Questions and answers about our health care system

by Lesley Politi on December 4, 2008

Questions and answers about our health care system

What’s wrong with our health care system?

We spend more money on health care than any other industrialized nation, yet more than 15 percent – 45.7 million Americans – are uninsured. That number is sure to grow in the current financial crisis. And other countries with cheaper health care systems deliver higher quality care in many areas. The World Health Organization ranked the United States 37th in overall health care.

Why is it so expensive?

Total spending on health care in 2008 was $2.4 trillion, 16.6 percent of the gross domestic product. It is expected to be one-fifth of the GDP by 2017

Unlike all other developed countries that have some form of government-sponsored universal health care, most health care in this country is purchased, said Kevin Dahill, head of the Nassau-Suffolk Hospital Council. And we pay more for those services than other countries, said Gerard Anderson, professor at Johns Hopkins School of Public Health.

One reason for this, said Arthur Gianelli, chief executive of Nassau University Medical Center, is that hospitals get higher reimbursements for admissions than for preventive primary care, which is less expensive and can forestall costly treatments later on.

Why are so many uninsured?

Most Americans get health insurance through their employer. But the percentage of families offered job-based health coverage has fallen in the last decade, according to a report last year by the Kaiser Family Foundation, a not-for-profit that focuses on health care issues. Rising health insurance premiums are the reason employers don’t offer insurance. About one in three Americans report their family has had problems paying medical bills in the past year, according to a Kaiser poll last month.

What is Obama’s plan to fix the system?

President-elect Barack Obama campaigned on a plan that calls for allowing people to buy health insurance from a national health insurance exchange if they are uninsured or want new insurance. Otherwise, people would keep their current health plans. Insurance companies would be required to cover pre-existing conditions so no one would be denied coverage. Health coverage would be required for children, and there would be tax credits for families and small businesses. Large employers that did not offer “meaningful” coverage would be required to contribute a percentage of their payroll to the national plan. He has estimated the cost would be about $100 billion a year in added government spending.

Are there other plans?

The main difference between Obama’s plan and Sen. Hillary Rodham Clinton‘s (D-N.Y.) plan is that hers requires that everyone, not just children, have health insurance. Recently, Sen. Edward Kennedy (D-Mass.), chairman of the Senate committee on Health, Education, Labor and Pensions, named Clinton to lead a working group on insurance coverage. Kennedy is reportedly crafting his own health plan.

Finance Committee chairman Sen. Max Baucus (D-Mont.) also has introduced a plan. Like Clinton’s, Baucus’ plan would eventually require that everyone have health care. Like the Obama plan, people could choose between private insurance policies and a public plan. People ages 55-64 would be able to obtain Medicare coverage, and Medicaid would be available to everyone below the poverty level. The State Children’s Health Insurance Program would be expanded to cover all uninsured children.

A bipartisan bill introduced last year by Sen. Ron Wyden (D-Ore.) and Sen. Robert Bennett (R-Utah) incorporates aspects of GOP Sen. John McCain‘s health care plan, which encouraged individuals to buy their own health plans – although their bill also guarantees universal coverage.

During a two-year transition period, employers would be required to convert their workers’ health care premiums into higher wages; employees would be required to purchase health coverage with their higher wages. After two years, all employers would make “Employer Shared Responsibility Payments” that would be used to help those of modest incomes.

What are the chances real changes will take place?

Some former opponents of Clinton’s failed health plan in the 1990s, including the health insurance and pharmaceutical industries, have signaled they are open to some kind of reform. And some are saying that the financial crisis may actually prompt Congress to act.

“What we have seen is that health care is part of the economic crisis,” said Kaiser’s Diane Rowland. The question, she said, is whether there will be money to pay for a new health plan.

Others questioned whether any of the plans would lead to meaningful change.

“You won’t have dealt with fundamental reforms that need to be done” in how health care is delivered, said Raymond Goldsteen, professor of preventive medicine at Stony Brook University.


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