Wednesday, November 21, 2012

Two Cheers for Obamacare

{The following column will appear in the Anahim-Nimpo Lake Messenger in December}

On November 6, I breathed a sigh of relief when Barack Obama was re-elected for a second term as the President of the United States.  Although his victory carries no guarantee of either world peace or fiscal sanity, intransigent conservatives in Congress were at least not rewarded for their worst behavior.
Most importantly, the election means that the Patient Protection and Affordable Care Act —“Obamacare”—is here  to stay. This legislation addresses both of the most serious flaws in the American health care system: the huge number of uninsured (46 million people) and under-insured (25 million);  and runaway costs (two-thirds of personal bankruptcies in 2007 were due to illness or medical bills).  In recent years,  these twin issues of coverage and cost have reinforced each other in a vicious downward spiral. Coverage has declined because premiums and co-payments are rising; premiums and co-payments keep rising because of the lack of effective cost containment.  

A recent report comparing health prices said it all.  A routine doctor’s visit costs approximately $30 in Canada,  $22 in Germany and ranges between $59 and $148 in the U.S. , with the Medicare rate for seniors set at $72. A bottle of Lipitor  costs $31 in Canada, $78 in Germany, and an average of $134 in the U.S.  MRI scans cost $304 in Canada, $632 in Germany, and an average of $1009 in the U.S.  A normal childbirth in a hospital?  $3200 in Canada, $2200 in Germany, and a whopping average of $9280 in the U.S.

 Increasingly, it was not just poor people who could not afford to pay these inflated prices.  The push for reform was partly driven by the growing plight of middle-class Americans. And the rising unemployment rates that accompanied the recession that began in 2008 meant that even more individuals lost affordable coverage. Something had to be done.

Will Obamacare succeed?  The criticism has been made that the Affordable Care Act does not sufficiently attack  the power of special interests—insurance lobbies, drug companies, and the corporate health sector—who have a financial stake in the existing system.  It is true that the government had to jettison the ‘public option’ (offering public insurance at lower premiums for a standard care package) in order to get the Ac t through the Senate.  And to gain the cooperation of doctors and pharmaceutical companies, the government had to agree not to control the prices paid for products and services.

But much has been achieved. When fully implemented, 95 percent of U.S. citizens will have the same basic health security that Canadians have. And the Affordable Care Act contains several payment and delivery options  that will foster higher value, lower cost and patient-centred primary care .  In the not too distant future, Americans may even have a thing or two to teach us about how to do health care.
Mark Crawford is an Assistant Professor at Athabasca University. He can be reached at .

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