Americans seem to agree that the nation’s health care system is sick. Do Congress and the new administration have the will—and finances—to cure it?
By Peggy Hathaway
In Washington, many people are hopeful that major health care reform will be enacted in the 111th Congress that begins this month. Both President-elect Obama and Congressional leaders have committed to fixing our broken health care system.
Affordable accessible health care for all Americans is seen not only as a moral imperative but also as essential to solving our economic problems.
As people lose their jobs and are forced into poverty and as employers are forced to choose between eliminating jobs or health insurance, states have much greater demands on limited Medicaid dollars—even as states are struggling with staggering budget deficits. Lack of universal health care hurts America’s international competitiveness. American businesses who have growing health care costs have a hard time competing with foreign businesses that do not have such costs because their countries provide health care for all citizens.
Health care costs in America are rising dramatically. Both total US health care costs and employer health care costs are rising at more than twice the rate of inflation (source: National Health Care Coalition, Facts on Health Care Costs, 2008. www.nchc.org/facts/ cost.shtml).
In the US, we spend far more on health care than other industrialized countries—even though over 46 million Americans lack health insurance whereas other industrialized countries provide health benefits to all citizens. In 2005 in the US, 16% of our gross domestic product was spent on health care, compared to 10.7% in Germany and 9.7% in Canada in recent years.
Momentum for Reform is Growing
When President-elect Obama announced former Senate Majority Leader Tom Daschle as nominee for Secretary of Health and Human Services, Obama also made Daschle head of a new White House Office of Health Reform. In making the announcement, Obama committed to modernizing our health care system, reducing costs for families and businesses, and providing affordable, accessible health care for all Americans. Daschle, who wrote a book on health care reform (Critical: What We Can Do About the Health Care Crisis, with Jeanne M. Lambrew and Scott S. Greenberger) is committed to the issue.
Both Senator Baucus (DMT) and Senator Kennedy (DMA), who chair the key Senate committees that deal with health, and House Speaker Pelosi (D-CA) have promised major health care reform. They are currently with the leading Republicans and the Obama administration to develop a bill that they hope to introduce early in 2009.
On November 12, 2009, Baucus released Call to Action Health Care Reform 2009 (www.finance.senate.gov), a white paper that ignited the momentum towards major health care reform. He invited people to comment on the proposal in order to stimulate debate and help people focus and come together on what they would like to see in a reformed health care system. While acknowledging that the cost for this or a similar proposal will be substantial, Baucus pointed out that “the costs of inaction, both in human and financial terms, will eventually be far greater than any initial outlays.”
What Would Health Care Reform Mean?
There are many proposals for health care reform. While the Baucus proposal is admittedly unlikely to be enacted as outlined in the white paper, it has many elements of health care reform that are included in one proposal or another and are worthy of serious attention.
The Baucus proposal would:
- Guarantee that people and small businesses can buy affordable health coverage:
• help people with low incomes with the costs
• provide tax credits for small businesses give people the right to buy health insurance on equal terms whether or not they have a pre-existing condition
• establish a Health Insurance Exchange where both people and businesses will be able to obtain health care coverage with a variety of choices
• enable people to buy into a new public health insurance plan similar to Medicare - After affordable, good health insurance choices are available to all, require people to have health coverage
- Strengthen public programs:
• phase out the 2-year waiting period for Medicare
• provide Medicaid to all Americans with income up to 100% of the federal poverty level and help states with Medicaid costs
• require states to use the State Children’s Health Insurance Program (SCHIP) for all children at or below a certain income level and help states with the costs - Focus on prevention and wellness:
• make sure that health coverage covers preventive services such as physical exams, immunizations and age-appropriate screenings – whether through public programs or private health coverage -
Reform the health care system to:
• strengthen the role of primary care and chronic care management,
• refocus payments so that doctors and other providers can provide better quality care,
• help medical professionals know and understand what medical treatments and technology work best,
• modernize health information technology to improve health care and make our system more efficient,
• take steps to make sure that we have an adequate number of health care workers who are well trained and educated.
In addition, many people who are concerned about people with disabilities are advocating that:
- Health coverage should include long-term services and supports in the community (rather than in nursing homes) including direct care workers. The Baucus proposal indicates the need to address these issues but does not make specific proposals
- People should have access the right wheelchair and other durable medical equipment that enable people with disabilities to live and work in their communities.
- Doctors and hospitals must have medical equipment that is accessible to people with disabilities (including equipment for routine
examinations and diagnosis such as mammograms).
While it is uncertain what eventual health care reform legislation will provide, it is certain that health care reform will receive serious attention from the Obama administration and Congress in 2009.
Peggy Hathaway is Vice President for Public Policy.
Call to Action Health Care Reform 2009
“If we fail to act, we will double our current national expenditure on health care from $2 trillion to $4 trillion, continue to witness the plight of tens of millions of our citizens without health insurance, shifting costs to those who do, continue to tolerate poor quality that leads to nearly 100,000 deaths a year, and watch our businesses become less competitive and our nation go further into debt. In short, … the cost of inaction, both in human and financial terms, will eventually be far greater than any initial outlays.”
