September 23 will mark six months since President Barack Obama signed the Affordable Care Act (ACA) into law, signaling a new national effort to save the American health care delivery system as we have known it since World War II.
No, it's not socialized medicine doctors and nurses have not been turned into public employees, no hospitals have been bought, and the system is still based on the purchase of insurance as a means of paying for care.
It is, in fact, the last best hope of preserving a market-based approach to health care in this country which is the largest industrialized country in the world without a national health plan.
New statistics released this week by the Census Bureau make explicit the logic behind the act and need for reform. For the first time since this data has been collected, the number of Americans with health insurance fell last year. 1.5 million Americans lost their coverage in 2009.
While that is horrible news for those people and their families, it is even worse news for those with coverage. Why? Because the need for care does not disappear just because a person does not have health insurance. They will eventually have to seek care for what ails them and, when they do, it will likely be through an emergency room at a hospital. They'll be sicker than they would have been had they sought treatment earlier and, if they are hospitalized, they won't have the ability to pay the cost.
Who will pay? Those people with insurance. This shifting of costs from those who can't pay onto those who can is at the heart of what has ailed health care costs in the United States in recent decades. Estimates are that the cost of providing care to the uninsured adds about $500 annually to the premium cost of each person with health insurance.
Things are probably even worse in Louisiana, where we have historically been a state where a smaller percentage of employers offer coverage to their workers than in other states. The percentage of Louisiana residents without health insurance has ranged between 18 and 24 percent over the past six years, according to a study done for the Louisiana Department of Insurance (PDF).
Small businesses are said to be the core of Louisiana's economy, yet as of the summer of 2009, 30 percent or less of Louisiana small businesses offered health insurance to their employees, according to a spokesperson for Blue Cross/Blue Shield of Louisiana. Rising premiums are forcing companies to either drop coverage entirely or shift a greater share of premium costs onto employees.
The employment based health insurance system that the United States has used since the end of World War II came into existence when President Harry Truman proposed a national health program here similar to the one Winston Churchill started in England. It is collapsing. The Affordable Care Act is an attempt to save that system without resorting to a single-payer plan.
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