Healthcare reform passes!

The Senate today - Christmas Eve – passed the healthcare reform legislation under debate since Obama took office. Now the Senate and House must reconcile their separate bills, pass that piece of joint legislation, and send it to the President for signature before this historic move becomes law.

However, reconciliation and passage seem likely. The law will almost certainly extend healthcare coverage to millions of Americans not covered now. This is truly a Christmas gift for the nation.

However, the final law, whatever its form, will contain many imperfections. Not all Americans will have guaranteed access to healthcare coverage. Bureaucracy is likely to expand. Private health insurance companies seem posed to reap record profits. Healthcare in the United States will remain the world’s most expensive with less than stellar results. In other words, much still must be done to ensure that all Americans receive the best possible healthcare at an affordable cost. Nevertheless, refusing to support healthcare reform because of its imperfections, known and unknown, as has every Republican in the Senate, is wrong. Progress is always incremental and the current effort is no exception.

Decisions about healthcare are fraught with uncertainties and unknowns. UCLA‘s teaching hospital perennially ranks at the top of the lists for both quality of care and most expensive end of life care but achieves no better than average results. UCLA doctors struggle to determine which patients will respond to leading edge but expensive care. (Reed Abelson, “Months to Live - U.C.L.A. Medical Center at Heart of End-of-Life Debate,” New York Times, December 22, 2009)

A hidden reality of the US healthcare system is that the system de facto rations such care today. Patients at UCLA have access to treatments not available at all medical centers. Patients who do not reside in the UCLA service area but who have substantial personal financial resources can purchase care there, or at other leading medical centers (the Mayo clinic, Sloan-Kettering, etc.). People with no money, though perhaps better candidates for some of these treatments, must accept the care provided in their local area.

This makes no sense to me, especially as I reflect on the birth of a baby to Mary and Joseph. That child, like the rest of us, had no say in the locale or time of his birth. Yet our parents, more than any other factor, determine our economic fate in life. Examples of poor who become exceptionally wealthy notwithstanding, the greatest determinants of one’s economic future are the identity and economic status of one’s parents, factors over which no child has control. So why should a nation ration healthcare based on ability to pay?

The Senate’s historic action today represents an important step away from that immoral policy with its ignored and ignoble premise that some are created more equal than others (i.e., the rich are more equal than the poor).