As I don't have a lot of time in the moment, my post on the history of American health care will be a very brief one. And anyway, all I could have done would be repeating what others said somewhere else. So I wanted to share those pages I like most, each of them with a unique way of presenting the facts. They all address the issue of the historical context of the current debate which I think to be a helpful hint for a generally better understanding.
The Public Broadcast Service (short: PBC) offers an interactive timeline including exactly as much information as I think to be good as an introduction to the topic: not too much, but fairly enough. It starts in the 1900s.
This video concentrates on the developments since the 1940s in a very simple and entertaining manner and is able to illustrate even rather abstract aspects quite well:
Finally, I warmly recommend the history of U.S health care in images published by the Free Speech Radio News. I found the picture above there and maybe it caught your attention. There are several more to be discovered, just take a look and see how people got more or less convinced through leaflets etc.
Up to now, I did not find sufficient information on the time before 1900, but I will add it as soon as I discover things worth sharing.
So as I wanted to include the Health Care and Education Reconciliation Act of 2010 signed in March of the previous year, I started to do some research about it and its contents during the last days. The first thing I learned was that there is actually not as much on the web as it is concerning the PPACA. There is not much quality stuff on it besides the original text, but luckily opencongress.org made me aware of a “plain English” summary by the House Rules Committee. Again, it always depends on the time and effort you can or want to invest. Anyway, this part of the health care reform does not seem to be that well known. Because of this, I will summarise it and limit myself to not more than 10 lines again:
The act amended the PPACA. It consists of two major parts: title I is headed “Coverage, Medicare, Medicaid and Revenues” and states, among other things, that: the income level for premiums and cost sharing is raised, the fines for remaining uninsured are reduced, 1 billion dollars are provided for the implementation of the reform, Medicare will profit from up to 75% discount on brand-name drugs by 2020 and grow more efficient (just like Medicaid), more money will be invested to reduce fraud and abuse in health care, implementation of taxes for health insurance providers and medical device manufacturers are postponed. Title II, named “Health, Education, Labour and Pensions”, includes that: more money is provided to support students and specifies loaning conditions, rejection due to pre-existing conditions will be illegal by 2014, more investments are made for community health centres.
It can be found all over the media, everybody seems to be discussing it and opinions seldom differed so widely about it: The American health care reform. When I started my project I was well informed about the up-to-dateness of this topic and had a personal opinion, but actually I must admit that I knew very little about the concrete contents of the amendment. So it is high time I sorted this out:
The health care reform in the United States, for which Barack Obama became a leading figure, was signed in 2010 and consists of two main parts: The Patient Protection and Affordable Care Act (short PPACA) and the Health Care and Education Reconciliation Act of 2010. Well, these are nice titles, but what is behind them?
Today, I will start with the Patient Protection and Affordable Care Act, which was signed by President Barack Obama in March, 2010. As most people are not keen on working through 974 pages of officialese, summaries of it are very popular. You can have them in any variation on the web: short ones, shorter ones and those aiming at the length of the original, quality ones and rather arbitrary interpretations, full texts or in note form…
What I am trying to do now is to offer a very brief recapitulation of the PPACA within not more than 10 lines. That should definitely be short enough to stay away of any limit of endurance:
Within the next years the government claims that it creates a programme similar to Medicare/Medicaid for people that are not covered by one of those or another plan yet, establishes a mix of private and governmental run health insurances called “National Health Insurance Exchange” creating competition within insurance companies, improves the quality and affordability of health care, enables to keep one’s insurance when changing employer, reduces or at least contains the costs of the health care system in general, removes the monopoly of drug companies, prohibits the denial of children with pre-existing conditions and ensures the expansion of preventive programmes.
I thank Robert Laszewski for his detailed analysis of the act to which I refer as a source. Those who appreciate critical report should really take a look at it.
If even this is not enough information, why not take your time and examine the full official version available as a PDF document (or use the index to find the sections most relevant to you).
Some of the main aspects and additional information are also presented in this video. But as it is published by the government itself it is of course extraordinarily positive:
So the Health Care and Education Reconciliation Act of 2010 will be added soon...
So because I wanted to find out why the former health care system needed change at all, it would be redundant to talk about those things that worked out well. Yes, believe it or not: Actually not everything was bad. The report (and the summary) mentions a number of facts proving this. Anyway, as opposed to the aspects presented by the global media, heres my list of facts that either surprised me or of which I think that they are not known enough to the broad public:
1. Health insurance is financed through private money (paid directly to the insurance companies or the by employer, who is then likely to take this extra money off from wages) and indirectly in form of taxes. Everyone in a full-time employment contributes to it. I think this is absolutely fine if all persons paying would benefit from this at least theoretically. But this is not the fact, as there are people who pay for social sevices like Medicaid (in case of low-income) and Medicare (for the elderly and disabled)through taxes while they themselves have no health insurance at all.
2. Paying health care services directly when a ceratin disease is not covered or due to being uninsured is extremely expensive, far more than I would have imagined: A serious illness or an accident can for example cost more than $100 000 of hospital charges (things like ambulance NOT included) and it seems to be not much better if you suffer from a chronical disease like diabetes: The average diabetic spent about §13 250 on health care.
So unsurprisingly 5 % of the Americans prefer to do without urgently required medical treatment.
3. Ethnicity determines the quality of health care you perceive. It is proven that especially Hispanic Americans, but also people with African or Asian background, American Indians and Alaskan Natives receive a rather low-grade quality of health care and have less access to is at all.
And yet even Anglo-Americans get only about 55 % of the care they need.
4. Health care as it is covers too many cases of unneccessary surgeries and medication while especially preventive measures are not nearly used as much as they ideally should.
5. The number of 46 million uninsured Americans is far too high. Besides those who just do not want health insurance there is a majority of people and families being too young to be covered by Medicare, not poor enough to profit from Medicaid but also not able afford private health care. So what are these people to do? They do not even have a chance. If I had to choose between health insurance or regular meals for my children, I know what I would pick.
6. According a study led by Heather Rosen, M.D., M.P.H in, from 2002 to 2006 uninsured children in the United States were about three times more likely to die from trauma-related injuries than children covered by commercial insurance. Although it is stated that there is not a proven cause and effect relationship, an interdepence of both factors seems to be very likely.
Of course, nearly everyone knows at least one example of a failure of the former American health care system compared to an optional other country in the world. But just stating that the whole system was bad because some woman could not afford a certain medication does not appear to be very convincing, though it still is a tragic situation. Individual biographies can be very useful examples in order to provide evidence for theories, however, they do not substitute facts. This is the reason for me not to build my post upon the contents of Michael Moore’s film “Sicko” from 2007, which I think to be brilliant though. He introduces numerous stories of people having no or problems with their health insurance and interviews those who worked for “evil” insurance companies. If you have not watched the film yet, I really recommend doing so. Here is the trailer, hopefully you acquire a taste for it…
It feels like it took me about ages of research until I finally found a collection of facts stating what went wrong with the American health care system that was not too biased in either direction. With "The Health Report to the American People" from 2006 the Citicen's Health Care Working group published a comprehensible roundup of pros and cons concerning the system at that time in order to inform the average American. Their aim was to enable a well-informed discussion about the topic so that civil participation has a chance to influence heath care policy. The whole report can be accessed as a PDF file, but for my purposes the apt summary published by the UFCW (United Food and Commercial Workers) will suffice.
I will add an even shorter overview as soon as possible.
I grew up with the German health care system and I took it for granted for quite a long time. To me, it was crystal clear that everyone who falls ill or is injured will be treated by a physician if necessary. I thought that health care was some kind of natural right and not depending on one’s financial solvency.
This experience might be the reason for me (and I’m sure many other people as well) to wonder how there can be Americans refusing to accept the Health Care reform in the United States. I always thought health insurance is a generally good thing everyone should benefit from? Now it would be easy to foredoom those people as ignorant and close-minded.
This is to some extend what I did throughout the last year. Of course, I know that money plays one of the major roles in the debate. However, this can’t be all of it. The really more than lively discussion still going on everywhere, among officials and citizens, in every form of media, even though the reform is already implemented (at least a major part to my knowledge) shows that the topic continues being up to date.
As I think one should only judge things one understands, my aim is to gain insight into the different perspectives on and the general discussion about the Health Care reform. Although I might and cannot share all convictions, I want to try at least to grasp them. In the upcoming weeks I’ll try to collect as much and diverse information as possible about the “problem”, related things that happen and change as well as different arguments and perspectives, not only for myself, but for those people with a similar mindset, for all wondering:
Why they do make such a hullabaloo about the Health Care reform?
See Rasmussen Reports’ recent survey: about 40% strongly favour the repeal of Obama’s reform (although I think 1000 people might not be that representative for the whole population…)
And although it’s a very sick joke, you should take a look at this cartoon. This is more or less what I thought to be wrong with the former system…
As I’ve never maintained a blog before, I’m curious about my project’s development. So I’m looking forward to new insights, unexpected discoveries, all kinds of advice and helpful comments or links.
