The healthcare reform debate is now back in full swing in Congress and is again dominating the news. President Obama offered the Republican members of Congress another opportunity for involvement in bipartisan healthcare reform legislation last week, but by all accounts his efforts fell on deaf or stubborn ears, forcing Democrats to start the reconciliation process in the Senate in an attempt to pass any type of meaningful healthcare reform this year. Of course, this has met opposition from the Republicans, who are quick to forget their own frequent use of reconciliation.
Healthcare reform must happen in the United States, the sooner the better, and by whatever means are legally available. The next few posts will be a part of the series The Itch for Healthcare Reform, and will be about this issue, including why it is so important, obstacles to change, more efficient and effective healthcare systems in other countries, what has to happen in the United States to make change a reality, and some ideas that will make healthcare in the United States second to none.
The first question is why is there such a need for US healthcare reform. Although the answer has many parts, it is also very simple: our system is broken. It is ineffective, inefficient, and by almost all measures, substandard when compared with healthcare systems in other first world countries.
Our system basically consists of doctors and hospitals that bill patients based on services provided. If a person can't afford the services, they may not receive treatment. There are laws that prohibit hospitals from turning away extremely sick or injured people, but they are only required to stabilize the patient, not provide full treatment.
Because of the expenses of healthcare, most people have health insurance, provided mostly by employers as part of a compensation package. People are able to buy insurance privately, but it is usually more expensive, less comprehensive, and more difficult to get. For those whose employers don't offer insurance and are unable to afford or obtain insurance individually, they may be eligible for government sponsored Medicare, Medicaid, or another government assistance program. If not, they must go without, and hope they don't get sick or injured. Unfortunately, the number of Americans who are without insurance has been growing and is currently disturbingly high. In 2008, it was estimated that over 46 million Americans are uninsured.
Because of the rising healthcare expenses, insurance companies are cutting back on what will be covered or how much they'll pay. Most policies have a lifetime maximum benefit, and it is not unheard of that patients exceed that amount. Deductibles and co-pays been increasing, and co-insurance of twenty percent is almost standard now. Some policies have an out of pocket maximum for co-insurance, but many do not.
As a result of some of the increased in heath-care costs and insurance changes, you can see how even with insurance healthcare bills can pile up. It is estimated that 25 million Americans are under-insured; that is, they have health insurance, but not enough to protect them from financial ruin if a serious injury or illness stricken a policy holder.
The rising costs of healthcare and the inadequacy of health insurance coverage is indicated not only by the numbers of uninsured and under-insured but also by the number of bankruptcies in America that are a direct result of health-care expenses. In 2007, 62% of bankruptcies were caused by medical expenses. Of those, 78% of those who filed bankruptcy had health insurance; 60% with private insurers. The percentage of bankruptcies file as a result of healthcare expenses in 1981? 8%.
We have been hearing a lot lately that America has the best healthcare in the world, as is evidenced by the number of world leaders that come here for care. When looking at the huge expense of our system, one might think that is right. Unfortunately, by many measures, that is wrong. The US measures 37th according the World Health Organization in overall healthcare. Our infant mortality rate is higher than most other first world countries at 6.8/1000 births (Japan is lowest at 2.8/1000 births; the UK 5.1; Germany 3.9). Our life expectancy is lower than many other countries, too, at 77 years (Japan is highest at 82.1; Switzerland 81.3; the UK and Germany are 79).
I think it is clear that our costs high for results that are poor. Our insurance industry leaves 71 million people behind, almost 24% of our population. Our system is not meeting the needs of our country, at the expense of low quality and prematurely lost lives. This is clearly not acceptable. Reform is needed. Now.