Minutes ago the United States Senate approved the Patient Protection and Affordable Care Act and sent the legislation to a conference committee with the House of Representatives.
With nearly all of the Senators at their desks and Vice-President Joe Biden presiding, the Senate just voted 60-39 to approve the Patient Protection and Affordable Care Act.
In his closing remarks about the bill, Majority Leader Senator Harry Reid (D-NV) compared the proposed law to Social Security and Medicare, and the analogy is apt. This law, like those two, is landmark legislation that expands the "social safety net." But its significance goes beyond that.
First of all, this bill extends benefits not just to the elderly but to all Americans. The intent of the bill is to help everybody – young families, middle-aged workers, small and large employers – find affordable health care.
Second, the bill creates a mechanism that will allow the government to regulate both the health insurance industry and, by extension, the health care industry. This will be absolutely necessary going forward because the bill itself does not do enough to control the cost of medical care. As a nation we all want to be healthier, and our health care providers have to learn how to deliver medical care with less waste and more efficiency, particularly as our population ages. By controlling how medical care is paid for, these reforms – including preventive care, wellness programs, community health centers, home health care, medical homes, pay-for-performance, and the productivity gains that may be realized through information technology - can help us achieve those goals. The bill lays a foundation that will permit our society to experiment and discover what we have to do to broaden access, improve quality, and reduce costs.
Third, the bill relies on private enterprise to both extend coverage and control costs. To the dismay of liberals, the public option was rejected, and private employers will continue to purchase health insurance for their employees, private medical institutions and professionals will continue to provide the care, and private insurance companies will continue to serve as brokers. This system is more complex than "single-payer," but it promises to harness both the energy of private enterprise and the rigor of the competitive marketplace to ensure that all Americans will receive necessary health care. Let us all hope that it works.
If we fail to enact reform legislation the cost of health care would continue to accelerate faster than our ability to pay for it. The cost of health insurance would continue to grow faster than salaries and wages. As employers absorb ever-increasing health care costs American products would become uncompetitive in the global marketplace. Medicare would go bankrupt and our federal and state governments would face ballooning deficits far into the future. And, most seriously, Americans would live less healthy lives and would die sooner than the people of other industrialized countries who have created more rational and more efficient health care delivery systems.
This is a historic moment for America. We are all in this together, and this legislation will help to move us towards a more just and more equal society.
Visit Professor Huhn's website on health care financing reform for links to information about proposed legislation, studies and reports, public agencies, and private organizations concerned with this issue.
{ 4 comments… read them below or add one }
I think a better comparison than Reid's would be to think of this as a person who has been drinking getting behind the wheel.
The majority think it is a bad idea. They have tried reasoning with them, they have tried shouting. Everything but physically grabbing them and forcing them to listen. But legislator/driver knows better than everyone. They don't have to listen. You can't make them pay attention.
At some point, your only recourse is to hope for the best In spite of everything that you know.
The best example proving that this will not reduce costs is the fact that we will spend the next 3 or 4 years paying for both systems. New taxes will be collected while we continue with the status quo.
At least in the one example you can call the police. Who do we call to stop Congress? My hope is that the 2010 and 2012 elections will play the part of the highway patrol.
Dave,
Do we disagree as to our goals or as to the means of achieving those goals? The three goals of this legislation are to (1) Expand access to health care; (2) Maintain or improve quality of health care; and (3) Control costs.
The principal means of achieving these goals are the following:
1. Individual and perhaps employer mandates to have or provide health insurance – in short, people who can afford health insurance have to purchase it;
2. Public subsidies for people who can't afford health insurance;
3. Expanding Medicaid to at persons earning less than 133% of the federal poverty level;
4. Creating insurance exchanges (pooling mechanisms) for persons to purchase insurance in the non-group market;
5. Regulating health insurance packages to eliminate exclusions for pre-existing conditions and annual and lifetime limits on coverage, and mandating coverage for preventive care;
6. Creating the Basic Plan and creating the Community Health Center Fund to contract with private companies to provide primary care for the poor and people in rural areas.
All of these provisions are contained in the legislation because the Congress is attempting to achieve the three principal goals regarding access, quality, and cost by utilizing the free market system of private health insurers and private health care providers.
If we are in agreement as to the goals that we wish to accomplish, what different means would you propose to achieve those goals?
Control costs? I thought the goal was to lessen costs, make them more in line with the costs over in Europe, which are like a half or a third of the U.S. costs with much better results. The bottom line, I thought you once stated, was the percentage of per capita GDP dedicated to health costs, or something like that. I wonder what that would be under the bills, or has all that gone by the wayside?
I find that the stated goals that you repeat are inconsistent with the legislation passed. It makes me wonder about the actual goals.
But this is one of the problems today. (See your faith & hope post) Speculating about the motives of people that you do not agree with. This is where a lot of the rancor comes from. I can't necessarily tell you why people are wrong, but I can try to point out that they are wrong. But I am digressing.
(1) Expand access-
First, the problem is deliberately overstated. There is a more recent (8 months old +/-) report that raised the number to 47 million. I am more familiar with the earlier report that everyone was quoting in the first half of the year that stated that 45.7 million people were uninsured, at some point, in 2007. At some point is huge, but was left out of virtually all reporting. It was not defined in the report, but I understand that 'at some point' could be a period as short as a month. In theory the problem could be 1/12th as large. So the problem is between 45 million and 4 million, quite a range. It isn't even debated that some of those counted were eligible for schip or medicare and would have been signed up had they arrived a medical office. So they were 'uninsured' simply because they were healthy. The number is also derived from polling, not by counting the number of policies, that also has its problems. Perhaps a better example of the deliberate overstatement is CNN adding two of these studies together and suggesting that nearly one-third of the nation under 65 went without insurance over a two year period. http://www.cnn.com/2009/HEALTH/03/04/uninsured.epidemic.obama/ No double counting there, right?
Next the blurring of health-care and health insurance. There are many without health insurance, but there are not many without health-care. I am certain that the quality of care people receive is less than those who are able to pay. But the idea that there is a line of 40 million people waiting for care is a fallacy, pure and simple.
(2) Maintain or Improve quality-
I am not happy with maintaining. I want continuous improvement. As I consume holiday treats,I dream of the day that we inject people with nano robots that clean out arteries. Seriously, I believe the easiest way to save money is to stifle the next generation of medical advances. If we actually get around to squeezing doctors, hospitals & pharmaceutical companies, they will same money by cutting back on R&D, to the detriment of all. If you mess up this system, what will that cost?
Improve quality is a goal I can agree with.
(3) Control costs-
The government is stupid, inefficient and ham-handed in every endeavor. There is no reason to believe this will be different. Fannie Mae was run by all kinds of politicians between election victories, why wont they stuff this health care bureaucracy with political patrons? What is the health care equivalent of the $30,000 toilet seat?
Control costs is a goal that I can agree with.
(You should have used letters for your next list)
1 First, this is unconstitutional. This should be left to the states. I look at health insurance similarly to the way I look at smoking. People shouldn't smoke, but they should be free to do so. Next, I bring up the healthy 26-year old. One bill says they can't be charged less than 1/3 the amount they an older person would be charged. The other bill says it can't be less than 1/2. Neither of these is economically sound. It is just forcing them to further subsidize the system.
2&3. I would feel better if there were performance incentives i.e. working, looking for work or caring for children. Working toward getting above the poverty line, or getting the next generation above the poverty line.
4. I don't follow what you are saying here. Pooling instead of a group, it sounds like the same thing to me.
5. If you must move from one insurance to another – i.e. moving from your parents insurance to your own, I can live with some form of pre-existing condition reform. But people keep acting like you should be able to get homeowners insurance while your house is on fire. Honey, I smell smoke, call State Farm and then 911. If you take out a home equity loan and bet it on a 4-team parlay in Vegas, should we have to bail this person out as well? When you need a new kidney and you do not have insurance, it is time to make you best deal with the doctor and leave the insurance company out of it. There is no risk or resource pooling to be done at this point. I suppose this goes back to society not holding people accountable for their own actions. (see smoking lawsuits)
6. We will have to see how this works out, again I bring up the inefficiencies.
If left to its own devices, the cost of medical care will solve itself. There will be some growing pains, I do not dispute that. However important health-care is to us will decide how much we pay, period. That is also true even if there was a government option. When the system has done all it is going to do, and it is not enough, people will work outside the system and buy more care wherever they think will help. Mortgage their house if necessary. Savings could be realized in the information flow and management. Every insurance company doesn't need a different form and the training and time to comply with each. I am intrigued by a national database of health information. I am not sure how the privacy issues get resolved, or data security. But if every professional – family practitioner, ER doctor and pharmacist had immediate access to everything it would improve safety and efficiency. There is probably a place for the government here. But they should be responding to the needs of the users of the system not mandating X, Y and Z.
I would like the cost of drugs reduced by charging other countries a more reasonable rate. I think I have stated this before. The first watt generated by a power plant costs several hundred million dollars. The hundred millionth watt generated is less than a penny. But the price charged for the service is pretty similar for all customers. If drug companies play nice I would reward them with additional patent time.
You may have heard this one from me also. I don't think punitive damages should be paid to a victim. After you get compensatory damages, you should have been made whole. Punitive damages, when they are necessary, should go into a pool that supports public subsidies. Punishment is the business of the State, leave the victim out of it.