AFTER what seems like
First of all, let me say that I doubt we'll see sweeping reform of the health care system soon (i.e., within the next year). Why? The problem is too large and complicated; the economy has taken a front seat; and there are many differing opinions about what health care change should look like--and many powerful lobbies fighting to keep it as is.
That said, there are government representatives, including prominent senators such as Ted Kennedy, who are already working on health care reform proposals.
The following are some of the key areas of the health care debate and how they may affect you.
PUBLIC VERSUS PRIVATE
President-elect Obama wants to increase access to both private insurance and government-administered health care by creating a public system--perhaps similar to Medicare--while also creating an extended private system.
In order to play, private insurers would have to meet certain criteria, such as no exclusions for pre-existing conditions. If you like the insurance you already have, you can just keep it.
How would this affect you?
Basically, if Obama succeeds in doing this, obtaining insurance should be less expensive and easier. Those who don't have access to an employer's plan or an inexpensive individual plan should be able to buy insurance at reasonable prices through the public plan--which will include subsidies--or a regulated private one.
PRE-EXISTING CONDITIONS
We should be witnessing the end of health insurance availability being the deal-breaker when it comes to decisions about taking and leaving jobs.
Under Obama's plan, insurance companies would no longer be able to deny coverage based on pre-existing conditions, decisions that can seem arbitrary at best.
How would this affect you?
If you have anything from arthritis to cancer, you should be able to change jobs or start your own business without having to worry about having health insurance. Hopefully, premiums will be kept under control as well.
INSURANCE FOR CHILDREN
This is the one area where mandates come into play. Parents will be required to insure their children, and again, subsidies will be available for those who need them. I'm all for all children having access to health care, but I'm still unsure about mandates and what the penalty will be for non-compliance.
How would this affect you?
If you have no children, it won't. If you do, you'll have to provide insurance for them or face some kind of penalty. Providing health insurance for all children is a desirable goal. I'll just be interested to see exactly how this will be enforced.
QUALITY AND TECHNOLOGY
Improving health care quality and technology will cost a lot of money--an estimated $50 billion to $60 billion--and this at a time when our economy's in the tank and the national debt is approaching $11 million. How in the world are we going to pay for this health care reform?
The proposed answer involves changes to the tax code, and improvements in health care quality and efficiency. These improvements would be made with a focus on preventive medicine and coordinated care for chronic illnesses, along with full adoption of information technology such as electronic health records.
The idea is that by investing money in improving quality and efficiency, we would ultimately save much more money down the road.
How would this affect you?
A centralized health information system would mean your health information would be available if you live in Virginia but show up in a California emergency room. Sounds good, but expect to see fierce debates regarding protection of privacy before this would become a reality.
We should see the wheels of the system turn a bit faster if efficiency measures succeed. As far as taxes, it remains to be seen whether health care reform will result in a noticeable change in individual tax burdens.
To say that health care reform is necessary is an understatement, and it looks like we're on the verge of major changes--if not soon, then in the next four years.
The big question is, will health care reform legislation get watered down to the point that nothing really changes? We'll see. One thing is for sure, though: The debate will be a lively one.
Dr. Arlene Lewis welcomes reader comments and questions. She can be reached by writing to her at Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401 or by e-mail
Email: newsroom@freelancestar.com.
Dr. Arlene Lewis is a gynecologist in private practice at Thrive! Health and Wellness Center in Fredericksburg. |