Tuesday, August 10, 2010

Why Health Care Reform Now?

By R.C. Braun, MD

Both during and after the health care reform debate many pondered two important questions: Why does our country need to reform our health care system? And, especially, why now when we are in the midst of a serious economic recession?

The response to the first question is in fact why it has it taken so long to change a system which is increasingly failing due to inefficiency, excessive cost, frequent poor results, and exclusion of far too many persons? All of these factors contribute significantly to our country’s economic problems and is why health reform is and was so needed.

Now, can we afford to reform our health care system? On the surface it appears that the proposed changes cost far too much. However, the changes are designed to be “budget neutral” by doing away with much of the waste and profiteering, and instead, promoting cost-effective care.

Many fears have been voiced, often promoted by organizations or businesses which might lose money or influence due to the new proposals. We are told that the government will take control of all health care and make medical decisions, that “I’ll lose my very good health insurance,” or that “Medicare will be drastically cut back” in order to pay for new programs for the uninsured.

It should be recognized that the majority of Americans who have good health care through private pay, insurance, or Medicare will only be slightly affected.

For Tennessee, this legislation comes at a critical time of near disaster for our health care “safety net.” TennCare, which 10 years ago was a national leader in providing health care for the needy, has been decimated to the point that now our state is one of the worst in the nation. The new legislation, among other relevant things, provides federal funding to Tennessee of more than $4 billion a year to cover 650,000 people who are currently uninsured.

Since our bureaucracy moves slowly, full implementation of the new legislation will not take effect until 2014. However, some of the following benefits for many of us will start before the end of this year. For example:

• Health insurance will be mandated, and help in providing it will be available for those in need.
• Insurance companies will be monitored, and will be required to pay out at least 80 percent of their premium income in benefits.
• Insurance benefits cannot be arbitrarily denied or excluded for “pre-existing conditions.”
• Annual checkups and preventive or screening services, such as mammograms and immunizations, will be covered without co-pays and deductibles.
• “Job lock” (continuing unsatisfactory jobs in order to keep health insurance) will disappear with “insurance exchanges.”
• Nearly all children can be covered up to age 26 on their parent’s policy.

Special Medicare provisions for seniors include:

• All guaranteed Medicare benefits remain intact, and reforms help the program remain solvent for years to come.
• Medicare Advantage (Part C) will be revised for better efficiency and fairness.
• Gradual reduction of the “doughnut hole” in Medicare Part D, starting with a $250 rebate this year.
• 50 percent discount on brand-name drugs.
• Investments in training more primary care physicians.

Implementation of the new health care legislation will not solve all of our health care problems, but the negative spell has been broken, and we can look forward to continuing improvements over the years.
Braun is a medical doctor in Pleasant Hill.
Copyright (C) 2010 by Tennessee Editorial Forum. 8/10