NOTE: Today’s focus on health care is the first of a two-part series. Next week: South Carolina’s options, policy future
AUG. 14, 2009 -- Sometime in the near future, a young adult male named Logan will rise, don a snazzy tunic and proceed down to the collective work area where he will be summoned in front of a “death panel” which will, because he has become too old, order his death.
Logan must then choose to accept his government’s health care decision or do the unthinkable -- become a “runner” and elude trackers he helped train.
This is either the opening of the movie “Logan’s Run,” or a doomsday scenario being put out by fearful critics of the Obama health care plan.
As ridiculous as this may sound, the opening of this story is not too far removed from the rhetoric being put forward by “old yellers” at recent town hall meetings across the nation, where emotion has trumped information. In the Upstate, they recently harangued U.S. Rep. Bob Inglis (R-S.C.) for his support of a health care reform bill when he actually voted against it. Inglis asked the yellers where they had gotten their misinformation, and when they told him a TV commentator, the congressman advised them to turn off their televisions.
So does that mean everyone carrying on at public forums were just wingnuts who had no idea of what they were talking/yelling about? Well yes, no and maybe.
The problem in attacking health care reform has been that there is no single plan – that it’s still in its nascent form -- more than a decade since Bill and Hillary Clinton last riled the nation with talk of the same.
In fact, a summary put out by a non-partisan congressional research group listed 16 different health care reform efforts afoot. Most come from the U.S. House of Representatives, with the Senate not having waded in as deep. So, the number of plans, and confusion, may soon increase.
A moving target
What this has helped do is to turn national health care reform debate into a shape-shifting, moving target where no one may know exactly what they’re talking about because no one can say what is exactly on the table.
That’s problematic for South Carolina, which already shelved its proposed cigarette tax increase, in part, over concerns of how the national debate will shake out.
In some ways, all of the national plans have the same three goals: expanding coverage, lowering costs and improving quality of care. But how they get there, is another matter.
Some of the plans called for a single-payer health care system, which mean everyone would be covered under a national health plan similar to the retirement system offered by Social Security. Others called for strengthening and expanding existing federal and state programs. Still others would point the country in the direction of expanding coverage of employer-based policies.
Other dividing points are whether the resulting reform should be government-run, overseen by the government or purely free-market. Another question is where do states, which already spend gobs of their own money along with federal pass-through dollars on health care, fit in?
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BY THE NUMBERS
Here’s a look at some of recent South Carolina statistics on health care, according to the S.C. Department of Health and Human Services, which oversees the state’s Medicaid program for the poor:
- 32 percent of the state is covered by public health care: 19 percent by Medicaid and 13 percent through Medicare for the elderly.
- Last year, Medicaid in South Carolina ate up $4.8 billion, with $1.4 billion coming from state sources including $943 million coming from the state’s General Fund budget. Ten years before that, the total was $2.2 billion.
- Quoting an insurance industry study, DHHS estimated that roughly half of the state (2.2 million people) were covered by private insurance.
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Philosophical questions
Philosophically, the big question America, and by extension South Carolina, now faces is whether health care should become a “right,” or a utility, instead of a privilege of the shrinking majority that can still afford it.
A bigger question has emerged, though, and that is how to pay for health care reform, in whatever form it may come. Fanning the controversy has been claims that reform will pay for itself.
Judging by the volume and tenor at health care town halls, no one believes bringing millions and millions of uninsured Americans into health care will be free and easy.
One federal estimate is for health care reform to increase government spending by $1 trillion over a 10-year period with most of those costs back-loaded, and the cheaper administrative costs coming in the first few years.
Adding to the confusion seems to be President Barack Obama, who has yet to proffer his own definitive solution, while at the same eloquently making the case for reform.
Easy case to make
Pretty words aside, it’s a pretty easy case to make. In short, health care costs are going up, as are the number of uninsured, while quality has been slipping, and more and more of the nation’s gross domestic product is getting eaten up.
- 45.7 million U.S. residents have no health insurance.
- 7.2 percent of the nation’s GDP went toward health care in the 1970s. That number has increased to 17 percent by 2009.
- From 1980 to 2007, medical costs increased 4.7 percent a year, not bad until you consider that the consumer price index only increased 2.5 percent annually over the same time.
- Insurance premiums increased nationally 114 percent between 1999 and 2007 alone.
- Medicaid makes up 20 percent of the federal budget and 27 percent of the amount spent annually on health care nationally.
On top of the increased costs, America’s worldwide health ratings have dropped, according to several studies, to the point that the nation was paying more and getting less than many other industrialized nations.
Obama has made the point repeatedly that if the current system is left alone, the nation will spend ever-increasing amounts of its wealth on sustaining the health care system in the years to come.
Rising costs in states
States, like South Carolina, have not been immune to the high cost of what some have argued has become mediocre medicine. According to that same federal study, states, kicked in $281 billion on public health care programs in 2007 alone.
In 2004, the South Carolina’s gross domestic product was estimated at $136 billion and its health care expenditures, according to an insurance industry study, were $21.4 billion. That meant South Carolina residents and companies may have spent more than one in seven dollars they earned on health care for the year.
Crystal ball: This debate is not going away, and when it’s concluded in Washington D.C., the battle will move to statehouses across the nation. Unlike Michael York’s character in “Logan’s Run,” South Carolina will not find sanctuary outside the system and will have to face the issue head-on.