The recent Health Care Reform Bill passed in the US. Has received a lot of media coverage, but do these changes to the US system actually raise more questions than answers? The biggest question of all – Does it actually reform health care in the US?
Why Does Government want Reform?
Unlike here in the UK, there is not a universal system of healthcare coverage. There are federally funded programmes, the biggest being Medicaid (for the poor) and Medicare (for the elderly). But generally it is up to individuals to obtain health insurance. Most get coverage through their employers, but others sign up for private insurance schemes. Under the terms of most plans, people pay regular premiums, but sometimes they are required to pay part of the cost of their treatment before the insurer covers the expense.
What Changes does the Bill implement?
In broad terms the bill aims to force the following changes:
• Tougher regulations for the insurance companies.
• Establish an individual mandate – in other words make health insurance compulsory.
• Set up insurance exchanges for those who do not have coverage provided by employers.
• Offer subsidies for the less well-off .
• Pay for most of the reforms by cutting waste in the Medicare programme.
What else does the Bill include?
As is often the case with government legislation and reports the bill consists of a lengthy document that many haven’t read and/or poorly understand. There has been some concern amongst experts regarding particular aspects of the bill.
For example under the revised system a government committee will decide what treatments and benefits an individual will receive from the insurance policy. The individual will have no choice in the process unlike true private health cover and unlike a private insurer, there will be no appeals process.
Others are alarmed that the reform gives the federal government direct, real-time access to all individual bank accounts for electronic fund transfer.
Does the Bill Truly Reform Health Care in the US?
The most pertinent question however remains whether or not this bill actually represents reform of the health system. To answer that question, we need a full understanding of health and our current western health care system.
In speeches preceding the bill President Obama himself indicated that less than 4% of the US health budget is spent on prevention. In fact even so called preventative medicine and “well man” clinics or assessments constitute tests designed to obtain early detection. Early detection isn’t prevention, its early detection of sickness! True health care comes form enhancing and maintaining health not treating sickness.
The president also acknowledged that whilst the Americans spend one-and-a-half times more per person on health care than any other country, they are not any healthier for it. Indeed, in the US per year approximately 250 000 people die as a direct result of medical intervention, constituting the 3rd largest cause of death (Journal of the American Medical Association). In contrast, a total of 60 000 Americans died in the entire Vietnam war.
In correspondence to the British Medical Journal, Ron Law noted that preventable medical errors in hospitals are responsible for 11% of all deaths in Australia and New Zealand. Adding the deaths resulting from properly researched and properly used drugs, the total expense of this health care intervention is almost 1 out of every 5 deaths (19%).
On 18/03/200 the BBC reported that as many as 30, 000 British people die every year from medical error – surpassing the combined totals attributable to car and plane accidents, suicide , falls, poison and drowning.
The Australian National Health and Medical Research council states that the nation spends 8-10% of the Gross National Product on health care. Yet 60% of Australians were sick within the last 2 weeks, 60% take drugs for a chronic health problem, 50% of adolescents are taking painkillers and 40% of 15 year olds suffer some kind of chronic disease.
Studies suggest that on average we are living 15 years longer, but also that on average we each suffer from 15 years of chronic disease in our life. In other words our current health care model enables us to live for an extra 15 years whilst sick!
These statistics should astound you. They should also concern you. It is not difficult to accept the reality that our current model of health care is flawed, unsuccessful and potentially dangerous.
Once we understand that our current approach to health care merely represents sick care, we can appreciate that in fact this reform bill has almost nothing to do with health care at all. It's more of an effort to expand a broken sick-care system. When faced with the problem that a sick-care system doesn't work, the US government is attempting to fix the problem merely by expanding the failures to include everyone by making it compulsory!
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