- Coverage – Our health care system allows some people to die while others receive care.
- Quality – The quality of care is lower by many measures than that of other countries.
- Cost – Despite its major flaws, our system is the most expensive in the world.
I’ve also summarized Reid’s broad solutions, based on things superior systems have in common: 1) unification, 2) universal coverage, and 3) nonprofit financing.
So… Did Obama’s health care reform bill manage to do any of these things?
The Patient Protection and Affordable Care Act (PPACA, otherwise known as “Obamacare”) was signed in March 2010, and was a sweeping reform to the U.S. health care system. It’s extremely complicated, and I’m by no means an expert—I recommend visiting the following websites for fairly simple summaries of what the law achieved:
- Obamacare: A short summary of the health care reform law (American Affairs)
- What’s In the Bill (a timeline by the Wall Street Journal)
- Focus on Health Reform (the Henry J. Kaiser Family Foundation)
- Health Reform Hits Main Street (a 9-minute video by the Henry J. Kaiser Family Foundation)
From what I can tell, PPACA was generally a step in the right direction, but did not do enough to truly fix our convoluted, over-expensive system.
In terms of UNIFICATION: Far from simplifying our health care system, it seems that PPACA is in keeping with the previous level of complexity. The reform package itself is 400,000 words long; Reid mentions that at a policy briefing for Congress after the bill was passed, “I noticed that the Senators and Representatives were all diligently taking notes about the bill they had just approved.”
A huge proportion of our health care costs go into administration: sorting out who’s covered under what plan and at what rate. In most countries, this cost is virtually eliminated because the same rates apply to everyone, and sometimes under a single, unified plan. As far as I can tell, our administrative costs will still be quite high within the reformed system.
As far as UNIVERSAL COVERAGE, the law does make great strides in that direction. According to Reid:
The number of Americans without health insurance has been increasing steadily for decades, reaching nearly 50 million in 2010. The new law will reverse that trend and provide coverage to millions of people who can’t get it today. How many millions is not clear, but the Congressional Budget Office estimates that as many as 32 million more people could have some form of health insurance by the year 2019. (That’s the good news; the bad news is that the same office predicts about 23 million Americans will still be uninsured in 2019.)
This expansion in coverage will come partly through expanding Medicaid; “The late Nikki White, the thirty-two-year-old lupus victim we met on the first page of this book, would likely have qualified for Medicaid under the new rules—and would have had a good chance to live.”
The law will require most people to sign up for health insurance, and will expand options (and cover some costs) for people who aren’t covered through their employer. This “individual mandate,” though controversial in this country, is necessary for keeping the overall costs of health care low. The law also prohibits health insurance companies from denying coverage based on preexisting conditions, a common practice prior to the law.
The third and final piece of Reid’s solution is NONPROFIT FINANCING, another piece that is not fixed by Obamacare. American health insurance companies will still be for-profit, and “will get away with some practices that are banned in every other rich democracy. The U.S. firms will still be allowed to deny your claims…When they do pay, they can still take weeks or months to do so, without the strict time limits that are common elsewhere.”
In summary: “[T]he sad truth is that, even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the most inequitable health care system of any developed nation. The new law won’t get us to the destination all the other industrialized democracies have reached: universal health care coverage at reasonable cost.”