Diana DiNitto is Cullen Trust Centennial Professor in Alcohol Studies and Education and a University Distinguished Teaching Professor in the School of Social Work. She is the author of “Social Welfare: Politics and Public Policy” and the co-author of “Chemical Dependency: A Systems Approach,” among other publications. She specializes in chemical dependency (alcohol and drug abuse), social welfare, politics and public policy.
Americans are sharply divided over the Patient Protection and Affordable Care Act of 2010 and related legislation, which are being used as a wedge in this fall’s elections.
The legislation is the major “policy punctuation” or change in health insurance legislation since 1965 when Medicare and Medicaid were enacted. The legislation is also notable for other reasons, including the votes it garnered. Sizeable majorities of House and Senate Republicans voted for the Social Security Act of 1935 (the cornerstone of the nation’s social welfare policy), and 50 percent of Republicans in the House and 40 percent in the Senate voted for Medicare in 1965, but not one Republican voted for the Patient Protection and Affordable Care Act, despite the benefits it will provide.
The 2010 legislation will close insurance gaps the private sector has failed to fill.
Conservatives have not provided proposals that would reduce the number of uninsured to any comparable extent. For many Republicans, tea partiers and other Americans, the 2010 legislation is too much government intervention even though doctors and other private sector health care providers will continue to operate in the free market system. In fact, given that more Americans will have access to health care, demand for health care services will increase. Many progressives or liberals wanted the legislation to go further than it did by adopting a single-payer system. Such a system would use standard claim forms and centralized government payment processing for all insured to save time and money that could go to provide health insurance, including insurance for mental and substance use disorders and dental care.
The nation’s health care bill is a major concern. Health care comprises more than 16 percent of the nation’s gross domestic product. Medicare, Medicaid and the State Health Insurance Program consume more than 20 percent of the federal budget. Medicaid is more than a quarter of the Texas state budget. Despite outcries about costs, the nonpartisan Congressional Budget Office estimates that the law’s funding mechanisms will reduce the federal deficit by $143 billion between now and 2019.
As we go to the polls, this fall, let’s remember a few critical health care facts. Compared to all or many other developed countries, the United States:
Spends more on health care per capita and
- has poorer health outcomes (for example, infant mortality and life expectancy)
- has higher uninsured rates and
- is the only country other than South Africa without national health insurance.
Among other things, the Patient Protection and Affordable Care Act and related legislation will
- increase the number of insured by 32 million
- prevent insurers from denying coverage for pre-existing conditions
- help lower-income individuals and small businesses purchase health insurance and
- attempt to improve health care quality and outcomes.
Texas has much to gain from the health care legislation because it has the highest percent of uninsured residents in the nation.
Had the United States adopted some form of national health insurance earlier in its history, Americans might have come to view health care as a right. Instead, for many Americans, health care has been a matter of luck — working for an employer who offers health insurance, living long enough to qualify for Medicare or having sufficient income to pay health care expenses out-of-pocket. Even those segments of the low-income population that have Medicaid might be considered lucky because they have health insurance.
Most of us will never be as witty as Molly Ivins or as provocative as Karl Rove when it comes to discussing politics, but neither we nor the candidates we elect should be so shrill that only dogs can hear us. Instead of throwing the baby (health care legislation) out with the bathwater (or the tea water), we should elect candidates who can work together to see that all Americans have health insurance and that health care costs are brought into proportion. The physical and fiscal health of Americans depends on it.
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