Healthcare Reform: Money, Morality & Mayhem

It’s easy to complain about how bad health care reform is going to be when you are insured and your employer pays 50-60% of your cost.  But let’s step back a minute, the actual name of the program is the Patient Protection and Healthcare Affordability Act.

What does it mean for someone like me, insured by my employer, earning a decent wage?  Not much – my healthcare costs go up a little each year anyway, and I complain about it every year.  The insurer raises their rates and my employer and I have to share that cost. Here’s an interesting tidbit:

According to a 2009 HAN study, profits at 10 of the country’s largest publicly traded health insurance companies rose 428 % from 2000 to 2007, while consumers paid more for less coverage. One of the major reasons is the growing lack of competition in the private health insurance industry that has led to near monopoly conditions in many markets.

In the past 13 years, more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets but haven’t delivered on promises of increased efficiency. According to the American Medical Association, 94 percent of insurance markets in the United States are now highly concentrated, and insurers are thriving in the anti-competitive marketplace, raking in enormous profits and paying out huge CEO salaries.

But will it raise my taxes?  The plan includes a 0.9 percent Medicare payroll tax on income over $250,000 for families, and $200,000 for individuals. Each of us pay this tax already, it’s the deduction on your paycheck under the heading "Medicare tax." This would increase this tax for these high earners from 1.45 percent to 2.55 percent, but only on the amount of income over the $200,000 or $250,000 threshold. So a family bringing in $300,000 a year, would pay roughly $450 more a year in Medicare taxes—about 0.15 percent of their income, or less than two tenths of a percent.

The plan also includes a new tax on what’s called "unearned income." Right now income from things like interest earned, dividends, annuities, royalties, and rents is usually not subject to Medicare taxes. The plan, as I understand it, would make these sources of income subject to a 2.9 percent tax, but only for single taxpayers earning more than $200,000 alone, or joint filers earning more $250,000.

There has been a hue and cry that, “this is socialized medicine” from people on the right and the left. The term is typically used to imply that the privately-run health care system would become controlled by the government, thereby associating it with socialism, which has negative connotations to some people in American political culture.

What do you think Medicare, Medicaid, CHIPS, VA benefits and the like are?  These plans are medical care that is publicly funded, subsidized and overseen by the government!  It is all social welfare! Most industrialized countries, and many developing countries, operate some form of publicly-funded health care with universal coverage as the goal. According to the Institute of Medicine and others, the United States is the only wealthy, industrialized nation that does not provide universal health care.

So, back to the plan and how it is bad….

One of the key provisions is the removal of patient co-pays for many preventive services. Without a co-pay, it may be that people will take advantage of preventive services more frequently. This is a good thing from a public health perspective, because if barriers to effective preventive services are removed, people actually may use these services more - ultimately resulting in improved health and reduced long-term costs because disease will be prevented or detected before costly treatments are required.

The economic case is just as compelling. The biggest threat to American economic growth in the next decade is not rising oil prices or the recent financial meltdown: It is the increasing cost of health care. The employers who cover 160 million non-elderly Americans have seen their premiums nearly double since 2000, and premiums are expected to double again in the coming decade. Workers who have given up wages already will be asked to give up even more, and still health costs will eat away at business profits and government budgets.

The biggest complaint I have heard is that people don’t want to be forced to buy health insurance – and I agree with them, to a point. If you don’t want to buy health insurance, you shouldn’t have to BUT don’t expect to be treated at the emergency room when you have the flu, allergies, broken bones, heart attack free of charge!  My insurance premiums rise every year because people like you do just that, and the hospital, clinic, doctor are forced to raise their rates to cover the costs incurred by you.

What does healthcare reform mean to someone like Vicki – her husband died four months ago leaving no life insurance, two teen-age boys, on medical leave from work, with COBRA payments exceeding $500 per month?

It means that she has had to enroll her two boys in the state healthcare program (she will make sure nothing happens to them) and that she is currently uninsured.  Now, she effectively had a heart attack in September and is on medication to control it, until the prescription runs out in 90 days. Her employer provides no short-term disability benefits, so she has no income for the time being and she has no insurance because she cannot afford $500 a month for COBRA.

What will she do if she gets sick? I have no answer.

I’ve watched the outrageous antics displayed during town hall meetings where the opponents of something as morally correct as helping the sick be able to afford the cost of staying alive - “act like idgits”. Many of these folks, it’s safe to assume, believe in the sanctity of marriage, call themselves compassionate conservatives or Christian Conservatives, and believe in the right to life. Yet, they display such outrage and bigotry over an issue that would greatly benefit lives so many human beings.

Proponents of the current health care reform legislation believe they are responding to a "moral" imperative. This, too, has a religious tone because our society’s sense of morality is shaped in large measure by its religious beliefs. And there are people (myself included) that sincerely believe that it is immoral for a nation with such vast resources that allows almost a sixth of its population to live without access to the medical care and resources that are critical for maintaining a quality of life. Without such access, one can argue that people with health care cannot truly pursue the happiness that we describe as one of our unalienable rights granted by our Creator.

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