Pondering Healthcare

There have been lots of articles in the news and blogosphere lately about the Affordable Care Act (ACA), more commonly known as ObamaCare.  It has been controversial for some time, but I would like to take a different type of look at some of the history leading up to the ACA and then at what I consider to be significant flaws.

A Little of the History of Health Care

The idea for something like the ACA is neither new nor the product of just one political party.  One President who called for healthcare reform in a similar format to the ACA was Richard Milhouse Nixon in his budget address to the Congress in 1974:

I am once again proposing a comprehensive plan for national health insurance that would make adequate insurance against the costs of health care available to all Americans. This far-reaching reform is long overdue. I urge early congressional action on it. The budget proposes measures to prepare for this program.

President Nixon included a few more details in that address.

The national health insurance plan I am proposing represents another major step toward improving the lives of individual Americans. My proposal calls for basic reform in the financing of medical care. It would bring comprehensive insurance protection against medical expenses within reach of all Americans, including millions of people who cannot now obtain adequate insurance coverage. Costs of coverage for low-income families would be federally supported, with payments scaled according to family income.

It will take several years for this reform to become fully operational. In the interim, the 1975 budget provides $26.3 billion for existing health programs. Under this budget, the momentum of cancer, heart, and other research initiatives would be sustained, and total funding for biomedical research would exceed $2 billion in 1975, almost double the 1969 level. To support continued reform of our medical care system, the budget proposes a total of $125 million in 1974 and 1975 to demonstrate health maintenance organization concepts throughout the Nation. I am also proposing a Health Resources Planning Act to enhance State and regional capabilities and responsibilities for planning and regulating health services.

Congress did not act on Nixon's request.  Nor was there action under Presidents Ford, Carter, Reagan, Bush (41), Clinton, or Bush (43).  This is despite repeated calls for health care in their various messages to Congress.  (The following are examples and should not been seen as exhaustive or complete).

President Gerald Ford

America needs to improve the way it pays for medical care. We should begin plans for a comprehensive national health insurance system. However, in view of the economic developments and the measures I have proposed to combat recession and inflation, I cannot now propose costly new programs. Once our current economic problems are behind us, the development of an adequate national medical insurance system should have high national priority. I urge the Congress to work with my Administration in order to devise a system that we will be able to afford.

President James Earl Carter

about a comprehensive national health insurance program, which can extend health care coverage to millions of needy Americans while controlling health care costs; and about the need for a human rights policy, which I believe is essential in the pursuit of our foreign policy.

President Ronald Wilson Reagan

I am asking Congress to help give Americans that last full measure of security, to provide a health insurance plan that fights the fear of catastrophic illness. My plan would provide acute care for those over 65 by restructuring the Medicare program. Under my proposal, the elderly would receive catastrophic health care coverage under Medicare, while limiting out-of-pocket expenses to $2,000. This coverage will be made available for an additional monthly Medicare premium of $4.92. The plan also aims to improve protection for the general population and for the long-term care of the elderly. For too long, many of our senior citizens have been faced with making an intolerable choice—a choice between bankruptcy and death. This proposed legislation would go a long way to help solve that dilemma.

President George Herbert Walker Bush

Infant and maternal health is an area where we must invest in the future. It is also an area where we must all be committed to improvement. I am particularly disturbed by the fact that the infant mortality rate for black infants is nearly twice that for whites.

This legislation does not do all that we want to do, but it does do what we can do at this time.

President William Jefferson Clinton

Today is an historic day. The Senate Labor and Human Resources Committee has become the first full congressional committee to report out a health care reform bill. The action of Chairman Kennedy's committee gives me great confidence that Congress will pass legislation this year that meets the expectation of the American people: guaranteed private insurance for every American that can never be taken away. Once again, Chairman Kennedy has demonstrated the leadership that has made him a driving force in the fight for quality health care for the last three decades.

Under the leadership of Chairman Moynihan, the Senate Finance Committee is moving. Chairman Moynihan is committed to achieving universal coverage and bringing legislation to the American people this year.

For the first time in our history, committees in both the Senate and the House are seriously moving forward on health care reform. While much work remains, today's actions prove that the job will be done. The momentum demonstrated in the House and Senate this week is heartening to me and all Americans who want and deserve real health security.

President George Walker Bush

This bipartisan Patients' Bill of Rights reflects the principles I laid out earlier this year. It provides strong patient protections for all Americans, ensures that doctors and patients make medical decisions, and holds health plans accountable by providing patients with meaningful remedies when they have been wrongly denied medical care. The bill also protects employers and their employees from unnecessary litigation that would increase health care premiums and force too many Americans to do without health insurance.

While the details vary, all of these Presidents of the United States attempted to get some form of additional healthcare for average Americans.  They all failed.  President Obama is the first to get legislation passed, but it doesn't quite make sense.

My complaint is not with the individual mandate which the GOP and Fox News have inaccurately called the largest tax ever.  As a penalty or a tax, the concept is necessary if we are going to have private health insurers managing our health care.  That last bit is my personal biggest problem with the ACA and should be the second biggest problem for Republicans.

First Concern with the ACA

Despite the cries of fear that the government is taking over your healthcare.  Despite the silliness that the government is getting between your doctor and you.  The reality is that private companies are in charge of your healthcare and are getting between your doctor and you.  That might be reasonable, but those companies have a bottom line goal of spending as little as possible.  Their goal is not to keep you as healthy as possible.  Their goal is not to ease the hassles of getting the care you need to survive.  Their goal, as is the goal of every other private corporation, is to earn money.

The ACA is good in that someone with a preexisting condition can now get health insurance.  One cannot be thrown off of health insurance completely because one's care is starting to become expensive.  The insurers are now required to spend eighty percent of their income on health care (that part is dramatic reform).  Those are all good points.

But, that does not change the insurer's goal of making money.  Their only reason to take reasonable care of you is if there is competition and you might change insurers.  The state exchanges that have so many Republican governors concerned might help with this, but it is an idea that has not be tried yet.

Second Concern with the ACA

If a concern is cost to business, why are we perpetuating an employer based health insurance system?

Many who complain about the ACA are complaining that it will cost jobs because it will cost small businesses too much.  The reason it is costing businesses anything at all is because after World War II some businesses added health care as a benefit to attract employees.  This was not mandated by the government.  It was a business choice.

Since that time, we have gone from having a primarily domestic economy to having a global economy.  The businesses which are competition for American businesses are mostly in countries with single payer health care systems.  Businesses in Europe and Asia do not pay for health care at all (well, they do pay taxes which in turn fund the health care but that is generally in the form of income and value added taxes that are not based on the employees).  It is not a level playing field.

Before someone jumps on me for lauding single payer systems, I will note that not all single payer systems are created equally.  One of the best systems, that of Taiwan, is supposed to be in fiscal trouble.  It is not my purpose to present any panacea for health care in this blog, just to ponder what is happening.

Third Concern with the ACA

The gimmick of pushing most of the costs out ten years is as annoying when done by Democrats as when done by Republicans.  Partly because of this, the Republicans can claim that ObamaCare is a failed system when most of it has not been put into effect yet.  Both the Democratic gimmick and the Republican attacks are lies.  Disgusting politics.

Final Thoughts for This Post

Given the Republican rejection of Republican ideas, such as the individual mandate, it is likely that nothing better than the ACA could have been accomplished during President Obama's first term in office.  While political parties are always rooting for replacement of members of the other party, they usual put country first.  The Republicans stopped doing so with the goal of replacing President Obama.  Perhaps it is racism.  Perhaps it is continued fallout from the near-impeachment and resignation of President Nixon.  Whatever the reason, the loss of the GOP as a political party that places the United States first was a huge loss.  I don't know how this can be repaired.