Healthcare reform was demoted to a partisan debate over entitlement expansion recently by the Wall Street Journal – Why The Healthcare Rush? In the midst of a global recession, significant unemployment, and extended COBRA benefits legislated by Congress bereft of financial support for families to purchase the benefit, the writer stated, “It’s not hard to see why Democrats are trying to hew to this full-speed-ahead timetable. Their health overhaul will run up a 13-figure price tag at a time when spending and deficits are already at epic levels and hook up the middle class to an intravenous drip of government health subsidies for generations to come.”
The Congressional Budget Office in December, 2008 released a summary document entitled Budget Options, Volume One – Healthcare. In it, CBO findings stated “CBO projects that, without any changes in federal law, total spending on health care will rise from 16 percent of GDP in 2007 to 25 percent in 2025 and close to 50 percent in 2082; net federal spending on Medicare and Medicaid will rise from 4 percent of GDP to almost 20 percent over the same period. Many of the other factors that will play a role in determining future fiscal conditions over the long term pale by comparison with the challenges of containing growth in the cost of federal health insurance programs.” Noting 45 million Americans are without health coverage, the CBO identified the current health care system in crises mode.
Private PPO costs are rising over 9% this year while premiums have been declining since 2003. Healthcare, business, and civic leaders have consistently identified, with great concern, the percentage of the GDP healthcare has been and is forecasted to become. With trepidation, all key stakeholders today acknowledge there is a problem. Health systems and hospitals are between the preferable rock and hard place – federally mandated patient satisfaction measurement linked to reimbursement while Medicare and Medicaid reimburse less than half the actual cost. Consumer demand wants immediate response and at the same time desires the benefits that come from research and technology. We have a cultural bias toward healthy aging and a societal behavior focused on “biggie,” “immediate gratification,” and “eat not – pay later.”
Healthcare is an industry like any other. Kaiser Family Foundation Health Tracking Poll: Election 2008 (conducted July 29-August 6, 2008) found that 24% of consumers nationwide reported they had difficulty paying for their insurance and healthcare. Since the recession began mid 2008 there is quantitative evidence that the number of prescriptions filled nationally has declined — Q1 and Q2 2009 were the first negative quarters in the number of prescriptions filled in over a decade. (Wall Street Journal, 3 June 2009) The number of primary care office visits per person has also decreased this year. Between 1999 and 2008 the average worker’s healthcare premium has increased 119% for the employer and 117% for the employee. In lieu of dropping coverage, cost shifting to employees is occurring. One in three workers in small businesses has annual deductibles of $1,000 or more, in contrast to one in five in the previous year’s survey. In one year, the percentage of workers enrolled in high-deductible insurance of $1,000 or more jumped to 18% from 12%.
We see firsthand elderly debating which medication they can take due to the cost and time of year it is – the Medicare doughnut – period when a beneficiary reaches their initial coverage limit and becomes responsible for the total costs of all medications based on the full cost of the drugs. Families who had grown up with healthcare benefits now searching because their no longer have employer sponsored healthcare coverage or cannot afford COBRA continuation benefits. These are the new healthcare poor – consumers who are middle class and no longer have benefits and coverage forcing them to search for solutions.
There is not a single solution to the healthcare industry crises. If there was Americans wouldn’t be flying to India for surgical procedures. Mothers wouldn’t be going home following birth when they are either weak, tired, or have not had the instruction needed o care for their baby. Canadians wouldn’t be flocking to the US for diagnostic testing due to long wait times at home. Administrations since Harry Truman have attempted to find a solution to healthcare coverage for all and a fix for the healthcare industry. This work has, for the most part, been unsuccessful. Perhaps the financial crises coupled with an outcry by consumers for assistance is creating the burning platform for reform noted by the Wall Street Journal. Potentially recognizing the mortality and morbidity rates in this nation are not the best in the world is the reason for change versus partisan politics.
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