Background on Health Care

OBAMACARE

• ‘ObamaCare’ refers to the Patient Protection and Affordable Care Act (PPACA) of 2010, which reformed healthcare insurance with the goal of near-universal coverage.

• Critics refer to ObamaCare as socialized medicine -- which could mean the government runs the healthcare system, as in the United Kingdom, but more accurately in the United States means that the federal government mandates individual health coverage.

• Individual Mandate: The crux of the opposition to ObamaCare is whether the federal government can mandate that individuals purchase health insurance -- that will be tested in a Supreme Court case late in 2012.

• ‘RomneyCare’ refers to the Massachusetts state version of mandated healthcare initiated under Gov. Mitt Romney -- its principal difference being a STATE mandate instead of a FEDERAL mandate.

• Opponents of ObamaCare suggest replacing it with the following list of reforms: cross-state purchasing; tort reform; Health Savings Accounts; small business pooling; and transparency for better patient choice.

• Tort Reform refers to changing the rules about civil litigation, typically to cap damage awards. In a political context, it usually applies to medical malpractice lawsuits, but in a legal context, it also applies to personal injury and product liability lawsuits. The term "tort" means "at fault;" when a doctor is found at fault, a jury can currently award unlimited damages. Awards in the millions of dollars put upward pressure on malpractice insurance rates; hence many conservatives favor tort reform as a means to reduce healthcare costs. Proposed solutions include capping lawsuit compensation or restricting "frivolous lawsuits." Trial lawyers--the recipients of legal fees from tort awards--heavily favor Democratic candidates, so Republicans would like to limit their legal fees.

• The Supreme Court decided the case “National Federation of Independent Business v. Sebelius” on June 28, 2012, on the constitutionality of ObamaCare’s individual mandate. Justices Roberts and Kennedy were very skeptical that the mandate was justified under the “commerce clause.” But the government’s lawyer made a strong case for the government’s taxing power—that argument eventually won the day—because the mandate would be administered by the Internal Revenue Service, paid on your Form 1040 on April 15th. The president had argued that the mandate was not a tax; the court decided it was.

• Prior to ObamaCare, comprehensive national health care reform had died in Congress in 1994 (after a report by a commission run by Hillary Clinton, hence the moniker "HillaryCare").
• 16% of Americans (42 million people) have no health insurance (and hence must pay for health services in full, or receive hospital charity).
• 14% of Americans receive some form of public health care or health insurance (70% have private health insurance).
• 20% of Americans are members of Health Maintenance Organizations (HMOs).

Congress and the Presidential candidates are debating a ‘Patient’s Bill of Rights’ which would establish rules of dealing with HMO managed care. The buzzwords in this debate are:
• External Appeal: Patients cannot currently appeal an HMO’s decision to deny coverage, even if the HMO doctor agrees with the patient. The ‘Bill of Rights’ would establish some form of expert appeal board external to the HMO.
• Medical Necessity: At issue is whether the doctor or the HMO management determines what is necessary. Determination of ‘necessity’ may become subject to expert review as well, or it may become measured against established standards of ‘generally accepted practices.’
• Legal Liability: Patients would be granted the right to sue HMOs for medical costs and damages, which is not a right under current law. Generally, liberals supoprt the right to sue HMOs while conservatives do not. This is the primary distinction between Republican and Democrat versions of Patient Bill of Rights proposals.
• Scope of Coverage: Some states regulate HMOs in ways similar to those described here; a ‘Bill of Rights’ could apply to them, to all HMOs, or to all patients.
• Prevention: Advocating prevention implies support for removing government from health care, or opposition to more federal health care funding or national insurance.
• Consumer Choice: Advocating consumer choice or reduction in healthcare bureaucracy implies support for removing government from health care, or opposition to national insurance.

• Medicare and Medicaid background is covered in the Social Security section (but quotations are cross-referenced here).

• The Supreme Court ruled unanimously in June 1997 that there is no constitutional right to euthanasia, but that states can allow euthanasia without federal intervention.
• ‘Euthanasia’ means ‘good death’ in the context of terminal illness. Buzzwords:
• Passive Euthanasia: Hastening death by withdrawing life support.
• Active Euthanasia: Causing death in response to a request from that person. The best-known examples are by Dr. Jack Kevorkian, who was found guilty of 2nd degree murder in March 1999.
• Physician Assisted Suicide: A physician supplies information and/or the means of committing suicide so that a patient can easily terminate their own life.
• Involuntary Euthanasia: A synonym for murder; used by anti-euthanasia activists.
• Right to Die: Establishing suicide as a civil right; used by pro-euthanasia activists.
• The state of Oregon passed a Death With Dignity law, which was active until the federal Department of Justice reversed its enforcement policy in November 2001.

• In Nov. 1998, 46 states settled the cases they had filed against the tobacco companies. (The other 4 states had previously settled, on similar terms)
• Now, the state legislatures are debating the best use of the settlement funds, which totals $246 billion to be paid over the next 25 years ($5 to $9 billion per year starting in April, 2000).