On October 13, 2009 the Senate Finance Committee approved, by a vote of 14 to 9, the “America’s Healthy Future Act”; which is a bill that aims to lower costs and provide quality, affordable healthcare coverage for an estimated 29 million uninsured Americans within the next decade. Moreover, the bill proposes to eliminate the discriminatory practices of private market insurance providers against individuals with pre-existing medical conditions as well as improve the overall efficiency and quality of healthcare delivery. Also, the Congressional Budget Office estimates that this proposed legislation will cost $829 billion and will reduce the federal deficit by $81 billion during the decade after its ratification. To ensure such favorable outcomes, the bill contains a variety of provisions.

 For instance, the bill prohibits insurance companies from charging women or those with prior illness an increased premium and also eliminates yearly and/or lifetime limits on the amount of coverage that is provided under a given health plan; which would make it illegal for an insurance company to drop the health coverage of a policy holder. Furthermore, the bill provides tax credits for small businesses to assist them in offering insurance to employees and will also offer a fifty percent discount on prescription drugs to seniors with gaps in their Medicare part D prescription drug coverage. These provisions would make the coverage more affordable and equitable for individuals with low to moderate incomes, particularly senior citizens and the working poor. While such provisions seem ideal, the prescription discounts for Medicare beneficiaries aren’t without drawbacks. For instance, according to the Congressional Budget Office, under the House bill (HR3200) Medicare recipients will see a five percent increase in their premiums by 2011 which would grow to twenty percent by 2019; however, expenses on prescription medications apart from Medicare premiums would decline overall. These discounts and savings on prescriptions provided by the Senate Bill may not be worth the cost of the increased premium of the House bill, especially, for the beneficiary who takes only one form of medication. The good news, however, is that there will not be any Medicare benefit cuts under the “Americas Healthy Future Act”.

Another proposal of the Senate bill is to transition the Medicare fee-for-service system based on the volume of care towards a reimbursement system based on the quality and value of care. Consequently, a percentage of hospital payments would be linked to performance and quality measures in terms of the care for general and high-cost health conditions. These standards would be designed to encourage physicians to avoid redundant testing and procedures, which are likely to impede efficiency and result in cost ineffectiveness; but instead, strive to achieve the most optimal patient outcomes in the most inexpensive manners.

Although a healthcare environment under this proposed legislation has plenty of appeal and potential, there are also several prospective issues that may arise as a result of its enactment. For instance, many Americans could be subjected to considerable increases in taxation as well as rationing of actual healthcare, which under some circumstances may be the difference between life and death. Furthermore, Republicans have strongly opposed these healthcare reforms and have made claims that this legislation is a slow start to a “government takeover”. Moreover, if the private insurance companies are unable to compete with the federal government, the government can possibly become a monopoly within the health insurance market. Also, private insurance companies have made claims that there would be an increase in private plan premiums instead of the “competitive decrease” that the federal government anticipates, which would impose greatly upon individuals who prefer private insurance coverage.

Taken as a whole, the healthcare reforms proposed in the bill are certain to change the way Americans pay for healthcare services, however, with regards to improving the quality and efficiency of healthcare delivery, the “America’s Healthy Future Act” doesn’t quite deliver. The bill seems to be lacking clear-cut practices or standards that will ensure that Americans will receive the highest quality of care. Moreover, it fails to define and/or standardize methods to reduce operating costs of hospitals and other healthcare organizations. Theoretically it would be ideal to provide affordable healthcare to the millions of uninsured Americans but, as the old saying goes “it’s not about quantity but quality”; and with respect to the likely increase in taxation to pay for this healthcare overhaul, many Americans deserve to get their “moneys worth”. Furthermore, if the quality of care declines under government healthcare coverage, citizens may find themselves at the mercy of private insurance companies, even more so than they are at present time, as they seek quality healthcare under the coverage of private plans with “hyper-inflated premiums”. It is not yet known as to whether or not there will be an actual healthcare reform under the proposed legislations but, if such a reform were to occur, the final body of legislation would have to accentuate tangible means that will guarantee quality care and cost efficiency in order to be truly beneficial to American society.

Ultimately, the demand for affordable and quality healthcare presents a challenge, and thus far, the private sector hasn’t achieved nor attempted to achieve this challenge. Instead, private insurance companies have sacrificed the well-being of countless Americans to ensure their own interests. Furthermore, many Americans have been sold a false sense of security under private health coverage because when it comes to the “bottom-line” policy holders are viewed as liabilities or expenses and when the insured become too expensive the insurance company is liable to drop their coverage. Therefore, it is imperative to afford the American people a better alternative which is both affordable and beneficial. It just so happens, that the alternative is being proposed by the United States government which is the same government that has instituted successful programs like Medicaid, Medicare, Social Security and W.I.C. to ensure the welfare of the American people. Albeit, these programs have not always been well received, they are still quite beneficial nonetheless. For that reason, a healthcare reform with a public option may be just what the doctor ordered.

 Written by Manuel Gonzalez, Intern for Optimum Capital Management