Great Healthcare Debate: Why We Need Obama



By: Aneesh L. Gupta
The Great Healthcare Debate column previews the upcoming 2012 US Presidential Election, and the ramifications it will have on our healthcare system.

In this November’s presidential election, the major talking points between the two candidates will likely include women’s rights, the economy, international affairs, and of course health care. With health care spending in the United States rising at an alarming rate, an aging population that will use more and more health services as they get older, and neither political side willing to completely eliminate the profit-driven insurance companies, something needs to be done about our health care system. And fast.

Both sides in this election have presented very different solutions for what they believe will solve, or at least soften, the impending crisis our health care system faces. The one with which most people are familiar, due to the Supreme Court ruling this past June, is the Patient Protection and Affordable Care Act (PPACA), more commonly known as ‘Obamacare’. The proposal presented by the Republican party, The Path to Prosperity, has been well known in political circles for quite some time, but was recently thrust into the spotlight due to the nomination of Paul Ryan for Vice-President. Both plans suggest drastic changes to our current system, but it seems that only one is the correct plan for our country.

Ryan's Plan:
Congressman Ryan’s plan does deserve some praise. He is acutely aware of the financial crisis facing all aspects of our country, and he understands that major changes need to be made for America to return to its place as the dominant financial power in the world. However, there are two major flaws with his plan. First, he in no way addresses how to control the rising cost of services and procedures that are the real burden in health care today. And second, in his rabid attempt to curb spending at all costs, Paul Ryan has forgotten about the people who make up the majority of this country: the middle class. While the list of problems with his proposal could be endless, a focus on the health care portion will suffice for now.

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Paul Ryan wants to make major changes to the Medicaid program. For example, Mr. Ryan wants to convert the current federal share of Medicaid spending into block grants for each state (1).While the federal government will save money due to the greatly decreased amounts they will be giving to the states, the social impact on the 50 million people who rely on Medicaid for health care will be incalculable. As states attempt to distribute the pre-determined amount of money they receive, certain individuals will ultimately be denied the coverage they need, and will thus seek medical treatment only in dire circumstances, greatly increasing the burden over-strained emergency rooms already bare. Medicaid reform is surely needed, especially with regards to the $33 billion in waste that Mr. Ryan believes will be eliminated via his reforms, but cutting out innocent people is an extremely short-term solution (1).

Mr. Ryan scores some modest points with his proposal for Medicare, but as expected, most of his plan is harsh and lacks long-term positivity. The minor credit Mr. Ryan deserves is for his acknowledgement of the frivolous litigation that has done more to raise health care costs than will ever be accurately calculated (1). By capping non-economic damages in lawsuits, the amount of defensive medicine being practiced will decrease dramatically and lead to lower consumer spending. On the other hand, his myopic view on how health care works has led him to devise rather pointless changes to the Medicare system. Mr. Ryan would like to convert the current Medicare system into one where future enrollees select from a list of coverage options and then buy into their selected program by paying a fee that is subsidized (to a degree inversely proportional to the wealth of the applicant) by the federal government (1). So, in summary, Mr. Ryan would like people to predict how much money they would like to spend on future health care costs, before they get sick. While health care expenditures are somewhat predictable on a population level, they are almost impossible to predict on an individual level, making Mr. Ryan’s proposal erroneous. The other change Mr. Ryan would like to make to is to ‘fix’ the Medicare physician compensation formula over the next 10 years. Congress tried to do this in 1997, and quickly learned that their so-called ‘sustainable growth rate’ formula would have to be continually modified to meet the changing demands of the health care market (2). Mr. Ryan provides no details on what formula he believes will cure this problem, and if he does implement a formula that proves incorrect, doctors across the nation will drop Medicare patients from their practices due to the payment cuts they will experience.

Obama's Vision:
In stark comparison to Congressman Ryan’s proposal stands President Obama’s. Whereas Mr. Ryan’s budget plan involved many aspects of government reform and gave little in the way of specifics, President Obama’s plan is exclusively focused on health and provides many details about what he plans to implement. By no means is President Obama’s plan a panacea for the health care crisis, and there will probably still be around 30 million uninsured people after it is fully implemented. But the proposals he has suggested are humane, feasible, and will have long-term positive consequences.

The first major change suggested by President Obama is to limit the damaging effect the insurance companies are having on both access to health care as well as rising costs. As part of the PPACA, insurance companies will no longer be able to discriminate against policy holders for pre-existing conditions, they must cover 100% of the costs related to preventative services and immunizations, dependents can be covered up to the age of 26, and there will be a cap placed on administrative/non-medical expenditures (3). Yes, this does take some profit away from insurance companies that make billions of dollars a year, but the numerous positive benefits greatly outweigh any pity one may have for those companies. Now, when policy holders need their insurance the most, they will not be denied financial support by an insurance company proclaiming that a pre-existing condition caused this illness and should thus not be covered. Also, insurance companies will be forced to spend more money on medical procedures and cover preventative services that will drive down future expenditures related to serious illnesses caught at later dates.

While Mr. Ryan wants to severely limit public program (e.g. Medicaid and Medicare) expenditures, President Obama views the expansion of these programs as crucially important for improved health care in our country. Beginning in 2014, individuals who do not qualify for Medicare, but who have family incomes up to 133% of the Federal Poverty Level, will now qualify for Medicaid, and the federal government will cover 100% of their costs up until 2016 (3). With regards to Medicare, payments will now be linked to quality outcomes, health providers located in rural areas will receive higher Medicare payment rates, and drug companies will have to give a 50% discount on brand-name drugs purchased in the ‘donut hole’ gap of drug coverage (3). These steps are the first to entice health providers to work in rural and underserved areas, pressure drug companies to make their products more affordable, and begin a payment process that involves the quality of the work and not just the work itself.

Innovation:
While these proposals are exciting and promising, they actually do not even represent the most innovative ideas set forth in the PPACA. The first of these innovative ideas is the establishment of health exchanges, which will allow individuals and small businesses to obtain coverage by directly comparing, and selecting from, any number of participating plans (3). These exchanges greatly simplify the insurance-selection nightmare, and will force insurers to be as competitive as possible with each other, thus driving down prices. The second innovative idea is to increase the number of health care workers, specifically those delivering primary care in medically underserved communities, by altering loan payment programs to make them more affordable for a larger number of students (3). The final innovation, and likely the one with the most long-term impact out of any proposal by either political side, is the massive spending increase on public health programs. These programs will include school-based health clinics, oral health campaigns, waving any fees related to preventative care, and providing counseling and pharmacotherapy to pregnant women who wish to quit smoking (3). These campaigns, along with many others, will go a long way in reducing the incidence of morbidity and mortality in future generations. Public health is just starting to gain momentum, and it will be interesting to see just how large an impact it can have on our health care system over the coming years.

Today vs. Tomorrow:
At the end of the day, the debate between Paul Ryan and Barack Obama comes down to one simple idea: today vs. tomorrow. While Paul Ryan really does have America’s best interests at heart, his ideas ultimately fall short. They are much too focused on immediate cuts, put thousands of innocent lives at risk, and do not deal with the real problem: the health of our citizens. Barack Obama, also with America’s best interests at heart, has proposed ideas that put Americans back on the right track to healthy living. President Obama’s ideas allow for more citizens to gain medical coverage, which will ultimately lessen the strain our nation’s health care is putting on our finances. It is time to fully embrace the fact that our capitalism-driven health care system is not working, and change is needed. America remains one of only a few industrialized nations in the world to not have achieved universal coverage for its citizens. At some point, we need to look at ourselves and decide if we are a country where only a small portion of our population receives health care, or if we are a country that fights for every American and their right to a healthy life.

Aneesh L. Gupta is currently a medical student at The University of Queensland School of Medicine in Brisbane, Australia.

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