The Tapestry of Health Care Reform

                                                                                                                The Tapestry of Health Care Reform

         Recently President Barack Obama signed into law the Patient Protection and Affordable Care Act, which Congress enacted to reform the nations laws on health care. This was a major objective of President Obama from the time of his election in 2008. It was acted upon after lengthy and heated debate about the issue by both sides for and against the legislation.

         A Tapestry is defined as a textile. It is a display of fine threads gently laced together by the artistry of nimble fingers, one stitch at a time. And every master of the art will tell you that it begins with a single stitch, with one thread woven and bound to the next. Tapestry is the collection of all those fine threads into a blanket of material that in the long story is a collection of each of the tiny steps taken to bind and weave it. So it is with health care for America.

         A history of American healthcare takes us to a view of where we began this debate. According to Jill Lepore, a writer for the New Yorker, the debate on healthcare reform began in earnest in the early 1900’s (Lepore, 2009). By 1912 the American Association for Labor Legislation formed the Committee on Social Insurance was formed. Isaac M. Rubinow, a Russian-born physician and writer who conducted a study called “Social Insurance.” Dr.Rubinow believed that sickness insurance would help eliminate and prevent poverty. In 1915, Rubinow’s committee had drafted a bill providing for universal medical coverage and believed no other social movement was as urgent to the benefit of the public; Congress began consideration of Rubinow’s bill, which was also put forward in sixteen states (Lepore, 2009)

                                                                                    By April of 1917 the notion was put on the back burner when America went to war with Germany and the view that Germany was a good role model to follow died in the enactment of war. In California, where the legislature had passed a constitutional amendment providing for universal health insurance, it was put on the ballot for ratification: a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it “would spell social ruin to the United States.” Every voter in the state received in the mail a pamphlet with a picture of the Kaiser and the words “Born in Germany. Do you want it in California?” Because of the feeling in the country about Germany the people of California voted it down. By 1919, John J. A. O’Reilly, a Brooklyn physician, was calling universal health insurance “Un-American, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.” (Lepore, 2009)                                          As with any change it is easy to blame the next person or the opposition. This year it is being called “socialized medicine.” In 1934, Rubinow published “The Quest for Security.” He urged F.D.R. to include health care in the New Deal.This was seen as government meddling in medicine, and the editor of JAMA indicated it simply was an Americanism versus sovietism. In 1965, it had become “creeping socialism.” Today we face the same rebuttals. President Johnson however took measures to address the threats against the laws by including both the AMA and various other healthcare industries into a partnership on an advisory counsel that oversaw rules governing Medicare laws. (Gawande, A., 2010)

         This year, Senate Minority Leader Mitch McConnell accused President Obama and his allies of “an audacious effort to Europeanize the country.”Again the old rhetoric reared its head.(Lepore, 2009)                                                                                                              History has a habit of repeating however, and last week President Obama signed into law

                                                                                         The Patient Protection and Affordable Care Act, which could also carry with it the severity of the same hostilities of prior attempts. Unlike the healthcare industry rejection of Medicare, this law’s opponents are the political groups whose main agenda is to get the upper step on the up coming elections in September or those who do not want government involvement at all. The argument is that healthcare is unaffordable. Proponents of the act argue that the best way to solve the costs problem is to create ways of improving healthcare by creatively using means to help patients rather than using the old standard of fees for services. (Gawande, A., 2010)                              Health care over the years has grown as an industry and along with it the enormous costs it charges when we become ill. This in effect makes any meaningful reform harder, it would appear that incompetence is customary. Most people view this as we have gotten along ok without it so far, so why change it? It would appear that if having no health plan in place is the American way. After all what are life, liberty and the pursuit of happiness about if it is not freedom of choice?(Lepore, 2009)                                                                                                    In the 1940’s, health care reform became a claim that there was a need urgently mandated for health care legislation. History  also shows that in 1798, John Adams signed an act for the relief of sick and disabled Seamen. And at that time both state and federal governments collected a tax which was used to build hospitals and provided medical care for merchant marines and navy seamen. Government sponsorship of that magnitude was not considered  un American because President Adams had thought of it without others involvement. According to Lepore that is the equivalent to saying the 2nd Amendment protects the right to AK47’s.  (Lepore, 2009)                                                                                                                  Social Security, Medicare and the Entitlements as they are called are certain benefits provided to people who have paid into them over the years. Medicare is our country’s health insurance program for people age 65or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. (Centers for Medicare Services, 2009)                                                                      Medicare, like any other health plan covers 80% of the cost of an illness based on a contracted rate they have with suppliers of services such as hospitals. doctors and medical equipment suppliers. They however do not cover everything, and including long term care. Patient’s liability with this continue to be the cost of the remaining 20%,plus the annual deductible and full cost of any non covered item, or prescription costs if Medicare Part D was not selected. As with any insurer, Medicare is facing continued escalation in prices charged by the industry. (Centers for Medicare Services, 2009)                                                                               Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. The long story in this is that Medicare pays the hospital and doctors bills of literally millions of American citizens, at a time they least can afford catastrophic costs associated to a long illness late in life. Still the fight ensued with the AMA wanting to defeat the bill. (Gawande, 2010)                              In describing the reforms President Obama explained that Healthcare reform in 2010 looks like is this. If you have health insurance, this reform just gave you more control by reigning in the worst excesses and abuses of the insurance industry with some of the toughest consumer protections this country has ever known -- so that you are actually getting what you pay for.If you don’t have insurance, this reform gives you a chance to be a part of a big purchasing pool that will give you choice and competition and cheaper prices for insurance. And it includes the largest health care tax cut for working families and small businesses in history.So that if you lose your job or you change jobs, start that new business, you’ll finally be able to purchase quality, affordable care and the security and peace of mind that comes with it.(Obama,2010)                                                            According to President Obama this reform is the right thing to do for our seniors. It makes Medicare stronger and more solvent, extending its life by almost a decade. He believed it was the right thing to do for our future. It reduces our deficit by more than $100 billion over the next decade and more than $1 trillion in the decade after that. (Obama , 2010) It is putting the control of healthcare in the hands of the patient. Doctors will be compensated not on how many tests they can run, but on the outcomes from what they provide.. (Gawande, 2010)

         The idea of protection from pre existing conditions is urgent. People who have had the misfortune of being ill should not be excluded from coverage. The notion of only pooling the healthy in a plan, and letting those who have had a serious illness die on the vine, is pure nonsense. It is foolery presented by an industry that have but one goal, profitability. (Gawande, 2010)                                                                                                    Healthcare for the poor, the middle class, and the rich should be available for everyone equally. The foundation of this country is life, liberty and the pursuit of happiness. There were no boundaries put on it. The founding fathers did not say it was only for the rich or those with money. It did not label the poor as undeserving the benefits. Life means life, and liberty means freedom. Together we are able to pursue happiness. Ill patients should never have been forced to  worry  about  if they will survive, or how to pay the unthinkable costs associated to illness they could not ever pay for.       

                                                                               In conclusion the time for reform was not only urgent and ecessary. America is not only about industries and businesses, but about its people. America is its people, all of them. Rich, poor, and middle class. America needs to reform; it needs to focus again on its people.          Do we ignore ill children who can not qualify because of a pre existing condition? I say not. This is America. We are assured of life, liberty and the pursuit of happiness. This is the tapestry we are made of and it is the fabric of our lives. Health care is a right, and because of that it contributes to our well being as American Citizens.



                   Works Cited                                      Centers for Medicare and Medicaid Services (2010), Social Security Adm        Administration, Retrievedfrom the web April22, 2010                                                     http://www.ssa.gov/pgm/links_medicare.htm

Gawande, A, (2010) Now What? The New Yorker. Retrieved from the web on April 3, 2010

         http://www.newyorker.com/talk/comment/2010/04/05/100405taco_talk_gawande?printable=true



Lepore, J (2009) Pre Existing Condition, The New Yorker, retrieved from the web April 15, 2010

         http://www.newyorker.com/talk/comment/2009/12/07/091207taco_talk_lepore#ixzz0lAu           nWJhB

Obama,B (2010) Weekly Address by the President. The White House Blog on HealthCare,Retrieved from          the web April 23, 2010                                                  http://www.whitehouse.gov/blog/2010/04/10/weekly-address-relief-middle-class-tax-time