The question of whether the government should get in the health insurance business will be debated fiercely in coming months as President Obama and some Democratic lawmakers push for the creation of a government-run plan to compete with private insurance companies. But the federal government is already in the health insurance business, providing coverage to more than 45 million elderly and disabled people through Medicare. And Medicare's record offers insights into the benefits and pitfalls of public healthcare.
As President Barack Obama pushes to overhaul the American healthcare system, the role of government is at the heart of the debate. In Europe, free, state-run healthcare is a given, but the system is far from perfect. In Britain, France, Switzerland and elsewhere, public health systems have become political punching bags for opposition parties, costs have skyrocketed and in some cases, patients have needlessly suffered and died.
Should a 97-year-old man undergo an expensive, dangerous open-heart operation to repair a lethal tear in a main artery of his heart? No, concluded the patient, Michael DeBakey, the world-famous cardiovascular surgeon who pioneered the operation. DeBakey's dilemma has become increasingly ordinary. Age is no longer the deciding factor, even for invasive treatment such as open-heart surgery. A more basic question is whether this never-too-old approach is an example of U.S. medical progress, or an example of why Medicare is headed for insolvency.
Desperate to find ways to pay for a healthcare overhaul that could cost more than $1 trillion over the next decade, Congress has begun to look at limiting the tax exclusion on employer-sponsored health benefits, which cost the federal government an estimated $225 billion in foregone tax revenue in 2008. Ending the tax break entirely is out of the question politically, but the Senate Finance Committee is likely to propose limiting it in some fashion—by requiring people with the most expensive insurance, or the highest incomes, or both, to pay some taxes on their health benefits.
Tens of thousands of Massachusetts patients who grapple with some of the most intractable mental health problems should face fewer barriers to treatment under a state law that went into effect July 1. But the cost of the state's latest healthcare expansion remains an open question. The expansion also illustrates two of the most pressing issues in healthcare today: equality for mental health services and the price tag for expanding medical care.
Across the country, activist groups on each side of the healthcare debate stepped up their campaigning while members of Congress were home for the Fourth of July recess. In Maine, there are moderate Republicans who could provide crucial support for the Democratic healthcare plan expected to emerge in the coming weeks, and efforts to sway their votes were intense.