What Obama's Health Care Reform Means for Heart Disease Prevention
Though the war in Iraq and the downturn in the economy continue to dominate political conversation among the presidential hopefuls, health care reform remains an enormous and looming issue, one that increasingly demands change away from an unsustainable status quo.
To be sure, informational tools that provide self-empowering information, such as that provided on health websites like this, are growing forces on the health care landscape that potentially may reduce costs by arming the health care-consuming public with better information.
But, break your leg and what choice do you have but to go to the hospital? Or develop pneumonia, colon cancer, or any number of conditions that cannot be managed through prevention and self-directed care, but require the services of the conventional health care system? Yes, emerging positive change in health will come from a number of new directions, but the need for conventional - and costly - care will continue.
Are we approaching the breaking point in health care? I’m not sure, but it sure feels like we are. Dealing with the uninsured is an everyday occurrence in most medical practices, certainly exceptionally common in hospitals. So, we turn to the presidential candidates for some ray of hope, hope that changes in the status quo might help alleviate the enormous pressures on all of us trying to obtain or maintain access to health care that is priced beyond reach for so many people.
While there are differences among the three candidates, all agree on several basic issues:
- Health care is too expensive for the majority of Americans. Costs are rising too fast, out of proportion to the rest of the economy.
- Too many Americans - some 45 to 48 million - do not have basic health care coverage that even covers emergency care, obstetrical care, or catastrophic injury. This is an intolerable and dangerous situation, one that not only threatens health but also leads to financial ruin to many who obtain care only to face monstrous bills.
- Importation of drugs from outside the U.S. should be permitted to reduce prescription drug costs.
Beyond these basic concerns shared by all three candidates, there are clear-cut, fundamental differences.
Is the patient so sick that drastic surgery is required for survival, as in the democratic candidates’ proposal for major upheavals in health care coverage? Or, does the patient simply need a bit of coddling and R & R, as provided in the McCain republican proposal?
The Obama Health Care Reform Proposal
“We now face an opportunity — and an obligation — to turn the page on the failed politics of yesterday's health care debates . . . My plan begins by covering every American [emphasis added]. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don't have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”
Barack Obama, Speech in Iowa City, IA, May 29, 2007
That tantalizing commentary - promise? - was issued by democratic presidential candidate, Senator Barack Obama in May, 2007. Health care coverage for everyone, with less burden on the individual and the premium payers (employers) for access to some minimum level of health care. More recently, Mr. Obama has suggested that approximately 15 million people may not be covered by his plan.
The Obama plan for health care reform will require, he estimates, $50 to $65 billion dollars to implement in the first year, to be paid for eliminating the tax cuts introduced by President George Bush and cost savings within the system. Briefly, Mr. Obama plans to bring affordable health care to Americans that includes:
Guaranteed eligibility: Pre-existing conditions cannot be a reason for a health insurer to deny or discontinue coverage. However, Americans will not be required to enroll (as they would in the Clinton plan).
Comprehensive benefits: The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan provided to members of Congress. The plan covers essential medical services, expanded to include preventive, maternity, and mental health care that many health care plans now exclude.
Subsidies: Individuals and families who do not qualify for Medicaid or SCHIP but still require financial assistance will be targeted to receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
Ease of enrollment
Portability and choice: Currently, changing jobs carries the potential for loss or substantial change in coverage. Under the Obama plan, you will be able to move from job to job without worrying about changing or jeopardizing health care coverage.
Mr. Obama uses rather strong language to convey his intention to reduce costs by going after the pharmaceutical and insurance industries:
“The biggest obstacle in the way of reforming this skewed system of needless waste and spiraling costs are those who profit most from the status quo - the drug and insurance companies who pocket a growing chunk of the medical bills . . ."
“Since President Bush took office, the single fastest growing component of health care spending has been administrative costs and profits for insurance companies. Coming in a close second is the amount we spend on prescription drugs. In 2006, five of the biggest drug and insurance companies were among the fifty most profitable businesses in the nation.”
While the Obama plan would guarantee a government-sponsored minimum coverage, individuals will maintain the option to purchase their own private health care coverage that goes above and beyond the minimum. There are also provisions for greater support of programs for mental health, lead poisoning in children, mercury contamination of foods and the environment, and autism.
The Obama plan (like the Clinton plan) derives leadership at the federal level, in contrast to the McCain proposal, which would encourage more health care reform leadership at the state level.
Some had feared that a Democratic agenda for health care reform might lead to some form of “socialized” medicine, similar to that practiced in Canada and the U.K. Mr. Obama’s plan seems to not deliver on that fear, but instead represents a hybrid of federal government sponsored minimum while maintaining the option of private insurance.
Critics of Senator Obama’s plan have expressed fear that the mandates that are included in his proposals, i.e., mental health coverage, maternity care coverage, anesthesia for dental procedures, etc. will substantially increase health care costs. Such precedents already exist, with states with more mandated inclusions in health care yielding higher health insurance costs, while states with less mandated inclusions have lower costs. Republicans also warn that the upfront costs will increase total health care expenditures, not reduce them.
One mandate that differs in the Obama plan vs. the Clinton plan is who would be required to carry health insurance. The Obama plan would mandate only that children - but not adults - absolutely be covered, whereas the Clinton plan mandates that everyone be covered.
In short, Mr. Obama details a plan to provides guaranteed Medicare-like coverage to all Americans (but not mandating enrollment), while preserving private health insurance choices, paid for largely from cost savings. Importantly, he plans to reduce health care costs by clamping down hard on the drug and health insurance industry through legislation intended to trim excess profiteering. Mr. Obama has also not been shy in expressing his views on the overall health - read “obesity” - of the American population, suggesting that during an Obama presidency, reforms aimed at education and wellness will also be instituted.
Next discussion: Senator Hilary Clinton’s plan for health care reform: The old proposal reissued or a new plan altogether?