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September 10, 2009
Ideology and the Heath Care Debate
In October 2009, Physicians Practice will publish the findings of their annual survey. Nearly 1600 physicians were asked this year about what health care reforms they’d like to see. Among the top ten were ‘get the government out of medicine entirely’, ‘institute a single-payer system that has universal coverage’, and ‘cap insurance and pharmaceutical company profits’. The results highlight the ideological divide between those segments that’d prefer to see more government involvement in our health care system, and those that’d prefer to see less—much less! The ideological divide was no less evident in Washington on Wednesday night when President Obama addressed congress to explain some of the details of his plan for health care reform.
The President’s reforms propose to offer more choice, lower costs, and improved security for people who already have health insurance. Under the proposal, insurance companies would not be allowed to drop or dilute coverage. For the uninsured, the new plan proposes affordable coverage for individuals and small business owners. Among other changes, it’d be unlawful for insurance companies to deny an applicant coverage on the basis of a pre-existing condition. Other proposed reforms include pilot studies for changes to medical malpractice laws.
The President made it clear that, while alternative proposals were welcome, he would not lie down easily on a public insurance option, nor his concept of an insurance exchange. In his words, a public insurance option would provide better choice and competition for consumers. Dr Charles Boustany replied on behalf of the Republicans. He told the press that his party opposes a government-operated insurance agency, and argued that competition in the insurance market could be improved by allowing families and small businesses to purchase their insurance across state lines.
One political commentator described the presidential address as ‘vintage Obama’, highlighting what he saw as a veiled contradiction: ‘Complete command of the issue, excellent cadence and pace. The reach out, as expected, to the GOP to join him half way, while standing firm on his beliefs and denouncing what he saw as the "politics" of division’(Rudin 2009). Another agreed that the President failed to exhibit the attitude of compromise he was demanding. William McKenzie of The Dallas Morning News wrote:
[Under Obama’s plan] there's no guarantee you can keep your health plan. If your company stops offering coverage and you end up on a public plan, you could lose your doctor. Look at Medicare. Washington has been tightening up Medicare payments to doctors, so fewer providers are picking up seniors. The same phenomenon could happen under a public plan. If you end up on it, and your doctor chooses not to participate, you're out of luck. The president wants a public option so consumers can have more insurance choices. Well, they could get more options if he supported letting insurers and consumers connect across state lines. That way, we all could get plenty of choices and wouldn't have to worry about the headaches of creating a federal plan.
All this political crossfire overshadows the facts. The US has the most expensive health care system in the world—around 1.5 times more expensive per capita than the average of other developed nations. For every six dollars an American earns, they spend more than one dollar on health care (Gawande 2009). You’d think, therefore, that our nation would be exceptionally healthy. Instead, we’re ranked 42nd in the world for average life expectancy—just above Mexico—and we have the dreadful honor of being the fattest country on the planet (Ohlemacher 2007). Research reveals that 41 percent of working age adults in the US have a medical debt, or have a problem paying medical bills (Gardner 2008). A study published in the American Journal of Medicine found that nearly two-thirds of personal bankruptcies filed in the US in 2007 were caused by illness and medical expenses. More concerning, most of these people had insurance at the start of their illness, were middle class, university-educated, and owned a home (Healy 2009). Meanwhile, insurance companies and their executives are rewarded for the relentless pursuit of profits.
The Democrats and GOP have agreed on a middle ground when it comes to expanding insurance access for people with pre-existing conditions, and providing health care assistance for very low income earners. But the coming months will further tell if our representatives in Washington are able to conceive of the world in shades of gray by building a bridge of compromise between their ideologies—or if they are only capable of confusing and polarizing the constituency. The danger of not compromising on ideology is that we will continue to compromise our health.
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
References & further reading:
Beckel, A & Michael, S 2009 Ten health reforms docs want, Physicians Practice.
Gardner, A 2008 Medical debt sending many over financial brink, US News & World Report.
Gawande, A 2009 The cost conundrum: what a Texas town can teach us about health care, The New Yorker.
Healy, M 2009 Medical bills led to two-thirds of bankruptcies in 2007, study finds, Los Angeles Times.
McKenzie, W 2009 Obama's health care speech got it right and wrong, National Public Radio.
Rudin, K 2009 The President spoke. What did people hear? What will congress do?, National Public Radio.
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