Health Care Reform - Chance of a Generation or the End of the American Dream?

Well, it's now official. At about 11 p.m. EST, the U.S. House of Representatives finally garnered enough votes and by the thinnest of margins, passed the $1.1 trillion Affordable Health Care for America Act, otherwise known as H.R. 3962. This health care reform bill would create a government operated health care plan known as a public option and is intended to compete with private insurance. Supposedly, this plan will make health insurance available to the 36 million Americans who don't have health insurance coverage by 2013. Critics are calling this bill the Health Insurance Company Protection Act.

President Obama stated, "Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass it's version of the legislation. I'm absolutely confident it will, and I look forward to signing the comprehensive health insurance reform into law by the end of the year."

Dennis Kucinich (D, Ohio) said, "We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care. We cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem. When health insurance companies deny care or raise premiums, co-pays and deductibles they are simply trying to make a profit. That is our system."

Here are some of important aspects of H.R. 3962:

• require that all Americans purchase insurance by 2013
• require those who do not purchase this insurance to pay a penalty based on their annual income
• require large corporations to provide coverage for their employees
• prohibit health insurance companies from denying coverage to those with pre-existing conditions
• this health plan will be funded by those couples earning more than $1 million a year
• also funded by individuals who make more than $500,000 a year

There are lots of stories out there about unnecessary tests and procedures. Like the heart doctor who ordered blood work costing $2,000, and a $1,500 echocardiogram. Or the doctor basing the number of tests needed based on a patient's annual income. And let's not forget the over eager orthopedic surgeon who operated on a patient's knee despite the fact that the radiologist MRI reported the knee appeared normal.

One doctor in our town is grouping together with 3 other doctors and forming their own group of select patients. For a sizable annual fee, these patients receive preferential treatment, less waiting time for appointments, access to a particular doctor of their choice. Those patients who won't or can't pay this fee are cut off from this particular practice and sent a nice letter - sorry, but if you can't pay, you're out. All of this on top of whatever you're already paying for your own insurance. It's an attempt for doctors to retain the entrepreneurial format they have always had. Only now, they want to make sure the "patients" have the necessary cash to pay for a barrage of test and procedures. Hey, this is America and we are a capitalist society.

A recent article in The New Yorker states that while McAllen, Texas has the "lowest household income in the country... it is one of the most expensive health-care markets in the country." McAllen is described as a medical subculture where doctors prescribe nearly 50% more tests and procedures as those in otherwise similar Texas counties. McAllen is where American health care is heading. The flip side to McAllen, Texas is the Mayo Clinic in Minnesota. There, doctors are put on salary and the hospitals are operated by the clinic. The care is top-notch and patient satisfaction is in the stratosphere. It's not a conventional fee-fir-service model that the rest of the country has. So if the Mayo Clinic is better and costs less, why aren't there more like this?

No doubt something needs to change. The current health care system in the U.S. is not really even a system. It's more like a very loosely connected pack of greedy, ravenous wolves tearing at the same carcass - Americans who need health care. With every doctor, lab, hospital, and medical facility hungry for more dollars, the current system only encourages more procedures, more tests, and more cost to the consumer. Entrepreneurial minded doctors are already forming ranks to stave off the frightful prospect of becoming a salaried cog in a huge government run machine. The reality is that fee-for-service health care plans are not working for most people in the United States. Something has got to give, and someone has to pay. If people think the idea of the American Dream is "everything free for me", it's time to wake up and smell the coffee.
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Sources: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande