The United States Senate Committee on Finance approved aproposal to reform health care on Tuesday, clearing it to moveforward. The bill passed by a 14-9 vote, gaining support from thecommittee’s thirteen Democrats, and one Republican.

Senator Olympia Snowe was the only senator from the Republicanparty to back the bill. However, she said this might change as thebill moves through Congress.

“There are many, many miles to go in this legislative journey.My vote today is my vote today. It doesn’t forecast what my votewill be tomorrow,” Snowe said.

President Barack Obama, who supports the bill as part of hiseffort to overhaul the country’s health care system, welcomed thecommittee’s vote. “We are closer than ever before to passinghealthcare reform but we are not there yet. Now is not the time topat ourselves on the back – now is the time to dig in further andget this done. In this final phase we should engage with each otherwith civility and seriousness that has brought us this far and thatthis subject deserves.”

The bill, which contains a ten-year plan with an estimated costof US$829 billion, is aimed at lowering healthcare costs andincreasing the affordability of insurance. Proponents will now seekto merge it with another bill from the Senate Committee on Health,Education, Labor and Pensions. Senate Finance Chairman Max Baucusemphasized, “Americans want us to craft a package that will get the60 votes needed to pass.” He argued that the Finance bill was thebest candidate to attract needed the centrist support.

Critics, however, have said that the proposed plan is toocostly, and will cause the government to interfere too much intothe private healthcare sector.

“We can now see clearly that the bill continues its marchleftward,” said the senior Republican on the committee, SenatorCharles Grassley. “This bill is already moving on a slippery slopeto more government control of healthcare.”

 

From supporters:

* In most cases, people have little influence on whether or notthey will contract an illness. Consequently, illness may be viewedas a fundamental part of what it means to be human and, as such,access to treatment for illness should be based on acknowledgementof the human condition, not the ability to pay[11][145][146][147]or entitlement.[148] Therefore, health care may be viewed as afundamental human right itself or as an extension of the right tolife. [149]

* Since people perceive universal health care as free, they aremore likely to seek preventative care which, in the long run,lowers their overall health care expenditure by focusing treatmenton small, less expensive problems before they become large andcostly.[150]

* A universal health care system allows for a larger capitalbase than can be offered by free market insurers (without violatingantitrust laws). A larger capital base “spreads out” the cost of apayout among more people, lowering the cost to the individual.

* Universal health care would provide for uninsured adults whomay forgo treatment needed for chronic health conditions.[151]

* In most free-market situations, the consumer of health care isentirely in the hands of a third party who has a direct personalinterest in persuading the consumer to spend money on health carein his or her practice. The consumer is not able to make valuejudgments about the services judged to be necessary because he orshe may not have sufficient expertise to do so.[152] This, it isclaimed, leads to a tendency to over produce. In socializedmedicine, hospitals are not run for profit and doctors workdirectly for the community and are assured of their salary. Theyhave no direct financial interest in whether the patient is treatedor not, so there is no incentive to over provide. When insuranceinterests are involved this furthers the disconnect betweenconsumption and utility and the ability to make value judgments.[153] Others argue that the reason for over production is lesscynically driven but that the end result is much thesame.[154].

* The profit motive in medicine values money above publicbenefit.[155] For example, pharmaceutical companies have reduced ordropped their research into developing new antibiotics, even asantibiotic-resistant strains of bacteria are increasing, becausethere’s less profit to be gained there than in other drugresearch.[156] Those in favor of universal health care posit thatremoving profit as a motive will increase the rate of medicalinnovation.[157]

* Paul Krugman and Robin Wells say that in response to newmedical technology, the American health care system spends more onstate-of-the-art treatment for people who have good insurance, andspending is reduced on those lacking it.[158]

* The profit motive adversely affects the cost and quality ofhealth care. If managed care programs and their concomitantprovider networks are abolished, then doctors would no longer beguaranteed patients solely on the basis of their membership in aprovider group and regardless of the quality of care they provide.Theoretically, quality of care would increase as true competitionfor patients is restored.[159]

* Wastefulness and inefficiency in the delivery of health carewould be reduced.[160] A single payer system could save $286billion a year in overhead and paperwork.[161] Administrative costsin the U.S. health care system are substantially higher than thosein other countries and than in the public sector in the U.S.: oneestimate put the total administrative costs at 24 percent of U.S.health care spending.[162] It might only take one government agentto do the job of two health insurance agents.[163] According to oneestimate roughly 50% of health care dollars are spent on healthcare, the rest go to various middlemen and intermediaries. Astreamlined, non-profit, universal system would increase theefficiency with which money is spent on health care.[164]

* About 60% of the U.S. health care system is already publiclyfinanced with federal and state taxes, property taxes, and taxsubsidies – a universal health care system would merely replaceprivate/employer spending with taxes. Total spending would go downfor individuals and employers.[165]

* Several studies have shown a majority of taxpayers andcitizens across the political divide would prefer a universalhealth care system over the current U.S. system[166][167][168]

* America spends a far higher percentage of GDP on health carethan any other country but has worse ratings on such criteria asquality of care, efficiency of care, access to care, safe care,equity, and wait times, according to the CommonwealthFund.[169]

* A universal system would align incentives for investment inlong term health-care productivity, preventive care, and bettermanagement of chronic conditions.[150]

* The Big Three of U.S. car manufacturers have cited health-careprovision as a financial disadvantage. The cost of health insuranceto U.S. car manufacturers adds between $900 and $1,400 to each carmade in the U.S.A.[170]

* In countries in Western Europe with public universal healthcare, private health care is also available, and one may choose touse it if desired. Most of the advantages of private health carecontinue to be present, see also Two-tier health care.[171]

* Universal health care and public doctors would protect theright to privacy between insurance companies and patients.[172]

* Public health care system can be used as independent thirdparty in disputes between employer and employee.[173]

* A universal single-payer system would significantly loweradministrative costs. Multiple peer-reviewed studies estimate theadministrative savings alone from such a switch to be over $200billion.[174] Medicare has a 4% overhead compared to a 14%administrative overhead in private insurance.[175]

* In a private system, insurance companies may be motivated bymoral hazard to cancel the insurance policies of the sick, which iscalled rescission. Thus, unlike the situation under nationalcoverage, individuals find out that they have no health coveragewhen it is too late to do anything about it.[176]

From opponents:

* Health care is not a right. [12][177] Thus, it is not theresponsibility of government to provide health care.[178]

* Free health care can lead to overuse of medical services, andhence raise overall cost.[179][180]

* Universal health coverage does not in practice guaranteeuniversal access to care. Many countries offer universal coveragebut have long wait times or ration care.[51]

* Access to necessary emergency care is already guaranteed. Thefederal Emergency Medical Treatment and Active Labor Act requireshospitals and ambulance services to provide emergency care toanyone regardless of citizenship, legal status or ability topay.[181][182][183][184]

* Eliminating the profit motive will decrease the rate ofmedical innovation and inhibit new technologies from beingdeveloped and utilized.[185][186]

* Publicly-funded medicine leads to greater inefficiencies andinequalities. [12][185][187] Opponents of universal health careargue that government agencies are less efficient due tobureaucracy.[187] Universal health care would reduce efficiencybecause of more bureaucratic oversight and more paperwork, whichcould lead to fewer doctor-patient visits. [188] Advocates of thisargument claim that the performance of administrative duties bydoctors results from medical centralization and over-regulation,and may reduce charitable provision of medical services bydoctors.[177]

* Converting to a single-payer system could be a radical change,creating administrative chaos.[189]

* Unequal access and health disparities still exist in universalhealth care systems.[190]

* Steven Burd, CEO of Safeway Inc. has stated that 70% of healthcare costs are a direct result from behavior and are thereforepreventable. He believes that individualized rational actions andmarket methods can create healthy behavior, which could reduceUnited States health-care costs by 40%. [191]

* The problem of rising health care costs is occurring all overthe world; this is not a unique problem created by the structure ofthe U.S. system.[51]

* According to the Association of American Physicians andSurgeons universal health care is a planned economy and thereforecauses turmoil; causing governments to greatly increase taxes ascosts rise year over year, as universal health care is economicallyimpossible.[192] Acc As an open-ended entitlement, Medicare doesnot weigh the benefits of technologies against their costs. Payingphysicians on a fee-for-service basis also leads to spendingincreases. As a result, it is difficult to predict or controlMedicare’s spending.[190] The Washington Post reported in July 2008that Medicare had “paid as much as $92 million since 2000” formedical equipment that had been ordered in the name of doctors whowere dead at the time.[193][194][195][196][197] According toCentrists.Org large market-based public program such as the FederalEmployees Health Benefits Program and CalPERS can provide bettercoverage than Medicare while still controlling costs aswell.[198][199]

* Some commentators have opposed publicly-funded health systemson ideological grounds, arguing that public health care is a steptowards socialism and involves extension of state power andreduction of individual freedom.[200] Representative Anthony Weinerintroduced an amendment that would allow Republicans with anideological opposition to single-payer health care to vote toeliminate the Medicare Act.[201] Every representative on the HouseEnergy and Commerce Committee voted to keep the government-run,government-administered, single-payer Medicare system.[202]

* Universal health care systems, in an effort to control costsby gaining or enforcing monopsony power, sometimes outlaw medicalcare paid for by private, individual funds.[203][204]

* Some supporters of American health care reform oppose cappingthe ability of Americans to seek monetary damages and redress(“tort reform”).[205]

* Much of the opposition to current proposals stems from theconcern that they will lead to mandated abortion coverage orotherwise increase the number of abortions performed in the U.S.[206]