USA : The Dawn of Health Care Reform
By Dr. Mohammad Taqi & Dr. Arshad Rehan
The landmark health care reform has been approved by the US House of Representatives and signed into law by President Barrack Obama, as we write these lines.
In a departure from decades of societal and political inaction, President Obama has delivered on his top domestic policy election promise.
“ Health care for all by the year 2000” was the declaration of the 1978 WHO meeting in Alma Ata. 32 years later something similar has been pledged to be delivered through the present health care reform.
The political perfection of the reform would have been a bipartisan consensus on the agenda and the nuts and bolts of its implementation. While “it aint broke, don’t fix it”, could never be claimed about the US health system, the bipartisan consensus still remained elusive. Doing nothing however, was not an option and even in the present state, the bill’s passage is a giant leap forward.
Many aspects of this reform – being dubbed as a new social contract- are fairly clear but additionally there are issues and initiatives that remain obscure. Like President Obama, we think that this is not a radical change but it is a major step forward.
As physicians who dedicate their lives to providing quality health care, any measure that makes health services more affordable for the American people is a top priority for us. We welcome the expansion the coverage to include some 32 million, heretofore uninsured, American citizens.
While it is not a universal coverage, it seems pretty close to it. It is projected that, in an incremental manner, about 95 % of the population – citizens and legal residents - would eventually enter the doors of health care system. The legislation proposes to do so through multiple measures.
An expansion in Medicaid to include families under 65 with gross income of up to 133% of federal poverty level and childless adults is a key component of the bill. The uninsured and self-employed shall be able to purchase insurance through state-based exchanges. Additionally, it includes the eligibility of the low-income individuals and families, wanting to purchase own health insurance, for subsidies.
Small businesses are being offered tax credits to make health coverage for their employees affordable. Up to 35 % tax credit on premiums will be available immediately and would increase to 50% in 2014. This, in theory, adds to effectiveness of the employers to retain work force and for employees to move between jobs. The ability to buy insurance without risk of being denied coverage should certainly help the Americans who lose jobs with employer-sponsored health plans.
For the Medicare population the reform closes the so-called donut hole, i.e. the prescription drug coverage gap which affected the nation’s elderly usually towards the end of the calendar year. The Medicare population has been pledged to receive rebates and discounts on the brand name drugs as well. Another important aspect is the approved coverage of preventive services for Medicare patients.
The Americans with employer-provided health care plans, no major shift is proposed in this legislation but they shall be able to add “adult dependent” children to their current policies. Combined with claiming adult dependent children on taxes, this could provide some reprieve for many families going through the economic crunch.
Some of the rather notorious practices of the insurance industry are to be regulated to prevent them from denying coverage to those with pre-existing conditions or charging them higher premiums, capping or limiting annual coverage and dropping coverage for the extremely sick patients. This is a welcome move to protect one of the most vulnerable sections of the population from economic ruin and physical suffering.
The fine print of the plan also emphasizes overhaul in medical and nursing education and improvements in the delivery of primary care services across cities and rural America . Rural health providers would get incentives to bring them at a relatively comparable level with the rest of the United States .
The health care reform in its present form is a rolling start. Many things will happen now, and then there are provisions that go into effect over almost the next decade.
While we believe in positive change and acknowledge the dangers of inaction, we also think that a truly new social contract cannot and should not be written with focus on one sector of the economy only. Indeed, one has to start somewhere and as long as we build and refine based on this start, we shall move America forward.
The physician community and consumers both remain concerned about certain known issues in the bill, many unknowns and the areas not touched by the legislation.
The revenue provisions of the reform claim to reduce the average American’s tax bill but would also levy higher Medicare taxes and investment taxation on families earning above a certain with increased tax penalties in the form of Medicare tax increase and taxation on investment.
Also, as the legislation proclaims to come down hard on waste and abuse in the health care sector, we find conspicuously absent from it any safeguards against the multibillion dollar litigation industry which has been the prime mover behind the wasteful defensive medicine that many providers practice in this country.
Health care related hardware and pharmaceutical industries are an integral part of America’s market economy and cities like Kalamazoo, Michigan have survived due to contributions from this section of the American entrepreneurs. Very little has been made public about impact of the reform on this sector of the economy.
Health care providers rendering specialized care are another group which perceives the legislation to be unfriendly, to say the least, towards them. It is imperative that all sections of the physician community are brought onboard without further delay. The primary care and specialty care are not mutually alien but rather compliment the delivery of quality healthcare. One cannot be ignored one at the expense of the other.
Many other issues like the Medicare payment formula, tort reform, rising malpractice premiums and reducing administrative burden on doctors remain outstanding.
As physicians and citizens, we remain committed to following the reform through to fruition. In this, we will partner with physician organizations, consumer groups and political parties - on both sides of the divide - to monitor, critique, improve and implement the programs that have been guaranteed and help add the components missing from this legislation.
We believe that this is a reform in making and many more adjustments would be needed along the way to reach the goal of healthcare for all Americans.
(Dr.Taqi teaches and practices Medicine at the University of Florida and is the president of Khyber Medical College Alumni Association of North America. Dr. Rehan, based in Ohio, is the organization’s president-elect and a practicing cardiologist. Contact: firstname.lastname@example.org)