- The First School of Thought
- The Second School of Thought
- H.R. 3590 Patient Protection and Affordable Care Act (PPACA)
- Summary of the Patient Protection and Affordable Care Act (PPACA)
- Criticisms against the Patient Protection and Affordable Care Act (PPACA)
- Candidates' Position
Health care is one of the most ideologically divisive issues in the country, with wide ranging implications affecting not only the health care industry (providers, employees, beneficiary industries) itself, but the average Americans in general, as well as the government (both at local and federal level), along with the national economy, owing to its sheer size.
This very complex subject unfortunately has been reduced to two chief fundamentals, namely, the mechanics of cost and the scope of coverage.
There are two major schools of thoughts dominating the mainstream thought process when it comes to the American health care system.
II. The First School of Thought
The first school of thought (primarily in the conservative sphere) believes that the federal government's involvement in health care should be similar to every other sector of the economy - minimal. The healthcare industry should be left to its own devices, and allowed to achieve a point of maximum efficiency through a system of trial and error based on our own unique blend of free market economics- the very same organic process that successfully propelled the American economy to become the largest in the world. The health care industry must learn to navigate itself through the vicissitudes of the open market, without the comfort of a federal safety net blunting its competitiveness and natural ability to evolve. Case to the point: this process of trial and error has already exposed the impracticability and harmful effects of a federal or state mandate on health care economics, which almost always result in insurance firms building additional cost into their premiums.
III. The Second School of Thought
The second school of thought (primarily within the liberal sphere), on the other hand, believe that health care is not a business. It is the fundamental right of every member of our society to have access to health care. By subjectively abdicating the responsibility of managing the national health care, and handing the task to the fragmented, uncoordinated and capitalistic private enterprises, we are risking the health and well-being of millions of Americans. Private firms, by its very nature, are chiefly answerable to their shareholders, and thus, will attempt to minimize its business risks and increase its return of investments by excluding the weakest and least commercially viable members of the society from health care coverage. The aged, the poor, the chronically ill and the high risk demographics will inevitably be left in the sideline as insurance companies and private healthcare providers pursue their overarching strategic goals. Furthermore, the United States is one of the last remaining developed country that has yet to implement a universal healthcare system. This is despite the fact that the United States spends more on health care per capita ($8,937) than any other developed countries. 29 of the top 31 developed countries in the world has a universal health care system (twelve single payer, nine two tier, and eight insurance mandate).
IV. H.R. 3590 Patient Protection And Affordable Care Act (PPACA)
The exponentially accelerating cost of health care has been a major source of concern for successive American administrations since the Nixon presidency.
In fact, there have been numerous health care proposals flying around the Capitol over the last four decades; nonetheless, there have been only incremental reforms and tweaks enacted thus far.
However, on March 23, 2010, President Barack Obama's controversial H.R. 3590 Patient Protection and Affordable Care Act (Full Text), referred to by many as Obamacare, was signed into law. It is the most transformative piece of legislation passed by Congress since the enactment of the Medicare Legislation of 1965.
V. Summary of the Patient Protection and Affordable Care Act (PPACA)
- Mandate for businesses (exception applies) and individuals to have an approved level of health insurance, enforceable by penalties
- A federal subsidy program to pay, either in part or full, the health insurance of 34 million uninsured American to comply with item 1.
- Prohibition for insurance providers to deny coverage based on preexisting conditions, a move which is expected to extend coverage to an additional 20% to 66% of the U.S. adult population, approximately 36 to 122 million Americans (Source: Government Accountability Office, Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million, March 27, 2012)
- A range of regulatory changes related to the Patient Centered Outcomes Research Institute (PCORI) and the Independent Payment Advisory Board (IPAB), including discounts on physicians reimbursement claims
- Health insurance exchanges
- Expanded access to Medicaid
- Staggered rollout beginning from June 12, 2010, to 2018
VI. Criticisms against the Patient Protection and Affordable Care Act (PPACA)
- The creation of mandates for businesses and individuals, as well as the introduction of a range of new regulations, expands the federal government's role in health care into unhealthy levels and encroaches on the personal liberty of individuals
- The creation of a federalized subsidy system, through a mixture of health insurance exchanges and Medicaid expansion to enable uninsured Americans to comply with the federal health mandate
- Penalizing healthier and younger insurance policy holders with higher premiums to subsidize uninsured Americans
- No real efforts to tackle the spiraling cost of health care
- Questionable figures used to calculate the PPACA's actual cost, with some claiming that it will actually increase health care costs by a significant margin
- The coverage is not universal, and as many as 20 million Americans are expected to remain uninsured upon the plan's full enactment
Obama Position on Health Care
Health care was one of the centerpieces of President Obama’s 2008 campaign, and with the backing
of a Democrat-dominated Congress, his landmark Patient Protection and Affordable Care Act of 2010
was signed into law after a hard-fought battle with Republican legislators. The Act introduced
comprehensive reforms on national health care legislations and will eventually expand coverage to 32
million uninsured Americans.
The Obama-Biden Plan
On health care reform, the American people are too often offered two extremes -- government-run
health care with higher taxes or letting the insurance companies operate without rules. Barack Obama
and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan
that strengthens employer coverage, makes insurance companies accountable and ensures patient choice
of doctor and care without government interference.
The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the
existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden
plan, patients will be able to make health care decisions with their doctors, instead of being
blocked by insurance company bureaucrats.
Under the plan, if you like your current health insurance, nothing changes, except your costs will
go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice
of new, affordable health insurance options.
The Office of the President Elect, Change.gov; The Obama-Biden Transition Team
“Today, after almost a century of trying; today,
after over a year of debate; today, after all the votes have been tallied –- health insurance
reform becomes law in the United States of America. Today.March 23, 2010: Remarks by President Obama at the signing of the Health Insurance
It is fitting that Congress passed this historic legislation this week. For as we mark the turning
of spring, we also mark a new season in America. In a few moments, when I sign this bill, all of
the overheated rhetoric over reform will finally confront the reality of reform.
And while the Senate still has a last round of improvements to make on this historic legislation --
and these are improvements I’m confident they will make swiftly - the bill I’m signing will set
in motion reforms that generations of Americans have fought for, and marched for, and hungered to
It will take four years to implement fully many of these reforms, because we need to implement them
responsibly. We need to get this right. But a host of desperately needed reforms will take effect
This year, we’ll start offering tax credits to about 4 million small businessmen and women to help
them cover the cost of insurance for their employees. That happens this year.
This year, tens of thousands of uninsured Americans with preexisting conditions, the parents of
children who have a preexisting condition, will finally be able to purchase the coverage they need.
That happens this year.
This year, insurance companies will no longer be able to drop people’s coverage when they get
sick. They won’t be able to place lifetime limits or restrictive annual limits on the amount of
care they can receive.
This year, all new insurance plans will be required to offer free preventive care. And this year,
young adults will be able to stay on their parents’ policies until they’re 26 years old. That
happens this year.
And this year, seniors who fall in the coverage gap known as the doughnut hole will start getting
some help. They’ll receive $250 to help pay for prescriptions, and that will, over time, fill in
the doughnut hole. And I want seniors to know, despite what some have said, these reforms will not
cut your guaranteed benefits. In fact, under this law, Americans on Medicare will receive free
preventive care without co-payments or deductibles. That begins this year.
Once this reform is implemented, health insurance exchanges will be created, a competitive
marketplace where uninsured people and small businesses will finally be able to purchase affordable,
quality insurance. They will be able to be part of a big pool and get the same good deal that
members of Congress get. That’s what’s going to happen under this reform.
And when this exchange is up and running, millions of people will get tax breaks to help them afford
coverage, which represents the largest middle-class tax cut for health care in history. That's
what this reform is about.
This legislation will also lower costs for families and for businesses and for the federal
government, reducing our deficit by over $1 trillion in the next two decades. It is paid for. It
is fiscally responsible. And it will help lift a decades-long drag on our economy. That's part of
what all of you together worked on and made happen.
That our generation is able to succeed in passing this reform is a testament to the persistence –-
and the character -– of the American people, who championed this cause; who mobilized; who
organized; who believed that people who love this country can change it.
It’s also a testament to the historic leadership -– and uncommon courage –- of the men and
women of the United States Congress, who’ve taken their lumps during this difficult
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