Health care debate and policy perspectives

Health Care Debate

As the summer's debate on health care reform stretches into autumn, many contentious issues still remain on the table. There are an estimated 46 million uninsured Americans (Carey, 2009). Among those who are insured, coverage is often inadequate, or is dropped by the insurance companies. This leads to a number of negative outcomes, including inferior health care, untimely death and financial distress. The cost of health care is rising, making it increasingly less affordable for Americans. To address these issues, many options have been proposed. These include a public option for insurance coverage, reforming the insurance industry with respect to dropping coverage and pre-existing condition discrimination, implementing malpractice reform and adding coverage for certain preventative measures such as mammograms (White House, 2009). This paper will examine the central issues of the debate on health care reform, with emphasis on controlling the rising cost of health care. It is hypothesized that controlling the rising cost of health care is essential for health care reform.

The public option is one of the most hotly-contested issues in the health care debate. The government would create a publicly-run insurance option that would compete with the private insurers. This would provide an insurance option for citizens with pre-existing conditions, and guarantee that they would not have their coverage dropped. The public option would be funded through savings that accrue from Medicare reform, much of which derives from reducing the overall cost of health care.

The second major issue is to reform the insurance industry. The public option will apply pressure to insurance companies by drawing customers away from them. If only those Americans who are otherwise unable to attain insurance adopt the public option, there will be little in the way of insurance reform. However, it is expected that health care reform will institute explicit changes in the ways that insurance companies deal with patients. They will be unable to drop coverage or decline on the basis of pre-existing conditions. These changes are contentious in the insurance industry because of the potential for profit reduction.

The third major issue is malpractice reform. At present, it is believed that many health care professionals practice what has been termed "defensive" medicine, whereby they seek to reduce the risk of malpractice suits, rather than maximize the quality of health care. This concept derives from the rising cost of malpractice insurance, which is one of the key drivers in the recent steep increases in health care costs, as these insurance costs are passed on by health care providers to patients and insurance companies. The precise form of malpractice reform, however, is not explicitly outlined in the health care reform plan (New York Times, 2009).

The fourth issue is with respect to preventative care. Health care reform seeks to provide better funding for preventative measures such as mammograms, flu shots, diabetes tests and other measures that will reduce overall health spending. The lack of such preventative measures is believed to be a key driver in health care spending -- Americans are simply not healthy enough because they do not engage in enough prevention. Unhealthy practices lead to higher health costs as the patient ages. Preventative measures taken throughout life will dramatically reduce the burdens on the health care system by reducing the need for expensive treatments.

Not addressed in the proposed health care reform is another significant contributor to rising health care costs, the cost of prescription drugs. Americans spend more on prescription drugs than do citizens of other countries, for a number of reasons. One is that the cost of drugs is not subject to caps, as it typically is in countries with more socialized medical systems. The other is that Americans are overprescribed, a function of malpractice issues and issues with respect to the way that drugs are marketed. As a result, prescription drug spending has increased fivefold since 1990 and is one of the fastest growing components of health care spending. Drug costs have gone from 26% of health care spending by private insurance companies in 1990 to 44% in 2006 (Kaiser Foundation, 2008). This issue has not been adequately addressed by health care reform. Instead, a deal appears to be made for $80 billion in concessions from the pharmaceutical industry in exchange for its support of health care reform (Kirkpatrick, 2009).

The underlying trend in each of these major issues in health care reform is controlling the rising cost. Malpractice reform seeks to control the cost of insurance to health care providers, so that they can pass those savings along to consumers. The public option provides a plan for affordable health care coverage for uninsured and underinsured Americans. This is deemed necessary because private insurers will not offer insurance to those it feels will demand too much in terms of health care costs going forward. Reducing the cost of health care will enable not only the public option to succeed but also will enable the insurance companies the ability to better compete with the public option. Coverage for preventative measures will reduce the health care costs associated with poor lifestyle choices and a lack of preventative care in the system at present.

However, the weakness in the health care reform is that is fails to address drug costs, which are among the fastest-growing costs in the health care system. This is a complex issue, and is only partly dealt with under the components of reform concerning malpractice and prevention. While health care reform addresses one cause of rising health care costs in hospitals -- malpractice risk -- it fails to address in a meaningful way the rapidly rising cost of prescription drugs.