Failed American Healthcare

Blog Editor’s Note:  Yelena Pecheny (School of Public Health, Senior) responds to the healthcare panel discussion hosted by the Parr Center for Ethics (see original post).

“If I was to describe the history of health reform in the United States in one word, it would be ‘failure’. If I was to describe it in two words it would be failure/incrementalism”. I’m not sure if Jonathan Oberlander meant the two were causally associated, as if incrementalism has been the reason for failure solely because they are linked ideas [Greg Salmieri certainly iterated it so later in the discussion]. If so, Congress had the right initial intentions in trying to completely overhaul the system when the issue of reform was placed on the agenda. If not, it seems to be the case that we will only continue down this path of failure, and America will be left to pick up the pieces of a broken system that continues to break itself.

Yesterday, speaker Nancy Pelosi announced the merged bill from the House which looks akin to the Senate bill albeit with several significant differences that could potentially extend negotiations well past Thanksgiving; however, Oberlander believes it could be sooner than that. The “Affordable Healthcare for America Act” includes a surtax on those earning more than $500,000 a year to help foot the bill as opposed to the Senate’s main revenue measure, an excise tax on “Cadillac” (high-value) insurance plans.

Both bills include a government insurance plan, AKA “public option”, but the Senate version would allow states to “opt out” of participating.

Other properties of the health bill as outlined by Oberlander, which he says will most likely be included in the Senate bill, are: Expansion of the Medicaid program for lower income Americans, regulation of private insurance, subsidies for moderate and low income Americans, and mandates on individuals and employers to finance and obtain health insurance.

Obama responded to the Act yesterday in a press statement, “I congratulate the House of Representatives on the introduction of the Affordable Health Care for America Act, another critical milestone in the effort to reform our health care system….. I’m also pleased that the bill includes a public option offered in an exchange. As I’ve said throughout this process, a public option that competes with private insurers is the best way to ensure choice and competition that are so badly needed in today’s market. And the House bill clearly meets two of the fundamental criteria I have set out: it is fully paid for and will reduce the deficit in the long term.”

Oberlander says there are still a lot of unresolved issues, “Who should pay for reform? Who should have access to public health insurance, what sort of obligations should we impose on individuals and employers, what should the role of public and private insurance be in this new system?” I believe the House has presumed to answer many of these questions and these issues won’t be left unresolved for long…

The discussion last night touched on the question of universal healthcare as a moral obligation, but very little was said about how ethics plays a role in the healthcare debate. Ethics do not equal morality and I believe they failed, in this regard, to shed light on the ethical issues surrounding the healthcare debate, issues like healthcare for illegal immigrants and funding for abortion and physician-assisted suicide in the new bill; issues that will affect American society as a whole as we collectively try to foot the bill.

I would say Lin Zinser, VP of Public Outreach at the Ayn Rand Center of Individual Rights, was my favorite speaker of the night simply for her clear and concise ideas. She brought up the issue of morality with government mandates, “The current bills are horrendous for America, they are going down the wrong path on an accelerator train. They’re going to force every individual and employer to buy health insurance. That means for any American, the priority— before you buy food, clothing, transportation, or education— you have to set aside money for health insurance and the one the government says you have to buy. And that’s immoral.”

Abortion was briefly addressed by Greg Salmieri, a lecturer from the Department of Philosophy in Objectivity and Values who shared his opinion most excitedly, “I think we have nowhere near enough abortions. I find morally repugnant the kinds of opposition some people have. I have a sort of moral contempt for people who have some of these kinds of views (i.e. opposition to abortion). There is a real moral problem with nationally funded healthcare to include coverage for certain services because people who are opposed to certain issues are forced to fund them. [However] it’s really awful not to want them.” I suppose he had to include his own opinion on that one as if he held some sort of higher moral authority and could only condescend to address those morally-stunted simpletons.  The truth is this, the House bill does support federally funded abortions; I took a look at H.R. 3962 and on page 110 it states that “the public health insurance option shall provide coverage for [abortion] services.” Services that Americans will be forced to pay for.

Abortion and Healthcare Bill

Ralph Byrns, Economics Professor at UNC, touched on a favorite topic of reform— providing health care for illegal immigrants during a discussion of rights to healthcare. He took a very direct and honest, in my words, straight up approach to addressing the question, “We have to recognize that there are costs that are hidden, as with [illegal immigrants] coming into emergency rooms… the simple fact is we’re going to pay for their health and their healthcare, period. It’s going to happen. So, figuring out how to pay for it in an efficient fashion is what we need to do… and some kind of comprehensive system where we don’t have it coming in through the back door.”  Society ends up paying for it through various methods of cost-shifting, so either way— through taxes for public option subsidies or higher hospital and insurance costs— we are paying for it. Of course it is easy enough to recognize the problem and say a solution is warranted, but providing no solution in its place does not further progress. That is the general sentiment I had about the entire panel discussion. Many problems were addressed, no practical solutions were offered, and the panelists generally stayed clear of taking sides on hotly contested items opting for moderation and reason, both entirely unfulfilling. As vehement as rhetoric is right now, in all probability Congress will come up with the same lackluster compromises; reality usually catches up to people and incrementalism will remain the rule of the day. At least for now.

As Pelosi said at the end of her address on Capitol Hill, “We have listened to the American people; we are putting forth a bill that reflects our best values and addresses our greatest challenges and we are putting it online for all Americans to see…” Remember, this Act was “founded on the principles of American success: opportunity, choice, competition, and innovation.” This might be even funnier than Obama’s remarks earlier…