Health and care in America

Nearly everybody agreed that health care reform was badly needed and long overdue in the U.S. That’s where agreement ended. Politics took over as competing views of ethical and moral medicine in America collided in the halls of Congress and in public debates over months of townhall meetings centered on how government is functioning, and what constitutes the common good.

Leaving aside the “Obama can do nothing good” and the “Republicans are the party of NO” arguments, the story of what happened in American health care this week and what it means going forward deserves good scrutiny.

Late Sunday night…

When the House of Representatives went into its dramatic and climactic weekend session to arrive at historic health care legislation, it was precariously short, by a handful, of the necessary votes to push it through. Ironically, it matched the number of pro-life Democrats holding out for more airtight language assuring no federal funding would go for abortion services, in line with longstanding provisions of the [Henry] Hyde amendment. House Speaker Nancy Pelosi had argued that House legislation was not about abortion, but the language of the bill betrayed her denials. Rep. Bart Stupak, leading the pro-life bloc of Democrats, claiming he was still determined to vote against the House bill without explicit exclusion of abortion funding, held the dramatic balance of power to the end. He capitulated on the president’s promise of an Executive Order promising “an enforcement mechanism to ensure that federal funds are not used for abortion services.”

It was a smokescreen. An executive order as such is meaningless. Decades of federal court precedent applied the principles of Roe. V. Wade to federal health legislation creating a statutory requirement for abortion funding. Statutory requirements override any executive order or regulation that come after. Bart Stupak and President Obama both knew that. A deal was in the works.

Winning over Stupak’s pro-life bloc was necessary to put the Obamacare vote over the top. Until that vote, Stupak had been following his conscience, he said, in upholding the teachings of his Catholic faith on sanctity of life and moral social policy. Right into that weekend House session, the U.S. bishops were actively imploring members of Congress to pass comprehensive health care reform that protects human life at all stages, especially the most vulnerable. They reminded Congress that the president promised no federal funds would be used for abortion, reflecting both the Hyde Amendment regulations and the majority will of the people. And that such funding, regrettably, was in the Senate bill the House was about to vote on and likely pass.

“What is tragic about this turn of events is that it needn’t have happened,” wrote the bishops. Those in the Senate who wanted to purge the Hyde amendment from this national legislation are obstructing the reform of health care.

“This is not quibbling over technicalities. The deliberate omission in the Senate Bill of the necessary language that could have taken this moral question off the table and out of play leaves us still looking for a way to meet the President’s and our concern to provide health care for those millions whose primary care physician is now an emergency room doctor.”

The House needed 216 votes to pass the Senate bill. With Stupak and his bloc voting “yes”, it passed 219-212. They made the pivotal difference.

Monday, going forward…

Though opponents argued about their particular concerns over things like a public option and the budget and the cost and taxes and the insurance industry and Medicare and Medicaid and voting procedures, and so on… even the New York Times commented that “the fight of abortion overshadowed every other aspect of the debate” over health care legislation.

Dr Donald Condit, a clinical associate professor of surgery at Michigan State University and expert on the ethical allocation of scarce health care resources, addressed that point in an Acton Institute article Health Care Rights, and Wrongs. He wrote: “the first principle, Respect for Dignity of the Human Person, is prerequisite. Health care reform is meaningless without it. Life must be safeguarded from conception to natural death. Tax dollars must not subsidize abortion or euthanasia. This principle must apply on both ends of the stethoscope, respecting both patient and provider. Health-care professionals must be able to follow their conscience in prescribing and providing treatment.”

But they are not, under the bill signed into law this week. Even the Executive Order promised to Stupak’s pro-life bloc turned out to be a gimmick.

So, what was gained in this version of health care reform? Herewith, some provisions, mandates, and a timetable:

Within three months of the law’s taking effect, patients with a “pre-existing condition” will have access to a new national “high-risk pool”, or subsidized coverage through a new federal insurance program. The dreaded “pre-existing condition” barrier will be removed completely by 2014, at which time coverage will be extended to much more of the population through Medicaid and new state-run insurance exchanges.

Six months after the legislation is enacted, another dreaded and all-too-common an insurance drawback will be prohibited: “lifetime limits on medical coverage”. Insurance plans will not be allowed to cancel the policies of people who fall ill. Also, children with pre-existing conditions could not be denied coverage.

Young adults will be able to remain on their parents’ plan to age 26, replacing the current state-by-state rules that end coverage at earlier ages, some as young as 18 or 19.

In 2013, families with annual income above $250,000 will be required to pay an additional 3.8 percent tax on their investment income, and contribute more to the Medicare program through payroll taxes.

In 2014, coverage will be extended to a wider population through the Medicaid program and new state-run insurance exchanges. Approved plans will form a “marketplace” for consumers to shop for policies. This is being hailed as a consumer-friendly online shopping center of private insurance for people not able to obtain coverage through an employer.

Also in 2014, the “pre-existing condition” stigma will be entirely removed, and people could no longer be denied insurance for such. Also, all lifetime and annual limits on coverage will be eliminated.

Another major stipulation for 2014 is the federal requirement that most Americans who do not obtain health insurance by then would face a penalty. The first year of such non-compliance, consumers would be fined $95, or 1 percent of income, whichever is greater. That penalty will rise to $695, or 2 percent of income, whichever is greater. Families falling below the income thresholds would escape the fines.

And by 2014, businesses employing more than 50 people will be required to provide a health plan for their employees. If they don’t they’ll be fined $750 a year per worker, which could increase through the reconciliation process.

Starting in 2018, employers offering so-called “cadillac plans” (or pricier ones) will be subject to a 40 percent tax on what the federal government deems excess premiums. (Experts say taxes levied on the insurer are expected to be passed on to the consumer through higher premiums or reduced benefits.)

By 2020, the Medicare Part-D gap will be closed so that seniors will not be charged sizeable out-of-pocket expenses for prescriptions over a certain amount. (However, the plan also slashes Medicare spending in half by then, from 4 percent annually to 2 percent or less a year.)

Benefits and drawbacks

Or, as some press are calling it…”Winners and Losers”. This is interesting, and getting little coverage. Though the bill sets up regulations for the development of generic versions of expensive drugs, some favored pharmaceuticals won a 12-year period of exclusive sales for brand-name drugs before competition from generic rivals sets in. Similarly interesting (and intriguing, for lack of explanation of backroom dealings), is that though health insurers will face tighter regulation under this law, certain favored companies will enjoy a huge 10-year tax levy delayed now until 2014.

“The most obvious quantifiable impact of the bill is an increase in taxes for upper income Americans, particularly on investment income,” J.P. Morgan Funds strategist David Kelly is quoted as saying, by the Christian Science Monitor. “More broadly, the law will expand demand [for healthcare] without much effort to rein in costs…The healthcare industry itself will be paying new taxes as well. A tax on medical devices and drug companies could impair their ability to raise capital, with a slight impact on new-product development…”

More serious skepticism is focused on the cost of this legislation being offset by savings, which are only projected and won’t be realized for years. Economists wonder if they’ll ever be realized. “The law doesn’t open up the insurance industry to competition across state lines, includes no meaningful malpractice reform, and imposes few incentives on consumers to take better care ofthemselves,” states the Monitor. “Rather than reducing costs, the healthcare plan appears to shift costs to employers and higher-income households…”

Furthermore, about half of the 32 million Americans who will benefit from insurance coverage under this plan will be added to the Medicaid rolls, a program already suffering under the strain of too few doctors for too many patients. “Government can control the supply of medical services, but they can’t control the demand,” Heritage Foundation expert Bob Moffitt told me last year in a radio interview. Moffitt is Heritage’s Center for Health Policy Studies director, a veteran well-known for his expertise in market-based solutions for health system problems. In his first year at Heritage, Moffit had to isolate himself in a room with President Clinton’s 1,342 page plan to nationalize the country’s health care system, and emerged five work days later with a draft analysis and recommendations for a consumer-driven health policy that could work.

“One out of every six dollars is spent on health care in this country,” Moffit told me, “and we need to focus on what we’re spending, and fix the gross inefficiencies.” Heritage had stronger words the morning after Sunday night’s House vote. “Late last night, in a narrow and partisan vote, the U.S. House of Representatives passed the most significant piece of social legislation in over seven decades. It did so in the face of overwhelming and principled opposition from the American people. Large majorities of Americans oppose this legislation because it offends the historic American dedication to the principle of self-government. They understand that this new law will accelerate Washington’s intrusion into our most personal and private decisions.”

Moffit warned last year about the proposed Federal Council for Comparative Effectiveness, a sort-of federal board of health, or “death panel” as it has come to be known in the media. It’s not a stretch. Health care resources will have to be rationed, at some point. Judging quality of life by mathematical equations of age and diagnosis is unacceptable, he said.

The bishops are concerned about that, too, as well as the spread of abortion. “Christian discipleship means, “working to ensure that all people have access to what makes them fully human and fosters their human dignity”… We are bishops, and therefore pastors and teachers. In that role, we applaud the effort to expand health care to all.

“Nevertheless, for whatever good this law achieves or intends, we as Catholic bishops have opposed its passage because there is compelling evidence that it would expand the role of the federal government in funding and facilitating abortion and plans that cover abortion...The statute is also profoundly flawed because it has failed to include necessary language to provide essential conscience protections (both within and beyond the abortion context).”

Beyond partisan politics that continue to plague all discussion and debate of health care legislation in America, the bishops beg that the focus be re-centered on the human person and the common good.

Get the first of those right and the second falls into place.

Sheila Liaugminas is an Emmy Award winning journalist. She blogs at MercatorNet and Inforum blog.


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