Health Care Reform - Research Paper Example

and Number of the Teacher’s RESEARCH PAPER: HEALTH CARE REFORM INTRODUCTION For nearly a century, Democratic presidents of the United States have unsuccessfully attempted to introduce changes to the nation’s health care system. It is of great significance, that President Barack Obama, the first African American president of the U.S. has succeeded in overhauling the nation’s health care system. He has signed legislation on March 23, 2010 guaranteeing medical insurance coverage to over thirty million Americans who presently lack it. The historically momentous bill signed by President Obama will make more than 95% of Americans eligible for health coverage, “would add 16 million people to the Medicaid rolls; and would subsidize private coverage for low- and middle- income people” (Overview, March 26, 2010). The legislation will ensure that private insurance companies are monitored more closely. Thesis Statement: The purpose of this research paper is to investigate Health Care Reform, and examine its various aspects, both benefits and other implications. DISCUSSION The Health Care Reform Law consist of two bills: HR 3590 the Patient Protection and Affordable Care Act, and HR 4872 the Reconciliation Act of 2010, which make health care affordable and accessible to almost all Americans “and hold the insurance industry accountable” (Sen. Will Espero, April 3, 2010). This will lift America on par with other nations that provide health care to all citizens. Over the next ten years, the law will cost the U.S. government approximately $938 billion. However, extending healh care expenditure over a greater patient base will lower health care costs over the long term. The new law will reduce the deficit by $138 billion in the first ten years, and decrease it by another $1.2 trillion in the following years. On the new reform program, one complication that was expressed for President Obama was that numerous health care plans were circulating on Capitol Hill. Hence, it was easy for the Republican critics to focus on the uncertainty created by the multiple plans, and “to raise people’s fears that reform might make things worse” (Fowler quoted in Manila Bulletin, July 19, 2009). Significantly, health care reform will not adversely impact employment, since increased access would promote the industry, leading to more than sixteen million new customers for health insurance companies. Moreover, it is important to note that although insurance companies have much to lose from the new legislation ensuring public option and tight regulations, several large insurers will be able to function profitably when every American purchases insurance (Schmitt 12). THE DILEMMA OF HEALTH CARE IN AMERICA Numerous interests influence “the definitions of health and disease, the approaches to prevention and treatment, and the financing and organization of health care itself” (Mechanic 17). Most of the problems faced such as high rates of uninsured persons, the uncontrolled rise in new and untested technologies, the decline in primary health care, and neglect of mental health and long term care are a result of the way the American nation organizes itself politically and economically, and how the marketplace is conducive to the growth of every kind of business enterprise. The size and sophistication of America is significantly immense; however, American medicine is developed around local markets and culture, and has an individualized approach. The public’s personal perspective, stories and anecdotes are highlighted, and there is absence of focus on populations and statistics. Policy initiatives to save several anonymous lives at lower costs are vitally required, in place of saving individual lives at great costs. To resolve the health care dilemma, it is essential that “health initiatives should be structured to meet health and well-being in populations, prevent illness and enhance function and physical vitality” (Mechanic 17). Health care initiatives should help to bring equity in society, eliminating social disparities of all kinds including class, race, region, gender, age or financial background. Despite America’s medical technology being of the highest quality, the health care system has been mediocre in every aspect, and too expensive for a major section of the population. Both Medicare and Medicaid were confronted with immense increases in future costs due to new technologies, growing numbers of people enrolled, a confusing network of complex and uncoordinated administrative functions, and an absence of effective care and treatment. Cost-effectiveness and effective outcomes of care were not taken into account while rationing care. The Medicare program attempted to curb costs through a focus on reimbursement approaches were moderated by the political power of “hospitals, health professional groups, and their lobbies” (Mechanic 181). Medicaid is a major cost for the states as well as the federal government, constituting nearly one-fifth of all state expenditures. The location of residence being related to the extent of medical resources available, determines the care one can receive, forming the largest difficulty of the Medicaid program. NEGOTIATIONS TO ACHIEVE HEALTH CARE REFORM Over the past several decades, attempts to reform health care have been blocked by various groups. For example, in the 1940s, doctors opposed the health care reform through the American Medical Association; in the 1990s, small business and insurance organizations led the anti-reform movement. On the other hand, president Obama was confronted with new obstacles such as the opposition to legislation using public fear and political manipulation attempting to stop the bill from passing, or to ensure that it fails to achieve the goal of universal coverage. The new health care reform bill “is a product of delicate and complex maneuvering around not only the outright opponents of reform but also around the fallout from choices made earlier by supporters of reform” (Schmitt 12). Various negotiations with interest groups were necessary, but each came with a cost. As opposed to single-payer health care, the greatest deal, in which participated all the major Democratic presidential candidates and the main pro-reform coalition, Health Care for America Now was to promote “public option” in a system of regulated private insurance. A well-designed public option was expected to become the main source of health insurance for American. This hope drew most of the single-payer constituency to the public option. “This deal may have been necessary for reform, but it nonetheless limits the possibilities” (Schmitt 13). Gorin (p.83) argues in favour of public option similar to Medicare, since a public health plan can control costs better than private health plans can. Further, without competition from a public plan, private plans would have no incentive to curb costs and provide higher value in terms of treatment. However, for this approach to be effective, public and private health care plans have to be on a level playing field. Fair competition should be promoted through including preexisting health conditions, community rating, and techniques of risk assessment. Fair competition between private plans and a public option in a broadly based coalition constitutes Health Care for America Now. The above approach was opposed strongly as extremely radical, and it was warned that a public option would lead to monopoly in health care. However, those opposing this view ignore the reality of growing concentration and consolidation in the private sector. Moreover, despite conservatives’ concerns about an uneven playing field, they did not object when Congress subsidized Medicare Advantage plans at the expense of traditional Medicare. Thus it was concluded that a public option would not destroy the private insurance market or lead to a take-over by the government (Gorin 84). Though the public option approach is meritorious, transition to the new system would be difficult. Competition works both ways, hence to control costs the public plan would have to reimburse providers at lower rates than private plans. If public plan rates were too low, health care providers would refuse to treat patients covered by the plan. To resolve this issue, every American should be given voucher of equal value paying for equally adequate medical coverage. Controlling costs will also be implemented through reducing the volume of service patients receive (Fisher et al 1). A public plan could take the lead in this aspect, but patients cannot be denied treatment available through private plans. Further, health care practitioners in high spending regions may refuse to adjust the volume of their practice. President Obama has proposed increased taxation on individuals with high incomes to fund health care reform, removing wastage from Medicare and Medicaid, and decreased Medicare payment to prescription drug companies. These proposals of the president are likely to meet with fierce resistance, even among his own Democratic party members. Further, with this beginning, the achievement of universal coverage would require hundreds of billions more (Gorin 86). Serious reform would require basic changes, especially in the introduction of limits for spending in the different areas of medical care. But these changes will be difficult to implement since they threaten the medical industry’s income. Though imperfect, the public option approach is the correct one. Although putting it into practice would be difficult, single-payer system would be even more so, “particularly because key segments of the Democratic Party, including the president, do not support it” (Marmor et al 2). On the other hand, contemporary times being difficult and uncertain, with deepening economic crisis, opinion could shift toward a single-payer system. However, it is essential to note that both advocates of single-payer system and those of public option are committed to universal coverage. If the liberals become divided, it will serve only to strengthen the conservatives who oppose both single-payer and public option sytems. This will make future unity more difficult around this or other issues. Hence unity is crucial among the Democrats. Hence, single-payer advocates need to join with progressives insisting on health care reform that includes a public sector plan as part of the combination. Only this strategy will help to achieve universal coevrage.   Further, the White House negotiated with pharmaceutical companies, hospitals, and doctors. Each compromise with lobbyists limited Congress’ freedom to craft a bill more appealing to voters or to spread out coverage more widely at a lower cost. Though the deals were effective in keeping the old enemies of reform at bay, the cost of these negotiations are significant with the implementation of health care reform (Schmitt 13). THE BENEFITS OF HEALTH CARE REFORM Legislation to reform the United States health care system has been possible solely due to the conviction and perseverence of President Obama and the Democratic Congressmen and Congresswomen (Sen. Will Espero April 3, 2010). The president emphasized on the need for “urgent action to control the nation’s spiralling health costs” (Gardner 4). In the absence of corrective action, the country’s deficits would increase, more families would go bankrupt due to high costs of medical treatment, and more businesses would close. Further, greater numbers of Americans would lose their health insurance coverage when they are sick and need it the most, and consequently more number of people would die. Obama’s health care reform plans meet three basic goals: provision of more security and stability to those who have health insurance, provision of insurance to those who do not have health insurance, and slowing the rise of health care costs for families, businesses and the government. Thus, the new legislation will make the following benefits available. Affordable and Quality Health Care for All Americans Health plans will have to provide coverage to people when they get sick. Care cannot be refused to children with pre-existing conditions. Insurance companies will be prevented from discriminating on the basis of pre-existing conditions, health status or gender. Both small businesses and middle class American families will be given the maximum tax cut for health care, in the history of the country’s health care, “through premium tax credits and cost-sharing assistance” (Sen. Will Espero, April 3, 2010). Further, creation of health exchanges as competitive marketplaces will provide individuals and small businesses the capability to purchase affordable health care coverage similar to big businesses. Further, employers offering coverage to retirees aged from 55 to 64 years will be assisted by a reinsurance program. Communuties requiring care to the greatest extent will be supported by the establishment of Community Health Centers. Government regulators will review plans demanding unjustified premium increases; “eligible small businesses would receive a tax credit” (Sen. Will Espero, April 3, 2010); health plans will be unable to place lifetime caps on coverage, and from 2014 onwards health plans will be prohibited from fixing annual limits on coverage. Health Care Reform and Investments in Existing Government Health Programs It will be ensured that the primary care doctors working for Medicare and Medicaid will receive increased remuneration. Relief will be provided to elders facing non-availability of prescription medication. Medicare beneficiaries needing aid will receive a $250 rebate, followed by a 50% discount on brandname drugs , which by 2020 will increase to a 75% discount on brand name and generic drugs. Further, Medicare’s elderly patients will have free annual visits to check their wellness. From 2011, they will be able to avail of free preventive benefits such as screenings for cancer and diabetes. Better quality of care will be provided for senior citizens with at least one chronic condition such as high blood pressure, or diabetes affecting 80% of Medicare patients. Sen. Will Espero (April 3, 2010) adds that to improve overall health and prevent chronic disease, the patient’s payment of cost-share for preventive treatment will be ended. Improvement of Health Care Workforce To increase the number of doctors, nurses and other medical professionals, educational scholarships and loan repayment programs will be provided. Practice in remote areas will be promoted through incentives to primary care health professionals. CONCLUSION This paper has highlighted health care reform and its various dimensions. The dilemma of health care in the United States of America, the negotiations that were needed for getting the legislation through, the importance of public option in a system of regulated private insurance, and its combination with single-payer system, rather than the single-payer system alone, have been examined. Since universal coverage is the optimal outcome achieved by the Bill, the best strategy to achieve the same was considered. It was found that single-payer advocates in unity with progressives, towards health care reform that included a public sector plan as part of the integration, was considered essential. The benefits of the new legislation have been discussed. Besides affordable and quality health care for all Americans, the legislation has brought about investments in existing government health programs, and a focus on improving health care workforce. WORKS CITED Fisher, Elliot, Goodman, David, Skinner, Jonathan & Bronner, Kristen. Health care spending, quality and outcomes: More isn’t always better. A Dartmouth Atlas Project topic brief. February 27, 2009. Retrieved on 5th April, 2009 from: http://www.dartmouthatlas.org/atlases/Spending_Brief_022709.pdf Gardner, David. Obama’s battlecry for healthcare reform. The Daily Mail. September 10, 2009. Retrieved on 4th April, 2010 from: http://www.questia.com/read/5032791700 Marmor, Theodore, Oberlander, Jonathan & White, Joseph. The Obama administration’s options for health care cost control: Hope vs. reality. Annals of Internal Medicine, 150.7.pp.1-6. Retrieved on 5th April, 2010 from: http://www.annals.org/content/150/7/485.full.pdf+html Mechanic, David. The truth about health care: Why reform is not working in America. New Jersey: Rutgers University Press. (2006). Overview. Health care reform. Updated March 26, 2010. The New York Times. Monday, April 5, 2010. Retrieved on 3rd April, 2010 from: http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html Sen. Will Espero. Health care reform: A historical vote in Washington. Health. Hawaii 24/7. April 3, 2010. Retrieved on 4th April, 2010 from: http://www.hawaii247.org/2010/04/03/health-care-reform-a-historical-vote-in-washington/ Schmitt, Mark. The obstacles to real health-care reform. The American Prospect, 20.9 (November, 2009): pp.12-15. The Manila Bulletin. Healthcare reform not easy. July 19, 2009. Retrieved on 5th April, 2010 from: http://www.questia.com/read/5030343501 Read More