It is difficult to predict how the current health care reform effort will conclude. If history proves true, it may fail. A pervading distrust of public programs, whether true or imagined, has soured American's trust of government initiatives. This factor will weigh heavily on health care reform successes. Both Democrats and Republicans share responsibility for public cynicism.
Add aggressive efforts by the threatened health care industry, committed to defeat legislation affecting their control and profits. The for-profit private health insurers see a more efficient and regulated insurance product as a potential death knell. There may be truth to this.
One can recall the tobacco industry's efforts to undermine public education to smoking's danger. Their efforts to fill the coffers of elected officials and discredit scientific research are well documented. Pharmacy corporations in their zeal to promote new drugs have acted in similar fashion. As in each of these issues, at stake is the overall health of the American people. Follow the dollar to understand the turf wars.
U.S. infant mortality, a good indicator of the nation's health, remains either 33rd of 46th on the list of countries around the globe. The ranking depends on which official list you use. America is beaten by the Europeans and a number of developing nations. Either way, the U.S. has no health care bragging rights within the international community.
Countries that protect people with universal access to health care beat the U.S. hands down reviewing health outcomes. Although U.S. medical management is highly skilled, the care is not consistent within the population and lacks equity; too many, 47 million, go without. That's the number tossed about but the tragedy is of much greater proportions.
Change is always difficult. Cars were built before there were roads or gas stations. After all, who would give up a horse for a stinky, noisy, unreliable automobile? The general thinking was that talkies could never replace silent movies, and digital watches would never replace the springs and gears of traditional time pieces. Replacing the old with the new is called a paradigm shift. Such change can be painful but necessary for societies to move forward. America's health care paradigm needs changing; too many are left at risk. Those with inequitable access affect the entire community.
Problems with health care concern the insured as well as the uninsured. As most people with insurance will have minor insurer harassments with primary care visits, they tend to be satisfied. Typically the insurer will ask for more information relating to the doctor visit or want to know if the injury or illness might be the responsibility of some other party. All these actions slow down the payment process and are irritating.
Trouble starts with escalating premiums and lack of affordability or when insurers refuse to pay for needed health care. There is more turmoil when an overly aggressive insurance review denies care already given. This puts doctors or hospitals in the position of chasing patients for money. Some may die for lack of treatment. Anyone who has experienced such a personal loss or financial catastrophe supports reform. Many are surprised at exorbitant co-pay charges for care they thought covered. Such co-pays can break a family financially.
If there is good news, it appears there is popular agreement for reform. The devil is in the details. The larger challenge will be whether Obama can convince Americans that reform is important enough for government to increase its role in the provision of health care.
The advent of troubled town-hall meetings may in the end work to the benefit of reform. Initially, I sensed that those disrupting the meetings were trucked in, but I am concluding that many are legitimate people demanding clarity. One thing for sure, health care reform has everyone's attention, for or against.
The escalating costs of health care along with the burgeoning numbers of uninsured require reform. We have a president who has taken the challenge where many have failed. In the end, the success or failure will depend on the will of the American people. That exemplifies the democratic process which has worked well to date.
Dr. Marc J. Yacht is retired director of the Pasco Health Department.