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Recent Health Policy Legislation


American Healthcare: On the Brink
By Max Deng

At heart, most pre-medical students probably find that their main interests lay in the sciences, only occasionally venturing into one of the social sciences to better understand their patients and to develop their own code and moral identity. However, a field many ignore at their own peril is politics. The simple truth is, given today's political climate, doctors and aspiring doctors cannot afford to ignore the issue of healthcare policy. With the recent passage of Obamacare and the current election, healthcare may very well be at a historical tipping point. Will Obamacare be triumphant? Will the old system return? Or will a new, innovative American healthcare system be discovered? Even if healthcare by itself is not interesting enough, at the very least the fact that healthcare is one of the most common topics during the medical school interview process must be taken into account. [1]

Though healthcare reform is obviously a contentious issue, there is one aspect that everyone can agree on. The healthcare system is a very complicated problem, to the point where Obama's recent healthcare legislation was over a thousand pages long. However, the original problems lay with the sheer number of uninsured Americans and the obscenely large amounts of money America was spending on healthcare (17.6% of the American economy [2]). To put that into perspective, America is spending about 1.5 times as much money on healthcare as the next leading country. Despite claims to the contrary, that isn't just because America has the best healthcare in the world. America has fewer doctors, fewer hospital beds, fewer discharges, longer stays, and considerably more tests being run (and at a higher price[2]). The US is particularly weak in the preventative and primary care areas of medicine and significantly overspends on administrative costs. This last point is especially relevant as the shortage of primary care physicians has begun to be addressed through the Obamacare bill, which provides additional funding for primary care residencies, tax incentives for primary care physicians in underserved areas, and financial aid for primary care students [3].

Furthermore, the original government systems, Medicare and Medicaid, were rather limited in scope and left forty-seven million people uninsured [4]. That's almost one in six Americans. A key part of understanding healthcare reform is understanding Medicare and Medicaid. Though Medicare and Medicaid are often used in the same breath, they are not interchangeable. Medicare is the national program aimed at providing coverage to citizens over the age of 65 and disabled people below that age. Medicaid deals with citizens under the poverty line and is called Medical in California. With more and more people becoming uninsured and the continuing rise of healthcare costs, it should come as no surprise that healthcare has become a central issue in this year's election.

In the most immediate sense, the debate on the future of healthcare is centered on the upcoming presidential race: Romney vs. Obama. Romney finds himself in a strange position. Though he has promised to dismantle Obamacare, many of his detractors within his own party believe that it was his own healthcare plan as governor of Massachusetts that gave birth to Obamacare. As of yet, Romney has yet to unveil the specifics of his alternative plan, but the general idea seems to be a movement away from a federal solution and towards a state-by-state solution. He believes that regulation of the insurance industry—curtailing predatory insurance practices, caring for the uninsured, etc.—should be dealt with by the states and that insurance should be provided by private companies without any major federal intervention or a public option. A large part of this is that Romney and his supporters believe that Obama is generating money for Obamacare by raising taxes, something they are adamantly against. Ultimately, while campaigning against Obamacare, Romney does not want to return to the old system but does want everyone to have some form of insurance[6]. During the last of the three debates, Romney also clearly stated that Obamacare would be one of the first cuts he would make as president.

Obama's stance is easier to discern given the recent passage of Obamacare. Obamacare is mostly aimed at reforming current systems, such as the expansion of Medicaid and curtailing predatory practices by insurance companies. These changes are especially relevant for people with pre-existing conditions and small business owners and employees. Finally, by 2014 Obama plans to ultimately create a marketplace or exchange where insurance policies can be easily compared and then bought and sold. This will lead to more competitive pricing as well as ease in finding the perfect plan[4]. The most controversial aspect is the inclusion of an individual mandate. This mandate holds uninsured individuals responsible for acquiring insurance or face having to pay expensive fines. Obamacare also contains provisions that would require plans to cover contraceptive measures such as birth control and possibly abortions in some cases [5]. Another major part of Obamacare that often goes unmentioned is the distribution of funds toward public health measures including the previously mentioned support for primary care as well as a preventative care fund [3].

In the end, it is important to stay aware of healthcare policy, especially now as the country approaches a critical stage in its development. While this page provides a general overview of some of the key discussion points, pre-medical students should do more research through credible web and text sources and form an opinion of their own for their own well-being as well as for the interview process. Though American medicine has shifted more and more toward specialization, policy changes combined with necessity may see increasing incentives toward generalizing, something that may be worth keeping in mind during medical school as residency decisions approach. For now, healthcare reform is focused on the insurance level, but discussion has already begun on reforming hospitals by reducing administrative costs and shifting toward performance based salaries rather than basing it on procedures and turnover rates. As responsible members of the pre-med community, being aware of healthcare reform is becoming increasingly vital.


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