8/15/2009

Now the Obama Administration is proposing big changes

Ambition is a wonderful thing when it pays off. How many times have we watched a slugger walk up to the plate, look the pitcher in the eye, and lift an arm to point where the ball is going to land somewhere in the next state, only to strike out? Well, the new President has just stepped up to the plate. We have the TARP bailout plan carried over from the last Administration. The new Stimulus Package has been passed. Now comes the budget. Anyone doing the math will find the number of zeros adding on to the deficit reaching epidemic proportions. It seems the country is proposing to plunge even deeper into debt when it's already in a recession, fighting two wars - one in Iraq and the other in Afghanistan - and facing a meltdown in the banking and car industries. Unemployment is at historic highs and, if the trend continues, the amount of tax collected will fall. Yet, the President is proposing major reform of the health care service. Is he biting off more than he can chew?

According to the latest figures, there are around 306 million people in the US and nearly 15%, that's about 45 million, do not have any kind of medical insurance. What do they do? Well, when they fall ill, they crowd into the emergency rooms and seek help from the underfunded public hospital system. There are two results. The first is that people wait too long before they go to hospital and, when they get there, receive an inadequate level of care. The second is that it places a serious financial burden on everyone. The emergency room in a conventional hospital has to cover its costs but, when the uninsured patients have no money, the only option is to increase the charges to the insured patients. This burden has been particularly hard on the employers' health plans and, to offset the increased premiums, employers have been passing some of the cost on to their employees - a forced pay cut. The public hospitals must beg for increased funding from local, state and federal bodies where budgets are already in deficit.

There is a new mood in government to do something about health insurance. In effect, the ideal plan would be to move to a single-payer plan which is the norm in the rest of the world, but that would upset too many vested interests. So the current plan is to go for a major safety net for all currently uninsured. There is already a plan for uninsured children. The Administration is proposing an element in the new budget to move all uninsured adults on to a national plan. If this can pass through into law, which is not certain given the opposition of the Republican party, it will provide a bolt hole for all currently insured. If the premiums on private health insurance continue to rise, more will move on to the national plan which, over time, could produce a single-payer system in the US. Now that would be an interesting social experiment.

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