Since last winter, when newly installed President Barack Obama announced that health care reform would be a legislative priority this year, I have intended to write about his concept and legislation to enact it. It is September as I type this comment. During the 7 months, efforts by anyone to write definitive explanations have not been useful because of the changes, variations, bipartisan proposals, and intentional misrepresentation by those opposed to major reform.
Punditry is even more implausible for an essay that has 3 months or more between writing and publishing, as this one does. By the time this is published, Congress will have acted or refused to act this year.
Not even the statement of the crisis is accepted unanimously. But here is some of it. Health care represents one sixth of all the spending in this country. The amount increases by as much 15% a year. If that continues, it would reach 100% of the gross domestic product in 75 years. Even so, there are 46 to 50 million people, including illegal immigrants, who have no form of health insurance coverage.
In terms of big costs, here are a couple of examples. One is the experience of a friend who was hospitalized overnight for the adjustment of his pacemaker. At his discharge the next day, he was handed a hospital bill for $147,000. Another is the price of pharmaceuticals to Medicare beneficiaries under the scheme passed by Congress at the behest of past president George Bush. The language forbids the Medicare agency from negotiating any reductions in the retail prices of drugs sold by manufacturers to the private companies empowered to establish medicine coverage plans. Another part of that same bit of legislation was a 15% incentive to health insurance carriers for offering managed care coverage (Medicare Advance) to Medicare beneficiaries, even those who are already or probably sick.
The increasing shrillness in opposition to broad reform is the concern of the insurance companies that they might lose their special subsidy. And some of the drug companies fear that federal agencies will not pay $30 for one pill that supposedly lasts a month in restoring calcium.
This current effort is not the first political proposal to reform health care reimbursement. President Bill Clinton campaigned in 1992 with a promise to do so. He appointed his wife Hillary to head a government team, which labored for 4 months, excluding any participation or input from doctors, hospitals, or private health companies. The legislative draft ran some 1400 pages. By the time it was finished, the insurance companies had mounted a remarkably effective lobbying campaign against it. The draft legislation was never discussed by Congress.
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