July 21, 2009

HealthCare Reform Requires More Time and Thoughtful Debate


Cancer patients, take notice: there appears to be another perceived “crisis” that must be fixed without thoughtful discussion, debate, nor even the consent of the governed. The stated rationale for healthcare reform has, focused on what the current administration has referred to as a “healthcare crises’ healthcare in America is “too expensive” and there are 47 million Americans without health insurance.” Americans have been told that there is an urgent need to act immediately—presumably, by finding a way to pay for the healthcare of these uninsured Americans. Conspicuously absent from this call to action is any mention of who these Americans actually are, a discussion of why they don’t have health insurance, whose responsibility it is to provide them with health insurance, and the nature of the underlying problems that led to this crisis. Cancer patients and all Americans have a stake in this debate and should listen carefully to the politicians and their proposed solutions.

First and foremost it is important to understand that cost is the central problem in healthcare, and controlling costs—not expanding coverage—is the essential first step to providing better healthcare and better access to healthcare to more people. Cost of healthcare has risen steadily under both Democratic and Republican administrations for over 30 years. Under our current healthcare delivery system, there is no way universal coverage can be achieved unless additional funds are procured. A lack of money, however, is not the problem. Total health spending in the US is more than 2 trillion dollars per year, which amounts to approximately $25,000 per family and $7,000 for every individual. In 1946 total healthcare costs were 4% of gross domestic product (GDP) and by 1960 had risen to only 5% of GDP. Total healthcare costs have risen to 16% of GDP in 2005 and are approaching 20% in 2009. Expanding healthcare services to more individuals without addressing the underlying problem of rising costs will only increase total costs further.

What is the evidence that there is an actual crisis of the uninsured? In 2005 the Congressional Budget Office (CBO) reported that 15.9% of Americans (46.6 million) were uninsured (the CBO is the source quoted by politicians seeking an immediate taxpayer-funded solution to the crisis). What is not mentioned is that in 1998, before the current administration, the CBO reported that 16% of Americans were uninsured. In other words the access to healthcare has not worsened over the past decade under the previous democratic and current republican administrations. Perhaps more interesting is that according to the CBO, the number of uninsured children in America has actually improved on both an absolute and percentage basis between 1998 and 2005: in 1998 11.1 million children were without health insurance compared with 8.3 million in 2005. These data clearly do not support the notion of a worsening crisis with regard to access to healthcare; they in fact suggest that improvements have been made in helping children in American get health insurance. This is not to imply that 47 million people living in the United States without health insurance is not a problem worthy of fixing, only to suggest that calling it a “crisis” requiring immediate action is somewhat misleading.

According to the 2005 CBO report, the majority are non-citizen immigrants and households with incomes in excess of $50,000 per year who elect not to purchase health insurance. First and foremost, according to the report, approximately 10-12 million of the uninsured are actually not American citizens, but illegal immigrants. Perhaps even more interesting is the observation that 8.74 million Americans earning more than $75,000 per year and 8.3 million Americans earning between $50,000 and $74,999 per year are uninsured. In other words 27 million of the 47 million without health insurance are either not actually “Americans” or are American citizens that have annual incomes in excess of the median household income and elect not to purchase health insurance. Perhaps a more accurate and appropriate question to be put forth by the politicians’ should be: Do taxpaying citizens want to pay for the healthcare of illegal immigrants or Americans making over $50,000 per year who elect not to purchase health insurance for themselves?

When illegal immigrants and wage-earners making more than the median household income in America are removed from the ranks of the “uninsured Americans,” the magnitude of the problem is reduced to 20 million citizens who remain uninsured.

What the politicians also elect not to tell you is that 45% of the “uninsured Americans” are only without insurance for four months or less and return to the ranks of the insured. This means that approximately 10-11 million American citizens, or less than 3%, are actually without health insurance. This number is consistent with that reported by the not-for-profit Kaiser Family Foundation, which, in a similar analysis to the CBO, found that there are approximately 8.2 million chronically uninsured Americans. So the question here becomes how to address the problem of short-term loss of insurance coverage between jobs and what to do about the approximately 8 million Americans who don’t have access to health insurance. Solutions for these problems are inherently different from solutions to provide health insurance for 47 million individuals.

Using inflated numbers to exaggerate a problem for the purpose of implementing a tax payer-funded universal healthcare solution to provide healthcare for individuals who can afford health insurance but elect not to purchase it and for non-citizen immigrants will only further increase healthcare costs to American citizens, reduce the quality of care, and prevent a meaningful discussion on the real, more-significant problems that have contributed to making America’s healthcare the most expensive in the world. Before asking the American taxpayer to spend more money to solve the crisis of the uninsured, which has been created by the government, politicians have the responsibility of addressing the known factors that currently drive costs in healthcare. Some basic questions that might be useful and more meaningful to address could include the following;

  • In a market economy, why isn’t there legitimate competition among providers delivering healthcare?
  • Why hasn’t medical malpractice reform been passed that would allow physicians and health systems to practice medicine instead of focusing on how to avoid litigation?
  • Is the current insurance-based system the best way to pay for healthcare? Is there any evidence that Insurance, and Managed Care companies help reduce costs or improve quality of care? Private Insurance and Managed care plans cost several times more than Medicare; is there any evidence that they provide better service or better care?
  • Why does America spend 1/3 of its total healthcare dollars in the last six months of life, and is this a wise use of healthcare resources?
  • Should taxpayers be obligated to pay for the healthcare needs of families that elect not to purchase insurance and have incomes that exceed the median household income in America?
  • Should taxpayers be asked to pay for the healthcare of illegal immigrants?

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