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The Health Care System In The U.S.

Health Care Reform

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The nation's health care system is once again in the spotlight as part of President Obama's policy agenda; it was a priority issue during the 2008 campaign. Growing numbers of Americans are uninsured; costs keep rising (annual growth rate, 6.7%); and the public is increasingly worried about the issue. The U.S. spends more money on health care than any other nation. By 2017, we will be spending about $13,000 per person, according to the annual projection by the Centers for Medicare & Medicaid Services. Less than 60% of us are covered by an employer's policy.

Who Has Health Insurance In The U.S.?

Only about 6-in-10 of us have employer-provided health care insurance, and almost 2-in-10 had no health insurance in 2006, according to the U.S. Census. Children in poverty are more likely (19.3 percent in 2006) to be uninsured than all children (10.9 percent in 2005).

The percentage of people covered by government health programs decreased to 27.0 percent in 2006 from 27.3 percent in 2005. About half were covered by Medicaid.

One political question: how to provide affordable health care to Americans with no insurance?

How Much Does Health Care In The U.S. Cost?

According to the Department of Health and Human Services, as a percentage of gross domestic product, known as GDP, health care spending is projected to increase to 16.3 percent in 2007 from 16.0 percent in 2006.

Through 2017, growth in health spending is expected to outpace that of GDP by an annual average of 1.9 percentage points. This projected differential in growth rates is smaller than the 2.7 percentage-point average difference experienced over the past 30 years, but wider than the average differential (0.3 percentage point) observed for 2004 through 2006.

What Is U.S. Public Opinion On Health Care?

According to Kaiser, health care was the number two issue early in the 2008 presidential campaign, behind Iraq. It was important to almost 4-in-10 Democrats and Independents and 3-in-10 Republicans. Most people (83-93%) who are insured are satisfied with their plan and coverage. Nevertheless, 41% are concerned about rising costs and 29% are worried about losing their insurance.

Public Agenda reports than in 2007, 50 percent believed the health care system needed fundamental change; another 38 percent said "completely rebuild it." In January 2009, Pew reported that 59 percent of us believe reducing health care costs should be a priority for President Obama and Congress.

What Does Health Care Reform Mean?

The U.S. health care system is a complex mix of public and private programs. Most Americans who have health care insurance have an employer-sponsored plan. But the federal government insures the poor (Medicaid) and elderly (Medicare) as well as veterans and federal employees and Congressmen. State-run programs insure other public employees.

Reform plans usually take one of three approaches: control/reduce costs but don't change the current structure; expand eligibility for Medicare and Medicaid; or scratch the system and start over. The later is the most radical plan and is sometimes called "single pay" or "national health insurance" although the terms do not reflect a consensus.

Why Is It So Hard To Reach Consensus on Health Care Reform?

In 2007, total U.S. spending was $2.4 trillion ($7900 per person); it represented 17 percent of gross domestic product (GDP). Spending for 2008 is expected to increase 6.9 percent, twice the rate of inflation. This continues a long-standing trend. Health care is big business.

Politicians want to control costs but they cannot agree on how to stem the tide of outlays or the increased cost of insurance. Some want prices controls; others think that market competition will solve all problems.

The flip side of controlling cost is controlling demand. If Americans had more healthy lifestyles (exercise, diet), then costs would decline as health care demand declined. However, we don't yet legislate these types of behavior.

Who Are The House Leaders On Health Care Reform?

House Speaker Nancy Pelosi (D-CA) has stated that health care reform is a priority. Three House committees will be instrumental in any plan. Those committee and their chairmen:
  • House Education and Labor Committee, Rep. George Miller (D-CA)
  • House Energy and Commerce Committee, Rep. Henry Waxman (D-CA)
  • House Ways and Means Subcommittee on Health, Rep. Pete Stark (D-CA)
All tax-related legislation much originate with the House Ways and Means Committee, per the Constitution. It also oversees Medicare Part A (which covers hospitals) and Social Security.

Who Are The Senate Leaders On Health Care Reform?

Health care reform is important to Senate Majority Leader Harry Reid (D-NV), but there is no consensus among Senate Democrats. For example, Senators Ron Wyden (D-OR) and Robert Bennett (R-UT) are sponsoring a bipartisan bill, The Healthy Americans Act, which acknowledges the positions of both sides. The relevant Senate committees and chairmen follow:
  • Finance Committee, Sen Max Baucus (D-MT)
  • Health, Education, Labor, and Pensions Committee, Sen Edward Kennedy (D-MA)

What Is The Obama Plan?

The proposed Obama health care plan "strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference."

Under the proposal, if you like your current health insurance, you can keep it and your costs might go down by as much as $2,500 per year. But if you don’t have health insurance, you will have a choice of health insurance through a plan managed by a National Health Insurance Exchange. The Exchange would provide a range of private insurance options as well as a new public plan based on benefits available to members of Congress.

What Is Medicare?

Congress established both Medicare and Medicaid in 1965 as part of President Lyndon Johnson's social services programs. Medicare is a federal program specifically designed for Americans over age 65 and for some people under 65 who have disabilities.

Original Medicare has two parts: Part A (hospital insurance) and Part B (coverage for doctor services, outpatient hospital care, and some medical services not covered by Part A). Controversial and costly prescription drug coverage, HR 1, Medicare Prescription Drug, Improvement, and Modernization Act, was added in 2003; it took effect in 2006.

What Is Medicaid?

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

What Is Plan B?

Although most discussion of health care issues in the U.S. revolve around health insurance and the cost of health care, those are not the only issues. Another high profile issue is emergency contraception, also known as "Plan B Contraception." In 2006, women in Washington state filed a complaint because of the difficulty they had in obtaining emergency contraception. Although the FDA approved Plan B emergency contraception without a prescription for any woman who is at least 18 years of age, the issue remains at the center battle over "conscience rights" of pharmacists.
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