Government health coverage mushrooms

Excerpted from "Census Numbers: The Trend Toward Government Coverage Continues," by Nina Owcharenko, (originally published in the Health Affairs Blog on September 14, 2011) --The percentage of Americans on government health programs continues to grow, while employer-based coverage continues to decline. According to the latest Census report, 31 percent of the population received coverage through the government in 2010 compared to 23 percent in 1987.

¹ N. Munro, "The New Patent Puzzle," National Journal, March 2, 2002 pp. 628-9.
² A. Pollack, "Debate on Human Cloning Turns to Patents," The New York Times, May 17, 2002, p. A12

In contrast, 64 percent of the population had private coverage in 2010, compared to 75.5 percent in 1987. Employer-based coverage declined from 62.1 percent in 1987 to 55.3 percent in 2010.

Most analysts, regardless of political views, generally agree that to make the system work better, there needs to be greater portability and continuity in health care coverage. This, however, is where the philosophical divide occurs. Those on the left generally see a larger role for government-based coverage, while those on the right see a greater role for individuals. One only needs to look at the Patient Protection and Affordable Care Act (PPACA) to see this take shape. The PPACA puts the trend toward government-based coverage on the fast track. The law will add an estimated 26 million people to Medicaid alone.

Even without PPACA, existing government-based coverage (Medicare and Medicaid) is fiscally unsustainable. Depending on assumptions of the Medicare Trustees or the Centers for Medicare and Medicaid Services (CMS) Actuary, Medicare faces long-term unfunded liabilities between $24.6 trillion and $36.8 trillion.

Those on the right (including myself) who oppose the government-based model see an alternative path toward portability and continuity based on individual ownership and market-based competition. The Heritage Foundation’s Saving the American Dream plan empowers individuals and families to own and control their health insurance. It establishes individual tax relief for people to buy coverage in a marketplace where insurers and providers are accountable to meeting consumers’ needs of higher quality at lower costs. It also reforms Medicare and Medicaid, putting them on a sustainable path forward.
Recent estimates by the CMS actuaries project that by 2020, government will control 50 percent of all health care spending in the country. Americans should take note that the health care system is moving to the tipping point where it will be more government-run than private.

Dave Steven, MD, MA (Ethics): "While a majority of CMDA members oppose PPACA, it is wise to examine the opposing views, especially when those views come from Christian professional colleagues who may disagree with you.

"Those who support Patient Protection and Affordable Care Act are largely involved in care for the poor, or are those who are very concerned about it. Many work in domestic mission outreaches in the inner city. They are troubled by the inequities of our present healthcare system and its neglect for the disenfranchised. Their concerns are real. I hear them from my children who live in inner city Memphis and work with Christ Community Health. They tell stories of patients being seen in the ER but not being able to get follow-up -- even simple things like a suture removal. They are troubled when specialists are unwilling to see Medicaid patients. People in this camp see the potential for broader government funding to solve the problems they deal with everyday, especially with the working uninsured. Their hearts are full of compassion. They have acted upon on their convictions by sacrificing for those that the Lord commanded us to care for. But at the same time, many with this view tend to ignore or discount the high cost that the new healthcare system will impose. They conclude that society needs to deal with the access problem first and cost concerns second. They may minimize the concern that raising the nation's annual healthcare bill (as predicted of PPACA) will make it harder to deal with costs when a day of financial reckoning inevitably arrives.

"In another camp are those who prioritize their concern over the perilous state of healthcare financing. They see it as unsustainable, or they oppose increased government intrusion. These physicians are more likely to be in private practice or employed by a healthcare business. Some have concluded that Medicaid and Medicare patients cost them more than they are reimbursed. Many refuse to accept patients in these categories, or they limit their numbers. They justify that decision with comments like, 'If the government programs put me out of business, I won't be able to help anyone.' They feel overburdened, doing more for less, struggling with mountains of paperwork and regulations. They favor non-government initiatives to solve the financial crisis in healthcare: tort reform, decreased bureaucracy, less regulation, competition, etc. Perhaps sometime forgotten by this group is that these proposals do not release them from God's command to take care of the poor. Nor will these proposals necessarily provide care for the poor, at least in the near term. And there is no assurance that these proposals will actually solve the problems in our current healthcare system.

"Debate is healthy -- if done in the right spirit. Whether you favor or oppose increasing government funding of healthcare depends on fundamental views about social order and your life experiences. Christians will disagree. While Christ gave us some moral imperatives (care for the poor), much of the healthcare debate is not about a moral issue. While we can and should fulfill our moral obligations no matter our various views, the healthcare debate is more a wisdom issue. And a first step as we seek wisdom is to start where Scripture tells us to begin in James 3:17, Real wisdom, God’s wisdom, begins with a holy life and is characterized by getting along with others. It is gentle and reasonable, overflowing with mercy and blessings, not hot one day and cold the next, not two-faced.'"

If we start there, we will be closer to our brothers and sisters in Christ long before the debate is over!"

Resources
CMDA's Healthcare Reform Resource Page
Webcast: 7 Key Principles of Healthcare Reform