Decades of try­ing, but health re­form re­mains elu­sive in US

Mil­lions left without health in­sur­ance

Kuwait Times - - INTERNATIONAL -

The United States, en­tan­gled in con­flict over­seas and strug­gling eco­nom­i­cally, was at a fraught mo­ment when the pres­i­dent called for a na­tional health care over­haul. The coun­try “now spends more than $75 bil­lion an­nu­ally on health care... yet de­spite this huge an­nual na­tional out­lay, mil­lions of cit­i­zens do not have ad­e­quate ac­cess to health care.” That ob­ser­va­tion could have been of­fered by cur­rent Pres­i­dent Don­ald Trump, or pre­de­ces­sor Barack Obama. But it was Richard Nixon’s lament, way back in 1972.

The US has a long­stand­ing rep­u­ta­tion for world-class medicine, doc­tors and hos­pi­tals, but for decades it has also been rid­dled with gap­ing holes that have left mil­lions without health in­sur­ance. Ev­ery pres­i­dent in liv­ing memory-in­clud­ing Bill Clin­ton and his wife Hil­lary-has made some kind of ef­fort to plug the gaps. But the prob­lems per­sist to this day, only mul­ti­plied. Dur­ing the 1970s, health care costs rep­re­sented seven per­cent of the US econ­omy. Eight pres­i­dents later, that fig­ure has bal­looned to 18 per­cent. The rate is half again more than that of France, with re­sults worse than most other wealthy na­tions. An Amer­i­can girl born to­day is ex­pected to live four years less than her French coun­ter­part.

Pub­lic, pri­vate

Repub­li­cans to­day are seek­ing a fresh over­haul. When the Se­nate re-con­venes to­day after a 10-day break, Trump will be un­der in­tense pressure to find a mid­dle path that wins over enough con­ser­va­tives and mod­er­ates in his party. At the heart of to­day’s prob­lem is the US sys­tem’s split per­son­al­ity-part pri­vate, part pub­lic-which com­pli­cates broader ef­forts at re­form. From the late 1920s, Amer­i­cans be­gan pur­chas­ing pri­vate in­sur­ance cov­er­age. After World War II, US com­pa­nies started of­fer­ing their em­ploy­ees health in­sur­ance, and mil­lions signed on.

But that did lit­tle to help un­em­ployed, poor or el­derly cit­i­zens. In 1965 the fed­eral gov­ern­ment stepped in, cre­at­ing the Medi­care pro­gram for those age 65 and above and Med­i­caid for lower in­come and dis­abled Amer­i­cans. Tens of mil­lions still fell through the cracks. Then came 2010’s Af­ford­able Care Act (ACA), Obama’s sig­na­ture do­mes­tic achieve­ment, which low­ered the share of unin­sured to about 10 per­cent. While that is a his­toric low, 26 million Amer­i­cans re­main without cov­er­age.

Health care ex­penses have swelled in part due to lack of gov­ern­ment reg­u­la­tion. Costs in­creased each year at an un­sus­tain­able rate, along with the ad­vent of new tech­nolo­gies like MRI scan­ning and 3D mam­mog­ra­phy. “This is the only in­dus­try where tech­nol­ogy ad­vances have in­creased costs in­stead of low­er­ing them,” wrote jour­nal­ist Steven Brill in his 2015 book “Amer­ica’s Bit­ter Pill.” “When it comes to med­i­cal care, cut­ting-edge prod­ucts are ir­re­sistible; they are used-and priced-ac­cord­ingly.”

In the United States, if you break a leg, the (pri­vate) hos­pi­tal sends your (pri­vate) in­surer the bill, which typ­i­cally amounts to sev­eral thou­sand dol­lars for a few hours in the emer­gency room. Each ex­am­i­na­tion, X-ray and fol­low up in­curs new charges. With “Oba­macare,” a move was made to shift away from the costly and in­ef­fi­cient fee-for-service model to pay­ments to hos­pi­tals based on qual­ity of care. But “we’re still a sys­tem based on vol­ume of care ver­sus value of care,” Howard Bauch­ner, edi­tor-in-chief of the Jour­nal of the Amer­i­can Medicine As­so­ci­a­tion, said.

“Un­til value or bun­dled pay­ments be­come more com­pre­hen­sive, it’s not clear to me that the rate of rise of costs will be con­tained.” Po­lit­i­cal com­pro­mise Bill Hoagland, se­nior vice pres­i­dent at the Bi­par­ti­san Policy Cen­ter and a for­mer top Se­nate bud­get staffer, says health care re­form has been a pri­or­ity for seven decades, with Congress strug­gling to rein in costs. “There’s one way to con­trol costs in this coun­try, which is some­thing that Amer­i­cans don’t like: that is price con­trols,” he said in an in­ter­view.

“This is a coun­try that prides it­self on the pri­vate sec­tor and choice, (not) the fear that gov­ern­ment comes in and over-reg­u­lates our health care and dic­tates to us which doc­tors we see or hos­pi­tals we go to.” The pub­lic-pri­vate du­al­ity is so deeply en­trenched that most Demo­cratic pres­i­den­tial can­di­dates have dropped the idea of a pub­lic sin­gle-payer sys­tem for all, like those in Europe. Only far left fig­ures like Sen­a­tor Bernie San­ders em­brace that op­tion.

Repub­li­cans, for their part, have long promised to dis­man­tle Oba­macare and re­duce the role of gov­ern­ment. But some in the party’s cen­trist wing op­pose such dra­matic sep­a­ra­tion, mak­ing full re­peal of the ACA un­likely. Hoagland be­lieves Democrats and Repub­li­cans ul­ti­mately will need to com­pro­mise in order to con­tain surg­ings costs and ex­pand cov­er­age. Time is short. At cur­rent trend­ing, health ex­pen­di­tures will ac­count for 20 per­cent of GDP by 2025.


NEW YORK: A small group of ac­tivists rally against the GOP health care plan out­side of the Metropoli­tan Repub­li­can Club in New York City.

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