Sensible Health-Care Reform (Part 1): Framing the Debate

This is the first of a series of commentaries examining the state of health-care including the serious problems with health-care delivery, the underlying root causes of those problems, the looming government fiscal catastrophe secondary to health-care entitlement spending, the failure of the recently passed health-care “reform” to address the grave problems facing our nation related to health-care delivery, the harm the recently passed health-care “reform” will cause to our seriously ill economy, and a proposal for a framework to truly, effectively, and sustainably reform our health-care delivery system.

The author feels obligated to disclose underlying bias: 1. this analysis reflects the author’s strong belief in the efficiencies and fairness of free markets as well in the individual’s right and responsibility of self-determination and of self-reliance. 2. I have 3 daughters, 3 nieces, and 9 nephews who deserve their opportunity to live the American Dream – a dream made possible by the protection of our inalienable rights endowed by our Creator

Although President Obama and the Democratic Congress has rammed through so called health-care reform, in fact, that “reform” can only make our health-care crisis worse, not better. To move forward with critically needed constructive health-care reform, it must be understood that two distinct starting points underlie the push to reform our current system. The first perspective stresses the need to address the problem of the uninsured and the related problem of pre-existing medical conditions. The second perspective stresses the need to control the escalating costs. Realistically to move forward with constructive reform, it must be acknowledged and understood that the first perspective must be subordinate to the second. Very clearly, the health-care cost growth is fiscally untenable going forward. Reform that expands access without first controlling costs can only result in accelerated failure of the system and is no reform at all. A health-care system that now threatens the financial viability of many individuals and families, many businesses, and multiple state and Federal governments makes all other health-care issues moot. Access to health-care for the uninsured or those with pre-existing medical conditions must be addressed but can not be addressed on a sustainable basis until tackling the fundamental issue of unsustainable health-care costs growth. That being said, proper reform that results in lower health-care costs and consequent lower health-care insurance costs, would go a long way toward addressing the uninsured and pre-existing medical condition problem by making coverage more affordable.

Before addressing the central issue of escalating cost, a brief examination of the uninsured population assists in placing perspective on the health-care reform discussion as well as on the proposed solutions. The number of uninsured persons is somewhat fluid. The US Census Bureau places the estimate of the number of the uninsured at 47 million or 16% of the population. Conversely, 250 million Americans have coverage and, for the most part, are satisfied with that coverage. The number of uninsured individuals is significantly related to employment. 2008 statistics from the CDC, found that change in employment accounted for 24% of the uninsured.

A study done by the Agency of Healthcare Research and Quality looking at statistics of the uninsured during the period of 1996-2008, found that for the full year of 2007, there were 39.9 million uninsured persons under the age of 65. That number included 5.9 million children who qualified for government subsidy or whose families were able to afford insurance. That number also included 12 million illegal aliens. The AHRQ also found that of those uninsured individuals 18-24 years of age, 55% were uninsured for at least a month but only 18% for a 2 year period, indicating many individuals without health-care are so temporarily. This data further suggests the actual number of chronically uninsured amounts to a fraction of the commonly reported 47 million uninsured thus bringing into question the logic of addressing the problem of the chronically uninsured (a small percentage of the population) by a massive Federal takeover of health-care that would affect the great majority who have and are happy with their insurance coverage.

A study out of Baruch College, City University of New York reviewed information from surveys of the uninsured population and found that 43% of those in the 18-64 year age group had incomes of at least 250% of the Federal poverty level suggesting that many persons in this category have made a financial allocation decision not to obtain health-care insurance though they likely could do so, albeit significantly constraining other discretionary spending. The investigators in this study classified these persons as “voluntarily uninsured” and the remaining 57% with lesser financial means as “involuntarily uninsured”. They further found that the entire uninsured population still has significant access to health-care services, but approximately 40% of services utilized by those with insurance. Interestingly, the percentage of the uninsured group accessing cancer screening services roughly equals that of those in the Canadian nationalized, single-payer system.

The next Dr Right installment will review the unsustainable health-care costs growth.

Call to Action: Though passed by an appalling political process and with complete disregard of our Constitution, though containing ineffective and even harmful policy, though disregarding the inalienable rights given to us by our Creator, the passed health-care reform bill is not the end of the debate but rather a new beginning. It is an opportunity to contrast irresponsible policy with prudent policy, to contrast misconceived policy with thoughtful policy, and to contrast policy that places government in the center with policy that places the individual in the center. Get in the fight and stay in the fight. We have learned, the hard way, the consequences of leaving it up to the career politicians. Contact your legislators and demand they exercise the privilege the voters gave them to represent us to effectively address health-care delivery and the other problem facing our state and nation. Learn about the issues and talk to others about the issues. Join your local grass roots organizations like the York 9-12 Patriots, York County Action, York Campaign for Liberty, and others, so we can take back the political process that has become corrupt and ineffective. We must work to bring up, from the grass root level, candidates – principled persons (Republicans, Democrats, and Independents) who will actually solve problems, who will respect the Constitution of the United States, and who will honor the “consent of the governed” entrusted to them by the citizens of our counties, states, and country.