problems in the statute. Those need a legislative fix."
Meanwhile, the antiabortion-rights National Right to Life Committee also criticized the executive order, saying that it "was issued for political effect" and "changes nothing" (Werner, AP/Washington Post, 3/22).
Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
Obamacare briefing: what US health reform means
It is hailed as a historic victory, but what does the bill really amount to?
After years of intense debate in the legislature, across the nation and throughout the media, Barack Obama's healthcare reforms, which have divided the US as nothing has since the Vietnam war, are to become law.
A vote last night in the House of Representatives will take the country closer than it has ever been to universal healthcare and spells historic victory for the President and his Democrats - while Republicans believe it will lead to their opponents' downfall at the polls.
"This is what change looks like," said Obama late last night at the White House, Vice President Joe Biden at his side. "Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics.
"This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction," he added.
In a few hours' time, the President is expected to sign the bill into law. The bill was passed by 219 votes to 212, with every Republican voting against it – and 34 Democrats, some of whom feared it as a vote-loser. When the ballot hit the 216 needed to ensure their victory, Democrats hugged each other, cheered and chanted Obama's campaign slogan: "Yes we can!"
What will the bill do?The Patient Protection and Affordable Care Act, which will cost $940bn over 10 years, will bring healthcare to 32m more of the USA's poorest people, taking coverage across the country to 95 per cent.
Its main provisions are to make health insurance almost mandatory, targeting individuals and employers; to vastly increase the threshold that determines who is eligible for financial healthcare support from the state; to reduce the price of drugs available to them and to prevent insurers from refusing to cover people with pre-existing medical conditions.
How are the American public reacting?As the bill came closer to law over the weekend, thousands of protesters gathered in Washington DC to heckle congressmen. Some hurled racist and otherwise derogatory remarks at African-American members including one of the 1960s civil rights veterans, John Lewis. A congressman was spat on, and another was called 
Filed under: US health care reform, US politics, Barack Obama
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Health Care Advocates: We Can't Let Up Now
Important change does not come easily. But it marched forward in Washington on Sunday. The vote in the House of Representatives in favor of health care reform was a historic step towards protecting health insurance for those who have it and providing coverage for 32 million now uninsured. The 221 Representatives who supported health reform in two key House votes acted in the interest of the American people. They stood up to an unceasing stream of fear-mongering, distortions, and untruths in the media, in public forums, and even in the House chamber. Those who voted yes deserve our gratitude; opponents should hear our dismay. (It's easy to register thanks or disappointment through the Coalition on Human Needs website.)
More than thanks, proponents in Congress need our help. So do the millions among us whose health care depends on the full enactment and implementation of the law
That's because the people who are fighting change are not going to stop now. They will keep slinging their talking points about bureaucrats getting between you and your health care. Someone has to point out that there are bureaucrats making health care decisions and denials, and they work for insurance companies. Opponents will try to scuttle the next steps in the Senate, and have vowed to seek repeal and obstruction. Someone has to remind the nation that lives are at stake. We must remember the 294,000 adults Families USA reported had died prematurely for lack of health coverage since 1995, the last time health care reform was debated in Congress - and warn that 275,000 more people will die if we let another decade go by without acting. Someone must speak of all the others who did not die but suffer needless losses - the former teacher who lost his sight for lack of $3,000 to pay for an operation, the baby born prematurely because the mother had little prenatal care, the family in bankruptcy because of medical bills.
The President and Members of Congress are expected to make a concerted effort to communicate the benefits of the legislation that just passed the House. But the public, hearing all the misinformation, is bound to be skeptical. Independent advocates must speak out too, forcefully and repeatedly.
I have my doubts that people with an open mind are persuaded by opponents trotting out taunts of "socialized medicine." Still, we don't want to forget to point out that the same labels were used against Medicare before it passed in 1965. I'd like to think that the racial and homophobic epithets hurled at Members of Congress by anti-health reform demonstrators hurt their cause.
We should seriously answer the accusations that the legislation is too expensive. It does cost a lot of money. But let's face it: health care is costing us a lot of money now, and we are at the mercy of punishing increases year after year. This legislation will rein in those exorbitant hikes, making savings over time that independent analysts say will reduce the federal deficit.
We must make sure that people around the country understand that soon after the law's enactment, people will see real benefits. Families will be sure their children can remain in their insurance plan up to age 26. New insurance plans will be barred from denying coverage to children based on pre-existing conditions. There will be temporary help for adults with pre-existing conditions until they receive full protection in 2014. New and existing plans will not be able to place lifetime dollar limits on benefits; some restrictions will take effect on insurers' annual limits on benefits. Older Americans will get $250 in relief from prescription drug costs when they enter the "donut hole" in 2010, with the donut hole phased out over time.
We must let people know that, starting in 2014, insurance meeting basic standards of comprehensiveness will be available to small businesses and individuals without coverage. If the legislation were fully in effect today, a family of four with an income of less than $88,200 would be eligible for help paying premiums. If their income were less than $55,125, the family would be able to get help with co-payments and deductibles too. These income levels will rise as living costs rise. Out-of-pocket expenses will be limited. People with incomes up to a little over the poverty line will be able to qualify for Medicaid.
Yes - the bill requires most people to purchase health insurance, starting in 2014. For some, that will be an unacceptable infringement on personal liberty. But for most, it is a reasonable compact, joining personal responsibility with protections from uncontrollable health care costs and unfair denials by insurance companies.
It isn't perfect. But the President, supporters in the House, and advocates for health care reform can be proud they are taking a giant step towards change that will make our lives better and make our economy stronger. The Senate needs to do its part this week. We have worked a long time for this victory. We can't let up now.
http://www.huffingtonpost.com/deborah-weinstein/health-care-advocates-we_b_509207.html
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United stand on health bill could hurt GOP
While electorate seems skeptical of legislation, some provisions are popular
 Yuri Gripas / AFP - Getty Images House Republican Leader John Boehner, left, and Republican Whip Eric Cantor lon Sunday. In a week when Democrats are celebrating the passage of a historic piece of legislation, Republicans find themselves again being portrayed as the party of no. |
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 | Video |
 | Dems bask in glory of health bill's passage March 22: While the fight for health care reform isn't over, Democrats on Monday celebrated the bill's passage in the House as the definitive step in a long, tumultuous battle. Nightly News |
| Video |
 | Breaking down the health reform bill March 22: While some changes under the health care reform will take place within months, the most significant change will come in 2014 when Medicaid insurance would undergo a huge expansion to cover families earning less than $30,000 annually. Nightly News |
| Video |
 | Hospitals look with hope to health reform March 22: At the Ohio State University Medical Center, where one in every 10 patients is uninsured, doctors are hoping health care reform will allow them to provide more primary care outside of the emergency room. Nightly News |
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WASHINGTON - Passage of the health care legislation challenges the heart of the Republicans' strategy this year: To present a unified opposition to big Democratic ideas, in this case expressed in a stream of bristling anger and occasional mischaracterizations of what the bill would do.
From a legislative perspective, the Republican strategy did not work, despite months of predictions from Republicans that the bill would fail and that that would cripple President Obama's presidency.
Mr. Obama will sign the bill Tuesday, although with the support of only Democrats. An additional package of amendments to remove some of the more politically problematic provisions is likely to become law within weeks.
In political terms, Republicans face strong crosscurrents. Polls suggest that a sizable part of the nation is unenthusiastic about the bill or opposed to it. Conservatives see it as a strike at the heart of their small-government principles, helping to explain why Republicans are optimistic that they will make gains in the midterm elections in November.
"There is no downside for Republicans," Michael Steele, the Republican National Committee chairman, said Monday in an interview. "Only for Americans."
But at the same time, many provisions of the bill that go into effect this year — like curbs on insurance companies denying coverage for pre-existing conditions, or the expansion of prescription drug coverage for the elderly — are broadly popular with the public. The more contentious ones, including the mandate for the uninsured to obtain coverage, do not take effect for years.
And in a week when Democrats are celebrating the passage of a historic piece of legislation, Republicans find themselves again being portrayed as the party of no, associated with being on the losing side of an often acrid debate and failing to offer a persuasive alternative agenda.
Stance sowed doubts
David Frum, a fellow at the American Enterprise Institute, the conservative research organization, said Republicans had tried to defeat the bill to undermine Mr. Obama politically, but in the process had given up a chance of influencing a huge bill. Mr. Frum said his party's stance sowed doubts with the public about its ideas and leadership credentials, and ultimately failed in a way that expanded Mr. Obama's power.
"The political imperative crowded out the policy imperative," Mr. Frum said. "And the Republicans have now lost both."
"Politically, I get the 'let's trip up the other side, make them fail' strategy," he said. "But what's more important, to win extra seats or to shape the most important piece of social legislation since the 1960s? It was a go-for-all-the-marbles approach. Unless they produced an absolute failure for Mr. Obama, there wasn't going to be any political benefit."
Republicans also face the question of what happens if the health care bill does not create the cataclysm that they warned of during the many months of debate. Closing out the floor debate on Sunday night, the House Republican leader, Representative John A. Boehner of Ohio, warned that the legislation would be "the last straw for the American people." Representative Marsha Blackburn, Republican of Tennessee, proclaimed several hours earlier, "Freedom dies a little bit today."
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"When our core group discover that this thing is not as catastrophic as advertised, they are going to be less energized than they are right now," Mr. Frum said.
He warned that the energy Republicans were finding now among base voters would fade.
The head of the Democratic Senatorial Campaign Committee, Senator Robert Menendez of New Jersey, offered a similar argument. "When this bill goes into effect, and none of the things Republicans warned about begin to happen — none of the death panels, none of the government takeover, none of the socialism — Republicans will have no credibility," Mr. Menendez said.
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In the East Room this morning, President Obama will sign the most comprehensive changes to the health care system in American history — and with that launch a fierce battle leading up to November's elections to define the law as either a crucial, overdue reform or a dangerous, Big Government power grab.
The president flies to Iowa on Thursday on the first of several cross-country trips to tout popular benefits in the bill that go into effect almost immediately. One advocacy group Monday began making 700,000 recorded phone calls to voters in a dozen congressional districts, blasting Republicans who voted against it.
Meanwhile, conservative talk-show host Rush Limbaugh told listeners that Democrats who voted for it should "be hounded out of office" and GOP officeholders promised repeal efforts, state-by-state resistance to key provisions and court challenges.
"The task now shifts from legislation to persuasion," says William Galston, a White House domestic policy adviser in the Clinton administration. Obama communications director Dan Pfeiffer says Obama plans "a sustained campaign to educate the public about the immediate benefits of health reforms."
The White House and Democratic congressional leaders also hope the health care victory will give them the political momentum and partisan unity to move forward on other issues — and a clear opening to focus more sharply on economic concerns, including unemployment, that Americans rank as their top priorities.
"Washington is a place that likes winners," says Lawrence Jacobs, director of the Center for the Study of Politics and Governance at the University of Minnesota. "When a president gets on a roll and gets a win like this, it snowballs."
Some changes in the bill demanded by the House and included in a separate measure have gone to the Senate for action as soon as this week.
Repercussions from the 219-to-212 vote late Sunday in favor of the Senate's original health care bill could be enormous.
Republicans see opposition to the bill and concern about its reach and price tag as issues that might enable the GOP to regain control of the House in the Nov. 2 congressional elections. Democrats hope to turn the issue into a positive for them.
And Obama has seen his approval rating erode as the health care debate has dragged on. In the past few days, as victory seemed increasingly likely, his standing rose to 50% approve vs. 43% disapprove in daily Gallup polling. Last week his rating was 46%-47%, the first time during his tenure that more Americans disapproved than approved of the job he was doing.
For the White House and Republicans, the target is no longer a few dozen undecided House members — abortion opponents, fiscal conservatives and liberals backing a government-run public option — who were furiously courted to approve the Senate version of the health care bill.
Now the target shifts to millions of Americans, including many who remain uncertain about what the 2,562-page bill means to them.
In the seven-month sprint to Election Day, some of them will continue to be bombarded by ads from both sides of the issue, invited to rallies and protests and encouraged to sign up for benefits in the plan.
"The prime question today is: What price victory?" says Robert Schmuhl, chairman of the American Studies Department at Notre Dame. "Passage of the bill is certainly historic, but its complexity and the enormous effort to get it to the finish line are bound to produce aftershocks long into the future. ...
"How it all plays out could well determine whether Barack Obama can win re-election in 2012."
Strategies in play
After a year of debate, the USA TODAY/Gallup Poll and other national surveys showed neither side convinced a solid majority of Americans that they were right. With a bill enacted and taking effect, the effort to define the legislation may only intensify.
"There's a moment here where there will be a set of decisions made in voters' minds about, was this about me and my family?" says Andrew Stern, head of the SEIU, a major supporter. "Or was this about doctors and hospitals and the government?"
Strategies for both sides to make their cases:
• Accentuate the immediate.
Some of the legislation doesn't go into effect for years, but Obama insisted that it include some steps that could demonstrate the bill's positive impact right away, says Neera Tanden, who until last month was one of his advisers on health care.
"Look, there's an essential quandary," Tanden says. "It does take awhile to get change like this up and running. But people deserve to see benefits relatively quickly."
Events featuring Obama and other administration officials will spotlight a prohibition on insurance companies denying coverage for children because they have pre-existing medical conditions, in effect in six months. At that point, the law also will allow parents to provide coverage on their insurance plans for their children up to age 26.
And seniors who are paying full prescription prices because they're caught in the "doughnut hole" of Medicare's drug coverage will get a $250 check in the mail this spring.
• Play the expectations game.
Both sides have emphasized the historic nature of the health care bill. Democrat John Lewis of Georgia, a civil rights pioneer, said during the closing House debate that the legislation was as monumental as the Civil Rights Act. Republican leader John Boehner predicted an "Armageddon" from a measure he said would "ruin our nation."
Democrats say the most fevered predictions by opponents — warnings that passing the bill will bring a move toward socialism and a loss of liberty — will help them win over voters when catastrophe doesn't develop.
"There are not going to be 'death panels' sprouting up," says Rep. Chris Van Hollen, D-Md., head of the Democratic Congressional Campaign Committee. "There's going to be a huge credibility gap on the other side."
"It's much easier to sell something that's real and tangible than defend against a caricature," White House senior adviser David Axelrod says.
Republicans say they can focus on the expectations Democrats outlined, too.
"The challenge the Democrats have is people are going to expect these major changes to health care now and maybe wondering, what was all the hullabaloo?" says Republican pollster Glen Bolger. "They're the ones promising everything, to solve all the health care problems."
• Sign them up.
Advocates want to encourage those who under the provisions of the bill are newly eligible for Medicaid and the insurance exchanges to enroll.
Ron Pollack, executive director of Families USA, says a new non-profit group would work with hospitals, pharmacies, doctors and community health centers.
The campaign is based in part on the early confusion and suspicion among some seniors toward the Medicare prescription drug benefit program when it was passed by Republicans in 2003 and took effect in 2006. Drugmakers and insurance companies financed an education campaign that encouraged seniors to enroll and, in the process, built political support for it.
• Energize your base.
Groups that tried to influence the vote in Congress are now turning to the midterm elections.
Americans United for Change, which supports the health care bill, begins airing TV ads in the Twin Cities today that denounce Rep. Michele Bachmann, R-Minn., for her vote against the bill. More ads and automated calls targeting a dozen vulnerable Republicans will follow.
"Finally, Congress passed the health reform bill to rein in the power of the big insurance companies and guarantee that all Minnesotans can get the same kind of health insurance as members of Congress," the ad says. "But our congresswoman, Michele Bachmann, voted against that."
The SEIU will air TV ads in a half-dozen districts thanking vulnerable Democrats who voted for the bill. And Organizing for America, a Democratic group that helped elect Obama, said supporters had committed to 9.3 million hours to work for Democratic candidates in the fall.
Republican stalwarts are energized, too.
The Republican National Committee has launched a fundraising appeal called "Fire Pelosi: 40 Seats Means No More Madam Speaker." Arizona Sen. John McCain, the party's 2008 presidential nominee who faces a primary challenge from conservative J.D. Hayworth, sent out his own fundraising appeal Monday headlined "Repeal the bill."
Not every critic is pushing for repeal, however.
The U.S. Chamber of Commerce, which spent $144 million on ads and lobbying against the bill, will work instead to fix the bill's flaws and "minimize its potential harmful impacts," Chamber CEO Thomas Donohue says.
Changing the subject
Health care may be Obama's biggest achievement to date, but aides say the president will work just as hard in coming months on the economy.
Sunday's victory will give those efforts a boost. "There's no doubt the Democrats and President Obama are stronger today than they were yesterday," says Jacobs, the political scientist.
Facing high unemployment and polls that show voters angry about the bank bailouts, Obama will focus on "continuing to get the economy back on track," Pfeiffer says. That means job creation and Wall Street accountability in the form of financial regulations now being considered in the Senate.
Last week, Obama signed an $18 billion jobs bill that passed with some Republican support in the House and Senate. Now, the president will push relatively small-scale initiatives to spur lending to small businesses, promote weatherization of homes and more.
He'll also promote "common sense rules" to govern the nation's financial institutions and protect consumers from predatory, and financially ruinous, lending and credit practices, Pfeiffer says.
Pfeiffer jokes that the State Department also may help fill Obama's plate.
The president will have some tricky foreign policy issues to tackle. Even as he continues the planned withdrawal of U.S. troops from Iraq and preside over the troop buildup he has ordered in Afghanistan, Obama faces other challenges: seeking international sanctions on Iran to try to check its nuclear ambitions; negotiating with Russia to reduce nuclear weapons stockpiles; trying to restart peace talks between Israelis and Palestinians.
He meets today at the White House with Israeli Prime Minister Benjamin Netanyahu.
Obama also has promised to work on an energy bill, now stalled in Congress, and immigration changes. Last week, he praised efforts in the Senate by Democrat Charles Schumer of New York and Republican Lindsey Graham of South Carolina to tackle the controversial issue. But the odds are slim that Congress could get a bill through this year — and the White House isn't inclined to ask vulnerable Democrats to take another very difficult vote right before voters go to the polls.
If there are other issues the White House would like to pursue, aides are reluctant to talk about them. Asked to rank those issues at Monday's press briefing, spokesman Robert Gibbs demurred.
"I picked Kansas to win the bracket," he said, citing the loss by the top-seeded Jayhawks in the NCAA basketball tournament, "so I don't see any reason for me to begin ranking said priorities."
http://www.usatoday.com/news/washington/2010-03-23-obama_N.htm
Healthcare reform
From Wikipedia, the free encyclopedia
Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:
- Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies
- Expand the array of health care providers consumers may choose among
- Improve the access to health care specialists
- Improve the quality of health care
- Decrease the cost of health care
[edit] The Netherlands
The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool. In this way, a compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Furthermore, health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks [1].
A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US.[2][3]
A video (in Dutch and English) is available which explains the reforms. Subtitles in English are available by clicking the 'T' control on the video control after clicking this link.
[edit] Russia
Following the collapse of the Soviet Union, Russia embarked on a series of reforms intending to deliver better health care by compulsory medical insurance with privately owned providers taking the role of the former state run institutions. According to the OECD [4] none of this worked out as planned and the reforms had in many respects made the system worse. Russia has more physicians, hospitals, and health care workers than almost any other country in the world on a per capita basis,[1][2] but since the collapse of the Soviet Union, the health of the Russian population has declined considerably as a result of social, economic, and lifestyle changes.
[edit] Taiwan
Taiwan changed its health care system in 1995 to a National Health Insurance model similar to the US Medicare system for seniors. As a result, the 40% of Taiwanese people who had previously been uninsured are now covered.[5] It is said to deliver universal coverage with free choice of doctors and hospitals and no waiting lists. Polls in 2005 are reported to have shown that 72.5% of Taiwanese are happy with the system, and when they are unhappy, it's with the cost of premiums (equivalent to less than US$20 a month).[6]
National Health Insurance or NHI premiums is similar to that of social security contributions in the US. Employers and the self-employed are legally bound to pay them. Unlike funds raised via US social security taxes, which can be borrowed in the interim to fund military and other spending, the NHI is a pay-as-you-go system. The aim is for the premium income to pay costs, but there is also a tobacco tax surcharge that goes to the NHI, and contributions from the national lottery.[citation needed]
[edit] United Kingdom
 | This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2009) |
Health care was reformed in 1948 with the creation of the National Health Service or NHS. It was originally established as part of a wider reform of social services and funded by a system of National Insurance, though receipt of health care was never contingent upon making contributions towards the National Insurance Fund. Private health care was not abolished but had to compete with the NHS. About 15% of all spending on health in the UK is still privately funded but this includes the patient contributions towards NHS provided prescription drugs, so private sector health care in the UK is quite small. As part of a wider reform of social provision it was originally thought that the focus would be as much about the prevention of ill-health as it was about curing disease. The NHS for example would distribute baby formula milk fortified with vitamins and minerals in an effort to improve the health of children born in the post war years as well as other supplements such as cod liver oil and malt. Many of the common childhood diseases such as measles, mumps, and chicken pox were mostly eradicated with a national program of vaccinations.
The NHS has been through several reforms since 1948 although it is probably fairer to say that the system has been through phases of evolutionary change. The Conservative Thatcher administrations attempted to bring competition into the NHS by developing a supplier/buyer role between hospitals as suppliers and health authorities as buyers. This necessitated the detailed costing of activities, something which the NHS had never had to do in such detail, and some felt was unnecessary. The Labour Party generally opposed these changes, although after the party became New Labour, the Blair government retained elements of competition and even extended it, allowing private health care providers to bid for NHS work. Some treatment and diagnostic centres are now run by private enterprise and funded under contract. However, the extent of this privatisation of NHS work is still very very small, though remains controversial. The administration committed more money to the NHS raising it to almost the same level of funding as the European average and as a result, there has been a large expansion and mordernisation programme and waiting times are now much more acceptable than they once were.
The government of Gordon Brown has announced several new reforms for care in England. One is to take the NHS back more towards health prevention by tackling issues that are known to cause long term ill health. The biggest of these is obesity and related diseases such as diabetes and cardio-vascular disease. The second reform is to make the NHS a more personal service, and it is negotiating with doctors to provide more services at times more convenient to the patient, such as in the evenings and at weekends. This personal service idea would introduce regular health check-ups so that the population is screened more regularly. Doctors will give more advice on ill-health prevention (for example encouraging and assisting patients to control their weight, diet, exercise more, cease smoking etc.) and so tackle problems before they become more serious. Waiting times, which have already fallen considerably under Blair (median wait time is about 6 weeks for elective non-urgent surgery) are also in focus. The NHS will from December 2008, ensure that no person waits longer than 18 weeks from the date that a patient is referred to the hospital to the time of the operation or treatment. This 18 week period thus includes the time to arrange a first appointment, the time for any investigations or tests to determine the cause of the problem and how it should be treated. An NHS Constitution for England has recently been published which lays out the legal rights of patients as well as promises (not legally enforceable) the NHS strives to keep in England.
[edit] United States
| Health care reform in the United States | ||||||||
|---|---|---|---|---|---|---|---|---|
| General | ||||||||
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The debate over healthcare reform in the United States centers around questions of a right to health care, access, fairness, sustainability, and quality purchased by the high sums spent. The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation, and a greater portion of gross domestic product (GDP) is spent on it than in any other United Nations member state except for East Timor (Timor-Leste).[7] A study of international health care spending levels in the year 2000, published in the health policy journal Health Affairs, found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.[8]
The U.S. is the only wealthy, industrialized nation that does not have a universal health care system, according to the Institute of Medicine of the National Academy of Sciences and others.[9][10] The number of people in America without health insurance coverage at some time during 2006 totaled about 16% of the population, or 47 million people.[11] Of these 47 million uninsured people, nine million or roughly twenty percent, reside in households whose income totals greater than $75,000[12] In addition, many or most of those with insurance are not sufficiently insured[13][14], with high-deductible policies, policies that do have limits on what they will pay for or policies that cost a significant percentage of their income[15].
In spite of the amount spent on health care in the U.S., according to a 2008 Commonwealth Fund report, the United States ranks last in the quality of health care among developed countries.[16] The World Health Organization (WHO), in 2000, ranked the US health care system 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study).[17][18] International comparisons that could lead to conclusions about the quality of the health care received by Americans are subject to debate. The US pays twice as much yet lags other wealthy nations in such measures as infant mortality and life expectancy, which are among the most widely collected, hence useful, international comparative statistics.
[edit] Health Care Reform in U.S. States-Hawaii, Massachusetts
Both Hawaii and Massachusetts have implemented some incremental reforms in health care, but neither state has become completely 100% covered. To date, The U.S. Uniform Law Commission, sponsored by the National Conference of Commissioners on Uniform State Laws has not submitted a uniform act or model legislation regarding health care insurance or health care reform
Whether a universally accessible health care system should be implemented in the U.S. remains a hotly debated political topic. However, even a former executive Wendell Potter of the CIGNA health industry switched sides when time came and now supports reform proposals. He was appalled by many things happening because of the health industry and could no longer stand it. His public testimony can be found here:[1] Reform proposals include the removal of the private health insurance market, the establishment of a "public option," premium subsidies to help individuals purchase health insurance, increased use of health information technology, research and incentives to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices.
A fundamental problem in evaluating reform proposals is the difficulty of estimating their cost and potential impact. In an effort to cut drug costs and potential drug-related toxicities, medical doctors have been instructed by the FDA only to prescribe those medications which are "absolutely indicated" in the management of patient's illnesses. The empirical data and theory underlying cost estimates in this area are limited and subject to debate, increasing the variation between estimates and limiting their accuracy.[19]
Another impediment to implementing any reform that does not benefit insurance companies or the private health care industry is the power of insurance company and health care industry lobbyists in the United States.[20][21] Possibly as a consequence of the power of lobbyists, key politicians such as Senator Max Baucus have taken the option of single payer health care off the table entirely.[22]
Public opinion on health care reform, sometimes called health system reform, suggests a high percentage desire reforms; however, do not want to see their taxes raised. According to The Patient Poll, a study of Pennsylvania adults age 21 and older conducted in July 2008 by The Institute for Good Medicine at the Pennsylvania Medical Society, 63.4 percent believed that the United States should enact some form of universal health care. But, when asked how this care should be funded, only 26.8 percent were willing to have their taxes increased. [23] On a national polling level, similar results were found in a USA TODAY/Gallup Poll that suggested high interest in overhauling the health care system, but less enthusiasm on the funding mechanisms.[24] Another survey of Pennsylvanians conducted in July 2009 through The Patient Poll from The Institute for Good Medicine at the Pennsylvania Medical Society suggests that the majority of Pennsylvania adults (68.2 percent) believe that health care is neither a right nor a privilege, and that both government and individuals bear some degree of responsibility.[25] In 2010, 82% of Obama voters who voted for Brown in Massachusetts support the public option.[26]
The House of Representatives passed a health care reform bill by a vote of 220-215 on November 7, 2009. [27] Currently the fate of the bill rests on the Senate. The legislation once included changes that would give the government the power to negotiate policy premiums and to provide a public option, but in an effort to acquire the necessary votes to prevent a Republican filibuster the public option was eliminated from the bill. This would have given citizens the option to buy into public programs like Medicare for which current members pay only $96.40 monthly.[28] Instead the bill now requires that all Americans purchase private health insurance or be subject to fines. [29] The insurance industry represents a significant lobbying group in the United States. The major health interests have spent an average of $1.4 million per day to lobby Congress so far this year and are on track to spend more than half a billion dollars by the end 2009. [30] This data may be indicative of why the current bill no longer offers a public option. Currently the bill now requires that all Americans purchase private health insurance or be subject to fines.[31]
After the Democrats lost their filibuster proof majority in the Senate, it seems that any reform is far away. Apparently, Anthem Blue Cross (a Health Business Corporation) saw it the same and is about to raise the prices for health insurance on California residents by as much as 39% in a single go. [2]
[edit] Elsewhere
| | This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2009) |
As evidenced by the large variety of different health care systems seen across the world, there are several different pathways that a country could take when thinking about reform. Germany for instance, makes use of sickness funds, which citizens are obliged to join but are able to opt out if they have a very high income (Belien 87). The Netherlands used a similar system but the financial threshold for opting out was lower (Belien 89). The Swiss, on the other hand use more of a privately based health insurance system where citizens are risk-rated by age and sex, among other factors (Belien 90). The United States government provides health care to just over 25% of its citizens through various agencies, but otherwise does not employ a system. Health care is generally centered around regulated private insurance methods.
Also interesting to notice is the oldest health care system in the world and its advantages and disadvantages, see Health in Germany.
[edit] See also
- Health care compared - tabular comparisons of the US, Canada, and other countries not shown above.
- Health care in the United States
- Health care reform in the United States
- Healthcare-NOW!
- Health-care reform in China
- History of the National Health Service - and related national sub-pages such as History of the National Health Service (England)
- Journal of Health Care for the Poor and Underserved
- Kaiser Family Foundation
- List of healthcare reform advocacy groups in the United States
- Massachusetts health care reform
- Matthew effect: sociological disparity of coverage
- Medicare Rights Center
- National health insurance
- National Physicians Alliance
- Progressive Democrats of America
- Puerto Rico Health Reform
- ShoutAmerica
- Single-payer health care
- United States National Health Care Act
- Universal health care
- Universal Health Care Foundation of Connecticut
- Health care politics
[edit] References
- ^ http://www.minvws.nl/en/themes/health-insurance-system/ Ministry of Health, Welfare and Sport
- ^ Wynand P.M.M. van de Ven and Frederik T. Schut, "UniversalMandatory Health Insurance In The Netherlands: AModel For The United States?," Health Affairs, Volume 27, Number 3, May/June 2008
- ^ Helen Garey and Deborah Lorber "Universal Mandatory Health Insurance in The Netherlands: A Model for the United States?," In the Literature, the Commonwealth Fund, May 13, 2008
- ^ OECD: HEALTHCARE REFORM IN RUSSIA: PROBLEMS AND PROSPECTS (2006)
- ^ PBS Taiwan: A New System They Copied From Others
- ^ PBS: Sick Around the World
- ^ WHO (May 2009). "World Health Statistics 2009". World Health Organization. http://www.who.int/whosis/whostat/2009/en/index.html. Retrieved 2009-08-02.
- ^ Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey and Varduhi Petrosyan, "It's The Prices, Stupid: Why The United States Is So Different From Other Countries", Health Affairs, Volume 22, Number 3, May/June 2003. Accessed February 27, 2008.
- ^ Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2007-10-22
- ^ The Case For Single Payer, Universal Health Care For The United States
- ^ "Income, Poverty, and Health Insurance Coverage in the United States: 2006." U.S. Census Bureau. Issued August 2007.
- ^ http://www.census.gov/prod/2008pubs/p60-235.pdf
- ^ Underinsurance in Primary Care: A Report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP) concludes in part, "Of those with insurance for a full year, 36.3% were underinsured."
- ^ Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families—Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007. From the report: "In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses)."
- ^ Report Finds Insurance Coverage Inadequate: Even Those Who Are Insured Struggle Making Medical Payments. From the statement, "Kathleen Stoll, health policy director at the Families USA consumer advocacy group, said 10.7 million insured Americans spend more than a quarter of their annual paychecks on health care."
- ^ Health care in US ranks lowest among developed countries
- ^ World Health Organization assess the world's health system. Press Release WHO/44 21 June 2000.
- ^ Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997
- ^ Sherry Glied, Dahlia K. Remler and Joshua Graff Zivin, "Inside the Sausage Factory: Improving Estimates of the Effects of Health Insurance Expansion Proposals," The Milbank Quarterly, Vol. 80, No. 4, 2002
- ^ Seabrook, Andrea & Overby, Peter (July 23, 2009). "Drug Firms Pour $40 Million Into Health Care Debate." NPR. Retrieved on July 23, 2009.
- ^ Lorber, Jennie (July 21, 2009). "Lobbying Increases as Health Care Debate Intensifies." New York Times. Retrieved on July 23, 2009.
- ^ Eggen, Dan (July 21, 2009). "Industry Cash Flowed To Drafters of Reform; Key Senator Baucus Is a Leading Recipient." Washington Post. Retrieved on July 22, 2009.
- ^ Nation must realize that health care reform isn't free, USA Today, July 17, 2009, p. 6A
- ^ Poll: Americans want health care bill, but not the cost, USA Today, July 14, 2009, http://www.usatoday.com/news/washington/2009-07-13-poll-health-care_N.htm
- ^ Patient Poll Research, Institute for Good Medicine at the Pennsylvania Medical Society, p. 5, July 2009
- ^ Suzy Khimm, "Grijalva: Use Reconciliation to Pass Reform" The New Republic January 20, 2010.
- ^ www.cnn.com/2009/POLITICS/11/07/health.care/index.html
- ^ http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100
- ^ http://news.yahoo.com/s/ap/us_health_care_overhaul
- ^ http://www.healthreformwatch.com/2009/06/27/health-care-reform-lobbyists-and-the-importance-of-being-there/
- ^ http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100
[edit] External links
- European Observatory on Health Systems & Policy at the World Health Organization
- International Network of Health Policy and Reform
- International Resources from Physicians for a National Health Program
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Health care reform in the United States
From Wikipedia, the free encyclopedia
| Health care reform in the United States | ||||||||
|---|---|---|---|---|---|---|---|---|
| General | ||||||||
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The debate over health care reform in the United States centers on questions about whether there is a fundamental right to health care, on who should have access to health care and under what circumstances, on the quality achieved for the high sums spent, the sustainability of expenditures that have been rising faster than the level of general inflation and the growth in the economy, the role of the federal government in bringing about such change, and concerns over unfunded liabilities. In 62 percent of all personal bankruptcy in the United States, medical debt is cited as a factor, the biggest single factor of all.[1][2] This is almost unknown in other countries in the developed world.[3] The United States spends a greater portion of total yearly income in the nation on health care than any United Nations member state except for East Timor (Timor-Leste),[4] although the actual use of health care services in the U.S., by most measures of health services use, is below the median among the world's developed countries.[5]
According to the Institute of Medicine of the United States National Academies, the United States is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage".[6] Americans are divided along party lines in their views regarding the role of government in the health economy and especially whether a new public health plan should be created and administered by the federal government.[7] Those in favor of universal health care argue that the large number of uninsured Americans creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality.[8] Opponents of laws requiring people to have health insurance argue that this impinges on their personal freedom and that other ways to reduce health care costs should be considered.[9] Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care which needs to be protected by their government.[10][11]
Recent reform efforts under the Democratic-controlled 111th Congress and President Barack Obama have focused on the Patient Protection and Affordable Care Act (known as the "Senate bill"), which was passed by the Senate in December 2009. The Senate bill went on to serve as the framework for the health component of the Health Care and Education Affordability Reconciliation Act of 2010. This bill and the Patient Protection and Affordable Care Act passed the House of Representatives on March 21, 2010 by a vote of 219–212.[12]No Republicans supported the bill.[13]
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[edit] Comparisons with other countries
[edit] Costs
[edit] Healthcare
Current figures estimate that spending on health care in the U.S. is about 16% of its GDP.[14][15] In 2007, an estimated $2.26 trillion was spent on health care in the United States, or $7,439 per capita.[16] Health care costs are rising faster than wages or inflation, and the health share of GDP is expected to continue its upward trend, reaching 19.5 percent of GDP by 2017.[14] In fact, government health care spending in the United States is consistently greater, as a portion of GDP, than in Canada, Italy, the United Kingdom and Japan (countries that have predominantly public health care).[17] And an even larger portion is paid by private insurance and individuals themselves. A recent study found that medical expenditure was a significant contributing factor in 62 percent of personal bankruptcies in the United States during 2007.[18]
The U.S. spends more on health care per capita than any other UN member nation.[4] It also spends a greater fraction of its national budget on health care than Canada, Japan, Germany or France. In 2004, the U.S. spent $6,102 per capita on health care, 92.7% more than any other G7 country, and 19.9% more than Luxembourg, which, after the U.S., had the highest spending in the Organisation for Economic Co-operation and Development (OECD).[19] Although the U.S. Medicare coverage of prescription drugs began in 2006, most patented prescription drugs are more costly in the U.S. than in most other countries. Factors involved are the absence of government price controls, enforcement of intellectual property rights limiting the availability of generic drugs until after patent expiration, and the monopsony purchasing power seen in national single-payer systems.[20] Some U.S. citizens obtain their medications, directly or indirectly, from foreign sources, to take advantage of lower prices.
A study of international health care spending levels in the year 2000, published in the health policy journal Health Affairs, found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.[5]
The Congressional Budget Office has argued that the Medicare program as currently structured is unsustainable without significant reform, as tax revenues dedicated to the program are not sufficient to cover its rapidly increasing expenditures. Further, the CBO also projects that "total federal Medicare and Medicaid outlays will rise from 4 percent of GDP in 2007 to 12 percent in 2050 and 19 percent in 2082 — which, as a share of the economy, is roughly equivalent to the total amount that the federal government spends today. The bulk of that projected increase in health care spending reflects higher costs per beneficiary rather than an increase in the number of beneficiaries associated with an aging population."[21] The Government Accountability Office reported that the unfunded liability facing Medicare as of January 2007 was $32.1 trillion, which is the present value of the program deficits expected for the next 75 years in the absence of reform.[22] According to the Centers for Medicare and Medicaid Services, spending on Medicare will grow from approximately $500 billion during 2009 to $930 billion by 2018. Without changes, the system is guaranteed "to basically break the federal budget," Obama said at a White House news conference July 22.[23]
A new study (published December 15, 2009 in Proceedings of the National Academy of Sciences) from authors at Duke University, National Council of Spinal Cord Injury Association, Brigham Young University, and North Carolina State University shows that it might be more accurate to think of health care spending as an investment that can spur economic growth. The study also shows that government projections of health care costs and financing may be unduly pessimistic.[24]
[edit] Prescription drug prices
During the 1990s, the price of prescription drugs became a major issue in American politics as the prices of many new patented drugs increased sharply, and many citizens discovered that neither the government nor their insurer would pay the monopoly price of such drugs. In absolute currency, the U.S. spends the most on pharmaceuticals per capita in the world. However, national expenditures on pharmaceuticals accounted for only 12.9% of total health care costs, compared to an OECD average of 17.7 percent (2003 figures).[25] Some 23% of out-of-pocket health spending by individuals is for prescription drugs.[26]
[edit] Impact on U.S. economic productivity
On March 1, 2010, billionaire Warren Buffett (who is considered one of the world's most savvy investors[27]) said that the high costs paid by U.S. companies for their employees' health care put them at a competitive disadvantage. He compared the roughly 17 percent of GDP spent by the U.S. on health care with the nine percent of GDP spent by much of the rest of the world, noted that the U.S. has fewer doctors and nurses per person, and said, "[t]hat kind of a cost, compared with the rest of the world, is like a tapeworm eating at our economic body."[28]
[edit] Quality of care
Average Life expectancy in the United States is 78.11 years, lower than in some other countries.[29] For 2006-2010, the U.S. life expectancy will lag 38th in the world, after most developed nations, lagging last of the G7 (Canada, France, Germany, Italy, Japan, U.K., U.S.) and just after Chile (35th) and Cuba (37th).[30]
The U.S. also has a worse infant mortality rate, 6.26 per 1000 live births compared to 5.72 for the European Union.[31] The Center for Disease Control and Prevention (CDC) suggests that higher rates of infant mortality in the U.S. are "due in large part to disparities which continue to exist among various racial and ethnic groups in this country, particularly African Americans".[32] Some studies claim the data collected regarding infant mortality and life expectancy do not lend themselves to fair comparison, as there may be differences in whether patients seek help, their ethnic background, diet, lifestyle, and the specific legal definition of a live birth.[33]
In 2000, the World Health Organization (WHO) ranked the U.S. health care system 37th in overall performance, right next to Slovenia, and 72nd by overall level of health (among 191 member nations included in the study).[34][35] The WHO study has been criticized by the free market advocate David Gratzer because "fairness in financial contribution" was used as an assessment factor, marking down countries with high per-capita private or fee-paying health treatment.[36] One study found that there was little correlation between the WHO rankings for health systems and the satisfaction of citizens using those systems.[37] Some countries, such as Italy and Spain, which were given the highest ratings by WHO were ranked poorly by their citizens while other countries, such as Denmark and Finland, were given low scores by WHO but had the highest percentages of citizens reporting satisfaction with their health care systems.[37] WHO staff, however, say that the WHO analysis does reflect system "responsiveness" and argue that this is a superior measure to consumer satisfaction, which is influenced by expectations.[38]
The United States ranked last across a range of measures of health care in a comparison of 19 industrialized countries, despite spending more than twice as much per person on health as any other of the countries.[39] The 2007 comparison by the Commonwealth Fund of health care in the U.S. with that of Germany, Britain, Australia, New Zealand, and Canada, the U.S. ranked last on measures of quality, access, efficiency, equity, and outcomes. This was attributed firstly to the lack of universal insurance, but also due to slow adoption of information technology and a lack of national policies to improve performance.[40] A followup in 2008 found that the U.S. had improved in some areas, but remained in last place because the other countries were improving more quickly.[39]
Another metric used to compare the quality of health care across countries is Years of potential life lost (YPLL). By this measure, the United States comes third to last in the OECD for women (ahead of only Mexico and Hungary) and fifth to last for men (ahead of Poland and Slovakia additionally), according to OECD data. Yet another measure is Disability-adjusted life year (DALY). According to Jonathan Cohn, health care scholars prefer these more "finely tuned" statistical measures for international comparisons in place of the relatively "crude" infant mortality and life expectancy.[41]
The U.S. system is often compared with that of its northern neighbor, Canada. Canada's system is largely publicly funded. In 2006, Americans spent an estimated $6,714 per capita on health care, while Canadians spent US$3,678.[42] This amounted to 15.3% of U.S. GDP in that year, while Canada spent 10.0% of GDP on health care. The Canadian system has been criticized regarding long wait times — 5.5 weeks for oncology and 40 weeks for orthopedic surgery — and provincial health ministers announced a plan to reduce these to four weeks for radiation therapy for cancer and 26 weeks for hip replacement surgery.[43] A 2007 review of all studies comparing health outcomes in Canada and the U.S. found that the quality of care in Canada is at least as good as that in the U.S.[44]
[edit] Uninsured
According to the U.S. Census Bureau, people in the U.S. without health insurance coverage at some time during 2007 totaled 15.3% of the population, or 45.7 million people.[45][46] According to the Census Bureau, this number decreased slightly from 47 million in 2006 due to increased publicly sponsored coverage in addition to the fact that about 300,000 more people were covered in Massachusetts under the Massachusetts health care reform law in 2007.[47] In 2009, the Census Bureau estimated that there are 47 million Americans who do not have any health insurance at all.[48] Other studies, which complement the Census Bureau and include data from the Agency for Healthcare Research and Quality, have placed the number of uninsured for all or part of the years 2007-2008 as high as 86.7 million, about 29% of the U.S. population, or about one-in-three among those under 65 years of age.[49][50]
It is estimated that the current economic downturn and rising unemployment rate likely will have caused the number of uninsured to grow by at least 2 million in 2008.[47][49] Fareed Zakaria wrote that only 38% of small businesses provide health insurance for their employees during 2009, versus 61% in 1993, due to rising costs.[51]
During September 2009, Senator Dick Durbin (D-IL) stated that the average family pays an additional $1,000 per year in insurance premiums to cover the uninsured.[52] President Barack Obama, in his September 9 remarks to a joint session of Congress on health care, called the cost of uninsured Americans "a hidden and growing tax."[53] However, CBO found that while broadening insurance coverage might lead to less cost shifting, "that effect would probably be relatively small and would not directly produce net savings in national or federal spending on health care."[54] The Pacific Research Institute, a conservative think tank, argues that the uninsured subsidize the insured, do not drive up the cost of health care, and use fewer services than the insured.[55] A 2004 editorial in USA Today asserted that United States Department of Health and Human Services (HHS) data show the uninsured are unfairly billed for services at rates far higher — on average 305 percent at urban hospitals in California — than are the insured; USA Today concluded that "millions of [uninsured patients] are forced to subsidize insured patients."[56] According to the editorial:
Many hospitals say they have to charge the uninsured high 'sticker prices' or risk violating a federal ban on charging Medicare patients more than other customers. Hospitals also must try to collect what patients owe, or they could lose Medicare reimbursement for bad debts, notes a 2003 study by the Commonwealth Fund, a health-policy-research foundation.[56]
The Boston Globe reported that, since Massachusetts mandated the uninsured to purchase insurance, emergency visits and costs have increased;[57] insurance premiums have increased faster than the rest of the United States, and are now the highest in the country.[58] Writing in the New York Times opinion blog "Room for Debate", the single-payer health care advocate Marcia Angell, former editor-in-chief of the New England Journal of Medicine, described the Massachusetts mandates as "a windfall for the insurance industry" and wrote, "Premiums are rising much faster than income, benefit packages are getting skimpier, and deductibles and co-payments are going up."[59] Michael Cannon of the Cato Institute, a conservative libertarian think tank, writes that Massachusetts' law mandating that everyone buy insurance has reportedly caused costs there to increase faster than in the rest of the country,[60] and argues that without the uninsured, "The insured would pay more, not less."[61]
A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States associated with uninsurance,[62][63] and more broadly, the total number of people in the United States, whether insured or uninsured, who die because of lack of medical care were estimated in a 1997 analysis to be nearly 100,000 per year.[64] In a study by the Manhattan Institute, a conservative think tank, Frank R. Lichtenberg of Columbia University found that the correlation between life expectancy and health insurance was not statistically significant.[65] He did find that access to advanced drugs (newly approved by the FDA) had a statistically significant correlation with higher rates of life expectancy.
[edit] History of reform efforts
The U.S. system already has substantial public components. The federal Medicare program covers nearly 45 million elderly and some people with disabilities. The Military Health System, TRICARE, and the Veterans Health Administration cover more than 9.2 million active military personnel and veterans and their families.[66][67] The federal-state Medicaid program provides coverage to the poor. The State Children's Health Insurance Program (SCHIP) extends coverage to low-income families with children. Native Americans are covered on the reservation (by tribal hospital). Members of many American Indian tribes or Alaskan Native communities are covered by the Indian Health Service pursuant to treaties, laws, or executive orders, but coverage is rarely equivalent to private insurance, with one-third less funding than the average American per capita and one-half that of American prisoners.[68] Merchant marines were eligible for publicly funded care through the Marine Hospital Service (later renamed Public Health Service from 1798 until the program was shut down by Ronald Reagan in 1981.[69]
Health reform became a coordinated movement during the unsuccessful 1912 campaign of progressive candidate Theodore Roosevelt. Franklin D. Roosevelt attempted to make a national health insurance program part of Social Security, but deferred action until 1944, when he endorsed the Wagner–Murray–Dingell Bill. After Roosevelt's death in 1945, Harry S. Truman continued support of an expanded bill, but was defeated by lobbying from the American Medical Association, conservatives opposed to labor unions, and refocusing of concerns after the outbreak of the Korean War. In October 1949, Congress adjourned without acting on S. 1679 and H.R. 4312.[70][71][72][73]
Debate continued along party lines, with Republicans favoring a voluntary choice of government or private insurance for those over 65, and Democrats seeking to create a national healthcare benefit. By 1964, one-half of those over 65 lacked health insurance. The Medicare program was established by legislation signed into law on July 30, 1965, by President Lyndon B. Johnson, as a part of his "Great Society".[70] Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people age 65 and over, or who meet other special criteria.
In his 1974 State of the Union address, President Richard M. Nixon called for comprehensive health insurance.[74] On February 6, 1974, he introduced the Comprehensive Health Insurance Act. Nixon's plan would have mandated employers to purchase health insurance for their employees, and provided a federal health plan, similar to Medicaid, that any American could join by paying on a sliding scale based on income.[75][76] The New York Daily News wrote that Ted Kennedy rejected the universal health coverage plan offered by Nixon because it wasn't everything he wanted it to be. Kennedy later realized it was a missed opportunity to make major progress toward his goal.[77]
Former President Jimmy Carter wrote in 1982 that Kennedy's disagreements with Carter's proposed approach thwarted Carter's efforts to provide a comprehensive health-care system for the country.[78]
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment.[79]
Health care reform was a major concern of the Clinton administration; however, the 1993 Clinton health care plan, developed by a group headed by First Lady Hillary Clinton, was not enacted into law. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) made it easier for workers to keep health insurance coverage when they change jobs or lose a job, and also made use of national data standards for tracking, reporting and protecting personal health information.[80]
During the 2004 presidential election, both the George W. Bush and John Kerry campaigns offered health care proposals.[81][82] As president, Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act, which included a prescription drug plan for elderly and disabled Americans.[83]
In February 2009, President Barack Obama signed a re-authorization of the State Children's Health Insurance Program, which extended coverage to millions of additional children, and the American Recovery and Reinvestment Act which included funding for computerized medical records and preventive services.
[edit] Public policy debate
[edit] Public funding
Issues regarding publicly funded health care are frequently the subject of political debate.[84] Whether or not a publicly funded universal health care system should be implemented is one such example.[85]
Jonathan Oberlander, Associate Professor of Health Policy and Management at the University of North Carolina, argues that finding a way to pay for universal coverage is a primary barrier to comprehensive reform.[86] A study published in August 2008 in the journal Health Affairs found that covering all of the uninsured within the existing private-based U.S. health care system would increase national spending on health care by $122.6 billion, which would represent a 5% increase in health care spending and 0.8% of GDP. The impact on government spending could be higher, depending on the details of the plan used to increase coverage and the extent to which new public coverage crowded out existing private coverage.[87]
However, in his April 1, 2009 testimony before the Congressional Forum on National Lessons for Health Reform, Dr. Leonard Rodberg, PhD, of the Urban Studies Dept., Queens College/CUNY, argued that a single-payer national health insurance plan would cost no more than the U.S. is spending now on health care and provide mechanisms for containing the growth in cost — while covering every American with comprehensive health care services.[88]
A fundamental problem in evaluating reform proposals is the difficulty estimating their cost and potential impact. Because proposals often differ in many important details, it is difficult to provide meaningful side-by-side cost comparisons. The empirical data and theory underlying cost estimates in this area are limited and subject to debate, increasing the variation between estimates and limiting their accuracy.[89]
[edit] Insurer competition and public alternative
According to economist and former US Secretary of Labor Robert Reich, only a "big, national, public option" can force insurance companies to cooperate, share information, and reduce costs. He has said that scattered, localized, "insurance cooperatives" are too small to do that and are "designed to fail" by the moneyed forces opposing Democratic health care reform.[90][91]
In 2009 the Congressional Budget Office found that the inclusion of a strong public option would lower the cost of health care reform in the U.S. by tens of billions of dollars.[92]
Another approach to increase competition was to propose the repeal of an antitrust exemption for insurance companies. A bill to this end was proposed by Senator Patrick Leahy and others in 2007.[93] A 2009 bill introduced by Representative Tom Perrielo was passed by the House of Representatives by a vote of 406 to 19.[94]
[edit] Delivery and payment systems
A variety of general and specific reform strategies have been proposed regarding the healthcare delivery and payment systems. Examples include: comparative effectiveness research; independent review panels; doctor's incentives; tax reform; prevention and wellness; insurance company anti-trust reforms; coverage mandates; tort reform; rationing of care; health care technology and process standardization; and single-payer payment processing.[95][96]
Surgeon Atul Gawande wrote in The New Yorker that the Senate and House bills passed contain a variety of pilot programs that may have a significant impact on cost and quality over the long-run, although these have not been factored into CBO cost estimates. He stated these pilot programs cover nearly every idea healthcare experts advocate, except malpractice/tort reform. He argued that a trial and error strategy, combined with industry and government partnership, is how the U.S. overcame a similar challenge in the agriculture industry in the early 20th century.[97]
Peter Orszag has suggested that behavioral economics is an important factor for improving the health care system, but that relatively little progress has been made when compared to retirement policy.[98]
[edit] Lobbying
America's health care industry has spent hundreds of millions of dollars in 2009 alone to block the introduction of public medical insurance and stall other reforms proposed by Obama and others. There are six registered health care lobbyists for every member of Congress.[99] The campaign against health care reform has been waged in part through substantial donations to key politicians. The single largest recipient of health industry political donations and chairman of the Senate Committee on Finance that drafted Senate health care legislation is Senator Max Baucus (D-MT).[100] A single health insurance company, Aetna, has contributed more than $110,000 to one legislator, Senator Joe Lieberman (ID-CT), in 2009.[101]
Economists Katherine Baicker, who was a member of President George W. Bush's Council of Economic Advisers,[102] and Amitabh Chandra argue that five "myths" about the US health care system hinder reform efforts. While each has a "kernel of truth," they oversimplify complicated issues to the point where they are "false or misleading." The myths they identify include "The Problem With The Health Insurance System Is That Sick People Without Insurance Can't Find Affordable Policies" and "Covering The Uninsured Pays For Itself By Reducing Expensive And Inefficient Emergency Room Care"[103]
[edit] Public opinion
Survey research in recent decades has shown that Americans generally see expanding coverage as a top national priority, and a majority express support for universal health care.[104] There is, however, much more limited support for tax increases to support health care reform.[104][105][106] Roughly two-in-three (64%) of Americans report they are "very or completely satisfied with their plan".[107] As of 2009, 58% supported a national health plan "in which all Americans would get their insurance through an expanded, universal form of Medicare-for-all"[108] but only 47% supported one "in which all Americans would get their insurance from a single government plan."[109] Polls of public support for a government-run insurance plan to compete with private insurers, the so-called "public option", have varied widely between 40% to 83% in support of such a plan, depending on the particular poll.[110] One polling analyst, Nate Silver, recommends the Time/SRBI and Quinnipiac polls as being most accurately phrased, which narrows down support to 56-62%.[111]
In an article published in the May/June 2008 issue of Health Affairs, pollsters William McInturff and Lori Weigel concluded that the current health care debate is very similar to that of the early 1990s, when the 1993 Clinton health care plan was under consideration. Similarities noted by the authors include a strong desire for change, a weakening economy, and an increased willingness to accept a larger governmental role in health care. New factors include high military spending and a higher burden placed on businesses by health care costs. However, the authors argue that many of the barriers to reform that existed in the early 1990s are still in play, including a strong resistance to government as the sole provider of care ("'I like national health insurance,' patiently explained one focus-group respondent. 'I just don't want the government to run it.'"). The authors conclude that incremental change appears more likely than wholesale restructuring of the system.[112]
A poll released in March 2008 by the Harvard School of Public Health and Harris Interactive found that Americans are divided in their views of the U.S. health system, and that there are significant differences by political affiliation. When asked whether the U.S. has the best health care system or if other countries have better systems, 45% said that the U.S. system was best and 39% said that other countries' systems are better. Belief that the U.S. system is best was highest among Republicans (68%), lower among independents (40%), and lowest among Democrats (32%). Over half of Democrats (56%) said they would be more likely to support a presidential candidate who advocates making the U.S. system more like those of other countries; 37% of independents and 19% of Republicans said they would be more likely to support such a candidate. 45% of Republicans said that they would be less likely to support such a candidate, compared to 17% of independents and 7% of Democrats.[113][114] Differing levels of satisfaction with the current system result in differences in the preferred policy solutions of Democrats and Republicans. Democrats are more likely to believe that the primary responsibility for ensuring access to health care should fall on government, while Republicans are more likely to see health care as an individual responsibility, and are more likely to believe that private industry is more effective in providing coverage and controlling cost than government. Democrats are more likely to support higher taxes to expand coverage, and more likely to require everyone to purchase coverage.[115]
A 2008 survey of over 2000 doctors published in Annals of Internal Medicine, shows that physicians support universal health care and national health insurance by almost 2 to 1.[116]
A CBS News/New York Times poll taken in April 2009 found that health care is the most important issue after the economy, and that 57 percent of Americans are willing to pay higher taxes for universal health care, compared to 38 percent that are not. Also 54 percent of Americans feel that providing health insurance for all is more important than the problem of keeping health costs down (49 percent).[117]
A Pew Research Center poll issued in June 2009 found that "[m]ost Americans believe that the nation's health care system is in need of substantial changes."[118] However, the survey found that, compared to the early 1990s when the Clinton Health Reform plan was being considered, fewer Americans believed the country was spending too much on health care, fewer believed that the health care system was in crisis, and fewer supported a complete restructuring of the system.[118] Most supported extending coverage to the uninsured and slowing the increase in health care costs, but neither issue found the same level of support as they did in 1993.[118] "[F]ar fewer [said that] health care expenses are a major problem for themselves and their families than was the case in 1993."[118]
A Time Magazine poll from July 2009 asked respondents if they would favor a "national single-payer plan similar to medicare for all" from Congress. The survey found 49% in support with 46% opposed and 5% unsure.[119]
In an August 2009 poll, SurveyUSA showed the majority of Americans (77%) feel that it is either "Quite Important" or "Extremely Important" to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance."[120]
In 2010, 82% of Obama voters who voted for Scott Brown in Massachusetts support the public option.[121]
[edit] State-level reform efforts
A few states have taken serious steps toward universal health care coverage, most notably Minnesota, Massachusetts, and Connecticut, with a recent example being the Massachusetts 2006 Health Reform Statute.[122] The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked primary-care physicians who were already in short supply in Massachusetts.[123] In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving health care coverage of 98% of its residents by 2014.[124] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy.
Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California in 1994,[125] Massachusetts in 2000, and Oregon in 2002.[126] The state legislature of California has twice passed SB 840, The Health Care for All Californians Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger (R) vetoed the bill, once in 2006 and again in 2008.[127][128][129]
The percentage of residents that are uninsured varies from state to state. Texas has the highest percentage of residents without health insurance at 24%.[130] New Mexico has the second highest percentage of uninsured at 22%.[130]
States play a variety of roles in the health care system including purchasers of health care and regulators of providers and health plans,[131] which give them multiple opportunities to try to improve how it functions. While states are actively working to improve the system in a variety of ways, there remains room for them to do more.[132]
San Francisco has established a program to subsidize medical care for certain uninsured residents (Healthy San Francisco).
[edit] Health reform and the 2008 presidential election
 | Wikisource has original text related to this section: |
Both of the major party presidential candidates offered positions on health care.
John McCain's proposals focused on open-market competition rather than government funding. At the heart of his plan were tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan."[133]
Barack Obama called for universal health care. His health care plan called for the creation of a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.[134][135][136]
The Philadelphia Inquirer reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance."[137] The Des Moines Register characterized the plans similarly.[138]
A poll released in early November 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the Iraq War. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.[139]
[edit] Federal proposals during the Obama administration
There have been a number of different health care reforms proposed during the Obama administration to improve the U.S. health care system. These include variety of specific types of reform ranging from increased use of health care technology through changing the anti-trust rules governing health insurance companies and tort reform to rationing of care. The Obama administration has suggested a package of reforms, as have several Congressional legislative proposals.
The Patient Protection and Affordable Care Act, which originated in the Senate, was passed by the House of Representatives on March 21, 2010 (with a vote of 219–212).[140][141] An amendment package is planned for separate passage in the Senate by the reconciliation process, which allows the Senate to pass it by a majority vote without possibility of filibuster, but if any additional changes are made in the Senate then the amendment package must return to the House for a separate vote.[140]
[edit] President's plan, 2009
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The President's plan, and arguments on its behalf, are available on the White House website.[142]
During a June 2009 speech, President Barack Obama outlined his strategy for reform. He mentioned electronic record-keeping; preventing expensive conditions; reducing obesity; refocusing doctor incentives from quantity of care to quality; bundling payments for treatment of conditions rather than specific services; better identifying and communicating the most cost-effective treatments; and reducing defensive medicine.[143]
Obama further described his plan in a September 2009 speech to a joint session of Congress. His plan mentions: deficit neutrality; not allowing insurance companies to discriminate based on pre-existing conditions; capping out of pocket expenses; creation of an insurance exchange for individuals and small businesses; tax credits for individuals and small companies; independent commissions to identify fraud, waste and abuse; and malpractice reform projects, among other topics.[144][145]
[edit] President's plan, 2010
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On February 22, 2010, Obama released his plan for health care reform. In his plan he outlines the key elements on which he wants to focus. Key elements of his plan are: policies to improve the affordability and accountability; policies to crack down on waste, fraud and abuse; policies to contain costs and ensure fiscal sustainability; and other policy improvements.[146]
On February 25 Obama held a Bipartisan Health Care Summit at the Blair House. Among the topics discussed were the rising costs of health care and unfair insurance practices. There were several issues that Republicans and Democrats shared agreement on, such as: Preventing waste and fraud in Medicare and Medicaid; addressing medical malpractice reform; reforming the insurance market; and giving individuals more choices in coverage, and giving small businesses the opportunity to pool coverage for their employees.[147] One of the disagreements discussed was the call from Republicans to throw out the current bill and start over. President Obama said he doesn't want to scrap a year's worth of work and start over saying "the millions of Americans that are suffering can't afford another year-long debate. There's too much at stake."[147]
On March 2 Obama sent a letter to Speaker of the House Nancy Pelosi, Senator Harry Reid, Senator Mitch McConnell, and Representative John Boehner. In the letter he referenced four Republican ideas that he thought deserved to be explored more. Those ideas were: random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs; expanding the proposed grants of $23 million to $50 million for states that demonstrate alternatives to resolving medical malpractice disputes; increasing Medicaid payments to doctors; and the possibility of expanding Health Savings Accounts, and making clearer language in the President's proposal to allow for high deductible plans.[148] He also spoke of provisions in the legislation that he felt should not be in there, such as the Medicare Advantage provision that provided transitional extra benefits to Florida residents, and the Nebraska FMAP provision which would have covered that state's expanded Medicare coverage in perpetuity.[148][149]
On March 8, in Glenside, Pennsylvania, Obama gave a speech entitled "Fighting for Health Insurance Reform", in which he restated the country's need for a sustainable health care system. He explained why he believes health insurance reform is a necessity and called on Congress to put aside politics and hold a final up-or-down vote on reform.[150]
[edit] Congressional proposals
Summary of differences between proposed Health Reform Bills| H.R. 3962, Affordable Health Care for America Act "House bill" | H.R. 3590, Patient Protection and Affordable Care Act "Senate bill" | |
|---|---|---|
| Financing | Places a 5.4% surtax on incomes over $500,000 for individuals and $1,000,000 for families.[151] | Increases the Medicare payroll tax from 1.45% to 2.35% on incomes over $200,000 for individuals and $250,000 for families.[151] |
| Abortion | Insurance plans that cover abortions (except those already allowed by the Hyde Amendment) will not be eligible for federal subsidies.[152][153] | Insurance plans that participate in the newly-created exchanges will be permitted to include abortion coverage, but a separate payment, not using federal funds, must be made for the portion of the premium attributable to abortion coverage.[154][153] Each state will have the option to exclude plans covering abortions from their insurance exchange.[154][155] |
| Public option | Yes.[151] | No. Instead, the federal government will mandate that newly-created State insurance exchanges include at least two national plans that are created by the Office of Personnel Management. Of these two national plans, at least one will have to be a private non-profit plan.[156][157] |
| Insurance exchanges | A single national insurance exchange will be created to house private insurance plans as well as a public option. Individual states could run their own exchanges under federal guidelines.[156][155] | Each state will create its own insurance exchange under federal guidelines.[155] |
| Medicaid eligibility | Expanded to 150% of the federal poverty level[151] | Expanded to 133% of the federal poverty level[151] |
| Illegal immigrants | They are allowed to participate in the insurance exchanges, but cannot receive federal subsidies. | They cannot participate in the exchange or receive subsidies. |
| CBO estimate of outlays | $1,050 billion dollars over 10 years.[156] | $871 billion dollars over 10 years.[156] |
| CBO estimate of proposal's net effect | Deficit would be reduced a total of $138 billion 2010-2019 after tax receipts and cost reductions.[158] | Deficit would be reduced a total of $132 billion 2010-2019 after tax receipts and cost reductions.[159] |
| Takes effect | November 22, 2010 | December 26, 2011 |
Currently, there are two major proposals being considered in Congress.
On November 7, 2009, the House passed their version of a health insurance reform bill, the Affordable Health Care for America Act, 220-215.
On December 24, 2009, the Senate passed their version, the Patient Protection and Affordable Care Act, 60-39.[160]
The two bills are similar in a number of ways. In particular, both bills:[161]
- Expand Medicaid eligibility up the income ladder (to 133% of the poverty line in the Senate bill and 150% in the House bill).[citation needed]
- Establish health insurance exchanges, and subsidize those making up to 400 percent of the poverty line[citation needed]
- Offer tax credits to certain small businesses (under 25 workers) who provide employees with health insurance[citation needed]
- Impose a penalty on employers who do not offer health insurance to their workers[citation needed]
- Impose a penalty on individuals who do not buy health insurance[citation needed]
- Offer a new voluntary long-term care insurance program[citation needed]
- Pay for new spending, in part, through cutting Medicare Advantage, slowing the growth of Medicare provider payments, reducing Medicare and Medicaid drug prices, cutting other Medicare and Medicaid spending, and raising various taxes.[citation needed]
- Impose a $2,500 limit on contributions to flexible spending accounts (FSAs), which allow for payment of health costs with pre-tax funds, to pay for a portion of health care reform costs.[162]
The two bills are also similar in that neither would have much, if any, effect on the rising costs experienced by most Americans who currently have private health insurance[citation needed]. Additionally, the seven million Americans with FSAs above $2,500 would see an increase in taxes due to the proposed $2,500 cap on FSA contributions.[163]
The biggest difference between the bills, currently, is in how they are financed. In addition to the items listed in the above bullet point, the House relies mainly on a surtax on income above $500,000 ($1 million for families). The Senate, meanwhile, relies largely on an "excise tax" for high cost "Cadillac" insurance plans, as well as an increase in the Medicare payroll tax for high earners.[164] The Senate Finance Committee approved provisions that would lump FSAs together with high-cost insurance plans and subject them to this excise tax.
Some economists believe the excise tax to be best of the three revenue raisers above, since (due to health care cost growth) it would grow fast enough to more than keep up with new coverage costs, and it would help to put downward pressure on overall health care cost growth.[165]
Unlike the House bill, the Senate bill would also include a Medicare Commission which could modify Medicare payments in order to keep down cost growth. According to the Department of Health and Human Services' Centers for Medicare and Medicaid Services, the Senate bill would increase the share of GDP consumed by medical spending from the current 17% to 20.9% by 2019, compared to 20.8% under current law, primarily as a result of increased insurance coverage under the Act, including extension of coverage to 33 million people currently without insurance.[166]
The bills would need to go to Conference where differences between them may be resolved. If the Joint Conference Committee is able to resolve any differences between each chamber's passed version of comprehensive health care reform, the resulting Committee Report becomes the lead proposal and goes back to each chamber to be voted on by the full-body. The Committee Report, if passed, can then be presented to President Barack Obama for his signature into law or be vetoed back to Congress. Congressional leaders plan to bypass submitting the bills to a conference committee in order to expedite the process.[167]
[edit] Differences in how each chamber determines subsidies
How each bill determines subsidies also differs. Each bill subsidizes the cost of the premium and the out-of-pocket costs but are more or less generous based on the relationship of the family's income to the federal poverty level.
The amount of the subsidy given to a family to cover the cost of a premium is calculated using a formula that includes the family's income relative to the federal poverty level. The federal poverty level is related to a determined percentage that defines how much of that family's income can be put towards a health insurance premium. For instance, under the House Bill, a family at 200% of the federal poverty level will spend no more than 5.5% of its annual income on health insurance premiums. Under the Senate Bill, the same family would spend no more than 6.3% of its annual income on health insurance premiums. The difference between the family's maximum contribution to health insurance premiums and the cost of the health insurance premium is paid for by the federal government. To understand how each bill can affect different poverty levels and incomes, see the Kaiser Family Foundation's subsidy calculator
[edit] Subsidies under House bill
The House plan subsidizes the cost of the plan and out-of-pocket expenses. The cost of the plan is subsidized according to the family's poverty level, decreasing the subsidy as the poverty level approaches 400%. The out-of-pocket expenses are also subsidized according to the poverty level at the following rates. The out-of-pocket expenses are subsidized initially and are not allowed to exceed a particular amount that will rise with the premiums for basic insurance.
| For those making between | This much of the out-of-pocket expenses are covered | And no more than this much will be spent by the individual (family) on out-of-pocket expenses. |
|---|---|---|
| up to 150% of the FPL | 97% | $500 ($1,000) |
| 150% and 200% of the FPL | 93% | $1,000 ($2,000) |
| 200% and 250% of the FPL | 85% | $2,000 ($4,000) |
| 250% and 300% of the FPL | 78% | $4,000 ($8,000) |
| 300% and 350% of the FPL | 72% | $4,500 ($9,000) |
| 350% and 400% of the FPL | 70% | $5,000 ($10,000) |
[edit] Subsidies under Senate bill
The Senate plan subsidizes the cost of the plan and out-of-pocket expenses. The cost of the plan is subsidized according to the family's poverty level, decreasing the subsidy as the poverty level approaches 400%. The out-of-pocket expenses are also subsidized according to the poverty level at the following rates. The out-of-pocket expenses are subsidized initially and are not allowed to exceed a particular amount that will rise with the premiums for basic insurance.
| For those making between | This much of the out of the out-of-pocket expenses are covered |
|---|---|
| up to 200% of the FPL | 66% |
| 200% and 300% of the FPL | 50% |
| 300% and 400% of the FPL | 33% |
The Senate Bill also seeks to reduce out-of-pocket costs by setting guidelines for how much of the health costs can be shifted to families within 200% of the poverty line. A family within 150% of the FPL cannot have more than 10% of their health costs incurred as out-of-pocket expenses. A family between 150% and 200% of the FPL cannot have more than 20% of their health costs incurred as out-of-pocket expenses.
The House and Senate bills would differ, somewhat, in their overall impact. According to Congressional Budget Office estimates, the Senate bill would cover an additional 31 million people, cost nearly $850 billion for coverage provisions over 10 years, reduce the 10-year deficit by $130 billion, and reduce the deficit in the second decade by around 0.25% of GDP. The House bill, meanwhile, would cover an additional 36 million people, cost roughly $1050 billion in coverage provisions, reduce the 10-year deficit by $138 billion, and slightly reduce the deficit in the second decade.[168]
[edit] See also
- McCarran–Ferguson Act United States federal law that exempts health insurance companies from the federal anti-trust legislation that applies to most businesses.
- United States National Health Care Act
- Health care compared - tabular comparisons of the U.S., Canada, and other countries not shown above.
- Health care reform
- Health economics
- Health insurance exchange
- Health policy analysis
- Health care politics
- List of healthcare reform advocacy groups in the United States
- National health insurance
- Medicare Sustainable Growth Rate
- 2010 Barack Obama speech "Fighting for Health Insurance Reform"
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- ^ a b Noam N. Levey and Janet Hook, "House passes historic healtcare overhaul," Los Angeles Times (March 22, 2010).
- ^ "House sends health care overhaul bill to Obama - Yahoo! News". News.yahoo.com. 2010-02-25. http://news.yahoo.com/s/ap/us_health_care_overhaul. Retrieved 2010-03-22.
- ^ – President Barack Obama, February 24, 2009 (2009-02-24). "Health Care | The White House". Whitehouse.gov. http://www.whitehouse.gov/Issues/health-Care. Retrieved 2010-02-05.
- ^ Remarks by the President to the AMA-June 15, 2009
- ^ Summary of Obama Speech-
- ^ Remarks by the President to a Joint Session of Congress on Healthcare-September 2009
- ^ http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf
- ^ a b "A Bipartisan Meeting on Health Reform | The White House". Whitehouse.gov. 2010-02-25. http://www.whitehouse.gov/health-care-meeting/bipartisan-meeting. Retrieved 2010-03-22.
- ^ a b Jesse Lee (2010-03-02). "President Obama Follows Up on Thursday's Bipartisan Meeting on Health Reform | The White House". Whitehouse.gov. http://www.whitehouse.gov/blog/2010/03/02/president-obama-follows-thursdays-bipartisan-meeting-health-reform-0. Retrieved 2010-03-22.
- ^ "Obama's new health care proposal keeps Louisiana Medicaid provision". 74.125.93.132. http://74.125.93.132/search?q=cache:aVSz18GS8BUJ:landrieu.senate.gov/mediacenter/inthenews/02-22-2010-2.cfm+the+Nebraska+FMAP+provision&cd=1&hl=en&ct=clnk&gl=us. Retrieved 2010-03-22.
- ^
- ^ a b c d e Accessed 24 December 2009
- ^ "Health-care reform and abortion coverage: Questions and answers", The Washington Post, November 15, 2009
- ^ a b http://www.npr.org/templates/story/story.php?storyId=121857029&ft=1&f=1001 Accessed 24 December 2009
- ^ a b MacGillis, Alec, Both sides question health bill's abortion compromise,The Washingron Post, Decemper 22, 2009
- ^ a b c Accessed 24 December 2009
- ^ a b c d Accessed 24 December 2009
- ^ Section 1322 of H.R. 3590
- ^ CBO Letter to John Dingle-November 20, 2009
- ^ CBO Letter to Harry Reid-Corrected-December 19, 2009
- ^ Pear, Robert (December 24, 2009). "Senate Passes Health Care Overhaul Bill". The New York Times. http://www.nytimes.com/2009/12/25/health/policy/25health.html?_r=1&hp. Retrieved December 24, 2009.
- ^ http://www.nytimes.com/interactive/2009/11/19/us/politics/1119-plan-comparison.html, http://crfb.org/blogs/updated-health-care-charts
- ^ The Oaklahoman Medical Expense Accounts Could be Limited to $2,500
- ^ Associated Press Flex Spending Accounts Face Hit in Health Overhaul
- ^ http://online.wsj.com/public/resources/documents/st_healthcareproposals_20090912.html, http://crfb.org/blogs/updated-health-care-charts
- ^ http://crfb.org/blogs/understanding-health-insurance-excise-tax, http://crfb.org/blogs/taxing-health-care-decisions
- ^ http://www.politico.com/static/PPM110_091211_financial_impact.html
- ^ http://www.chron.com/disp/story.mpl/ap/washington/6799466.html[dead link]
- ^ "Updated Health Care Charts | Committee for a Responsible Federal Budget". Crfb.org. 2009-11-19. http://crfb.org/blogs/updated-health-care-charts. Retrieved 2010-02-05.
[edit] Further reading
[edit] Books
- Mahar, Maggie, Money-Driven Medicine: The Real Reason Health Care Costs So Much, Harper/Collins, 2006. ISBN 9780060765330
- Starr, Paul, The Social Transformation of American Medicine, Basic Books, 1982. ISBN 0465079342
- Reid, T.R. (2009). The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care. Penquin Books. ISBN 978-1594202346.
[edit] Articles and links
- Comparing Health Care Plans: A Guide to Reform Proposals, Committee for a Responsible Federal Budget
- Doctors support universal health care: survey, Reuters, March 31, 2008 (first reported in Annals of Internal Medicine).
- Health Care Cost Survey Reveals High-Performing Companies Gain Health Dividend (2009) from Towers Perrin
- Hidden costs, value lost: uninsurance in America. Institute of Medicine Committee on the Consequences of Uninsurance. Washington, DC: National Academies Press, 2003.
- Paying More, Getting Less from Dollars & Sense
- Reducing Costs While Improving the U.S. Health Care System: The Health Care Reform Pyramid by Deloitte, January 2009
- Sick Around the World: Can the U.S. learn anything from the rest of the world about how to run a health care system? from Frontline, PBS.
- Barack Obama - Town Hall Transcript - August 11, 2009
- Charlie Rose Show - Interview with Mayo Clinic President & CEO Denis Cortese
- The New Yorker-Atul Gawande-The Cost Conundrum-June 2009
- GAO-U.S. Financial Condition and Fiscal Future Briefing-2008
- President Obama Remarks by the President to a Joint Session of Congress on Health Care September 9, 2009
[edit] External links
- HealthReform.gov official government site
- Health Insurance Reform Reality Check official White House rumor control site
- Health Care from WhiteHouse.gov
- Health Care in America from CNN
- Health Care Hub from C-Span
- Health Care Reform & YouTube from Governing Dynamo, includes nearly all White House videos on health care reform
- Health Care Reform collected news coverage from The New York Times
- Prescriptions for Change collected news coverage from NPR
- Healthcare Reform collected news coverage from Reuters
- Health-Care Reform 2009 collected news coverage from The Washington Post
- In Search of Health Care Reform interactive overview
- Congressional Budget Office official government site
- Estimated Impact of Health Care Reform Proposals from the Centers for Medicare and Medicaid Services
- Office of Management and Budget official government site
- Comparison of House and Senate Health Care bills from Committee for a Responsible Federal Budget group
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