Be the Best Nanny Newsletter asking to clarify what President Obama's speech last night about healthcare reform meant. One nanny said on our voicemail, "I am more confused now than before."
Currently our October 2009 Be the Best Nanny Newsletter monthly poll (which can be found on the top, right hand column of our blog at: http://bestnannynewsletter.blogspot.com/) shows that most household workers, that have taken our survey about health insurance, do not have health insurance benefits provided by their employers. So the topic of healthcare reform is important to many nannies.
Due to the questions we will discuss the proposed healthcare changes and the effect those changes might have on nannies and their families.
There seems to be a lot of confusion about the proposed healthcare changes and the effect those changes. Various aspects of different proposals have provoked heated and passionate debates. We will try to add some light to the debate.
One of the difficulties in this discussion is that, as of now, no healthcare law has passed. There are at least three different healthcare bills in the House, and different drafts in the Senate but no single set of proposals to consider. The absence of a final bill to consider has led to rumors and fear.
Nonetheless, we will examine the effects of those proposals we consider most likely to be enacted. First though, we will examine the reasons for the calls for healthcare changes and clarify some concepts.
Consider a moment, how would you rate healthcare in the United States? The cost of healthcare compared to the rest of the world? The cost of healthcare compared to other developed nations? The availability of healthcare in the United States?
The United Nations ranks the relative healthcare quality of all nations by measuring a broad range of statistics, services and results. The United States ranks 37th according to the United Nations rating model, the lowest of all developed nations except for South Africa.
For the year 2007, healthcare in the United States averaged $7290 per person. The average annual cost of health insurance in the United States for a family of four without employee or government subsidy is $12,680.
In France, that cost per person was $3601, the United Kingdom $2992, and Italy $2686. Nations with smaller populations, such as Luxembourg and Belgium also spent less per capita than the United States, but by not such a wide margin. Yet each nation enjoyed a higher and broader level of healthcare services than the United States. Similar disparities between the United States and other developed nations extend across the globe, from Peru to Sweden to Japan.
Determining the number of uninsured citizens is difficult. Analysts range from a low estimate of one in every seven Americans being uninsured to the highest estimates of one in five not have access to insurance. While estimates range from 21 million to 60 million uninsured, most analysts use a figure of around 44 million. These numbers do not include illegal immigrants.
Basically, there are four types of healthcare systems used throughout the world.
1. In most third world and poor nations, care is provided to those who can afford it; the rest suffer.
2. In Canada, private doctors and hospitals are paid by a single-payer, the government, financed by taxes.
3. In the British system, the government employs the healthcare providers and supplies the infrastructure and finances the system through taxes.
4. In Germany, hospitals and insurers are private companies and are financed from payroll deductions.
The United States uses all four systems in varying degrees.
1. The American Medicare program is similar to the Canadian system.
2. The Veteran's Administration is modeled after the British healthcare system.
3. Employer-funded programs resemble the German system.
4. Public hospitals are morally, ethically, and usually legally obligated to treat the seriously ill. The financial burden of paying for the poor, whether working or unemployed, usually falls on the state or local government, often through a Medicaid program. Medicaid is for the financially poor, Medicare is for the elderly.
Many fear that healthcare reform will lead to socialized medicine. To define, socialized medicine is direct government financing and direct government supervision of healthcare services. The Veterans Administration that provides care for veterans and soldiers would be the United States example of socialized medicine.
Except for Medicare and the Veterans Administration system, the United States does not have national health insurance available to all citizens.
Traditionally, each state has its own insurance regulatory agency that promulgates rules that usually favor one insurer over another. Therefore, in many regions of the country, few health insurer choices exist. In 26 states, one insurer covers 50% or more of the residents. The largest metropolitan areas often have eight or more choices of insurers.
Employee-based insurance plans usually offer s one choice of an insurer, or the company is self-insured. Those seeking health insurance are effectively banned from shopping across state lines, and cannot carry their insurance with them if they move to a different state.
The "public option" is a controversial Federal insurance program that is being considered to be included as a central feature of healthcare changes. The advantages of such a program would be national coverage, portability, and broad-based membership that would provide competition to private insurers.
The fear of the "public-option" insurance is that such a program would be too costly for the government to implement, that it would imperil private insurers and lead to a single-payer socialized medicine model of healthcare. Lacking details of a passed bill, it is impossible to accept any any estimates of costs or cost savings as accurate. Without doubt, some supporters of "public-option" prefer a single-payer model for healthcare. Enacting a "public option" insurance plan need not inevitably lead to a single-payer system.
Other budgetary impacts of a healthcare bill are likely to include an expansion of both Medicare and Medicaid, subsidies for the indigent and the working poor to buy Federal insurance and new taxes or fees to fund the programs.
Additional likely changes would include health insurance being mandatory for every citizen, prohibiting the denial of services because of pre-existing conditions and the removal of caps on lifetime benefits. Coverage of addiction services and mental illness is likely to expand.
We have intentionally skipped mention of some programs that we consider as unlikely to be passed, such as a national non-profit co-op program and an all-ages Medicare system.
Next, we will start inspecting the likely effects of a healthcare bill on you and your family by focusing on a very untypical typical American family.
If you work as a nanny please take the survey so your input can be included in our October 2009 issue of Be the Best Nanny Newsletter, by clicking here.