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The Health Care Reform

A Brief Understanding of the Pros and Cons

By Rishi Das
Towne Meadow Elementary
Carmel, IN
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Introduction

On March 23, 2010, President Barack Obama signed the new law “The Patient Protection

and Affordable Care Act”, popularly known as the Health Care Bill, and jokingly called

“Obamacare”. As we have heard often on the news for the past few months, the democrats

almost unanimously supported the bill, whereas every republican voted against it. So how much

do you really know about Obama’s health care reform? This paper will give a summary of what

has happened, what is happening, and what will happen. I will also explain how the reform

could help many people, as well as anger, confuse, and tax many of us.

Background and History

The U.S. is the only developed and industrialized nation that does not have a universal

health care system. In comparison, most European nations have government controlled health

care systems, even though they may not be perfect. Currently, the US spends more than $2

trillion every year behind health care (Tumulty, Pickert, & Park, America, the doctor will see

you now, 2010), which is way more than any other nation. We also have the most modern

hospital facilities, the newest medical innovations and the best technology in the world, and a

fairly large number of well trained doctors, nurses, and other healthcare workers. Yet the US

population is among the unhealthiest and has a shorter life expectancy compared to other

developed and industrialized nations, and more than one-third of our population does not have

any health insurance coverage (Tumulty, Pickert, & Park, America, the doctor will see you now,

2010). Therefore, there is something wrong about the current overall status of our heath care

system, and there is no doubt that something needs to be done to correct it.
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The health care issue appears to be highly political. It is to be noted that President

Obama is not the first to attempt healthcare reform in the US. One of the early successes

happened during the presidency of Lyndon Johnson in 1965, when Medicare and Medicaid were

created to take care of our old, disabled and poor people (New York Times, 2010). The last

major push for health care reform came during the Clinton presidency in 1993, when Mrs.

Hillary Clinton brought forth a health care bill (New York Times, 2010). This bill died in 1994

due to stiff opposition by the Republican Party (Reuters). One thing that became clear to me

during my research was that the democratic presidents have more often promoted health related

issues, while the republicans have opposed all proposed reforms. As a child growing up in a

staunch democratic household, I therefore think it is a good thing that we finally have something

happening for healthcare issues. However, is the health care reform bill, in its present scope, the

best answer to our problems? In my opinion, NO, and in the next few pages, I will explain my

reasons.

Methods

The thought of reading and understanding a legislation that is more than 2400 pages long

was utterly impossible to me, plus I do not understand lawyer-like language yet. Therefore, I

focused on news articles from respected sources such as TIME magazine, CNN Money, New

York Times, Reuters and CBS, etc. The majority of my research was conducted over the internet

and by reading paper magazine subscriptions available courtesy of my parents. Initially I created

an outline of the paper by drafting key questions and preparing a mental map of the paper. My

readings answered some of my questions, and the remaining was researched by using appropriate

keywords on search engines such as Google. Microsoft Word was used to create the text of the
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paper as well as assemble the bibliography. I used web resources such as Diigo.com as online

libraries. Finally, I obtained assistance from my parents, who are both university professors in a

health related field, in verifying the authenticity of my resources and in drafting interview

questions. I interviewed two professors, Jason Range, JD and Ralph Hatcher, MD at Butler

University, College of Pharmacy and Health Sciences, Indianapolis, IN. My mother introduced

me to her colleagues and served as my back-up note taker (as I am not a very fast writer), but the

interview was conducted completely by me, from the start to finish. I also took as many written

notes as I could during the interview. Later I transcribed the notes and showed the script to the

two interviewees to make sure they agreed to my written text, and that I did not make mistakes

while taking notes.

Results

The key positive things proposed in the health care reform bill include 1) medical

benefits for adult children until age 26 through their parents, as many college students currently

cannot afford health insurance and thus have no coverage, which puts them at great risk, 2)

insurance companies cannot refuse people based on pre-existing medical conditions, meaning if

they were already sick before they asked for coverage, especially children, and 3) closes a

“doughnut hole” for seniors citizens on Medicare, where they have coverage for some amount,

then pay out of their pocket up to a certain amount, and then receive aid again, which puts retired

people on fixed incomes into a lot of trouble (Barry, 2010) According to Jason Range, Esq., a

major component of the program is that it will help 32 million currently uninsured Americans to

get insurance; Dr. Hatcher, on the other hand, was concerned about this benefit for several

reasons, including potential abuse of the healthcare system and the immense pressure to be put
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on the already stressed healthcare infrastructure of this country. Under the new law, individual

states will have to come up with their own plans and resources to provide health benefits to its

residents. While Mr. Range emphasized on the tax benefits associated with this clause, Dr.

Hatcher was highly critical of it as he considers this to be an “unfunded mandate” (federally)

which many economically stressed states will not be able to meet, and thus several states have

already brought lawsuits against the proposal. Small businesses, i.e. those with 50 or more

employees, will now be forced to provide health insurance to their employees, although there

will be tax breaks offered to these companies to reduce the pain to some extent.

Since all republicans have voted against the bill, I took interest in finding out what they

were bitter about, but I was unable to identify any official document offered by the Republican

Party that offers a counterpoint to the proposal. However, news articles quote republican

spokespersons, one of them being Dr. Charles Boustany, a heart surgeon, whose chief concern

appears to be the financial burden of the reform if it goes into effect. Financially, the supporters

of the health care bill claim that it will cost close to $1000 billion over the next 10 years;

however, it will reduce budge deficit by about $150 billion during that period and more than $1

trillion over the subsequent 10 years (CBS). Other republicans, such as House Republican

Leader John Boehner, have offered alternative middle grounds such as a) let families and

businesses buy health insurance across state lines, b) allow individuals, small businesses, and

trade associations to pool together and acquire health insurance at lower prices, the same way

large corporations and labor unions do, c) give states the tools to create their own innovative

reforms that lower health care costs, and d) end junk lawsuits that contribute to higher health

care costs by increasing the number of tests and procedures that physicians sometimes order not

because they think it's good medicine, but because they are afraid of being sued (ABC, 2009).
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Table 1: Interview transcript from Rishi Das’s interviews with two university professors on the topic of health care reform.

Interview questions, Response from Jason Range, JD* Response from Ralph Hatcher, MD**

asked by Rishi Das (FOR health care reform) (AGAINST health care reform)

What do you think the Ultimately it will be budget neutral; there will be some Over 2 trillion dollars in projected expense.

health care law will gain and some drain, i.e. increased spending in some Worst thing is that it will not even accomplish

cost the American areas offset by decreases in others. By the target date of what we set out for.

people? 2014 for full implementation of the law it will all even

out

How does the law Medicare is for individuals who are 65 or older, or Very adversely, because according to President

affect our old people, disabled. Healthcare reform will help seniors, Obama approximately 500 billion dollars will

specifically Medicare? specifically prescription drug coverage or Medicare part be taken away from the Medicare budget to pay

D, by eliminating the “doughnut hole” as more drugs will for other plans and programs.

be covered and to a greater extent. In addition, people

who choose to work after age 65 will be helped by the

new law
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Who will treat all the More emphasis will have to placed on basic health This one is particularly tough – because when

patients if we have promotion, which means more primary care physicians, people think medical care is all free, they will

universal health family doctors, internists, pediatricians, OB-GYN be inclined to run in and get as much of it as

coverage? (woman’s) doctors they can, and ultimately abuse it. Plus there

will be tremendous increased demand on the

healthcare system as more than 30 million

people, who currently do not have coverage,

will be covered and supply will not be able to

keep up with demand. Additionally, enrolment

in medical schools is dropping around the

country so we will be making far less

physicians than will be necessary

How will the individual The law will affect each state differently, based on States will be hurting badly as they have to meet

states be affected by population and demographics, e.g. Florida has a large unfunded mandates. They are left on their own

this law? Will it affect proportion of senior citizens among its population and to generate funds to provide for services that the

Indiana? will be affected differently from, let’s say Indiana. The federal government demands, but is not paying
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law will help Indiana in general because it sets aside for. Therefore, several states have already sued

funding for public health promotion efforts, such as the government. Some large states such as

cutting down on smoking and fighting obesity, which are California simply cannot afford this law.

both bad in Indiana

Can the government Yes, by creating electronic medical records. This will No. Not in a “normal” way as it is impossible

really monitor the help doctors access and maintain patient records much to keep track of the daily activities of the

implementation of this more efficiently, and allow for better communication of healthcare system, the physicians or the

law? If yes, how? If patient medical info between different physicians, patients. Unless the government enforces

no, why? thereby reducing duplication of tests and reducing overall mandatory reporting, i.e. maintaining electronic

costs patient records, but that could potentially violate

patient privacy issues.

 * Jason Range, MBA, MS, JD is a practicing lawyer who joined the faculty of College of Pharmacy and Health Sciences,

Butler University, in 2008. Jason is currently pursuing his PhD and teaches on topics related to diversity, health care

economics, accounting and health care policies. He is a declared democrat and strongly supports health care reform.

 ** Ralph Hatcher, MD is a practicing ER physician who also has a family practice in Zionsville, plus teaches anatomy as a

faculty in the College of Pharmacy and Health Sciences, Butler University. He is a declared republican and strongly opposes

health care reform.

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Discussion

On March 1, 2010, the billionaire investor Mr. Warren Buffet said during an interview on

CNBC news that “the current healthcare system is like a tapeworm eating away at the US

economy and American competitiveness”. He emphasized that we have fewer doctors, nurses

and hospital beds per one thousand residents compared to other developed nations, yet we spend

nearly twice as much on healthcare. According to Mr. Buffet, this new bill does not do anything

to change the basic cost situation of our healthcare industry. He mentioned that we will need

more fundamental changes that attack the cost factor, and that we should treat this problem like a

national emergency (CNBC, 2010).

I have grown up listening to stories about Mr. Warren Buffet and Mr. Bill Gates, as my

parents are great fans of these two individuals and their philosophies. In an earlier interview

with CNBC at Columbia University, Mr. Gates joined Mr. Buffett in his criticism of the current

health care bill – they both welcomed the idea of reform but mentioned several concerns as to

why the bill has limited chance of success unless we make changes in places not even discussed

in the document (CNBC, Warren Buffet - Bill Gates; Keeping America Great, 2009).

After doing my research and listening to individuals such as Mr. Buffett and Mr. Gates, the two

university professors I have interviewed, and of course my parents who are both university

professors in the medical field, I have formed the opinion that healthcare reform is absolutely

necessary in the USA; however, the way the current bill is drafted leaves out many issues

unaddressed, which raise questions regarding the feasibility of success of this reform in the long

term. On the surface, the healthcare bill seems to take care of our young, old and poor people,

which is very good and necessary. The creation of electronic medical records and data sharing
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among various health care providers also appears to be a very positive step despite privacy

concerns. However, my main concerns regarding the changes proposed are as follows:

1) Who will pay for the health care reform? Some of the funds will be generated by

diverting revenues from other programs, but for the most part, the public will pay for healthcare

reform in the form of increased taxes. This prospect has angered and frustrated a lot of people

who are already hurting because of the economic downturn. The richer you are, the more you

will pay for funding healthcare reform. Insurance premiums for most existing policy holders

will increase because insurance companies will need the revenue to cover the 30+ million new

entrants into the system. According to Dr. Hatcher, in the short term, funds will be diverted from

Medicare to pay for the programs, which may not turn out well. In my opinion, the worst

affected individuals will be young, healthy, working professionals, as they will be paying for

these programs for many years before they actually need the facilities for themselves. However,

when the time comes for them to use the program in their old age or due to ill health, just like the

social security system, there will be no guarantee that there will be anything left for them, or

even that the programs will sustain that long. In effect, the young folks now may be paying a lot

of money and getting nothing in return in the future, which is not fair. Even in the short term, a

change in leadership to the Republican Party may mean major changes or even the death of the

health care reform, which may mean that a lot of people will have paid up a lot of money short

term for nothing in the long term.

2) Basic costs: As it is right now, health care in US hospitals and clinics is simply too

expensive. Many unnecessary tests are done, sometimes because the doctor wants

documentation and evidence for everything for the fear of being sued. Not all doctors treat the

same disease with the same quality of care, for instance, a doctor in state X may not be doing
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enough to treat heart disease, which may result in more cost (or early death) to the patient later,

but a doctor in state Y may be doing too much, so much that it may not be doing any further

good to the patient after a certain point. There must be concrete policies and mechanisms to

reduce such wastage and disparity in care, which the healthcare bill apparently does not contain,

and there are no incentives to consciously trim out wastage. Simply asking the hospitals to

reduce overall budget every year, which the bill does, may not achieve the desired results as they

can choose to cut out some expenses essential to the public but not to the hospital administration,

particularly since the bill does not clearly define what must be cut (Tumulty, Pickert, & Park,

America, the doctor will see you now, 2010).

3) Infrastructure: Every article I read seems to emphasize that out healthcare system is

already stressed to the limit. We do not have enough doctors, nurses, pharmacists, etc., nor do

we have enough hospital facilities or space. The bill proposes nothing about changing the

current infrastructure, yet it plans to provide insurance to more than 30 million currently

uninsured individuals. So, who will take care of them? While I understand that if these

individuals receive regular primary care they would not be using emergency medical care

services as much as a last resort (which could potentially reduce cost), I feel this is a speculation

as we do not know what the true burden on emergency room care will eventually be. I agree

with Dr. Hatcher that we as human beings have the tendency to abuse “freebies”, and thus the

inclusion of these 32 million individuals for primary care may break the system completely.

4) Growth and recovery of economy: There is pressure being placed upon small business

owners, who will now have to provide health insurance to their employees or be asked to pay a

fine by the federal government. It costs thousands of dollars per employee to buy insurance, and

for small groups, the rates are very high. On one hand, President Obama is talking about small
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businesses being essential to the economic growth and recovery, but with this kind of pressure

many small businesses may be forced to close. On the short term there will be tax breaks for

these businesses, but in the long run these temporary tax benefits may not be enough. Overall, I

feel that the bill arrived at a time when the economy in the country is in very bad shape;

therefore, even if some of its key elements are really good, the fear of further stress on the

economy because of the new rules is frightening and angering people, and that cannot be good

for any country or its government.

5) Control and management problems: The federal government is setting down rules but

the individual states are supposed to implement it in their own way through private insurance

companies. In my opinion, private companies are in business for profit, not the greater good.

Therefore the various states, which already have no money and are making budget cuts in

essential services such as education, cannot cope with the mandates and are already suing the

federal government. So in this case, the boss wants something done but is not giving his people

the ability to carry out the work – simply asking them to get it done, somehow. Perhaps the

federal government should have accepted responsibility for implementation of the mandate,

financially and personnel wise, only then can they fine or punish people for not listening to them.

6) Education: As mentioned before, we have a shortage of healthcare providers.

According to Dr. Hatcher, himself a practicing emergency room physician and university

professor, the enrolment numbers in medical schools are at an all time low. There could be two

main reasons for this situation; a) our school system is not preparing enough graduates with a

strong enough background to be capable of tackling medical school and related fields such as

biomedical engineering. It is no secret that US students lag behind their global peers in science

and mathematics standards, but nothing much has been done about it. Perhaps the federal as well
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as the state governments should be focusing harder on our middle and high school education and

spending resources appropriately such that we can grow our own doctors and engineers for the

future; b) perhaps the payback from medical and related professional schools is not enough

when compared to the investment in terms of time and money – meaning that a doctor graduates

in his/her thirties with a huge tuition debt – may be the earnings and the high risk nature of the

work is simply not enough to compensate what the individual has been through – maybe this is a

place for change as the government should ensure that these individuals are well compensated

and protected such that they feel happy and capable to serve the public. For example, a large

number of doctors in Britain work for the government (Harrell, 2009).

Last, but not the least, we must educate our citizens in healthy lifestyle habits as it is not

enough to provide healthcare simply when they are sick. Preventing a disease is much easier and

much more cost effective than treating a disease, even if quality of life issues are not counted. It

might be much better use of our limited resources if we can educate people to lead healthy

lifestyles from an early age, starting from elementary school itself. For that, fundamental

changes will have to happen in the food industry, some of which are already taking place (like

posting calorie counts in restaurants, the ban against trans fats, etc.), but not enough. And

ultimately, our own citizens must take responsibility of our own health, particularly preventable

diseases such as heart disease and diabetes. If I understand the health insurance system

correctly, the premiums paid by individuals is not enough to pay for their care when they sick

and hospitalized – it is the collective premiums from many other healthy individuals that actually

pays for their care. Therefore, there must be penalties against people who willfully choose to be

unhealthy – for instance, how do you feel about a person who eats junk food all day, becomes

obese and weighs several hundred pounds and then goes and seeks healthcare when heart disease
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and diabetes develop? On the other hand, there could be incentives offered to lead a healthy

lifestyle, e.g. reduced health insurance premiums for people who maintain a healthy weight,

exercise, eat well and go for annual preventive health checkups. Only then can we begin to

become a healthy nation.

Conclusions

In this paper, I have researched and summarized the key elements of the health care bill,

and outlined some of my concerns regarding the same. There is no doubt that health care reform

has been long overdue, because the current health care infrastructure of this country would have

simply been unable to meet the increasing demands over the long term and could eventually fail,

causing a major crisis. Therefore, there are many reasons to cheer for the current healthcare

reform, as it includes crucial benefits for the young, old and poor citizens of this country.

President Obama and his team must be complimented for their success in making the health care

reform a reality, because other previous presidencies have failed in their efforts. However, it

appears that in their hurry to get the bill approved, the team has failed to come up with concrete

plans which have the promise of long term success, and as a result the bill has some major flaws

and loopholes that could lead to its failure in the future. Opponents of the program cite financial

arguments against the bill, particularly the increased tax and insurance premium burdens on the

middle to upper class citizens. However, as a young individual I have additional concerns about

the program, namely the lack of infrastructure changes, sweeping changes to our education

system which would help train more health care professionals, and in general a strong movement

of some kind (such as one with consequences for one’s voluntary actions and health decisions –

good or bad) to help guide this country into leading a healthier lifestyle and disease prevention
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efforts. Only time will tell if the program will succeed. In the meantime we have to assume that

everything will work as proposed, which may not be the case when the law takes full effect by

2014. We must hope for the best that the government and citizens will cooperate, learn from

mistakes and make necessary changes as we go along, in order to bring about some positive

changes. Hopefully USA will soon catch up to the rest of the developed world in terms of

healthcare and maybe someday in the future lead others by its example.
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