We hear a lot about “Obamacare” these days. Much of it is politically oriented misinformation that describes various fearsome and costly outcomes. I will try to inject some objectivity into this discussion.

The law is entitled The Patient Protection and Affordable Care Act. It is an attempt to modify an untenable unaffordable and unsustainable health care system that now leaves many citizens without health care and often exposed unnecessarily to more serious illness or even an early death.

THE PROBLEM

In spite of ideological arguments and regardless of whether you believe health care is a human right or a saleable commodity we have a system that the country cannot afford.

Eighteen cents of every dollar spent in the US today goes to the health care system. That equals an annual expenditure of $8000.00 per man, woman and child in the country or a total yearly expenditure of 2.5 TRILLION dollars. This cost has doubled in the last decade and continues upward.

More than fifty million people are without health insurance and probably twenty-five million more are underinsured. These people will often wait until their illness is very serious or life threatening before seeking help. This usually involves hospital emergency departments where the care is often hurried, temporary and much costlier.

Unlike every other industrialized country the United States does not provide comprehensive health care and one-fifth of its population does without. This is at a total cost twice that of the next most costly country. Switzerland spends $4000 per person per year and furnishes care for all its citizens. All other industrialized nations offer comprehensive health care to all at much less cost.

Japan, one of the least costly, has the most comprehensive system and enjoys the longest life expectancy (83 yrs.).

Life expectancy in the United States(79 yrs.) is less than the world average and the overall quality of health care is judged by the World Health Organization to be significantly below that in other industrialized countries. Two-thirds of bankruptcies in our country begin with a serious illness and most of these people had health insurance.

THE SOLUTION

The new law is to begin to modify these extremely serious and unsustainable problems. The law tries to work within the current system to limit costs and broaden the scope of health care for the majority of people. It falls short of a complete solution but it is an important beginning. The Congressional Budget Office estimates the law will LOWER the budget deficit $210 billion in 10 years.

WHAT IT DOES

The law provides for a sliding scale of subsidies to help buy health insurance for people who cannot afford the premiums.

If you had health insurance as of March 2010 the only change will be added protection from cancellation or any limit of benefits due to illness or use of the policy.

Medicaid is expanded to cover all those under age 65 with an annual family (of four) income less than $32,000. The added costs will be paid by the federal government for four years. States must then pay 10% of the total increase. This would affect 290,000 people in Kentucky. Kentucky has not yet committed to expand its Medicaid program but the state would benefit (estimate $12 billion) to a greater extent than most other states due to the number of people affected which is a large portion of the uninsured.

Everyone with pre-existing health problems previously not insurable must be offered health insurance. This applies to children now and adults in 2014.

Children of insured adults will be continued on family policies until age 26.

Females may not be charged higher premiums than males for health insurance.

The law provides for preventive check-ups and immunizations and forbids any co-pay charges for these services.

The “donut hole” in Medicare Part D was adjusted with a$250 subsidy in 2010 with yearly increased discounts and closure by 2020.

It provides $11 billion over ten years to support current Community Health Clinics and to help establish new ones.

Health Insurance companies can no longer cancel policies for illness nor set annual or lifetime limits on benefits.

The law supports employer paid health insurance by tax credits for small businesses with less than 25 employees(35% this year- 50% in 2014).Small businesses may also form groups for the purpose of negotiation with health insurance companies. Businesses with more than 100 employees must offer paid health insurance policies.

States are required to establish a Health Insurance Exchange program by 2014. This new program will offer an independent market of health insurance plans. This will add competition to the health insurance market and assist businesses and individuals to compare plans and obtain coverage. The Congressional Budget Office has estimated this will lower premiums about 4%.

Health Insurance overhead expense will be limited. The law requires 80-85% of premiums to be used for benefits. Limits are also set on overhead expense for executive compensation.

The benefits equal those of health insurance plans of current federal employees. Members of Congress will also be required to have a similar policy. The law limits subsidies to Medicare Advantage companies and requires them to pay benefits equal to those of the basic Medicare plan

HOW TO PAY FOR IT

In spite of many false claims, the tax increase affects only 10% of the population. People with annual incomes of more than $200,000 (joint filers $250,000) will have an added tax of 3.9% only on their INVESTMENT INCOME. An increase of 0.9% will be added to the Medicare Payroll Tax.

There is a 40% tax on “Cadillac” health care policies. These cost more than $27,500 a year (family) with extraordinary benefits for a few people.

The fine for those who do not purchase health insurance is 1% of their federal income tax. The minimum is $95 in2013 increasing to $695 per adult in 2016. The fine is levied and collected by the Internal Revenue Service. If not paid there will be no arrests or other legal action. Unpaid fines will be deducted from future income tax refunds.

Exempted from this requirement or any fine are those who do not pay income tax; religions who oppose health insurance; Indian tribes; anyone in prison; undocumented immigrants and anyone who cannot obtain health insurance for less than 8% of their annual income.

WHERE THE LAW NEEDS HELP

The law will add $475 billion to health insurance companies due to the requirement for all to buy health insurance.

It does not control Health Insurance Companies future increases in premiums or in co-pays.

32 million people will gain new health care from the law but 23 million will still be without health care in 2020.

This law is only a beginning but it is a significant one. There has been no realistic alternative offered by those who favor repeal and there is not likely to be one. We should scrap the current“ misinformation contest” and concentrate on modifying this law to achieve a comprehensive high quality health care system for all the people of the United States.

About the Author: 

Dr. Thornton Bryan is a retired family physician. He practiced in Cadiz from 1955 to 1973 then left to join the faculty at the University of Iowa in the new Department of Family Practice when Family Practice became a recognized specialty with its own 3 year residency and certification board. He later joined the faculty at the University of Tennessee and was there for 13 years.  When he retired he came back to Cadiz to live.  He sent us the article he wrote for the Cadiz Record earlier this summer and gave us permission to publish it. 

In his email, he wrote " I feel very strongly that the United States has an unsustainable Health Care System dominated and controlled by insurance companies who want to sell medical care only to those who can afford it (a group diminishing daily) .  We suffer terribly when our system is compared to those in the rest of the world."