Aug 022012

From Hillary-care to Obama-care

By Cannon-Marie Green Milby

On October 4, 1957, the U.S.S.R. sent Sputnik, the first rocket-powered satellite, into orbit. The U.S. had been beaten to the punch and now feared that it was no longer number one in technological advances. In the weeks that followed, Newsweek warned that, unless the West stepped up its scientific development, Russia would be ahead in almost all fields in a few years. The U.S. Office of Education also published a study showing that Russia outranked the U.S. in every aspect of scientific and technological education. American education underwent a makeover, and the 22 million children born in the U.S. between 1946 and 1951 found themselves with the weight of the free world on their shoulders.

Fifty-five years after Sputnik, the children from 1957 have grown up and now represent the largest aging population the American health care system has ever faced. The United States leads the world in health care spending, which takes place within a system that excludes people from basic health insurance coverage on the basis of pre-existing conditions. Though the reasons may be different from the early days of the Cold War, the need for advancing science—and strong science education—is as urgent today: we will not solve the health crisis in the U.S. without it. However, in 2009 American students ranked twenty-fifth in the world in science and math.

Innovative science won’t fully address the looming health care crisis, though. We also need better public policy about heath care.

In 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The PPACA is federal health care reform legislation that increases health insurance coverage to all Americans, incentivizes preventive health care, and is expected to reduce the projected federal deficit over the next 11 years. The law is polarizing, though, and lawmakers on the state and federal levels are using partisan politics to intentionally derail heath care reform. Outside the media attention on these fights, fundamental changes are occurring as a result of the PPACA and actions taken in the private sector. This tug of war creates massive uncertainty about what heath care reform will look like and how we can make it happen. It also makes it easy to forget that American families and employers absolutely need access to more affordable health care. 

The push for health care reform is not new. In 1993, the Clinton Administration proposed a heath care reform plan that would achieve near universal coverage for Americans. Not unlike today, health care reform was a polarizing issue, despite the threat of rising health costs for American businesses in world markets, coverage systems that penalized and discriminated against people who needed health care, and the heavy burden on hospitals giving free medical care to the uninsured. The backlash against the plan was so severe that health care reform was swept under the rug, and as this happened, Congress repealed the Glass-Steagall Act, which deregulated banks and heavily contributed to the 2007–2012 global financial crisis. Millions of Americans lost their jobs and health insurance, and in 2007, 62 percent of all personal bankruptcies were medical.

Numbers, not rhetoric

If one looks to the numbers, not the rhetoric, about health care needs and costs, it’s clear that the formula of “fee-for-service” is flawed; this approach costs more and more as acute episodes and chronic diseases increase. In the big picture right now, paying more is actually getting the nation less. Less money in governmental coffers, less in individuals’ and family’s pockets. We are treating emergencies rather than solving problems, and creating more disparity in health care and insurance coverage, which exacerbates pre-existing social and economic disparities rooted in health.

The national numbers are almost too big to grasp. From the year of the Clinton health care reform proposal, 1993, to 2010, the annual national health expenditures increased from $921.5 billion to $2,593.6 billion.  According to, a project of The Kaiser Family Foundation (KFF), in 2010 the U.S. spent $389,084,333,952 on Medicaid and $11,653,301,427 on Federal Medicaid Disproportionate Share Hospital (DSH) Allotments, which help hospitals that serve a disproportionate number of low-income patients. In 2010, 29 percent of Americans had coverage through programs like Medicaid, Medicare, and other publicly funded programs.

The cost to insurees and employers isn’t any less serious, pushing the numbers of privately insured individuals down. also reports that only five percent of Americans elect, or can afford, coverage through the individual market, which had an average cost of $2,580 in 2010. Premiums for employer-sponsored health insurance coverage, depending on whether coverage is single, family, or plus-one, ranged between $1,090 and $3,692 per year for employees. Employers paid between $4,132 and $11,060.
And then there are those who fall outside coverage. They end up with empty wallets, and the government and providers with a huge bill. According to KFF, 16 percent of Americans were uninsured in 2010. The cost of being uninsured to individuals, families, and employers is a significant part of national health expenditures. According to a KFF report in October 2011, uninsured individuals and families pay for about one-third of their care out-of-pocket, totaling $30 billion in 2008. Federal, state, and local funds paid 75 percent of the remaining balance of $57 billion for uncompensated care.

While we are spending staggering amounts on health care, as individuals and as a nation, we are still losing the fight against chronic disease and the damage it does to families and the economy. And because costs are increasingly pushing health care coverage out of reach, being uninsured has become the status quo for too many Americans.

The end result is even more damage to the economy as the poorer health and shorter lifespan of the uninsured result in losses to the economy up to $207 billion. Each year, chronic illness accounts for about 75 percent of heath care expenditures and results in lost productivity in the workplace totaling more than $1 trillion.

The weight of the issue

In addition to increases in annual national health expenditures and the number of uninsured Americans, failing to reform health care twenty years ago has another legacy: one of the most pressing health issues the U.S. faces today—obesity. The Centers for Disease Control and Prevention (CDC) estimates that since 1993, when the Clinton heath care plan was introduced, there has been a dramatic increase in obesity. In 1993, we had the highest obesity rates we’ve ever seen—at 15 to 19 percent, but that was only in 12 states. By 2010, every state had obesity rates that exceeded 20 percent. In fact, 12 states had rates greater than 30 percent. reports that nearly one-third of American children are overweight or obese; in 2009, 10 percent were uninsured and 34 percent were enrolled in Medicaid. This increased prevalence of obesity is responsible for almost $40 billion in increased medical spending between 1998 and 2006, including $7 billion in Medicare prescription drugs. Haomiao Jia, PhD, and Erica I. Lubetkin, MD, MPH have found that “[t]he overall health burden of obesity among U.S. adults has increased consistently since 1993.” We cannot afford the social or financial cost of refusing to reform heath care.

The U.S. needs a heath care system that reduces the burden, social and financial, of health status. This is particularly important as it relates to children and the future of the American economy. To make reform tangible to stakeholders, the country needs a location that can be the national model of health care restructuring and development (from the payment for and delivery of health care, to educating a new generation of health care professionals). This location is Lexington, Kentucky.

In part two of this series, Cannon-Marie details the ACA and argues Lexington is especially well positioned to utilize the ACA to benefit Kentuckians.


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