Monday, August 20, 2007

To Govern or Not To Govern...That is the Health Care Debate Question

As health care is widely debated and presidential candidates "Vow to Overhaul U.S. Health Care" (The New York Times, July 6, 2007), the debate is resonating loudly with American voters. It's good the candidates acknowledge the need to improve affordability and access to health care, or rather at least pander to our discontent. Unfortunately, President Bush has failed to demonstrate an understanding of the concerns of working-class americans in their pursuit of healthy lives and financial security. Or maybe Bush didn't read the 2006 Citizens' Health Care Working Group Report which was commissioned as part of the Medicare Drug Act of 2003. In any case, Bush's arrogance shined brilliantly through his recent statements at the Cleveland Clinic - "I mean, people have access to health care in America. After all, you just go to an emergency room." (Cleveland, Ohio, July 10, 2007).

As the media discusses each candidate's health proposal, one might led to believe that Congress has ignored the health care crisis in America. But that assumption would be incorrect as there are currently more than 800 proposed bills/resolutions which address various aspects of "health care" in our country. Check it out at the Library of Congress. However, only one such resolution, H.R.676 "United States National Health Insurance Act," has been specified in a candidate's campaign. Representative Kucinich co-sponsors H.R.676 and offers it as a solution to health care reform. Although other candidates' plans may closely resemble currently proposed legislation, none have identified a specific bill/resolution which matches the details put forth in their proposals. Wouldn't it be nice if they did so? That way we could study the bill and determine it's relevance to our personal situations. Interestingly enough, personal research has revealed that Senators Clinton and Obama co-sponsor much of the same legislation and seem to support the same health care views.

Moreover, according to popular media, the health care debate revolves around government control versus individual choice, "universal coverage" versus a free-market solution, individual mandates versus tax incentives. Too often these messages exploit our fear and attempt to distract from the possibility that effective policy change is possible and that citizens deserve a voice in the debate. As each candidate reveals his/her health care proposal, I try to consider it's effects and compare that with coverage I currently have. So far, I'm not convinced that any of the candidates or legislatures truly "get it" and understand the serious social plight of many Americans. For a physician's perspective, read "Worry, Government, Health Care and Ultimately....Health" by Zagreus Ammon.

Here's my perspective: As a self-employed person, I purchase health insurance in the private individual market. Premiums for an underwritten policy for a 38-year old woman in the Washington, D.C. area, cost me $3384 annually (up 20% from last year) with self-employment tax adding $478 to the total cost. This "managed-care" PPO plan features $25 doctors' visit copays, 10% coinsurance, a low $100 in-network deductible, and includes prescription coverage. Several presidential candidates are promoting increased participation in the individual health insurance market. That would mean many more americans would have coverage similar to my own. However, last year my health care expenses exceeded $15,000 out-of-pocket in addition to the cost of insurance premiums, with an adjusted gross income of $19,417 and total taxes due of $4761. I am forced by the current free-market system to keep my earnings below 200% federal poverty level in order to qualify for assistance in obtaining a single MS medication costing $21,000 annually. That's no freedom of choice!

In reality the debate is not whether to have more government control or less government control. As it is government regulations allow the private insurance and pharmaceutical industries to transfer wealth (or would-be financial security) to those who in turn expend enormous amount of money and power to influence the opinions and actions of both citizens and officials. For an enlightening view on the role of government in the market place, read Dean Baker's editorial, "Fixing Health Care: Not Government versus Market" (TruthOut, July 10, 2007).

Here is a sampling of current proposed legislation which addresses the need in making health care for affordable and accessible to american citizens. It is by no means exhaustive, but will be rather informative.

National Universal Coverage:

  • H.R.676 - "United States National Health Insurance Act" or "Expanded and Improved Medicare for All Act" - 27 pages

State-based Universal Coverage:

  • H.R.1200 - "American Health Security Act of 2007" - 178 pages

Create Health Service Force:

  • H.R.3000 - "Josephine Butler United States Health Service Act" - 135 pages
Encourage Healthy Behaviors:
  • H.R.2633 - "Healthy Lifestyles and Prevention America Act" or "HeLP America Act"- 173 pages

Individual Responsibility and Increase Use of Insurance Pools:

  • S.1783 - "10 Steps to Transform Health Care in America Act" - 291 pages
Increase Small Business Participation through Tax Incentives:
  • S.158 - "Access to Affordable Health Care Act" - 122 pages

Increase Individual Participation through Tax Incentives:

  • S.1019 - "Universal Health Care Choice and Access Act" - 164 pages
  • H.R.2626 - "Comprehensive Health Coverage And Reform Enhancement Act of 2007" or "Comprehensive HealthCARE Act of 2007" - 128 pages
Shared Responsibility and Termination of Government Programs:
  • S.334 - "Healthy Americans Act" - 166 pages
  • H.R.3163 - "Healthy Americans Act" - 170 pages

Full disclosure: I am not an expert in policy or the healthcare industry. I am an individual who has struggled in obtaining necessary care in the past two years without incurring great financial costs and expending enormous mental and emotional energy.

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