Tuesday, March 23, 2010

An Historical Day for the USA

President Barack Obama signed the landmark health care legislation passed by the House of Representatives on Sunday night. The bill, H.R.3590, Patient Protection and Affordable Care Act (Passed by Both House and Senate) changes the landscape of health care in the United States. The House also passed H.R.4872, the Health Care and Education Reconciliation Act which needs to be passed by the Senate and signed into law by the President.

Health care insurance will become truly portable and not based on the "largesse" of large and small employers. Employer provided health care insurance evolved from a simple perquisite to a mechanism to maintain employee "loyalty". Also called "staff retention programs", employers provide "incentives" to employees keep them from changing jobs. In many cases, these incentives become obstacles to change not rewards for effective work. The lack of insurance portability is a large obstacle to mobility for Americans. The buying power of large employers in the health insurance market is another inequity that will be addressed. For-profit health insurance companies have incentives for weeding out expensive customers and retaining healthy ones. Their rules about "pre-existing conditions" and limits on coverage for those who fall ill while covered are all designed to maintain profitability.

At the same time, the American people have not been able to rationally discuss the limits we must place on health expenditures as a country. This is expected in the climate of fear produced by the lack of universal access to health care and the hidden decision making on costs and benefits. Costs have spiralled as quality has lagged. Huge disparities in quality of care occur based on ability to pay and argue with insurance companies. Some people are too sick to argue and simply die without making a big fuss (these are the ideal customers for insurance companies). The oft repeated mantra, that America has the best medical system, is, simply, a false myth.

This legislation stands with Social Security and Medicare in providing freedom from want and facilitating personal liberty as expressed in the 2nd sentence of the Declaration of Independence -

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

P. S. At the signing ceremony, Vice President Joe Biden's remark, quietly spoken into Obama's ear, was captured by the sensitive microphones - "...this is a big f!@#$ing deal..." I agree entirely. :)

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