Guaranteed Healthcare

Although many may think today that we have always had employer-sponsored health insurance (ESI) in this country, that is not the case. While some companies offered coverage in the 1930s, the basic concept gained momentum only after the start of World War II. The war effort required a rapid buildup of industrial capacity in the face of a severe labor shortage as many men went off to war. Employers needed a healthy workforce, and needed to compete for workers. Federal wage and price controls made it difficult for them to offer higher pay, so that ESI became an important recruitment tool. Employers were helped by an IRS ruling that made their costs of ESI tax-deductible;  these benefits also were not taxable for employees. (Somers, AR, Somers, HM. Health and Health Care: Policies in Perspectives. Germantown, MD. Aspen Systems Corporation, 1977, pp 109-11)

We saw in our last post how the intensifying class war in America over the last 30 years has hollowed out the middle class and led to the widest gap between the haves and have nots in our country’s history. In this Second Gilded Age, the right has been winning the war by its promotion of deregulated markets and its attacks on government, thereby sacrificing the public interest to the benefit of the politically elite and the few at the top. In this new landscape, Social Darwinism increasingly prevails—sink or swim, take care of yourself, don’t expect any ‘handouts’.

As the Great Recession rolls on after three years, without signs of relief on the horizon, a growing army of many millions of Americans is finding it impossible to gain access to necessary health care that is affordable. Meanwhile, class warfare is gaining intensity with a widening gulf between the left and right over the major issues of the day, including the future of U.S. health care. As political gridlock continues, the battlefield is littered with many preventable deaths, many lives wounded by the ravages of untreated or under-treated disease, and growing stress in affected families.

Under the theory of moral hazard, it is postulated that insured people overuse health care services and that patients themselves are a leading cause of health care inflation. If they would just have more “skin in the game” through enough cost-sharing (co-payments, deductibles and other restrictions), it is assumed that costs could be reined in.

As the last three posts have shown, the primary care infrastructure of the U.S. health care system is crumbling, overrun by specialization, sub-specialization and market forces. As a result, access to primary care is not available to a growing part of our population, costs go up as value, quality and outcomes of care go down, and any accountability within the market-based system remains out of reach. The “reform” legislation of 2009 cannot be expected to alleviate these fundamental problems, “building” as they do on our present flawed system of financing and delivering health care. Since all incremental efforts to reverse these trends have failed, we need more fundamental approaches.

Up to the middle of the last century, most Americans could count on good access to generalist primary care physicians with the training and commitment to evaluate and treat their medical problems, whatever they might be. Those days are long gone. The ratio of generalist physicians to specialists in this country reversed from about 80:20 percent in 1930 to 20:80 percent in 1970. Since then we have seen the generalist tradition being carried on by family physicians, general internists, general pediatricians, and osteopathic physicians, but their aggregate numbers today are no more than 30 percent. And that number is falling fast as more medical graduates seek out the higher pay and more attractive life styles of the non-primary care specialties.

Yesterday’s blog post by John Goodman and Thomas Saving of the National Center for Policy Analysis (NCPA) is the latest in an avalanche of unfounded assertions and distortions that have characterized the writings from this center for many years. The Dallas-based NCPA, established in 1983, describes itself as a “nonpartisan public policy research organization, with the goal to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector” (its website). This latest post puts forward, without context and with cherry-picked references, carefully selected statements that might seem to some to support their case—that deregulated markets will solve all of our health care problems. It would take a very long paper, or a number of papers, to respond to the many unfounded claims in their latest post.

Amidst all the crises confronting our country today—ranging from the deficit, rising unemployment and underemployment, mistrust of legislators and the government—there is another major crisis: the continued deterioration of primary care that threatens to break up the very foundation of U.S. health care. Underreported and widely misunderstood, the continued decline of primary care results in uncontrollable inflation of health care costs, decreased access to necessary care, increasing fragmentation and depersonalization of care, and unacceptable quality and outcomes of care. As health care costs spiral out of sight and consume an ever-increasing part of the country’s GDP, this trend, unless reversed, can destabilize and eventually bankrupt our health care system, and perhaps even our country.

It was clear from the beginning of the health care “reform” charade that the insurance industry, the drug industry and other parts of the corporate medical industrial complex were working to assure that any legislation that passed would add to their financial bottom lines. They largely succeeded in this. The following examples illustrate how well some of these industries made out with the final result, the Patient Protection and Affordable Care Act of 2010 (PPACA), which passed in March:

    In our last post, we reviewed a daunting set of challenges to access and quality of care for Americans unfortunate enough to get cancer. In this post, we ask the obvious question whether, and to what extent, the new health care law, the Patient Protection and Affordable Care Act of 2010 (PPACA), may help to alleviate these problems.

Disparities within the U. S. health care system result in serious impacts on access to care for patients with cancer at all stages from screening and prevention to treatment and survival. Access barriers further lead to disparities in the quality of care received. These concerns led the American Cancer Society to launch a national effort in 2007 calling for system reform that will provide “4 As coverage”:

Our last four posts have examined the PPACA from the perspectives of the four main goals of health care reform — cost containment, affordability, improved access and quality of care. Here we draw these goals together in asking whether this legislation delivers enough to be worth the $1 trillion investment over the next 10 years, and whether it will really work.

In our last three posts, we examined how the Patient Protection and Affordable Care Act of 2010 (PPACA) stacks up against the goals of reform for cost containment, affordability and access to care. Here we consider what its likely impact will be on the quality of care, the fourth major goal of the reform effort.

The Patient Protection and Affordable Care Act of 2010 (PPACA) is being touted by its proponents as moving the country to near-universal coverage and a great step ahead in U.S. health care. But what does this really mean? Are the many barriers to care almost a thing of the past?

In our last post, we looked at some of the uncontrolled drivers of rapidly rising health care costs despite all the assurances of our politicians supporting the new health care law, the Patient Protection and Affordability Care Act of 2010 (PPACA).