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The Brutal Politics of Health Reform

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Background: U.S. Health Care in Comparative Perspective
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Universal healthcare and the 2012 elections: What is Washington saying?

A constant theme of Brill's article is the "chargemaster" list. It's a list of prices for particular services and items administered at a hospital, and it's the basis for all prices charged to individuals and to insurance companies. There's an alternative method, which Medicare uses.

When the government reimburses hospitals for treating medicare patients, it draws on a calculated list of what it actually costs to provide a service. These prices are drastically lower than the ones on the chargemaster. An interesting reform might be to tie the prices of all fees to this Medicare reimbursement list, and then allow a certain mark-up for the hospitals to make a profit. A peculiar problem of the American healthcare system is that uninsured or underinsured people face steep charges if they go to the hospital.

These fees are based on the previously mentioned, outrageously over-priced chargemaster. Insurance companies negotiate lower prices, and the government insists on a particular schedule of fees when it pays for Medicare and Medicaid patients.

Yet individuals who have no insurance are at the mercy of the hospital, and they must pay whatever the hospital charges them. To make matters worse, people often don't know how much they're going to be charged until after they've been treated.

This begs the question of whether it's fair for some people to pay far more for healthcare than those who are covered by insurance. On the conservative side, one argument about healthcare is that prices are so high because hospitals and doctors have to be concerned with malpractice lawsuits.

One wrong step and they're on the line for millions of dollars of liability. If they don't exhaust every option, then they might even be on the hook for that. Brill suggests that this leads to massive over-testing, and doctors are ordering all kinds of tests like CT Scans that aren't really necessary. By tightening the rules for proving malpractice - i. This could help bring down spending significantly, although the counter argument is that this could lead to inferior care.

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Some articles have Google Maps embedded in them. This is used to display charts and graphs on articles and the author center. This service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. It is well known that the U. What is less well known is which segments of the population lack coverage, and how the high-cost care that does reach the public results in many respects in mediocre health outcomes.

Myths about American health care are pervasive, and factual correctives are needed. Most of the roughly 50 million uninsured are not unemployed or welfare recipients, as many believe. Rather, the majority are members of working families. Although adults under age 65 typically receive health insurance as an employment benefit, not all are so fortunate.

Most small businesses, many medium-sized firms, and even some large firms do not offer health insurance to their employees. Although ethnicity is correlated with lack of health insurance, the ethnic group least likely to have insurance is not African-Americans, as many believe; it is Hispanics. More than one-third of Hispanic workers Comparative Health Care Expenditures.

Health care costs in the U. For example, infant mortality rates in the U. States click for larger version. The percentage of total health care expenditures spent on administration and insurance in the U. Comparative Mortality Rates from Noncommunicable Diseases click for larger version.

Since physicians control most health care purchasing decisions, and they are not constrained in most health care settings by cost considerations, incentives for excessive diagnostic procedures are built into the system.

These incentives are heightened by the fear of lawsuits — an exaggerated fear, perhaps, since the number of paid malpractice claims per active physician has been declining steadily for the past twenty years. A second factor that has driven U. But in terms of providing good health care to the nation as a whole, the U.

And the unceasing growth of health care costs is unsustainable. Barack Obama campaigned for president in on a platform of health reform. He scored a decisive electoral victory, and the Democrats gained a filibuster-proof vote majority in the Senate 12 and increased their majority in the House of Representatives. In the early months of his presidency, Obama made overtures to congressional Republicans in an effort to reach agreement on the outlines of a bipartisan consensus health reform program.

Those hopes vanished during the summer of The criticisms had an effect on public perceptions, as the complex and poorly understood health reform proposals never commanded majority support in opinion polls. Nevertheless, Democratic majorities in the House and Senate passed differing versions of health reform in the autumn of , opposed by almost all Republicans in the House and all in the Senate. Hopes for reform dimmed.

Health reform was one of the major issues in the congressional election campaign. The rationale for the decision was a surprise to many observers. Presidential Election Results, , by State click for larger version. Health Insurance Coverage, , by State click for larger version. However, Obama was re-elected by a substantial majority, defeating Mitt Romney by a margin of in electoral votes see Figure 4. Democrats gained two Senate seats and eight House seats, although Republicans retained control of the House.

PPACA, a complex piece of legislation, aims at improving all three dimensions of the health care system — access, cost, and quality. Of the roughly 50 million uninsured Americans, slightly more than half will likely receive health insurance coverage when the law is fully implemented, leaving the nation well short of universal coverage.

The following provisions are designed to expand access to care:. The federal programs are so large and so many providers depend on them for payment that federal policies tend to have considerable impact even in the private sector. As of this writing, action on the latter two measures has stalled. Under pressure from private health insurers and seniors, the Obama Administration scaled back the planned Medicare payment reductions.

These costs are covered by increased taxes and fees, so that the net effect is predicted to be a reduction in the federal budget deficit. The biggest source of additional tax revenues is higher-income taxpayers, who face a 0. The health care sector, which will benefit from tens of millions of new customers, is also subject to new taxes and fees directed at pharmaceutical manufacturers, medical device manufacturers, and health insurers except for nonprofits covering the poor, elderly, or disabled.

Other revenue will be raised from penalties on large and medium firms not offering coverage to their employees, from individuals choosing not to obtain qualified coverage, from tax shelters lacking economic substance, from comprehensive health plans offering upscale service, and from a tax on tanning beds.

Implementation of the new law has predictably sparked numerous controversies. Implementation involves complex sets of regulations and guidance issued by federal agencies such as the Departments of Health and Human Services, Labor, and the Treasury, as well as policy choices by the fifty states, a majority of which have Republican governors 30 or Republican-controlled legislatures 27 or both.

Heretofore, each state has determined the income level that qualifies residents for Medicaid assistance. A second major implementation issue is the creation of insurance exchanges, or markets where individuals and small businesses can shop for health insurance plans.

But as of this writing, 26 states have indicated that they will refuse to do so. In those states, the federal Department of Health and Human Services will operate the exchanges.

Measures to control the cost of health care remain controversial. Among the first to feel a financial sting will likely be younger men.

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Health Care Reform. Incorrectly called Obamacare, with the proper name should be called, affordable Health care act, stated to have been designed to help millions of people. But questionable at best.

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