Rescuing Health Care

The dramatic rescue effort to save the lives of 33 miners in Chile has riveted the world’s attention in recent weeks. It shows respect for life—that each life matters. But what would you think of one of the world’s wealthiest societies that let not just 51, but 51 million of its people go without health insurance, which for most of them means no affordable health care when they are sick? We are, of course, that nation. Two years ago, when the effort to reform the health system began, that number was millions smaller, between 45 and 47 million. But the Recession has caused it to grow quickly, according to the U.S. Census Bureau.

So millions of Americans need a rescue. Before the reform was passed into law by Congress, insurance companies in the United States could refuse to cover the chronically ill; could drop any policyholder who became chronically ill; and could set annual caps and lifetime caps on coverage. Insurers could also deny a customer’s claim for payment on the basis of an error made on the insurance application. Insurers did not allow parents to keep their uninsured, young adult children on their family policies. And insurers could raise premiums without any governmental authority so much as asking them why the increase, or why so much? And if you owned or worked for a small business, which millions of Americans do, your rates were much higher (according to one report, 18 percent higher) than larger employers paid for the same coverage. Not fair, is it? Those unfair practices meant that many small businesses had to forego covering their employees. And “medical bankruptcy” was the result for individuals and families whose premiums rose astronomically or whose coverage was dropped or who for whatever reason were uninsured.


All that--and much more--will change if the reform is implemented fully in 2014. Fortunately, some improvements have already begun. Since mid-September some of the industry’s worst practices have become illegal.

Insurers can no longer refuse the sick, drop the sick, or set lifetime caps on coverage. As long as a customer can pay the premiums, the coverage continues. Increases in premiums must be reviewed by a federal board; it sees the insurance rates nationwide when granting or refusing proposed rate hikes. Now, parents whose young adult children up to age 26 have no access to health insurance can include them on their own policies. Insurers can’t deny coverage on a technicality or application error, either; instead they must prove fraud. And the law prohibits insurers from gouging small employers, charging them much more for the same coverage large businesses offer. Now, tax credits are available for qualifying small businesses to help them offer affordable plans especially to low-wage workers.

Is this socialism, as opponents have charged? No. It is not even a “government program.” The government has hired no doctors or nurses, set up no competing insurance companies, bought no clinics or hospitals. New government-run hospitals and clinics are not part of the new reform of health care law. (Note: The federal government does all of that for veterans, however, but few pundits have called the Veteran’s Administration socialist, or tried to close the hospitals and other services they run.)

In fact, the reform passed by Congress will enable private insurers to grow their businesses—a very capitalist idea—by requiring that every adult buy minimal coverage, which each can choose. Insurers stand to gain some 51 million new customers. The reform is pro-business. It has also left in place the private, employer-sponsored plans that currently provide coverage for most Americans. But the reform tries to help workers when they are laid off, fired, or have quit and find themselves without insurance.

Eventually, individuals, families and small businesses will be able to purchase a plan from a statewide or regional “exchange.” And exchange is an aggregate of customers with real buying power, where the premiums ought to be lower than those currently offered to anyone not in a large employer’s plan.

Why should healthy Americans who would rather not buy insurance be required to buy it by law? Because it benefits the society as a whole. Anyone can become injured or ill, and the costs of care are high. Requiring health coverage is just like requiring drivers to buy liability insurance—good drivers, bad drivers, young and old—because accidents are too risky and expensive to let any driver go without it. It is like requiring all taxpayers to pay for roads (even those who don’t drive and stay at home), schools (even those without children or who school them at home or in private schools). Some goods society as a whole needs and everyone ought to share the basic costs and benefits. Imagine what our roads and our schools would be like if whoever wanted to could opt out of paying that portion of their tax?

Of course, whatever some fail to pay, others must pay. Right now, hospitals are legally obliged to perform emergency room care for the uninsured. Hospitals see it as a burden. The “federal government” reimburses them for part of that care; the rest of us make up the difference in higher hospital prices. Also, the “federal government” means the taxpayers: we already pay for health care for the uninsured—even those who could afford it but don’t bother to buy it, like some young and healthy people. Yet what we pay is outrageously expensive. Emergency room care costs much more than care in a doctor’s office; much more than routine, preventive care. It should be used only for emergencies.

With the reform, all Americans will be required to carry insurance, more equally shouldering the cost. Those with very low incomes will receive government assistance; the hope is that they can maintain their health through routine, preventive care.

Will the reform be expensive? Without the reform bill, employers routinely saw health insurance rates rise each year. The reform should reduce the size of such increases. Those who currently carry no insurance will have to buy it. One third of the uninsured are young, working Americans; they must now enter the insurance pool. Insurance only works if the pool contains a mix of health and sick; an influx of young healthy people helps everyone.

The reform is not perfect. It does not include a public option to keep competition keen and prices low. And it does not do enough to curb the constant increase in the cost of health care; that major hurdle must still be crossed. An executive order holds it to the Hyde Amendment—no federal funds for abortion. It does not allow legal immigrants to participate in the exchanges for five years; and does not allow illegal immigrants to purchase on the exchanges at all. Yet, the reform law has already removed enough waste in Medicare to prolong Medicare coverage for another decade. That’s an achievement. And for the reasons I’ve given, the reform is a vast improvement over what we had or would have without it. If voters can keep opponents from repealing the law or eviscerating it over the next few years, which they have promised to do, then no American need ever declare medical bankruptcy again.




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7 years 10 months ago
Very good article and defense of, "Obamacare". Just one thing, "no American need ever declare medical bankruptcy again." - er, most affordable health care plans include deductables and co-payments. 20% of a $250,000 bill is $50,000 owed. I just had a friend who had a 10 hour operation and 10 days in the hospital which cost this much.
And, " few pundits have called the Veteran’s Administration socialist, or tried to close the hospitals and other services they run." True, also true that the US Military is the largest socialist organization in the world. Well, maybe second to China. Nobody, it seems, complains about that either!
And, "It does not allow legal immigrants to participate in the exchanges for five years; and does not allow illegal immigrants to purchase on the exchanges at all." Oh, this is suppose to be nice? Sort of equivalent to hospitals not providing health insurance to their own workers. Which practice doesn't escape "Catholic" hospital practices either. Suppose to save on the budget, I guess. Example: work less than 20 hrs/week - no insurance. New employee - no insurance for 90 days. Too bad you are exposed to viruses and pathogenic bacteria! Too bad if you have to come to work sick because you can't afford to stay home or have medical care. Weird, isn't it!
Marie Rehbein
7 years 10 months ago
Letting 51 million people go without health insurance is not really bad.  Letting them go without access to affordable health care is.
7 years 10 months ago
For those interested there is a very recent relatively short book by Sally Pipes called
''The Truth About Obamacare'' 

If you have a Kindle or a Nook, you can get it for $10.  Depending upon which side of the fence you sit on or if you just want to know what the issues are, this is an informative book.  Too often people just shoot from our hip with little facts on what we are talking about.
7 years 10 months ago
''Is this socialism, as opponents have charged? No.''
I disagree and believe the answer is yes.  Socialism can take many forms and one of them is when the government mandates certain outcomes thereby eliminating the freedom of the citizens or business organizations.  These organizations that carry out these mandates are then not really independent of the government even if you want to call them businesses.   Socialism is not just when they officially own/run it but also if the government makes non government organizations proxies for its policies  The outcome is often little different. 
Anytime the government is coercive and Obama Care is very coercive, there is a march towards socialism.  It doesn't matter if the units outside of government are supposedly independent but in reality are just organized to carry out government fiats. It is one thing to say you cannot do this as most laws are intended to do, it quite a different thing to say you must do this.
7 years 10 months ago

I have commented quite extensively on health care in the past so why repeat it here. 

We were told by Mr. Reidy not to give long answers when someone could be directed to a source.  That is what I did.  I suggest you go for the $10 for the book to know what criticisms are.
7 years 10 months ago
A couple comments before this thread disappears and which will probably have to be repeated again and again because it is obvious the authors here and many commenters do not understand it.
The military is not socialist organization. and even if it were it would have no meaning in terms of the discussion of heath care.  The military is a hierarchical organization existing within a society which could be socialistic or not.  The facts are unrelated.  In reality the military is a very non socialistic organization based on unequal ranks and within the military there is a very unequal distribution of resources.  If one finds that some small aspect of an organization requires equal distribution of some resource, it does not mean that all resources are distributed equally.
 ''Socialist'' isn't a bad word to me, it is a type of economic organization that sometimes works very well, as in the VA''
As just noted above this is not a true let alone a relevant concept for the military.  But socialism is one of the most poisonous concepts in the history of man kind.  It is one based on hate and resentment and cannot exist for any length of time because it must take from others who one does not like to feed this resentment.  A concept of love would be one encouraging everyone to rise and emulate the more successful and would promote such a society.  True love would demand an unequal society but one that encourages its members to rise to a new level over the past.  To leave others behind so that they will have the incentive to also rise.  Unequal societies have their problems but they are never solved by forcibly leveling them as socialism intends.  It is as Hayek has said, a path to slavery and the real irony is, there will always be an elite to rule over the masses in any socialist society and who will control the resources  almost inevitably for their own benefit.
True social justice is not one that redistributes forcefully from others to provide temporary relief but one that encourages those who have to help those who do not have.  Socialism turns the whole Good Samaritan story upside down and would not rely on the love and generosity of the Good Samaritan but would set up coercive forces to take a fellow traveler and make him help and give up his resources for whoever the coercive force decides needs his resources.  Eventually, in the end there would be no more travelers to help others, just the robbers.
I am currently at a reunion of very successful people (I am probably one of the least successful people here) and I find more love of their fellow man within this group than I do within the authors on this site and it is a secular group.  It is one of those that want to share their success both of knowledge and resources with others and they got that way by striving to rise above others. Does everyone in the group exhibit this behavior?  No, but a great many do and they do it within private organizations and non government ways.  That is what the Jesuits should reach out and touch because it is there within their reach.  Not support the forcible redistribution of society's resources with the result they will kill the Golden Goose and end up with chaos.  The gospels are messages to love and help others, not to force people to do what they do not want to do.  They are also messages meant to get us past this life not to set up a heaven on this earth as the liberal agenda tries to do but can only eventually fail.
Marie Rehbein
7 years 10 months ago
I tend to agree in principal with JS Cosgrove's assessment of the value of living within in a system that rewards acheivement.  However, I find it a bit difficult to accept that making health care costs commesurate with someone's resources undermines that system.  The socialist label is not appropriate to the concept that people should be able to obtain health care at a cost that reflects their ability to pay for it rather than at some price indicative of the dearness of it.


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