Citizens Guide to Health Care Reform

Citizens Guide To Health Care Reform By Robert L Mccan
Citizens Guide To Health Care Reform By Robert L Mccan

How do we create a health care system that (1) includes every citizen, (2) improves the quality of health care for everyone, and (3) reduces escalating costs?  Dr.Bob McCan in his latest book shows how the new Patient Protection and Affordable Care Act of 2010, called “Obamacare” by some, addresses these three fundamental concerns.

The book begins with perspective and a summary of provisions of the new law.  The author believes this to be the most far-reaching legislation of the past 100 years, as important for every citizen as Medicare and Social Security are for seniors. He provides convincing evidence that this approach to health care reform has been the conservative alternative of Republicans for at least two generations and was researched and promoted by the conservative Heritage foundation. 

Their plan was enacted by a Republican governor in Massachusetts and was adopted by President Obama because he believed a more robust single-payer system would be difficult to enact.  Most Democrats prefer a plan where government controls the system and provides services at half the cost of our present profit-laden system.  Republican leaders sponsored and voted for this current plan—until Democrats adopted it, when it became the epitome of evil.

The law builds on the present system, which includes both private and public components.  It maintains private insurance for large companies, while setting minimum standards for policies.  It assists and encourages small businesses by paying part of the cost and by creating insurance company exchanges in each state where insurance rates are lower.  Independent self-employed persons can get insurance there at rates far lower than now because of the large pool to be insured. Those who work at jobs that do not provide insurance, or for those too poor to afford it, receive supplement payment on a sliding scale, depending on the amount the person or family can afford to pay.  The sixteen million in that pool are joined by an equal number who can afford insurance but who choose to avoid the cost.  These are the persons “mandated” to get a minimum level policy to protect themselves and the public from overwhelming cost when an accident or major illness strike

One quarter of our citizens already receive health services from government.  The law strengthens and expands each of these programs.  Veterans and active duty military personnel will continue with their 200,000 VHA employees and annual budget of $50 billion.  Medicare funds citizens when they turn age 65 and has 47.5 million beneficiaries.  Children’s Health Insurance Program (CHIP) is another piece, providing medical care for some 7.5 million children who otherwise go unattended, and Medicaid, the second largest public program serves those who have used all their resources in medical care or otherwise are destitute.

The new law places restraints on health insurance companies by limiting profits to 20% and by requiring them to insure everyone, even those with pre-existing conditions.  It cooperates with states in setting up an exchange in each state with guidelines within which states can function.  The law provides ways to assist individual consumers to determine health plans that best meet their needs at lowest cost to them.  It expands health services into underserved areas in inner cities, rural areas devoid of good services, and on Indian Reservations.  The law nudges the whole system away from “fee for service” toward total coverage for a set fee, with an emphasis on wellness and efficient care.

Dr. McCan takes an in-depth look at issues related to universal coverage.  He studies “best and worst” states and shows how state policy leaves a quarter of the population uninsured in Texas with only five percent or less uninsured in Massachusetts.  Generally the “red” states in the south, where most people face illness and death without proper medical care are the very states that protest the loudest against “Obamacare.”  The book looks carefully at the issues related to the mandate that requires everyone who can afford insurance to take a minimum-level policy.  A law, passed and signed by President Ronald Reagan, provides emergency medical treatment to everyone whether or not they can afford to pay.  The result produces a large number of bankruptcies and over $1,000 extra per policy for everyone who pays for health insurance to cover the cost of those who refuse to pay but can afford it.  Since virtually everyone will use health services at some point, everyone should accept responsibility to help pay for these services.

Chapters on quality and cost are filled with striking examples that illustrate the need to move from the wild-west of uncontrolled health care to a rational system that provides best practices at lowest cost.  Dr. McCan writes from expansive knowledge and deep indignation as he points to poor hospital practices that needlessly kill up to 100,000 patients annually.  He illustrates how clinics owned by doctors use more tests that needed to drive profits.  There have been few rewards for saving money or keeping people well and a great deal of money from expensive treatments of questionable value.

Another chapter studies the health care systems in six industrial countries most similar to our own.  The facts are that people in these countries hold their systems in high regard, their people live longer and on average they pay only slightly more than half what we spend.  Their people believe it would be inhuman and highly immoral not to provide health care equally to all citizens.

Dr. McCan, who is an ethicist by training and who taught as a professor of Public Policy Ethics, has a chapter on the moral underpinnings of the Affordable Care Act. He shows how public policy from the time our nation began has always been to support “the general welfare.” The essence of a moral approach is to seek “the common good.” The author points to the social teachings of the Roman Catholic Church in providing health care through government for all citizens, to mainline Protestant churches that teach Jesus’ special concern for the poor and for those needing healing. Likewise, mainline Jewish groups emphasize justice and compassion for the poor which expresses itself in public policy.

Without rancor but with clarity Dr. McCan details how Republicans in Congress are  spreading fear and use false information to turn unknowing persons against the health-care law, and hence against the President.  Many examples show how Democrats are trying to solve our problems, and Republicans are throwing up roadblocks.  It is with sadness that Dr. McCan calls for Democrats to redouble their efforts to win the coming election and thus provide opportunity for the law to more fully take effect.

The book is imminently readable, driven by passion, yet careful in its scholarship.  It deciphers from a citizen perspective the many disparate parts of a complex health care law and for the first time explains it to the public in a clear, concise way.