Health Care Bill — Where is the reform?

Don’t let anyone fool you — Health Care reform is essential. Why? Because from spending 1 out of $20 on health care in 1960 we have arrived at a point that we are spending 1 out of every $6 on health care now. And of course, this cost is expected to sky rocket. President Obama is right — exponentially growing health care costs, completely independent of making health care universal, will sink the American economy.

Strangely enough though, the current bill being considered by the House of Representatives is not about reform driving cost down and funding universal health care but universal health care without any meaningful reform. 

 Section 1 — CBO Report

To build the case though, allow me to start with some key facts and data points from the Congressional Budget Office’s (CBO) “Long Term Budget Outlook” published in 2007 regarding Health Care:

1. On Total Health Care Spending

A> “Total spending on health care in the United States, including both private and public spending, increased from 4.7 percent of GDP in 1960 to 14.9 percent in 2005, the most recent year for which such data are available.”  That is a greater than 300% increase in share of spending on health care obviously at a loss to other facets of life.

B> The report identifies the primary cause for this increase as, “Most analysts agree that the most important factor contributing to the growth in health care spending in recent decades has been the emergence, adoption, and widespread diffusion of new medical technologies and services.”

C> Other factors for cost increase identified in the report are rise in disposable family income, rise in insurance coverage and aging of the population.

2. On  Medicare Program

A> Overview of Medicare: “Medicare provides federal health insurance for nearly 43 million people who are aged (about 85 percent of enrollees) or disabled or who have end-stage renal disease. The elderly become eligible for Medicare at age 65; the disabled become eligible 24 months after their Social Security benefits start.”

B> Medicare is funded via various sources, payroll tax of 2.9% of taxable income, being a primary source. Think of it as money you are putting aside to be paid for medical care when you get old or, god forbid, disabled. CBO report also states, “As of June 2007, 18 percent of Medicare beneficiaries were enrolled in private health plans under the Medicare Advantage program,” i.e. were paying additional for enhanced coverage.

C> In 2006, Medicare spending totaled $382 billion.

3. On Medicaid Program

A> Medicaid is a joint federal–state program that pays for health care services for a variety of low-income individuals. The program was created in 1965 by the same legislation that created Medicare, replacing an earlier program of federal grants to states to provide medical care to people who have low income. The federal government’s share of Medicaid’s spending for benefits varies among the states and currently averages 57 percent.

B> In 2006, the total spending was $160.9B and total beneficiaries were 60.9M people. Out of which children accounted for 29.5M – approx. 50%.

Section 2 — some more key data points:

1. Americans spend $2.5T (trillion) annually on healthcare.

2. Medicaid is only 6.7% of the total healthcare bill for USA and hence hardly the cause for the crisis.

3. Kaiser Health Tracking Poll from June 2009 finds, “Struggling to afford needed care — The survey continues to find that a majority of Americans (55 %) say that they or another member of their household have put off some sort of needed medical care because of the cost over the past 12 months. About 1 in 4 say they have skipped a recommended test or treatment, and a similar percentage have chosen not to fill a prescription. 26% say they or a family member had problems paying medical bills over the past year, similar to the proportion reporting problems in our April tracking survey. This number rises to nearly half (48 %) among those suffering health problems, and is nearly as high (43 percent) among the uninsured.

Section 3 — Key observations based upon the above data

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Iran – Reform Resuscitated?

In an article titled, “Iran Cleric Defy Election Ruling” the BBC reports, “In a statement to the press, the Assembly of Qom Seminary Scholars and Researchers said some members of the Guardian Council had “lost their impartial image in the eyes of the public.”

How can one accept the legitimacy of the election just because the Guardian Council says so? Can one say that the government born out of the infringements is a legitimate one,” it said.”

It goes on to say, “On Saturday, Mr Rafsanjani – an influential figure in Iranian politics and a prominent backer of Mr Mousavi during the election – met with the families of some of those who have been detained.

It was the first time he had spoken publicly since the election. He told the families that nobody with a “vigilant conscience” could be satisfied with the current situation.

“I hope with good management and wisdom the issues would be settled in the next days and the situation could improve … We should think about protecting the system’s long-term interests,” Mr Rafsanjani said.

A BBC correspondent said that Mr Rafsanjani appeared to be hinting that a process was going on behind the scenes, which might resolve the current crisis.”

While it remains incredibly hard to imagine the authoritarian regime buckling under pressure but it is truly unparalleled times in the life of the Islamic Republic of Iran. Never have there been open rifts within the clergy and never has the authority of the Supreme Leader been questioned by the clerics themselves as now.

May be a power-sharing arrangement is still possible? Or at least some reforms announced by the current regime itself to lighten up on social restrictions? May be the death of the 20 people (reported) will not be in vain?

What are your thoughts?