The main argument of those that are against the health care mandates states that having a mandate that forces people to buy something such as health insurance, can lead to a slippery slope. This means that the government can force people to purchase other things. This idea of a mandate violates the principles of liberty found in the Constitution, and the nature of a free market that America has been built upon. Not only that, but requiring all Americans to have health care can be more costly and inefficient. On the other hand, those that support universal health care argue that “it’s the key to making health care more affordable and accessible to everyone” (Cannon and Davenport). This means that even the initial costs of implementing health care for everyone are worth having, if this guarantees that all Americans will have health care.
until the symptoms are more severe. These delays may result in unnecessary hospitalizations for conditions that could have been treated on an ambulatory basis and, in some cases, place uninsured children at a higher risk of premature death. If left untreated, some of the common childhood illnesses that can be detected and treated with routine care can also have long-term negative impacts on children’s development, including middle-ear infections, asthma, and iron deficiency. To the extent that timely and appropriate medical care might ameliorate or even prevent these conditions, insurance contributes to better future functioning and life chances for children. Further, provision of preventive care to children can have beneficial long-term effects that extend beyond health, so that society can reap the rewards in the future. The Committee recognizes, however, that there are many factors in addition to medical care that influence children’s health and development.
Most Americans would be delighted to have the quality of care found in places like Rochester, Minnesota, or Seattle, Washington, or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average. If we brought the cost curve in the expensive places down to their level, Medicare’s problems (indeed, almost all the federal government’s budget problems for the next fifty years) would be solved. The difficulty is how to go about it. Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail.
The perspective of this report on coverage of families also highlights the importance of the interdependence of individuals within families, the shared health and economic consequences of uninsurance, and the importance of stronger efforts to view the family in its entirety and to consider health insurance for the whole family. Among private, employment-based insurance plans there has been a small but promising trend to expand the definition of family to include both partners in a relationship, for example, unmarried couples, both mixed sex and same sex. This development increases the opportunity for some adults to receive coverage as dependents.
Approximately 20 million children are currently covered by Medicaid and the State Children’s Health Insurance Program (SCHIP) program expansions. Nonetheless, almost 5 million children who are potentially eligible for these programs remain uninsured (Urban Institute, 2002a). Recent efforts to simplify the application and re-enrollment processes in many states have contributed to increased coverage. The Committee’s evidence-based review shows clearly that lack of insurance for children reduces access, appropriate utilization, and some health outcomes. In addition, lack of coverage for parents means they are less likely to obtain care or to have positive experiences with the health care system and that this is likely to have a negative impact on their seeking care for their children.
In addition, there are families more likely to suffer negative consequences of having uninsured members, even though they are relatively more likely to have insurance than are the populations above. These families have members in late middle age, approaching retirement. Their increased risk comes from the fact that their health care needs and costs are likely to be higher than those of younger families. The limitations of employment-based insurance and the frequency of retirement before the age of Medicare eligibility put both the early retiree and the dependent spouse in danger of losing coverage. In fact, some health conditions and certain chronic illnesses can precipitate early retirements, either for the worker to care for an ill spouse or because work is no longer possible for the ill member of the family.
Families having some or all members with no insurance for extended periods are at greater risk of adverse consequences than are those with brief gaps in coverage. The Committee has shown that families with members uninsured for long periods are more likely to incur substantial health care costs for services and to suffer adverse consequences to health. These risks have added significance because of the types of families most likely to have some or all members uninsured.
A key example of a parent’s health affecting that of the child can be seen during pregnancy. Providing public health insurance to previously uninsured pregnant women increases the use of prenatal care but not to the level seen with privately insured women. Uninsured women and their newborns receive less prenatal care and fewer expensive perinatal services than do insured women. Uninsured newborns are more likely to have adverse outcomes than are their insured counterparts. The evidence to date on whether expanding coverage improves an outcome such as low birthweight is not definitive, however.
In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.
Some hospitals, health centers and clinics provide medical care, prescription drugs, dental care, and other services regardless of your ability to pay. Anyone may use a community health center, whether you have health insurance or not. How much you pay will depend on your income. .
In its previous report, the Committee highlighted the importance of ease of access to a regular and continuing relationship with a health care professional, which is associated with better health outcomes and is usually facilitated through insurance. In this study the evidence demonstrates that uninsured children are less likely than insured children to have a usual source of health care or a regular physician. For children, gaps in coverage are associated with health access and use that resemble those of chronically uninsured children. There are several limitations of current insurance arrangements that hinder ease of access to a usual source of care for families. There is also evidence that expanding public programs to previously uninsured children brings a significant increase in access to and use of health services.
To determine whether overuse of medical care was really the problem in McAllen, I turned to Jonathan Skinner, an economist at Dartmouth’s Institute for Health Policy and Clinical Practice, which has three decades of expertise in examining regional patterns in Medicare payment data. I also turned to two private firms—D2Hawkeye, an independent company, and Ingenix, UnitedHealthcare’s data-analysis company—to analyze commercial insurance data for McAllen. The answer was yes. Compared with patients in El Paso and nationwide, patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care.