Along with economic security, the future of Medicare has emerged as a significant issue in the presidential campaign. The Patient Protection Act, passed more than two years ago and recently upheld by the U.S. Supreme Court, provides insurance reform, not healthcare reform. But both are needed.
The Patient Protection Act imposed new requirements on health insurers: young people can stay on their parents’ plans until age twenty-six, coverage cannot be denied to people with pr-existing conditions, there are larger caps on lifetime expenditures on behalf of the insured person, and eighty-five percent of premium income must be spent on patient care. The Act also mandates that everyone purchase health insurance.
The individual mandate was one of the focal points of the lawsuit brought by just over two dozen states’ attorneys general against the Act.
The states argued that the individual mandate is unconstitutional because it exceeds the powers that the Constitution grants to Congress. But the Supreme Court reasoned that the penalty due from individuals who don’t buy health insurance constitutes a tax – and Congress has the power to impose taxes.
Do the justices see the ramifications of what they’ve done?
If buying insurance is a payment in lieu of a tax, why not call the payment a tax? If it’s a tax, why have the insurance companies collect it? We have an Internal Revenue Service that already collect taxes.
The insurance companies are not a friend of efficiency in healthcare: their profit is derived from a portion of the money that passes through their hands on the way to your doctor or hospital. While an insurance company may balk at paying for the care you need, on the whole, they want to see more payments made to healthcare providers. With more payments to doctors, the insurers get to keep more: cost containment is not one of their goals.
Insurance companies contribute to inefficiency: each has its own forms, its own methods, its own hurdles for your physician to jump over. Physicians spend too much time battling insurance companies on behalf of their patients. Winning those battles is a form of patient care, but that isn’t what your physician trained to do. When your physician has a back-office staff to join the battle, that staff contributes to the bill, not directly to your care.
The Patient Protection Act was crafted to reduce federal spending on healthcare. Paul Ryan’s budget plan, deviously named “Path to Prosperity”, counts on these savings, even though Republicans have vowed to repeal the legislation. Mitt Romney, just nominated by the Republican Party as its candidate for president, repudiates the Patient Protection Act, even though it was modeled in part on the insurance reform he signed into law as governor of Massachusetts.
We have health insurance reform – if we can keep it. We need healthcare reform – if we can achieve it.