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Sunday, March 28, 2010

Two Cheers, One Jeer for ObamaCare!

There was a single frame political cartoon I saw in one of the dailies, just after The United States Government passed The Patient Protection and Affordable Care Act, 2010. It showed a caricature of House Speaker Nancy Pelosi in a doctor's uniform holding a newborn baby in a towel, with the word "Health Care Bill" written on it, standing next to a donkey dressed in nurse's outfit, looking over at the patients waiting bench with a human skeleton adorned in a workman’s outfit, with the donkey saying; “next patient”.

The economic giant that is The United States of America, was put to a standstill due to the issue of Health Care reform. The cartoon displayed this most humorously. The economic growth persons in the economic forecasting and analysis field were expecting by the end of 2009 was less than modest. In fact, it was spotty- at best- with no clear sign of anything to be thankful for other than to be one of the few people still left alive, if only half dead.

Hopefully, the recent U.S. health care bill, at its fruitful best, can prove as a model for other countries wishing to introduce a form of universal health care, or be basis on what to reform or what not to reform with an existing universal health care package- it's best we can gain from this process, for having to wait for economic deliverance from The USA.

The only country in The Caribbean that has a universal health care system is Trinidad and Tobago. This is on the basis that every person is afforded health care within the public system, even though the system has a private option.

Trinidad’s universal health care system isn't an insurance centric model, but rather one on the provision and availability of care, along with a prescription drug plan for chronic illness.

The Health Care bill just passed in The United States, was, primarily, centred on providing insurance options and insurance regulations for the benefit and protection of consumers. The biggest achievement to date was the fact that the bill actually passed, with moderate taxes to be levied along with additional reforms- such as the elimination of insurance discrimination on persons with pre-existing conditions.

This aspect makes the bill a little odd on one end, due to the extent that it actually mandates persons to purchase health insurance by making it illegal to not have any insurance, pre-existing condition or not. This, in effect, increases the amount of payments to insurance companies. While on the other end, it sets caps on premiums for certain circumstances.

Whether or not these premium caps cancel out the increased payments through the increase of persons paying into the insurance system (creating losses at the firm level), is something the insurance agencies must track and assess for themselves based on their new competitive environment.

The bill also provides for the expansion in government subsidies to persons earning between 30K and 45K a year, of up to 75% of the premium. However, the cuts in Medicare -the government sponsored senior citizen health care option- via the elimination in the Medicare Improvement Fund, would, more than likely, go towards only half of the subsidy coverage I dare estimate- taking into consideration the expected amount of increased persons into the system (over 30 million), additionally coupled with the wide range of persons that are un-insured currently who fall under the 45K per year income bracket.

Through all of this, the second biggest achievement is that the bill synergises subsidy payments for persons, to then be paid into the private insurance market (no public option), along with excise taxes on the insurance companies with higher premiums, for that to be paid back to the government (no clear mandate on if these payments are earmarked to go back into the system). While this "evens out" the market providers, it also does not crowd out private insurers with a government option- while at the same time providing coverage to persons who may not have been able to afford the premium, along with not widening the deficit and increasing the public debt to fund universal coverage.

While acknowledging that prime synergy- which I felt quieted the private insurers- the bill defeats itself on the core matter of taxes to be levied on medical devices, which in effect makes new technology for medical practices more costly and effectively raises the price for medical services. This should raise concerns over the quality of care to individuals.

Additionally, the bill does not provide for a targeted expansion of the amount medical service providers, in a way that would ease the burden of the increased amount of persons that will be seeking medical aid under the scheme.

Facilitating an increase in quality services seems like a "no-brainer". The fact that the health care systems in Canada and The United Kingdom, are strained because their universal health care system is undermanned and facilities under invested- even when factoring in the huge tax burden in both countries, which sets aside funding for health care and to which the US is implementing excise taxes on items such as medical devices.

While it could have been equally as bad to have within the next 5 years an increase in service providers- as pointed out earlier that the bill does not provide for- coupled with the excise taxes on medical devices, causing an effect of cutting into the market share of the existing service providers and squeezing their margins and consequentially pushing their prices up, it is clear that this bill doesn't factor in provisions for adequate and timely ran facilities and services for the expected increase in patients.

While we have to praise the political and subsequent insurance achievements of ObamaCare, the possibilities of inadequacies in future health care quality needs certain attention.

Initiatives I would have ideally fought for are 1. Subsidizing and expanding “mandatory” employee insurance and full medical coverage, to and for all persons who worked over three years for the rest of their life along with their children, but only up to a certain age (with tax and subsidy mixes for special brackets); 2. Mandatory government provisions for persons with disabilities along with their children up to a certain age; 3. Zero tariffs on certain prescription drugs; 4. Increased scholarship and training within the health care field; and 5. Tax reform and increased income and excise taxes in certain sectors- but not on medical care providers or devices for the funding of this programme.

The start of KempCare...some shudder to think!
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