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Obama Care: Dispelling the Myths
By Carter A. Wilson, Ph.D.,
Guest
Column
Health
care reform (the Affordable Care Act of 2010, a/k/a Obama
care) will be a central issue in the upcoming presidential
election. However, it is likely to be an emotionally-charged
and polarizing issue because Obama care opponents promote
the types of myths and misinformation calculated to exploit
fears.
Opponents
claim that Obama care is socialized medicine. They insist
that it involves the government taking over Medicare,
rationing health care, dictating to medical doctors and
establishing death panels. Some opponents have recounted
horror stories of Canadians who have died because they had
to wait several hours in long hospital lines or several
months before getting lifesaving cancer treatment.
The
implication is that Obama care is socialized medicine
modeled after the Canadian system and likely to involve long
delays in medical treatment. Let us dispel these myths of
Obama care.
Obama Care does NOT establish a system of socialized
medicine.
It is a conservative, capitalistic reform. It is well-
grounded in our private enterprise, for-profit health care
system. Private hospitals, private health clinics,
independent physicians, private health insurance
companies--all for-profit, private enterprises associated
with health care continue to operate as before. The
government takes over nothing.
Nothing
is more absurd and more revealing of the misinformation of
Obama care than the myth that Obama care involves a
government takeover of Medicare. Medicare is and has
always been a government-run program. Obama care changes
nothing here.
Obama care does not establish death panels. This
myth was created deliberately to promote fear. It came from
a perverse interpretation of the provision to create an
Independent Payment Advisory Board. This board will have no
power whatsoever. It will be responsible for making
recommendations to the president for ways of improving the
Medicare and Medicaid program by reducing waste, eliminating
fraud and enhancing the efficiency, coordination and quality
of services. The law prohibits the board from considering
any rationing of services or restricting benefits.
Obama care does not dictate to doctors. It
shifts power from private insurance companies back to
doctors. There had been many documented cases in which
medical doctors were required to get pre-approval for
medical procedures from the private insurance company.
Decisions made by insurance companies were based more on
financial and less on medical judgments.
This
problem became more evident during the Obama care
Congressional hearings in the fall of 2009. One particular
case stood out, that of Robin Beaton, a 59-year old, retired
registered nurse who had been in good health. She testified
that in 2008 she went to a dermatologist to be treated for
acne. Shortly afterwards she was diagnosed with an
aggressive form of breast cancer.
She
testified that the Friday before the Monday she was
scheduled to have a double mastectomy her insurance company
flagged her chart and informed her that it was launching a
medical investigation. The insurance company found that
when she was a young child she occasionally had a fast
beating heart. This condition was irrelevant to anything
including her current cancer.
Nevertheless, the company defined it as a pre-existing
condition and used this condition to justify terminating her
insurance coverage. Even though her doctors pleaded with the
insurance company that the surgery was necessary to save her
life, the insurance company canceled her policy.
Whereas
many medical doctors opposed Clinton’s health care reform,
they supported Obama’s reform proposals. This shift in
support was most evident in the changing position of the
American Medical Association (AMA). The AMA opposed
Clinton’s health care reform bill but gave full support to
Obama’s health care bill.
The AMA
shifted its support for Obama’s health care reform not
because this anti-socialized medicine organization turned to
the dark side and became socialists. This organization
supported Obama care because it outlawed the use of
pre-existing conditions to deny health care treatment. Other
organizations of medical doctors also supported reform, most
notably the Physicians for National Health Programs. This
organization had long advocated a more liberal and
aggressive health care reform proposal than Obama care.
There has
been a slight shift in the position of business
organizations over Obama care. In 1993, organizations such
as the National Federation of Independent Businesses, the
U.S. Chamber of Commerce, the Business Roundtable, and the
National Association of Manufacturers were all united and
strongly opposed to health care reform. All of these
organizations campaigned bitterly against Clinton’s health
care reform.
However,
by the mid-2000's these organizations had split over health
care. The National Association of Manufacturers (NAM) became
concerned with the issue of controlling health care costs.
NAM issued this statement, which is still on its website:
Ninety-seven percent of NAM members provide health care
benefits to their employees. Since 1999, employer-sponsored
health care premiums have increased by nearly 120 percent.
The rising cost of manufacturers’ health care is
unsustainable. It is threatening the ability of
manufacturers to create jobs and compete in the global
economy. (http://www.nam.org/issues/Health-Care/Manufacturers-Healthcare.aspx)
The National Association of
Manufacturers had at least backed off on an attack of reform
and it had expressed concern about controlling costs.
This NAM
statement speaks to another Obama care myth: Obama care
is a jobs killer. On the contrary, if NAM is correct,
avoiding reform would be the jobs killer. Obama care will
expand health care coverage. This expansion will create new
jobs in the health care profession: jobs in nursing, medical
technology, nutrition, hospital security, maintenance and
many others. The concern is that Obama care would have its
most severe impact on small businesses. This is a legitimate
concern. It explains the strong and continuing opposition to
health care reform from the National Federation of
Independent Businesses and the National Restaurant
Association. Fixing Obama care should focus on minimizing
these impacts.
Another
myth surrounding Obama care is the notion that the United
States has the best health care system in the world. The
U.S. has the most expensive health care system in the world.
However, the high expense does not yield the best results.
Consider these figures from the Organization for Economic
Co-Operation and Development health data (http://www.oecd.org/documents/).
The U.S. spends $7,960 per capita or per person on health
care, compared to $4,363 for Canada, $3,978 for France,
$3,487 for the United Kingdom, $3,137 for Italy, $3,067 for
Spain, and $3,029 for Japan. Indeed, the United States is
unrivaled in the world in terms of how much money it spends
on health care costs.
Yet, in
terms of life expectancy among women and men, the United
States is second to last among developed countries. That is,
women and men live longer in Canada (82.8, 78.3), France
(84.4, 77.7), United Kingdom (82.5, 78.3), Spain (84.9,
78.6), Italy (84.5, 79.1), Japan (86.4, 79.6), Australia
(83.9, 79.3), Austria (83.2, 77.6), Switzerland (84.6,
79.9), etc. than they do in the United States (80.6, 75.7).
The only
developed country with a mean life expectancy lower than the
U.S. is the Czech Republic (80.5, 74.2). Among developed
countries, including the Czech Republic, the United States
has the highest infant mortality rates. Among developed
countries, excluding the U.S., infant mortality rates range
from a high of 4.92 for Canada to a low of 2.74 for Sweden.
The rate for the Czech Republic is 3.73. The U.S. rate is
6.06. With the most expensive health care system in the
world, American are dying at an earlier age and have higher
rates of infant deaths compared to other developed
countries.
Obama
care is a complex and extensive piece of legislation. It is
about 2,500 pages. The bill responded to several major
health care problems, most notable access, patient
protection, and costs.
The
access problem is the most serious, but the least debated.
The problem is that about 49 million people have no health
insurance coverage. Estimates of the impact of the lack of
coverage have varied. Vicente Navarro in his 1993 book,
Dangerous to Your Health: Capitalism and Health Care,
estimated that about 100,000 people die a year because they
cannot afford health care. He provided several examples, all
from Baltimore, Maryland. One example was of John Dunlop.
Dunlop
had worked for Bethlehem Steel for more than 20 years. When
he was laid off he lost his health insurance and could no
longer be treated for a heart condition. He died three years
later of a stroke.
More
recently, a Harvard university study concluded that there is
a strong association between a lack of health insurance and
death. The lack of insurance among about 50 million is
associated with about 45,000 death a year (Wilper,
Woolhandler, Lesser, McCormick, Bor and Himmelstein “Health
Insurance and Mortality in U.S. Adults,” American Journal
of Public Health, vol.99, no. 12, 2009).
To expand
access to health care the bill extends Medicaid coverage to
families below 133 percent of the poverty line. It increases
the eligibility age of siblings for private family health
insurance from 18 to 26. It provides subsidies to help cover
the costs of health insurance for families up to 150 percent
of the poverty line. It mandates that all individuals have
health insurance.
In
response to the patient protection problem, the law
prohibits insurance companies from denying coverage because
of pre-existing conditions and from setting life-time cost
limits on medical expenses. To respond to the escalating
costs of health care insurance, Obama care encourages states
to create health care exchanges and pooled private
competitive health insurance markets. Because individuals
and small businesses pay more for insurance because they
lack the purchasing power of large corporations, the health
care pools allow individuals and small businesses to buy in
bulk as well. The most controversial aspect of Obama care is
the individual mandate; that is, the part of the law that
requires all individuals to have health insurance.
The
debate over Obama care should not be over whether this
program is a government takeover of Medicare, a form of
socialized medicine, the creator of death panels, or the
killer of jobs. These things are largely myths.
The
debate over Obama care should focus on real and practical
issues: Will these reforms solve the access and cost
problems? Are the individual mandates valid under the
Constitution and if not, then what? Should health care be a
human right, guaranteed to all Americans? How much is the
expansion of Medicaid going to costs? How can the impacts of
Obama care on small businesses be minimized? In the current
budget cutting era, how will we cover the increasing costs
of Medicare and Medicaid? How will state governments respond
to the pooled private competitive health insurance markets?
Will these markets bring down costs? How will these changes
impact Medicare? What about preventive medicine?
Carter
Wilson, Ph.D. is a professor in The University of Toledo's
Department of Political Science and Public Administration
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