Healthcare reform was the major piece of legislation that President Obama tried to pass in the first year of his administration. Obama campaigned for president on the promise that he would reform healthcare in America, and the American public agreed with him, that they wanted the healthcare system reformed. Opinion polls taken in the fall of 2008 indicated that over 60% of the public was in favor of healthcare reform, yet by the autumn of 2009 over 60% of those polled were against the healthcare reform bills before congress. What happened to foster this large swing in public opinion in less than one year?
The huge drop in public support for healthcare reform can be attributed to a combination of factors, both substantive and political.
The fact that the bill was over 2000 pages long caused many people to fear the worse in the bill. When it became clear that few, if any, in congress actually knew what provisions were in the bill, but were going to vote for it anyway, many Americans became concerned.
As the public discovered what was actually written into the bill, the opinion of the voting public against the bill grew steadily stronger. Some of the major points in the bill that turned voters against it were:
- Requirements for everyone to buy health insurance or pay a fine
- Increase in taxes starting in 2010 but benefits not starting until 2013 or 2014
- The fact that several provisions were probably unconstitutional
While Americans want something done about the ever increasing healthcare costs, this bill did not really address any of the factors causing healthcare costs to continually increase:
- Regulations that require specific coverage in every healthcare policy
- Defensive medical testing because of unlimited liability to lawsuits
- No accountability in the entire healthcare system
- Limited competition for insurance companies due to government regulations
The political process which was required to pass the bill was very appalling to anyone who was paying attention to the process.
When the Unions and government employees were exempted from the tax on “Cadillac” healthcare plans, many voters smelled a rat. When the people passing this bill were exempted from its provisions, the American public took notice. When republicans were essentially locked out of any debates on the content of the bills and weren’t allowed to add amendments to the bill, the American voters voiced their opposition to the process. The number of, and dollar amounts, of bribes doled out to obtain the required number of votes needed to pass the bill may have been the deciding factor that caused public opinion to drop below 50%.
This frustration came to a head in the special election for the Senate seat in Massachusetts. The voters there elected a Republican candidate, in a predominately Democrat state, who clearly campaigned against the Healthcare reform bill. Other politicians viewed the outcome of this election as a clear sign that the public did not support the healthcare reform bill, and concerned about their own re-election, withdrew their support for the bill.
The American public rejected the Healthcare reform bill of 2009 for a combination of reasons:
The substance of the bill took too much control out of the individual’s hands. Government intervention in insurance policy coverage requirements, doctor re-reimbursement, and testing procedures all felt too much like socialized for most Americans to handle. Increases in taxes and fines for non-compliance angered many voters in today’s economic climate. Too many voters saw the cost far outreaching the benefits in the healthcare reform bill.
The politics involved in the passage of separate bills in the separate chambers of congress proved to most voters that the bill was about power and politics, not the American public. They correctly saw that the Healthcare reform bill was mostly a power grab by the Obama administration. The American public was not ready to turn over an industry that represents one sixth of the economy to the government. Not after the government essentially took over two American automobile companies, major banks, and major investment firms.
In hindsight, which is always 20/20, the Obama administration tried to do too much, too fast, and too secretively.
The healthcare industry still needs to be reformed, but the American public clearly said this bill was not the solution.
The California Health Care Almanac recently released its annual report on the uninsured in the state. The report has been released annually for over 20 years and over that period the percentage of Californian’s, who are not eligible for Medi-care, and are not covered by an employer’s healthcare insurance has risen by 9%. The rate of uninsured Californian’s has risen only 6 tenth of one percent in the past 8 years, from 20% in 2000 to 20.6% in 2008 (The latest year that statistics are available). California has a higher percentage of uninsured residents than the National average and the largest actual number of uninsured individuals—6.6 million.
The general trend of the healthcare insurance picture in California is that both the number and percentage of residents that are uninsured is increasing at a rate that is slightly greater than the rate of the uninsured in the nation as a whole. While California has the largest number of uninsured individuals of any state, it ranks 8th for the number of uninsured when stated as percentage of population with a rate of 20.5%. The national average for the uninsured is 17.5%, and Texas has the highest percentage of uninsured residents at 27.6%
The trend for who provides the healthcare insurance coverage is changing from privately provided coverage to publicly provided coverage. Employer provided healthcare insurance has declined by 5.2% over the past 8 years, while individually purchased healthcare insurance has increased only 1.1%, leaving the public to provide healthcare insurance to increase by 3.6%. The number of people eligible for public healthcare insurance is increasing faster than the number of individuals receiving public healthcare insurance.
An interesting statistic is the one concerning the changes in the types of insurance coverage in different income brackets. The insurance coverage source (private, public, or uninsured) stays essentially the same in the lowest (under $25,000/year) and the highest (over $75,000/year) income brackets. The trend in the two middle ($25,000 – $75,000) income brackets is moving from private sources to public sources and uninsured. The percentage of the two middle income groups who rely on public sources for their healthcare insurance has essentially doubled from 1994 to 2008
The highest number of uninsured residents is among the self-employed and those working for employers with less than 25 employees. It is curious to note that among residents employed by the public sector, the uninsured rate is 8.3%, higher than the national average for public employees.
As is to be expected, the rate of uninsured individuals is highest in the younger age groups when children are no longer covered by their parent’s healthcare insurance plan. Younger individuals tend to have lower family incomes and the lower income brackets also have higher uninsured rates than higher income brackets
The percentage of uninsured individuals differs along racial/ethnic lines as well. The only ethnic group that has a larger percentage of uninsured individuals than the state average is the Latino group at 29.9%. The report also lists the uninsured rate of non-citizens in California at 48.3%.
Analysis of the Data
While the report is titled ‘California’s Uninsured’, it spends a significant amount of time tracking the trends on who provides the source healthcare insurance. Whether the individual is covered by employer provided healthcare insurance, privately purchased healthcare insurance, or publicly funded healthcare insurance, the aggregate will be the total of insured residents. If you do not have healthcare insurance it doesn’t really matter to you who provides the healthcare insurance for those who have it.
One statistic that clearly demonstrates a major flaw in the entire healthcare insurance system is the number of individually purchased healthcare plans. Only 7.7% of residents purchase their own healthcare insurance. This means that very few California’s are taking responsibility for their own healthcare.
The fact that California’s uninsured rate is slightly higher than the national average can be explained for two reasons:
1) California’s population is younger than the national average, and many young people make the sound financial decision to forego healthcare insurance.
2) California has a high rate of non-residents, and non-residents have a very high rate of uninsured for healthcare. Latinos account for 58% of California’s uninsured population.
The complete study can be found in the California Health Care Almanac: California’s Uninsured, December 2009
Over the past decade many governmental entities and private organizations have tried to quantify the quality of healthcare in America. The bottom line is that there is wide variance in the quality and cost of healthcare through the United States. It is hoped that by tracking the results of the various studies that are being conducted around the country, that the quality of healthcare can be improved while the increase in the cost of care can be restrained.
The California Healthcare Foundation has sponsored a comparative study which compares the quality of California Healthcare to that in the rest of the Nation. If the state of California were in school it would receive a ‘C’ for the performance of its healthcare system, compared to the rest of the nation.
California outperforms the National average in:
- Maternity and child healthcare
- Hospital care of patients with heart problems and pneumonia
- Cancer rates and cancer mortality rates
California underperforms the National average in:
- Care for geriatric patients
- Nursing home quality of care
- Diabetes diagnosis and treatment
California has about average care in:
- Hospital re-admission rates
- Improvement in hospital treatment of Pneumonia and Heart disease
- Home healthcare providers
In the years covered by the study (2001 – 2005), the average annual increase in healthcare costs was 6.5 %, while the increase in quality of healthcare grew only 1.4%. This suggests that there is room for improvement in the cost effectiveness of healthcare throughout the Nation.
The most interesting result of the study is that California outperforms the National average in the care of the younger portion of the population. California scored high in care of expectant mothers, infants, and children. California performed well on measures related to pre-natal care, low birth weight, and low infant mortality rates. California ranked high in birth-related traumas, immunization levels for children, and reduction in admission rates of certain pediatric conditions.
Treatment for cancer and heart related conditions are at the national level of care, or slightly above the national average. Measures of standard of care in surgical treatment in hospitals and outpatient care are inline with the national averages.
At the other end of the population age scale the State under performed in most categories of geriatric care. The number of seniors receiving vaccinations is below the national average. End of life care is measured as falling below the National standard of care, and the quality of nursing home care falls short of the national average.
It is important to note the California improved in its treatment of Pneumonia, cancer, and heart related cases faster than the national average. This may indicate that the standard of care in California is improving at a faster rate than the nation as a whole. However, there were still total of 1031 preventable adverse events in California hospitals in 2007. Since 2007 a total of 57 hospitals were fined $25,000 for each licensure violation.
ANALYSIS OF THE DATA
The data from this study would seem to indicate that the California healthcare system does a good job in treating the younger segment of the population. It does an average job in treating health conditions of the general population. But it does a poor job in the treatment of the older segment of the population. This may be because the population of California is younger than the average population throughout the rest of the nation. Perhaps more emphasis is placed on the younger patients, or California attracts better qualified doctors because of the younger population. In any case, the state of California may want to reallocate its healthcare resources to provide better healthcare for the geriatric portion of its population. This will become even more important as the population ages.
The complete study can be found in the California Health Care Almanac: Quality of Care facts and figures, August 2009
