Healthcare Debate: Preexisting Conditions Back on the Table
This month, the Trump administration signed onto a lawsuit that would overturn certain sections of the Affordable Care Act requiring insurers to cover preexisting conditions rather than charging more for them, triggering more discussion surrounding the healthcare debate. The Act was signed by former President Obama in March 2010 in an effort to reform the healthcare system in the United States.
Changes to the tax code over the years have created enticing incentives for companies to provide health coverage as a benefit to workers. Now most Americans get their insurance through their employer, and, quite often, health insurance is thought of as a benefit that comes with a job (unless one cannot sustain one). Medicare coverage came into effect for the older population in 1965, and Medicaid came into the picture the same year, extending benefits to those who were low-income and found it difficult to work due to a disability or certain life circumstances.
Then the Affordable Care Act aimed to open up the insurance market to anybody who wanted coverage. It created a marketplace where middle-income individuals could shop on their own for private health coverage, and it simultaneously extended Medicaid to millions of low-income Americans.
The latest move by President Trump forces Americans to revisit the age-old debate concerning whether health insurance is a privilege or a right. Writer, surgeon, and public-health researcher, Atul Gawande reported on this issue last year and found there is still a great divide between the two ways of thinking.
One woman he interviewed, a librarian named Monna, said, “If you’re disabled, if you’re mentally ill, fine, I get it. But I know so many folks on Medicaid that just don’t work. They’re lazy.”
Another interviewee, Joe, added, “I see people on the same road I live on who have never worked a lick in their life. They’re living on disability incomes, and they’re healthier than I am.”
As Gawande noted, “A right makes no distinction between the deserving and undeserving.”
He went on to report, “Medical discoveries have enabled the average American to live eighty years or longer, and with a higher quality of life than ever before. Achieving this requires access not only to emergency care but also, crucially, to routine care and medicines, which is how we stave off and manage the series of chronic health issues that accumulate with long life. We get high blood pressure and hepatitis, diabetes and depression, cholesterol problems and colon cancer. Those who can’t afford the requisite care get sicker and die sooner. Yet, in a country where pretty much everyone has trash pickup and K-12 schooling for the kids, we’ve been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that’s open to all.”
This is a solid point. What ultimately distinguishes between a privilege and a right, and how can Americans assume they have the right to access some of these things, but not others?
Gawande credited the long-ago repeal of the Vaccine Act as foreshadowing where society would eventually find itself. He wrote, “The repeal of the Vaccine Act of 1813 represented a basic failure of government to deliver on its duty to protect the life and liberty of all. But the fact that public vaccination programs eventually became ubiquitous (even if it took generations) might tell us something about the ultimate direction of our history—the direction in which we are still slowly, fitfully creeping.”
One thing’s for sure – no headway is likely to be made to solve this issue anytime soon. And, the debate may just go on forever.