Sunday, March 25, 2012

Supreme Court to hear arguments on health care legislation

The US Supreme Court will soon be hearing oral arguments regarding the Constitutionality of the Patient Protection and Affordable Care Act of 2010, derisively referred to as "Obamacare".
  CNN: Justices to tackle epic debate over constitutionality of health care reform
Despite its complexity, the high court has narrowed its focus to just four key issues:
One: Constitutionality of the individual mandate (also known as the "minimum coverage" requirement), the key funding provision.
Two: Whether the individual mandate is a "tax," thereby limiting authority of the courts to immediately decide the mandate question.
Three: Whether other parts of the law can survive if the mandate is struck down.
Four: Federal vs. state conflict over expansion of the cooperative Medicaid program.
Well, here is my take.  The Government already mandates that health care facilities may not simply turn away people who are in urgent need of medical care even if they can not afford the services.  The statistic cited in the linked article says that in 2008, $43 billion of uncompensated health care services were provided for millions of uninsured patients.  These costs end up being paid by those who do have health insurance, through higher premiums. The $43 billion has to come from somewhere right?

Are the people who are opposed to the Government mandate for health insurance really prepared to say that health care facilities should turn away the uninsured who can't pay? That is the other side of the same coin. You can't refuse to buy insurance and then expect everyone else to cover your bills if you can't cover them.  Why, that would be socialism,  like we have now.  If people want the right to remain uninsured, then they have to pay for everything out of pocket or arrange credit, or they're out of luck regardless of medical condition. So if you bust up your knee but can't cover surgery you'll just have to learn how to walk with a stoop.  And if pops needs triple bypass surgery, but didn't but the insurance and has no way to pay, then too flipping bad. The business manager said you're credit score is too low and you're gonna die. Talk about death panels.

The way it is, the ones who still have health insurance end up paying for the medical services for the uninsured through higher premiums. Because this is the main driver of increasing health care costs and union job compensation packages, it is disingenuous for conservatives to point at the specter of rising costs for union employees while clamoring to not have to pay into the health care system while relying on the health care safety net the Government mandates.

That said, it isn't enough for the government to simply mandate expanded health care services upon the nation without a plan to provide the services for the millions of new patients. If we just add to the demand for health care without adding to the supply, then it will create either rising costs and/or shortages.   If the government aims to make health care more available, then it needs to promote policies that serve to expand the number of service providers.

This could be done by using more physician assistants and information technology to help make preliminary diagnosis to free up the time of physicians for more useful purposes.  There needs to be more community health centers to provide basic medical services instead of relying on hospital emergency rooms to treat advanced cases of ailments that would have been easy to treat in early stages.  There needs to be financial incentives that promote healthier life styles, diets, safe driving, vaccinations, personal habits, that work to keep medical costs lower.

There needs to be tort reform to increase the accessibility of medical services and to discourage waste via defensive medicine, which can drive extraneous medical testing just in case a lawsuit is ever filed after an operation fails. In cases where the doctor's office also operates an in-house medical  lab that performs the tests the doctor orders, where is the motivation to reduce unnecessary costs?  There needs to be thousands of small incremental improvements and waste reduction efforts in all phases of the medical industry if we want to have high quality, accessible, affordable health care for all.

So while the Supreme Court ponders the Constitutional issues, it would be reasonable if the Legislature and the President worked toward policies that take into account basic economics about supply and demand curves as they relate to health care services.   If we increase demand, we need to increase supply or else prices will rise and in the end, this will only make health care services less available, not more.

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