Global IssuesU.S.: Triage for a Terminally Ill Health System
Early on Christmas Eve morning, the United States Senate will vote on the health care reform legislation that has been at the forefront of President Barack Obama's domestic agenda since he was sworn into office just over 11 months ago.
The vote on Thursday is a step forward in the decades-long debate about health care in the United States, but it is by no means the end of the race. More than 51 million people in the U.S. are uninsured, a staggering number in a country where the median income was 50,740 dollars in 2007.
While all of the proposed legislation extends coverage to more than half of this group, none of the proposed plans will cover everyone.
The legislation that will likely make it to Pres. Obama's desk early next year certainly doesn't solve the issue of health care in the United States and it has revealed a moral dilemma that touches upon core values in the U.S.
In addition to leaving approximately 20 million people without coverage, the legislation the Senate will vote on does not include a public insurance option, requires individuals to purchase insurance or face fines, does not mandate employers to contribute to this coverage and provides only limited insurance industry reforms.
But despite its shortcomings, the legislation will likely gather the support of almost all Democrats in Congress, has received vocal support from the president, and has gained the - sometimes begrudging - support of many health policy experts.
There are a few key points that have that support. First, while there is still a huge gap in the number of people that will have access to affordable health care coverage, this legislation proposes to cover an additional 30 million people — that's approximately the entire population of Canada, or about the number of people living in the world today with HIV/AIDS — not an insignificant number.
Secondly, this legislation will make it easier for individuals to purchase insurance through the implementation of insurance exchanges, new marketplaces in which individual consumers who don't have access to employer-provided coverage can purchase comprehensive plans that are subject to basic rules.
If they purchase their coverage through the exchanges, the government will provide tax credits for people or families that earn up to 400 percent of the federal poverty level — approximately $88,200 for a family of four.
Additionally, both the House and Senate version of the bill include an expansion of Medicaid, the public programme that covers low-income individuals and families.
Finally, this legislation bars insurance companies from denying coverage to people with pre-existing conditions. In the current system, individuals applying for health care coverage can be denied insurance or discriminated against for 'pre-existing conditions' ranging from cancer to asthma.
A poll conducted in 2006 by USA Today, The Kaiser Family Foundation, and Harvard School of Public Health, found that one in 10 people with cancer couldn't get health insurance, while six percent said that they had lost their coverage when they were diagnosed with the disease.
While the new legislation would prevent insurers from denying coverage, the Senate version of the bill still allows insurance companies to charge some customers significantly higher premiums than others.
Similarly, the lack of a public option in the more conservative Senate legislation has raised the hackles of many long-time health care reform proponents.
'The bill was supposed to give American choices about what kind of system they wanted to enroll in,' former head of the Democratic National Committee and physician Howard Dean wrote in The Washington Post last week.
'Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries,' he added.
While these issues will continue to be debated around kitchen tables and in the halls of Congress, it is unlikely that there will be much movement in this round of the legislation.
If the Senate passes the bill Thursday morning, the Affordable Health Care for America Act will face informal negotiations in early January to reconcile the House and Senate versions of the bill, forgoing the longer and more formal negotiations of a conference committee.
The final version will likely resemble the more conservative Senate version of reform because Democrats in the Senate face a very narrow majority required to pass the bill. Analysts speculate that the bill will therefore gain more votes in the House, winning over some of the more conservative members of the Democratic party who resisted the House's more progressive version of reform.
If the bill makes it to the president's desk next month, it will mark the pinnacle of a months' long debate that has brought out deep divisions in the political psyche of the country.
The debate over the past several months has sometimes been wrested away from the true components of health care reform by unfounded rumours about death panels and government-controlled health care.
Yet from a historical perspective, such diversions are not all that unusual. Since the U.S. started addressing health care reform almost a century ago, plans to include a public option have been labeled communist, Sovietism, and un-American.
In this light, Senate Minority Leader Mitch McConnell's accusation earlier this year that the president and his allies on health care are mounting 'an audacious effort to Europeanise the country' doesn't seem quite so out of character.
President Obama acknowledged the historical precedent this summer in a conversation with religious leaders about the reform.
'These struggles always boil down to a contest between hope and fear,' he said. 'That was true in the debate over Social Security, when F.D.R. [Franklin Delano Roosevelt] was accused of being a socialist. That was true when J.F.K. [John F. Kennedy] and Lyndon Johnson tried to pass Medicare. And it's true in this debate today.'
Despite the intensity of emotions on the issue, there is a consensus that the health care issue is having a tremendous impact not only on the health of the United States, but also on its economic well-being.
In the U.S. the per-person cost of health care in 2006 was 6,714 dollars. In the 26 countries where life expectancy is longer than that in the U.S., the average cost of health care per person was 2,964 dollars, according to the World Health Organisation.
Similarly, the U.S. pays nearly twice as much for its prescription drugs as do people in other countries, yet still the Senate struck down a provision that would have allowed people to order medications from abroad.
Also, according to analysis by the Center for American Progress, the 51 million uninsured and underinsured have cost the U.S. economy between 124 billion and 248 billion dollars this year alone due to their poorer health and shorter lives.
All of these indicators demonstrate that the U.S. can't wait any longer for change, no matter how incremental its form. Many are hoping the Senate's Christmas Eve vote will be a welcome gift of hope for millions of people in the U.S. who have lacked the access to fundamental health care, and for a global community that is waiting to see if the U.S. can right its economic woes.
© Inter Press Service (2009) — All Rights ReservedOriginal source: Inter Press Service