Health Care in the United States: Is it a right?
As citizens of the United States watch, listen and participate in the ongoing debate of health care reform, there is one question at the center of the debate – and one that seems to determine your stand on the health care issue: Is health insurance coverage a right?
The majority of people in the United States are covered by insurance. However, according to the most recent Census estimate, in 2008 15.4 percent of Americans under age 65 – 46.3 million people – were without health insurance.
There is much debate on whether the Census figures accurately reflect those without insurance, but the questions remain. What are the rights of citizens? Does everyone deserve and should they be given health insurance, even if their employer doesn’t offer any or they choose not to purchase health insurance themselves?
According to the Department of Labor Bureau of Labor Statistics, as of March 2009, medical care benefits were available to 71 percent of private industry workers, but only about half of those workers participated in a plan. And for those who did participate, employers paid 82 percent of the cost of premiums for single coverage and 71 percent of the cost for family coverage.
Dr. Stacey Bowen, DO, in Toledo, Ohio, says that people who aren’t insured choose not to be, so their costs should be their own. Since there is medical coverage for low income people available through Medicaid, Bowen said those who are middle income earners not covered by health insurance have chosen to purchase a third car or a larger home instead of medical coverage. And, she said, when those who do not have health insurance need medical treatment, they visit emergency rooms where they cannot be turned away.
However, Jim Morone, chair of Brown University’s Political Science Department and co-author of The Heart of Power: Health and Politics in the Oval Office, said that’s not a full picture of the uninsured or underinsured in the U.S. He said many of those who have no health care coverage cannot afford to purchase it. And because states operate Medicaid, it varies across the country when it comes to who is covered and not covered.
As an example, he pointed to Texas and New York to highlight the differences in Medicaid coverage from state to state. In Texas, Medicaid covers those persons eligible for Temporary Assistance for Needy Families (TANF), or who qualify for Supplemental Security Insurance (SSI) or have incomes below the TANF income cap. As of 2008, that was a parent with two children earning $188 a month or less, according to state information. In contrast, New York’s requirements are much higher. A family of three may earn up to $1,048 a month to qualify for Medicaid in New York, as of April 1, according to state information. And some people can qualify for Medicaid if their income is above those levels and they have medical bills.
“It’s an incredible patchwork,” Morone said, adding that leads to many people not receiving health care. While he does agree that people do use emergency rooms and do find care there, they don’t receive medical attention for such care as cancer treatment or psychological issues, he said.
“There’s an estimated 18,000 Americans who die every year as a consequence of not having insurance,” he said. “Without insurance, it’s hard to access treatment and many people put off treatment (due to the cost or difficulty in accessing care).”
With a public option being considered as part of at least the major health reform bill now in the House of Representatives – H.R. 3200, there is concern about how that will be handled in comparison to Medicaid or even Medicare. Dr. Bowen said a government-run insurance program or social medicine would be detrimental to all people. She said with the reimbursement rates of Medicare already at such a low rate, she’s concerned over how another government-operated program would impact her ability to work as a general practitioner.
She said when looking at programs, such as Canada, she’s concerned because of the long waiting periods, which she said do exist and do result in deaths because of prolonging treatment. And, she added, insurance and hospital bureaucracy are the real issues here and those are the ones that should be the focus of reform.
Add that to negotiations with insurance companies, which she said are horrific, and the result for her as a physician has been no paycheck in three years. As a general practice physician, she said she is paid far less by insurance companies for doing the same treatment as a specialist. As an example, she said, she is paid less for drawing fluid off of a patient’s knee than an orthopedic surgeon is paid for doing the same procedure. She believes that will only get worse under a government plan and that general practitioners will disappear.
Morone agrees that the system is a mess, but he said it’s a complicated system and trying to fix it, therefore, is also complicated. An example is the billing system.
An Explanation of Benefits (EOB) from an insurance provider shows an initial billing from the physician, practice or hospital, minus the in-plan deduction to equal the final amount billed. So, if the original billing is the cost, why settle for less?
Bowen said the negotiation process for payment is so complex that medical providers bill at a rate they believe will help them to get costs covered. Morone said it’s even more complex than that. He said there are operating costs for medical practices and hospitals, and there’s a complicated formula to determine what procedures pays what.
He compared it to renting hotel rooms. Depending on what savings plan a person has, such as an AAA member or AARP member; people get rooms for different rates. So, what does a hotel room cost? It depends on discount programs, travel times or number of rooms, among other things. The costs of health care procedures are similar – it depends on the insurance and what the company has negotiated.
“There’s so much shifting of costs in the system that how much cost a patient bears depends on the insurance company and the incredible negotiating system,” Morone said. “There’s not a fixed cost for a procedure, there are costs for running the office or hospital.”
America’s Health Insurance Plans (AHIP) has released statements saying that reforms can solve the problems without creating a government-run plan and has proposed guaranteeing coverage to all Americans, eliminating pre-existing condition exclusions and no longer basing coverage premiums on a person’s gender or age. But, AHIP said these must be paired with a requirement to get everyone into the health care system. In addition, there must be cost containment included, according to AHIP.
Some are calling for the marketplace to fix the incredible disparities in the health care coverage system. But Morone said that’s not likely. While it’s not impossible for the market to fix the system, it’s not practical, he said. That’s because, he said, society won’t let a hospital fail or a person who couldn’t afford to pay for treatment to die after being hit by a bus. And, he said, we couldn’t give cheap medicine, so it’s hard for the market to do its job.
“It’s not like buying a computer,” he said.
Morone does like the plan President Barack Obama has endorsed because he said it does something to address the problems, but doesn’t do too much. And, he said, a public option gives a process for cost control. Similar to Medicare, a public option would set a reimbursement rate, setting cost controls.
Bowen hates the idea of the government taking over any part of the health care industry. She points to the pharmaceutical companies who research and develop medications that she said have saved lives. She’s concerned that will change with too many government restrictions on the system.
The Pharmaceutical Research and Manufacturers of America (PHRMA) support health care reform by making a commitment to the White House and Senate Finance Committee to help most seniors who are affected with the Medicare Part D coverage gap by providing a 50 percent discount for brand-name prescription drugs, an $80 billion investment. But the organization stresses that reform should not be made through price controls.
Obama has promised to overhaul the health care system, saying he’s determined to be the last president to deal with it. While Morone said he supports Obama’s plan, he said the president won’t be the last president to confront the issue.
Obama’s office didn’t return phone calls or answer questions that were e-mailed upon White House staff request. In a response to the initial list of questions e-mailed to the White House, staff asked for (additional) specific questions following the President’s address on Sept. 9. However, the list of questions was never answered.
History of Health Insurance
Health insurance coverage in America has seen price increases since 1952, steadily increasing at a greater rate than the rest of the economy. World War II was the initial biggest boost to employer-paid health insurance coverage. During the war, the IRS put limits on employee pay, but health insurance was a new thing and was exempted from those pay limits. So, employers used that as a way to offer employees additional compensation.
In the 1950s, President Dwight D. Eisenhower made the exemption permanent. In 1952, about 10 percent of workers had employer-paid health insurance. By 1962, most workers had health insurance coverage.
As of March 2009, medical care benefits were available to 71 percent of private industry workers, compared with 88 percent among state and local government workers. About half of private industry workers participated in a plan, compared to the 73 percent of state and local government workers. Employers paid 82 percent of the cost of premiums for single coverage and 71 percent of the cost for family coverage, for workers participating in employer sponsored medical plans.
Sources: Jim Morone, Chair of Brown University’s Political Science Department and the United States Department of Labor
