Those lamenting the loss of Obamacare too quickly forget former Speaker Nancy Pelosi’s comment: we have to pass it before you can read it. Having read all 2,485 pages of this legislation, it was quite evident that its flaws were many, duplications numerous, interlocking problems of delivery with the kinds of professionals needed to make it function limited, funding inadequate, and would fall on taxpayers and those being insured as well as its major expenditure being the one thing everyone promises not to touch, preexisting conditions — the pathway to bankruptcy if not rethought.
Nowhere in the U.S. Constitution is there a stipulation that the government must provide health care for our citizens. That is socialism. Despite the morality of the question, health care is not a right but a privilege unfortunately available most likely to those with money. Christian Scientist and Seven Day Adventist are sample religious mindsets that don’t like health care imposed. If universal access to care is to be paid for, all persons must participate. The young, who believe they are immortal, don’t want to pay for their share of the universal cost burden … but their behavior and activities often end up needing a lot of care, for which they can’t possibly pay, except by contributing a fair share to the universal pool. Those aging or infirmed beyond reasonable recovery have families desirous of their sustenance yet aren't willing or able to shoulder costs.
Health care is also burdened from a paradigm of delivery dictated by those who are perceived as paying the bill rather than those who have a need. The Massachusetts Romney plan is a functioning prototype. We are all paying the bills, and/or incurring the debt. The cost of the 'system' is currently in excess of $3 trillion … of which $1 trillion is overhead and profit.
Medicine’s compartmentalization of care into primary, secondary, tertiary, and quandary levels based on specialty access often does a disservice based solely on health care need and doesn’t deal with access. The internal structure of the health care professions and its system is a major part of the problem. The needed leadership by persons with a broad view of the whole set of problems, i.e. generalists, has not been adequately considered or valued, thereby specialists rule though they don't necessarily talk to others and have run generalist out of hospital care.
North Carolina has seen Brunswick County and Alexander face closure of hospitals, leaving people with miles to go before care is often available. Midlevel practitioners with varying degrees of supervision are too often left to fill in these critical areas; however solving the major problem of access remains. Corporate ‘healthcare’ has driven the elements of ‘healthcare’ out of small towns, very much as Walmart has destroyed small town businesses. Not every small town can or should have a hospital but the "certificate of need" statues were designed to prevent overbuilding encroachment solely for the dollar rather than the needed service.
Republicare Options for Care
As in most things, this nation is eating too high on the hog. We’re probably spending enough on cosmetic surgery, Botox, and Viagra than it would cost to take care of many rural counties. There are 3,145 counties in the USA each with a health department. The thinking in health needs to be retooled to allow health departments to become the gateways to care which would insure some level of services are available to all with supplements available through cash, government vouchers, insurance on a sliding fee scale, etc., to cover costs. Screening exams, well-child exams and a lot of things which are not complex can be done with referrals to the next level available all without bankrupting the system. Contracted services for rehabilitation, physical therapy, or other treatments could also be rendered without burdening county budgets. Emergencies should remain just that.
Surgery and chronic disease care along with long term care will be an increasing burden as the baby boomers age, and this population outnumbers those who are left to pay for care. It is also the need for Catastrophic Insurance which will be a major dilemma. The issue of pre-existing conditions won’t go away for those with birth defects, non-fault injuries, genetic issues, and end of life services when folks want it all but can’t pay for any of it. Continuing coverage on parent’s policies until age 26 is unfair to those not in colleges. As with Social Security, 18 should be the legal age of adulthood or maybe 21 at best, after which all should be treated as adults.
The government shouldn’t think health services can be provided on the cheap with reimbursements to health care providers well below their cost. Making the Medicare "tax" minimally apply to the first $250,000 income seems reasonable. These latter two funds should be separated out from the treasury to insure that they aren't spent for wars, other entitlements or programs which diminish their original purpose. SS and Medicare should not be taxed as it was front loaded at its inception. Health Savings Accounts seem hollow promises for those without jobs.
The cost of prescriptions is out of sight due to patents which allow manipulation of formulas long after the research costs are likely recovered. If medicines are imported, will we have purity controls to protect patients? Why not decrease the patent time to five years and for ten years thereafter allow the patent bearer of such to recover a percentage of cost from anyone else making the drug? Given that most of the real break-throughs are made in academic institutions or government labs, why should big pharma profit from taxpayer invested discoveries? Why are taxpayers absorbing liability for needed vaccines and drugs while pharma skims the profits? Also quit advertising drugs on television creating needs which most didn't know they had. Disallowing insurance from dictating when refills may be had if prescribed by doctors is a necessity.
Medicare should remain for those with chronic disabling medical conditions regardless of age and for those over 65. Medicaid should face scrutiny for a more reasonable poverty level based on Department of Labor data with those who are able bodied not so covered. Health Insurance across state lines may see those states with low rates flooded with purchases from those in states where care costs much more than those rates can accommodate. Disability should have the same federal criteria whether military, Medicare or other resources are being tapped.
If the Affordable Care Act is to be replaced, let it be on the basis of access and put the responsibility for costs where it must unfortunately ultimately lie, with the users of services.
Dr. Ada M. Fisher was the first black woman to serve as the Republican National Committeewoman. She was a candidate for the U.S. Senate from North Carolina, a candidate for U.S. Congress, and a candidate for the North Carolina House of Representatives. She is the author of "Common Sense Conservative Prescriptions Solutions for What Ails Us, Book I." For more of her reports, Go Here Now.
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