Alright, Tom. Here you go. I've been holding off on writing about health care/insurance reform because I haven't had adequate time to go through the bill and understand what it all means. I haven't still but I'm going to go ahead and make some comments based on what I know so far. Of course, it's subject to criticism (comments?).
So was Joe Biden correct when he pulled a "Biden" and whispered "This is a big f*#king deal" to Obama in front of a microphone to the world just before the signing ceremony? Well, yes and no.
First, let's spend a little time trying to understand why we even had this enormous debate in the first place. What was the problem? Well, you can really break it up into three problems: 1) high and rapidly growing costs for health care and insurance (the percentage of GDP devoted to health care grew from under 6% to over 16% from 1962-2007), 2) a lot of uninsured people (~46 million U.S. residents did not have health insurance in 2008), and 3) very large projected Medicare deficits and increasing Medicaid costs that are leading the federal budget down a very unsustainable path.
So why have health care costs risen so much in the U.S. anyways? Well, unfortunately there is no smoking gun here. There are many different factors at play. One of the most convincing causes to me is just the idea that we adopt and diffuse expensive medical technology at much higher rates than other countries. In addition, health care providers (physicians, nurses, etc.) just make more money here. So what's wrong with all of that? Well, it turns out that this increase in the cost of care doesn't really translate into better quality of care. On one hand, we do not have to wait long for noncritical surgeries compared with other countries and we are able to quickly have access to the latest and greatest products from our big medical companies. But on the other hand, our life expectancy is pretty below average compared with the rest of the developed world (check out this excellent graphic by the National Geographic) and infant mortality rates are high compared with other developed countries. That just doesn't seem right.
What about health insurance costs? Well, it obviously is tied to this increase in health care costs and that's the primary reason it has also increased (it's essentially how the insured pay for care...through premiums and deductibles). But you also need to add in the administrative costs. I'm not sure how those costs have trended through time.
So as a country we are paying way more but getting less. But should we really care about the situation at a national scale? Well, I would argue that we definitely should when the imbalance between cost and quality is this enormous. What gets so many people fired up about this subject is that the people with insurance generally love their health care. I love mine that is provided to me as a state employee. I don't use it too often but whenever I have, it's been fantastic. And I am confident that if anything bad were to happen to me, I would have great care immediately available to me. So any change from the current system is understandably going to raise the eyebrows of the people with great insurance.
But what about the people without insurance? Well, they are one of the primary reasons we are lagging behind the developing world in those quality indicators. They really don't have any care unless something catastrophic occurs when the government (i.e. taxpayers) or a charity foots the bill. So why would anyone not have health insurance? Well, they just can't afford it because their employer doesn't help pay for it or they're unemployed. Apologies for stating the obvious but it's important to emphasize and understand that not all uninsured people are blood-suckers who are just hoping for a government hand-out. This is even more apparent during a recession like our current one when everyone knows someone close to them that cannot afford health insurance for one reason or another. Sure there are abusers of the system but I don't think anyone would claim that the status quo is A-Okay (unless you truly are a selfish troll that thinks that they are impervious to the threat of unemployment during difficult economic times).
Okay...are you still with me? In PART 2, I will address the third problem and then get into the actual bill that was signed into law yesterday. Stay tuned.