PREAMBLE: We delayed this month’s issue due to the uncertain outcome of a political confrontation in the United States of America over raising its debt ceiling, which would have resulted in a US default on its budgetary commitments. The confrontation was resolved meekly at the “eleventh hour”, late on October 16, when a majority of elected officials came off their soapboxes and voted for sanity.
The standoff came about, as anyone who watches the news knows, due to an abortive attempt by an ultra-right wing Republican faction to block the US from finally aligning itself with other developed countries in providing universal health care. This faction was lead by Senator Ted Cruz from Texas, the state with the greatest proportion of persons not covered by health insurance: about 1 person in four – an underclass of people that it seems this faction would like to keep that way on a permanent basis.
Many Americans see their country as ”exceptional”, and exceptional this certainly was: a startling display of grand-standing as the world watched in dismay as the United States was pushed to the precipice of a default that would certainly cause irreparable damage to its own and the global economy.
During this crisis, many individuals from a political lunatic fringe (dubbed the Tea Party) made deliberately false statements about the new health care provisions, using the opportunity to sow confusion in the minds of Americans at large. Despite all this, the new health system was launched ahead of time on October 1st, 2013. Core provisions are supposed to be in place by 2014. Although with its early launching, and perhaps largely because of this, operational glitches were widespread e.g., registration webpages not fully functional, but no major amendments were made as a result of the simultaneous carnival of political opportunists.
Watching on, it was difficult to accept that the USA – a nation often projected as the leader of the free world – was being subjected to what can only be viewed as a form of sedition by self-proclaimed defenders of political freedom, all the while attempting an end-run to deny Americans a measure of universal health protection that citizens of all other developed countries have enjoyed for decades.
It is with this background in mind, including the importance of US global leadership, that we devote this issue to the core elements of the Patient Protection and Affordable Care Act, so that readers may appreciate what it was that the Tea Party sought to overturn by using the threat of default as political blackmail.
UNIVERSAL HEALTH CARE AS THE EVENTUAL OUTCOME OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT – As viewed by a Non-American
In the United States, the private sector has long dominated the health care system, yet has failed to meet the health care needs of some 50 million non-insured people, about 20% of the population. The Patient Protection and Affordable Care Act (modeled after a system now in place in Massachusetts, brought in under a state Republican administration under former Governor George Romney, but dubbed “Obamacare” by political opponents of the federal Democratic administration which designed the legislation), intends that everyone has access.
Dramatic changes are now taking place: under this new legislation (to be fully phased in by 2020), the US will begin to close the gap on universality and other deficiencies will be addressed. The legislation was upheld by the Supreme Court on June 28, 2012, against challenges by numerous states and individuals and the National Federation of Independent Businesses. Nonetheless, even with this policy shift, the US will remain the only developed nation that depends predominantly on a private insurer, private provider entrepreneurial model.This acknowledged, the US system also contains substantial public sector elements that will continue to grow: Medicare for the elderly (a universal single payer system where providers are not directly employed by government); a program called Medicaid to address essential health care for low-income families based on eligibility criteria, financed jointly by state and federal governments; Veteran’s Affairs health care (a single payer system whose providers are employed by the Department of Veterans Affairs, although not applied to persons in active service who are covered by private insurers under “Tricare” - an employer based insurance scheme).
The Patient Protection and Affordable Care Act (passed in 2010) is too complex to address in its entirety in this blog. People of developed countries with more equitable systems will find the barriers to health care access and/or affordability in the US to be instructive, e.g., the ability of insurance companies to deny coverage for pre-existing conditions – this practice is to cease in 2014.
Obamacare will take many years to fully implement, but does have the prospect of bringing the US into line with the principle of universal coverage that has been in observed for decades in all other developed countries, and increasing numbers of developing ones. Access to essential health care is also addressed under the Universal Declaration on Human Rights (Article 25: http://www.un.org/en/documents/udhr/ )
Readers interested in further information on the Patient Protection and Affordable Care Act in the U.S., as upheld by their Supreme Court, a summary of its key features is available at the following site: Senate Democrats http://dpc.senate.gov/healthreformbill/healthbill04.pdf
Wikipedia has also been updated on this topic although their full article is much longer and history more detailed http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
Our Opinion:
"Obamacare" is a major step forward to a more equitable health system in the USA. Issues of effectiveness and efficiency will be tested, studied and addressed as it attempts to provide quality care for all citizens under the new legislation. This process should not be treated as a political football by Republican extremists although no doubt there will be legitimate policy challenges as it makes its way forward to the goal of universality. If the Tea Party continues to engage in obstructionist antics, primarily for local constituency gains, and risk default once again, the reputation of the US for sober global leadership will only be further damaged.
Background References
American College of Physicians. Position Paper: Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries. Ann Intern Med 2008;148:55-75. http://www.annals.org/content/148/1/55.full#T1 Accessed October 17, 2013.
White F, Nanan D. A Conversation on Health in Canada: revisiting universality and the centrality of primary health care. J Ambul Care Manage 2009; 32,2:141-9. http://journals.lww.com/ambulatorycaremanagement/Abstract/2009/04000/A_Conversation_on_Health_in_Canada__Revisiting.9.aspx Accessed October 17, 2013.
Guyatt GH, Devereaux PJ, Lexchin J, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open Medicine 2007;1,1:E27-36. http://www.pnhp.org/PDF_files/ReviewUSCanadaOpenMedicine.pdf Accessed September 15, 2012.
The World Health Report 2000 – Health systems: improving performance. Geneva, 2000 http://www.who.int/whr/2000/en/whr00_en.pdf Accessed October 17, 2013.
Supreme Court of the United States. National Federation of Independent Business et al vs Sebelius, Secretary. Health and Human Services et al. Certiorari to the United States Court of Appeals to the Eleventh Circuit. No 11-393. Decided June 28, 2012. As cited in the Washington Post: Full text of the Supreme Court health-care decision. June 28, 2012. http://www.washingtonpost.com/wp-srv/politics/documents/supreme-court-health-care-decision-text.html Accessed October 17, 2013.
