Saturday, October 19, 2013

Price of Health Reform Equity
Health Care: Can There Be Equity? The United States, Sweden, and England.
Odin Anderson,  Title of 1972 Book, John Wiley and Sons
A nation’s pattern of health care delivery tends to reflect the commonly accepted values of its citizens. Though almost the last half century, the health care delivery system pattern of the United States has moved increasingly towards equal access for all recipients.
“The Question of Equity.” Duke University Forum, 1984

As the government shutdown ends,  and the second debate to avoid a subsequent shutdown on January 15, 2014 begins, the central question is ,  given the differences between governing philosophies of President Obama and the GOP,  be bridged, and can another shutdown be prevented ? 
This leads to other questions. What combination of government and the marketplace most effectively delivers health care services?   Does ObamaCare tamper too much with the machinery of the health care marketplace?   Does it cause a drag on the economy? Does it turn the U.S, into a part-time worker nation? Does it really achieve equity?  Are government health systems from other countries relevant and applicable to the U.S. health system?
These questions came to mind with a birthday gift from my son.
My son, Spencer, an Episcopal priest now working at an orphanage for abused girls in Haiti,   sent me Doctor Paul Farmer’s book To Repair the World (University of California Press, 2013) for my birthday.
Doctor Farmer is a modern day Albert Sweitzer.   He is an infectious disease specialist at Harvard Medical School, where he chairs the Department of Global Health and Social Medicine at Harvard Medical School.  He also serves as Chief of the Division of Global Health Equity at Brigham and Women’s Hospital He doesn’t spend much time at the medical school.  Instead he travels the world, visiting impoverished nations and treating poor patients.   He is especially active in Haiti.
 His book consists of 19 addresses, given mostly at medical schools, universities, and health care forums – Brown,  Boston College,  Oxford University, College of Holy Cross, Northwestern, University of Miami, John Hopkins, Tulane, Georgetown, Union Theological Seminary, Emory, All Saints Parish, Princeton, Boston University,  and Harvard Medical School (twice) , Harvard School of Public Health,  and School of Government.  
In his talks and his visits to poor nations, where he spends his time treating patients,  initiating prevention programs to protect against AIDs and other infectious disease, he speaks of the need for social justice and health care equity and spending more money and devoting more time and resources for the poor, including clean drinking water,  decent schools,  and other basic huam rights.  
His talks, basically  inspiring essays,  are witty, well-written, and inspiring.  The speeches  are rooted in his experiences and successes on the ground.

As I read them, I found myself asking, “Is total equity – fair and  impartial  distribution of health care resources and access – possible in a capitalistic country like the United States?”  
President Obama’s overreaching goal  in this health reform law, to provide health care to the poor and less fortunate among us, by redistributing govenment-controlled health resources to the poor and the lower middle class four times below the poverty level.  
This is an inspiring goal, and we all, in one way or another, even among heartless conservatives among us, endorse it?
But equity comes at a  price?   
Is health care equity,  short of a single-payer totally-government controlled system,  possible in the U.S,?   And there is a price,  variously estimated in round numbers at $1 trillion to $3 trillion over the next decade. 
And there are sacrifices to be made :
- A 40% to 50% reduction in hospital and physician incomes,  the expense of complying with 25,000 new government regulations,   
- constraints on what physicians  can and cannot do,
- restrictions of what procedures and treatments patient can receive,  

- increased costs of developing and paying for new drugs,  

- higher risks for health plans with higher costs  as they are asked to cover all comers,

- higher premiums and ever higher deductibles as costs are shifted from employers, drug firms, and medical innovations to pay as the costs for doing business and complying with government regulations  mount.  

-  Finally, there is the price of dealing with the bureaucracies required to enforce equity.  We have had a taste of this bureaucracy, its difficulties, and its expenses   since the October 1 introduction of online health exchanges, which are far behind schedule.    
Furthermore, it is now clear health premiums and deductibles  will spike in many states,  not all, and will be received with dismay by many citizens,  74% of whom in a poll today,  opposed ObamaCare.
Tweet:   Can there be health care equity in the United States, given the multiple adverse consequences of ObamaCare now surfacing?

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