“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
– the very first line of the Preamble to the U.S. Constitution
“…promote the general Welfare.”
There it is, black and white, right there in our U.S. Constitution. It could mean that the sworn duty of the government is to promote health and wellness among our citizens. Or it could simply mean that the government’s role in health care is to intervene in times of crisis.
We’ve seen a battle of ideals for the past 10 years over health care on Capital Hill. Regardless of the final conclusion, there will probably be some upcoming cuts to the Affordable Care Act, removing several million people off of their current health insurance.
I am not making a judgment on this approach, nor am I going to argue that a Single Payer system is better or worse than a non-Single Payer system. There are good reasons for all of us to believe that the entire health care system, as we know it, is headed towards disaster. And we, as a nation, need to rise up, understand the fundamental issues, and ask what we can do to help promote the general Welfare for ourselves and our communities.
I’m hoping you’ll leave this article with a bit more knowledge around the challenges we face as a nation, and an avenue in which you can express ideas for the improvement of health care. You CAN make a difference. First, let’s go over some fun facts and figures.
US HEALTH CARE IS THE MOST EXPENSIVE IN THE WORLD.
As a nation, we are riddled with the most expensive health care in the world. Per person, it costs the United States almost $9,900, compared to an average of under $3700. Breaking down the $9,900, almost half of that cost is publicly funded through our taxes, while the other half is funded through your premiums and out-of-pocket expenses.
And yet, here we are… worrying about a Paris Accord commitment of two billion dollars that we no longer have to pay. Our health care bill, annually, is over three trillion dollars. This means that, when we see annual increases of 5 percent, we are paying 75x more than what we saved by exiting the Paris Accord. Yearly.
The entire GDP as a country was 18.46 trillion dollars in 2016. The health care bill is 17% of our GDP. All other countries are between 8 and 11.5%. Almost one out of every five dollars in America is Health Care.
We clearly have a system more expensive than any other country in the world. Why?
THE US GOVERNMENT DOESN’T PLAY AN AUTHORITATIVE ROLE IN CONTROLLING HEALTH CARE COSTS.
Let’s revisit the Preamble to the US Constitution for a second, and note that RIGHT AFTER the part where it says “promote the General Welfare,” it follows up with “…and secure the Blessings of Liberty.” Liberty has incredible breadth of interpretation. Some people believe that Liberty is achieved through freedom from government. Others believe it is achieved through freedom from obligation or hampering conditions. The battle for this definition has raged across our nation’s history, destroying political parties, and rising them up again.
Why am I bringing this into a discussion about Health Care? Because I think the control of health care costs are where our citizens (and by proxy, elected officials) take sides. People who don’t believe the US Government should take a big role in controlling health care costs will err on the side of company profits, suggesting that the free market can regulate appropriately. They will point to the Lasik industry as a prime example of this ($11,000 procedure when it was first mainstream now costs $3500 today). Those who do believe that the US Government should step up and force drug and administrative companies to control costs think that this is a major way to reduce the burden on the individual citizen.
The ACA does a great job at bringing health care to the masses, but maintains very little power over price negotiation for health services and products. After all, it’s not Universal Health Care, and there are many factions out there in the health care industry who don’t want costs to be controlled (insurance companies, hospital workers, and labor organizations to name a few).
That being said, there ARE cost cutting incentives that the ACA provide for, and we’ll address that in a minute.
WE HAVE LOTS OF SPECIALISTS, AND USE A LOT MORE EXPENSIVE TECHNOLOGY.
More than any system in the world, the United States relies less on general health practitioners, and more on specialists. We get MRIs, EKGs, and other types of technology services that require specialists to run them. We also rely less on Primary Care Providers than other countries, which has a huge impact.
Lack of transparency of prices contributes a great deal to the health care economy. There is no easy way to compare costs of services, and there is reliance on the health insurance companies and providers to dig into the market to compare similar prices for services.
WE ARE CURRENTLY A DISEASE CARE SYSTEM, AND TURNING US TO A HEALTH CARE SYSTEM HAS DUBIOUS EFFECTS ON COST.
According to the National Conference of State Legislatures, 75 percent of health care spending in the US goes to treat chronic diseases and conditions, a much greater percentage than other countries. Most of these chronic diseases are preventable, or can be treated using alternative methods.
For five years, my friends and I have concentrated on raising a great deal of money for Veterans’ non-profits. We focus on expanding preventive and alternative health care programs for vets. Acupuncture, physical therapy, yoga, meditation, and cleaner eating vs. swallowing prescription drugs proves to work for many veterans with PTSD and significant injury. Many lifestyle programs have helped veterans go back into their former lives.
While I’ve seen the benefits of preventive care, does it reduce overall health care costs? The Congressional Budget Office doesn’t seem to think so. The CBO, in attempting to analyze the budgetary effects of preventive care, wrote: “when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway.” Taken by itself, the CBO makes an excellent point. Preventive care COULD just be a net cost to any system, and it’s difficult to measure the impact on the 75 percent of chronic disease treatment I mentioned above. Data is needed, and the CMS Innovation Center(more on them later) must get it to justify continued expansion. Other countries have data, but we must compare the country’s situation as well (for example, the US has a higher percentage of elderly and those with pre-existing conditions).
Preventive and alternative care is not a “one size fits all” approach for everyone, and it doesn’t solve every issue. There are diseases that have to be dealt with on a day to day basis with prescription drugs and hospital visits, and that will not go away. But there is no question that many of these diseases are preventable.
IS THE AFFORDABLE CARE ACT THE PROBLEM OR THE SOLUTION?
There is a great deal of talk to “repeal and replace” the ACA with the prevailing opinion that the ACA is the problem. The opposition for ACA states that, while the Act has brought more people onto health care than any other time in our history, many have been older/sicker than expected, which has increased the cost of health care for healthy Americans and businesses who have shouldered the burden. The idealogical battle between offering businesses tax incentives and full blown Universal Healthcare in the US rages on, with the pendulum shifting depending on who is in power.
But the root cause of our issues, the costs of health care, keep rising. Is this the ACA’s fault?
The answer is yes, but really, no =). On the “yes” side, if you’re a healthy middle class American, then you are shouldering the costs for many of those folks who now have been given health care. Through your rising premiums (which are rising faster than the cost of health care), private health insurance companies are making you and your company pay more for your health insurance to share the burden of the unemployed and those with pre-existing conditions.
But the answer is really “no.” The rising OVERALL costs of health care are not the fault of the ACA, and to the contrary, the ACA has done a great job at controlling the rise of costs in comparison to the previous decade. After ACA was enacted, rises in health care have been at an average of 4.2% per year vs. 7.1% the previous seven years before the ACA. This is a record low since 1960.
WAIT, HOW IS THE ACA CONTROLLING COSTS?
The effectiveness of those measures can be debated, but we should call out the top four:
1) The ACA mandates that all citizens need to have some form of health care, theoretically driving down the cost for everyone.
The individual mandate has its roots in the Republican Party, introduced by Mitt Romney on the state level in Massachusetts, later adopted by Obama for the ACA. This is one of the most controversial aspects of the ACA. It mandates that all citizens must have a form of health care, OR must pay a tax penalty based upon their Modified Adjusted Gross Income (MAGI) Every year, the fee has been steadily increasing. But if the cheapest health care plan in your state is 8% of your MAGI, you are exempt from having to pay the fee. There is cost assistance, Medicaid, and other options available for folks to be able to get some sort of affordable health care, including bare bones catastrophic plans for younger folks. Much of this depends on your state marketplace.
2) Rate Review & The 80/20 Rule
The Center for Consumer Information & Insurance Oversight, established under the ACA, has helped to implement two very important cost measures. The first is the Rate Review, a process which brings scrutiny and transparency to health insurance rate increases for Americans. The second, the 80/20 rule, regulates the percentage of premiums that go to administration of health insurance (20%), and require Health Insurance companies to spend 80% of their premiums on Health Care.
3) The Center for Medicare & Medicaid Innovation
The Rate Review and 80/20 Rule do a great job at helping lower costs for Health Insurance companies, but do NOTHING for Health Care provider costs (hospitals, etc), the real root of the issue. This is where the CMS Innovation Center comes in. Among other ideas, they have created a financial incentive program for issuers to participate in if they focus on cost reduction for their services.
IS THE ACA CONSTITUTIONAL?
This is the core of the debate that pits both parties in Congress against each other. On the one side, having federal or even state government force a person or entity to own insurance can be seen as an attempt to obstruct liberty that the Constitution provides us. After all, the VERY NEXT LINE after “promote the General Welfare” in the US Constitution is “…secure the Blessings of Liberty…”
This is an argument echoed by some judges. Judge Roger Vinson was the first to rule this in the affirmative, and in citing the original Boston Tea Party, stated that “it was difficult to imagine” that the Founding Fathers meant to create a government “with the power to force people to buy tea.”
But does evidence for government involvement in Health Care exist at the time of the Founding Fathers? The answer is yes. In 1799, the Act for the Relief of Sick and Disabled Seamen was supported in a bipartisan manner by Federalists and Democratic Republicans. Many of these people were part of the Constitution’s writing and adoption. The act authorized 20 cents a month out of the paychecks of seamen, marines, and the officers of the United States Navy in exchange for health care services from the established Marine Hospital Service, an organization of Hospitals set up to care for them. Because yellow fever and other diseases were rampant at the time, the 5th Congress felt the need to step in and start driving better health care for seaports.
This one action DOES suggest that the US Government in the 1700s didn’t see itself as independent of health care. But it also doesn’t go so far as to suggest that they supported individual mandate and non-profit health care. At least with this act, it is safe to say that certain aspects of the ACA are not without Constitutional merit.
IS PROVIDING HEALTH CARE FOR ALL CITIZENS THE RIGHT THING TO DO?
Alexis de Tocqueville is misquoted sometimes as saying something very insightful about America’s moral values in the early 1800s. “America is great because she is good. If America ceases to be good, America will cease to be great.” While he DIDN’T say that, and while he never touched upon the subject of health care, he did make this observation of our citizens:
“Men attend to the interests of the public, first by necessity, afterwards by choice: what was intentional becomes an instinct; and by dint of working for the good of one’s fellow citizens, the habit and the taste for serving them is at length acquired.”
Excerpt From: Alexis de Tocqueville. “Democracy in America — Volume 2.”
200 years later, we, as a nation, are working towards those instincts specifically in Health Care. In 1989, during a defense of the individual mandate, politically conservative Heritage Foundation member Stuart Butler drew an important distinction: “If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.” Health care should be qualified and judged on a different level than any other type of shortfall.
The “right thing to do” simply can’t be a financial, constitutional, or even moral discussion in isolation. All aspects must be researched, examined, and concluded TOGETHER to create the right way to move forward.
Because you made it this far, I wanted to thank you. I know that health care has a tendency to politicize people and opinions, and it was my genuine hope that we keep this topic to facts. Health care is the difference between living or dying, and quality of life. This article was written with honesty, research, and the motive to get people involved.
In my view, the general health of Americans is more important than caring about whether an approach is “big government” or not. If better health care is enacted through state governments, or even through the private industry, so be it. The goal of ANY approach, whether enacted through privatization or socialization methods, should be to reduce costs to MAKE HEALTH INSURANCE AFFORDABLE for as many citizens as possible. My conclusion is less of an answer to the problems of health care, and more of a call to action for you, the reader. I encourage you to design methods that will bring down our costs, and post your ideas in the comments. I also invite you to submit your ideas to the CMS Innovation Center. They want to hear from you, and they WILL listen.
The lives and those of our loved ones hang in the balance. Let’s promote our General Welfare together. It’s the first three words of the Preamble, “We The People,” who will ultimately solve this puzzle.