Why and How the "New" Health Care Legislation Falls Short

America and Americans regard ourselves as the richest nation in the world, with the most freedoms, the most opportunities, and the best quality of life. These optimists are wrong. This richest nation in the world is well down the list of countries offering not merely health insurance and health benefits but also "wellness" programs intended to keep people from getting sick. More obese children than anywhere else in the world. Worse food eating habits than probably anywhere else in the world. Hospital care that seems to depend on quick turnovers. Infant mortality that ranks well below the average! All these negatives and we still think we do not need health car reform! President Obama's health care legislation is too much of a political and even religious compromise to be considered the optimum health care plan.

First of all, some sort of bill was needed. Millions of Americans need some sort of help. Here are some overall facts: "About 46 million Americans are uninsured at any one time, and millions more have no coverage for pre-existing conditions or discover when they get sick that their policies have loopholes and limits that leave them bankrupt. Many people are locked into jobs for fear of losing insurance. Those without coverage are more likely to postpone treatment and to be denied care" (Starr 19). Even so, many of these uninsured will not benefit now, and maybe not for years.

Instead of real reform and fixing all the loopholes that insurance companies and medical providers now use to prevent total health care, the President crowed about the passage of the bill: "Obama characterized the law as major, but not radical, reform. 'This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like,' he said" ("Obama Signs Health Car Reform" p. 1). What this legislation does would be the equivalent of replacing worn tires on a car where the motor needs overhauling before it totally stalls. This HR article also covers some of the bill's provisions which will be delayed: In addition to prohibiting group health plans from excluding patients from coverage based on pre-existing conditions starting in 2014, the law ends lifetime limits on benefits starting in September 2010, bans rescission when an insurer cancels coverage even though the policy has been kept current starting in September, and allows dependents to stay insured under their parent's health plans until age 26 starting in September. So, while some provisions kick in later this year, one of the truly major problems with current health care won't improve for nearly four years! That is NOT reform! That is wishful thinking and a delaying tactic to soothe the health care industry's lobbyists.

There are many immediate problems with this legislation. One deals with the availability of physicians and specialists. Anyone who has been to a hospital or clinic lately has noticed that, for whatever reason, American medical schools have seen a drop in native American students and have sought out qualified candidates from outside the U.S., mostly from India, Pakistan and the Philippines. Increasing the millions of Americans being covered by insurance will certainly require an increase in the number of medical professionals serving them. "Under the new law, 32 million Americans will be able to obtain insurance coverage and access the high-quality healthcare they deserve. The act also creates a program to establish and fund community health teams to provide medical homes and coordinated care for individuals with chronic conditions...(But) the need to implement better care models is a critical component of ongoing reform. In addition to providing insurance, it is essential that we better integrate the delivery of care by physicians, hospitals and other providers" (Kirch 24).

Mr. Kirch (2010) sees the problem about increasing the quality of care and numbers of medical providers as essential. Now more than ever, he explains, America has to expand the physician workforce to accommodate millions of newly covered Americans and a rapidly growing Medicare population. He writes that according to latest figures, U.S. medical schools are trying to increase enrollment. "Congress must join in this effort by lifting the caps on Medicare-supported residency positions so that future physicians can finish their training" (Kirch 24). Again, money! Training morew doctors is costly!

Changes and improvements are needed now. And this legislation just passed does not really address many of the problems with America's health issues: "There is no doubt that the U.S. healthcare system suffers from widespread inappropriate variation and waste. Solving this problem, however, requires collaboration and statesmanlike leadership" (Bibalkle 75). Sadly, there is no real leadership in health care issues in America.

What's worse is that most people really don't understand the bill and how they will be affected, if at all:

"Under the law eventually 94% of legal residents will have health coverage, up from 83% today. Once the law phases in, in 2014, insurers will no longer be able to turn anyone down because of a pre-existing condition; from pregnancy to heart disease, they'll all be covered. The law also restricts the practice of 'rescission.' By 2016 you'll be dunned $695 a year or 2.5% of your income, whichever is higher, if you don't have health insurance. over $250,000. Starting in 2013, couples will pay additional taxes on earnings above $250,000" (Regnier 70).

The Obama administration claims that passing this health care reform bill is as important as passing Medicare was when Lyndon Johnson was president. Obama is wrong. Back then doctors, hospitals and insurance companies all opposed the idea of Medicare. But, somehow it got passed. Today, the AMA supported Obama's bill. So did most medical providers, including the nurses' union. So, why are at least 14 states wanting to do whatever they can to kill the bill? Here is one reason: Politics. Not medicine. Not health. Pure politics: liberal versus conservative. "Conservatives are casting the November midterm elections as a vote on repealing the health-reform law. If they regain power, they are unlikely to repeal the whole thing... they will try to strip out the critical but less straightforwardly appealing elements of reform--the requirement that larger employers provide health benefits and that uncovered individuals buy at least a basic policy" (Gawande 26).

What these conservatives are screaming about is "socialized medicine!" They are against a one-payer health reform bill. This is where the government offers medical insurance for all its citizens. Why are these people, like the Tea Party, so opposed?

Here is one reason: "Opponents of the health care overhaul package are deeply distrustful of government...A tea party activist declared at a rally in Iowa, 'Every single person's body in this whole country belongs to the government now'" (Schneider para 9). Many people still hear that slogan: "Don't let the government decide who your doctor should be!" No matter how many times President Obama's speeches tell his audiences that you still choose your doctor, somehow many people oppose government control of health care because they want to be checked by a doctor not a bureaucrat.

What is difficult to understand is that these people who oppose the bill are in just as much of a bind as the poor who have no insurance at all. Nobody will argue that one of the most difficult choices that many people have to make is the cost of their health insurance. Even with insurance these people often have to make expensive co-payments and sometimes even get turned down by some insurers. "Pharmaceutical companies are making big bucks, U.S. doctors are some of the highest paid, fancy new technologies are being sold that purportedly do miraculous things, the hospitals are getting their cut and the insurance companies keep raising their costs, so surely all is swell. Not really. According to the N.Y Times there are '60 million uninsured during a year'" (Engler para. 6).

Yes, more people will be covered. More people will not be dropped by their insurers. But not everyone will be covered. And those left behind either will have to be subsidized by the government or ignored. So, while some countries cover everyone- even some poorer countries, the U.S. will be ignoring many who fall into cracks: too poor, too ignorant, too careless. The idea of health care for everyuone, run by the government just won't work in the U.S. At least that's what the Repuboicans say. But, look at Canada: "Consider for a moment what would happen if a Canadian prime minister came to power in a landslide comparable to the one that swept Obama into the White House...The PM could have even a sweeping healthcare reform bill signed, sealed, and rubber-stamped by the GG within a fortnight" (Potter 12).

Many Americans know about the Canadian health care system. In fact, many Americans go to Canada for their medications which cost far less than the same medicines in the U.S. "Americans are increasingly asking why the United States is the only western industrialized country that has not managed to achieve universal healthcare coverage for all of its citizens. They also are wondering why we don't learn from our neighbors to the north and move the current Canadian universal coverage approach south" (Halvorson 82). What Canada does is spend less money for each patient than we do in the U.S. As Halvorson (2007) explains, The truth is that Canada now spends about $3,600 per person per year less than we spend on healthcare costs in the United States because-very simply-Canadians spend less money on the actual purchase of care.

"How do they do that? First, by setting fees. Fees are much lower in Canada. A physician office visit that costs $80 to $100 in the United States costs only $38.60 in Nova Scotia. The government of each Canadian province determines the exact fee schedule and price list for every physician in the province-and those Canadian fee schedules for physicians are set far below U.S. fee schedules" (Halvorson 82).

A lot of the costs for health care in the U.S. is due to administrative costs. In Canada, the government sets budgets for hospitals, for example. Good, for the msot part. But there are some drawbacks. Canadian hospitals don't have the money to spend on new hi-tech equipment, so there is a longer wait for some operations. But setting fees and challenging high costs for administration would be helpful in the U.S. Obama's bill does not cover that. In fact, the whole bill might have lost if government restrictions were included. Again, Halvorson (2007) makes an important point the Obama bill should have included: Most European countries have achieved universal coverage by using a combination of private health plans, government programs, individual consumer mandates, subsidized or free coverage for low-income people, and a private marketplace for hospitals, physicians, and other caregivers. "We Americans need to figure out what combination of those factors would best meet the needs of our citizens and let us achieve universal coverage here" (Halvorson 83).

We better figure it out soon, because in a 2007 report, American health care really looks bad based on surveys on physicians' and patients' experiences and views of their health systems conducted in Australia, Canada, Germany, New Zealand, the U.K., and the U.S. between 2004 and 2006. Key findings include:

• On measures of quality, the U.S. overall ranked 5th out of 6 countries. The U.S. ranked fifth in coordinated care, and last in patients reporting that they have a regular doctor (84% vs. 92%-97% in other countries).
• On access measures the U.S. ranked last overall, including last on timeliness of care: 61% of U.S. patients said it was somewhat or very difficult to get care on nights or weekends, compared with 25%-59% in other countries.
• On efficiency, the U.S. ranked last overall, including last on percent of patients who have visited the emergency room for conditions that could have been treated by a regular doctor if one had been available. ("U.S. Health Care Systems 2).

There are even some worse statistics which ought to frighten many Americans who think we're the best in everything: "American life expectancy is only the 17th highest in the world. More importantly a World Health Organization study that counted years of good health showed that the U.S. ranked even lower by that measure. "The United States rated 24th under the system or an average of 70.0 years of healthy life for babies born in 1999" (Engler para. 9).

These rankings are a disgrace. And yet this recently passed Obama bill does not really solve most of these problems. What is making the whole situation worse, one might think, is the opposition of the attorneys-general of at least 14 states whno are suing the federal government. "Thirteen state attorneys general - 12 Republicans and one Democrat - signed onto one lawsuit against the U.S. departments of Health and Human Services, Treasury and Labor (Virginia initiated a separate suit)... The issue at the heart of the lawsuit is the constitutionality of the so-called 'individual mandate'...'The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage,' the lawsuit reads" (Williams para. 2). The issue, so it seems, is states' rights. They feel the government cannot call for control over health care (or anything else) that is not specifically mentioned in the Constitution as a federal right. Chances are this suit will either eventually be dismissed or go to the Supreme Court.

This is just one more obstacle in giving every American the right to health care, but somehow penalizing those who choose to ignore that right. Maybe one of the problems with Obama's bill or any bill about health care and health insurance is whether health care is a right or a privilege. Maybe the bill should have begun with a very clear message to every American. This ought to say that access to affordable health care is not a privilege only for those who can afford it, but a right that every citizen ought to have the opportunity to take advantage of.

Perhaps the only way a real health care reform bill can be passed is if politics are totally out of it. Of course, all politicians have an opinion. Even before this bill was considered, before Obama got elected, before the Democrats won Congress, here is what former Senator Carol Mosely Braun said:

"If you think about it, every person in America can get health care, whether or not they can pay for it. The problem is that because of our inefficient system of payment, many, if not most, get the most expensive care, many more get inadequate or postponed care, and still more live in a state of anxiety about their ability to maintain their health. Emergency rooms are all the health care delivery system many people know, and insurance companies make decisions doctors used to make" (Braun para. 1 ).

Let's go back for a moment to the MacLean's comparison of Canadian politics with those in the U.S. The article claims that with the political majority that Obama got in the election of 2008, his party should have passed the right health care bill and not tried to compromise to try to get Republican votes. This is one reason so many younger people in America are sick and tired and do not trust politicians. Health care is a must. It should not be a compromise. As it happened, no Republican voted for it either in the House or the Senate. And the Republicans now say this health care bill will be a big issue in next year's election. Why? Because these conservatives- practically all our grandparents' age, rich and not caring about the poor uninsured are scaring Americans- intend to frighten us. Sara Palin began it. She talked about one section of the original bill which allowed payments for people to talk to their doctors about their final care. She called them "death panels." Senator Grassly of Iowa went on the campaign trail to tell his constituents that the bill will want Grandma to die. All lies. But gullible Americans still believe it. In doing some research on politics and people, I found an interesting example: Josef Goebbels who was minister of propaganda for Hitler said that if you tell a lie often enough people will believe it. That is what is happening in America now. Politicians are lying about the health care bill. Yes, it is imperfect. It solves too few problems. But it is better than nothing. Sad to say, this is why many people are disappointed in Obama as a leader. He promised change. The health care reform bill that was passed was small change.

Maybe we need to believe President Obama who claimed that this was just a first step. But the next steps cannot wait until 2014 and beyond just to placate some conservative politicians. Health care should be a right not a political compromise.

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