A Way to Get Started…

The Opening Ceremony for the Olympics was a testament to British culture, documenting its triumphs and failures.  In an unorthodox move, Danny Boyle, the director of Slumdog Millionaire and the Opening Ceremony, chose to spend a significant amount of time highlighting the two crowning achievements of the United Kingdom as he sees them: children’s literature and universal healthcare.

The U.S. has created several single-payer health-care “systems:” the military provides healthcare to its members, and Medicare and Medi-Cal support healthcare for the elderly and impoverished.  However, the U.S. also largely relies on employer-provided health insurance, and individual health insurance for those whose employers do not provide it.  As a result, there is the highly publicized significant portion of the population without health insurance.

Now that the Affordable Care Act has passed Supreme Court muster, our insurance system will undergo an “overhaul” that attempts to bridge the gap between the insurance system we currently have and the U.K.’s universal system.  The main methods for this increase are: health insurance exchanges where individuals who are uninsured can gain the benefits of being part of a group plan, namely lower monthly premiums.  Low income individuals will further see their premium subsidized.  Additionally, even more people will be eligible for Medi-Cal.

However, the Supreme Court has allowed the states to “opt out” of the Medicaid (Medi-Cal in California) expansion and decline to set up health insurance exchanges, which leaves a big question open: will our new healthcare system accomplish any of its goals?  Several major states, like Texas, have already indicated that they will use this new power to reject the requirements to create an exchange and expand Medicaid.  The federal Department of Health and Human Services HHS) will step in to create its own exchange.  However, those who should have been eligible under the Medicaid expansion may not be eligible for the exchange and those who participate in HHS’s exchange may not be subsidized under the law, leaving these citizens in substantially the same position they are in now: uninsured.  It should be noted that there are income-related exceptions to the “tax” on being uninsured, so they will not necessarily face additional taxes if caught in this newly created no man’s land.

Additionally, other major states, like California, have been working on implementing the expansion creating an exchange.  One of California’s solutions to its budget woes, however, is to cut payment rates for physicians under the Medi-Cal system.  As a result, California already faces an ongoing physician shortage.  It is possible that the current law, then, will simply create what Obama was afraid of while campaigning: a system in which insurance providers and medical professionals flock to certain states more favorable to their goals, while citizens left in the less favorable states see a decreased quality of care.  If you remember, during the 2008 election campaign cycle, some of President Obama and Senator McCain’s most vehement debates were between further opening the insurance market to competition among states on the one hand and what we now know as ObamaCare on the other.

In either event, it is certain that the healthcare debate will continue to rage in this country.  I, for one, hope to see a system emerge that we would be proud to put on display in front of the world as one of our crowning achievements.  Today, one thing is for certain: by all accounts, we aren’t there yet.

See the highlights of the Opening Ceremony.