Millions of Americans are gaining access to healthcare for the first time not only in their lifetimes, but also in generations. The poorest Americans are most likely to be uninsured. One third of Americans who live in poverty are children. /Heifer 12X12 image by Betty Londergan
Practically and politically, all Americans need to make up their own minds about the federally driven healthcare reform efforts across the country.
Practically, the reforms are so far-reaching they will touch most of our families directly or indirectly. For the first time, the majority of Americans are being asked to become informed consumers of healthcare. If you pick the wrong healthcare coverage, it could cost you or a loved one thousands of dollars in deductibles and other cost sharing.
Politically, healthcare is this year's dominant issue. Republicans have cast the Patient Protection and Affordable Care Act as President Obama's Waterloo, with this fall's midterm elections billed as a referendum on the Obama administration's signature domestic policy initiative.
After spending the past three months deep in the weeds of U.S. healthcare reform efforts, I can report the following truths to help guide my fellow citizens for practical and political purposes:
- Underperforming: The U.S. healthcare "system" is broken and needs fixing. America has the best doctors and medical technology in the world, but healthcare quality and accessibility varies greatly from state to state and community to community. And the current fee-for-service healthcare model promotes volume, not value. Fee-for-service promotes a twisted incentive for healthcare providers: the sicker the population, the higher the volume of patients, the higher the fees.
- Desperate measures: Obama probably lied when he repeatedly said "you can keep your health plan if you like it." President Franklin Roosevelt definitely lied when he maneuvered the United States into World War II. Hitler had to be stopped, so Americans forgave FDR for fibbing. If Obama can fix U.S. healthcare, Americans will forgive him, too.
- Dialogue: The focus on healthcare reform from DC to every American's downtown is a good thing.
- Blended approach: The PPACA is closer to a Republican road map than a socialist plot. The PPACA is a patchwork of market-based reforms and expansion of existing government programs. On the market side, new "exchanges" established by federal and state officials provide a marketplace for private insurers to offer health insurance policies to individuals and small businesses. The exchanges hold the promise of expanding healthcare access to millions of low- and moderate-income Americans. On the government side, Medicaid is the biggest program expansion. Half the states have embraced Medicaid expansion, with some crafting a "private option" through the new individual exchanges. Millions of poor Americans have already gained health insurance through Medicaid expansion efforts over the past year.
- Common good: The primary goals of the PPACA are to expand access and lower costs while maintaining a high level of healthcare quality. Any alternative to the PPACA should be measured against these worthy aspirations.
