NPI's Cascadia Advocate

Offering commentary and analysis from Washington, Oregon, and Idaho, The Cascadia Advocate is the Northwest Progressive Institute's unconventional perspective on world, national, and local politics.

Friday, August 31st, 2012

Patient Protection Act a start, but U.S. still needs true healthcare reform: Medicare for All

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.

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