The confusion of the health care system in the USA

Author: Rosa Maria Young

Promises made during elections campaigns have a way of changing once the politician is elected. It has happened with many US presidents and is happening again with President Obama. In several of his promised reforms and changes. That is why the overhauling of the health care system is already causing so much ink running and so many problems. Obama promised to “repair” the system but it is going to prove am impossible task without adding to already huge deficits. The president also said during the campaign that he was opposed to a federal law mandating the purchase of health care coverage. Earlier this month he said he would consider supporting such a measure, if it has room for exemptions for small businesses and individuals who cannot afford the premiums… If one reads all the many options proposed by the president, the democrats, the republicans, senators, governors, health insurers, etc. it is easier to say how many people are confused and reasonably so and more doubts are growing about the passing of a health care program which would benefit those who really need it. For instance, adding to the problem of lack of insurance for many Americans there is the rampant problem of unemployment. Nobody can deny that. And yet some proposals would create a disincentive for employers to hire low-income people. Take one of the under options for revamping the health care, the one that would offer federal subsidies or tax credits to help people with low or moderate incomes buy insurance on their own. Under this option employer would employers would be required to pay “100 percent of the cost of the tax credit for workers receiving the tax credit. In other cases employers do not have to provide coverage, but would have to pay “50 percent of the national average Medicaid costs for workers enrolled in Medicaid,” the program for low-income people. As Senator Orrin G. Hatch, a Republican of Utah, has said “This means that small-business people won’t hire anybody who’s on Medicaid,.” “They won’t hire any low-income workers. They get penalized for doing it.” Some Democrats are worried about the same. Then we have the costs and the eventual savings. And here is a total disarray with everyone in the fray providing different ideas about cutting costs and none satisfactory enough if one reads them carefully. President Obama began by saying that “For example, if more Americans are insured, we can cut payments that help hospitals treat patients without health insurance.” Well my math might be fussy, but how how can more Americans be insured if they don’t have jobs and the government is adamant against providing single-payer option? As Health and Human Services Secretary Kathleen Sebelius said, “a single-payer option is not on the table.” Mr. Obama’s budget director, Peter M. Orszag, indicated that payments to hospitals will be reduced to try to encourage them to work more productively and efficiently. Hospitals according to him could figure out ways of treating patients “more effectively, through health information technology, a nurse coordinator instead of an unnecessary specialist,” for example. These “productivity adjustments” would account for $110 billion in savings. Would be interesting to see which kind of hospital care your average patient would get with this approach. Also in a kind of wishful thinking the administration expects to lower payments to hospitals that treat large numbers of low-income patients. Medicare and Medicaid make extra payments to these hospitals, but Mr. Orszag said those payments will become less necessary over time, as more of the nation’s 45 million uninsured acquire coverage through the new program. (By now I am a little lost about which new program and how the now uninsured are going to be in it.) This would account for $106 billion in savings. The way I add it just in hospital savings we have $216 billion. But let me give a rest to the president and his administration and let us go to some plans offered by senators such as the much heard one by the committee’s Democratic leaders, Senators Edward M. Kennedy of Massachusetts and Christopher J. Dodd of Connecticut, which would cost about $1 trillion over ten years but leave 37 million uninsured compared with the 50 million who are uninsured now, which brings us to the hospitals cuts and we cannot but ask that if so many people remained uninsured, it might not be feasible to cut special federal payments to hospitals that serve many low-income people.

We will be following the developments on this.