Barriers to More Healthcare Reform Are Numerous
Apathy and fear are among the biggest stumbling blocks, experts say.
WASHINGTON -- The lack of greater movement toward universal healthcare coverage -- especially a single-payer system -- in the U.S. can be boiled down to four letters: AFIG, according to Philip Caper, MD.
The "A" stands for Apathy, Caper said Wednesday during a briefing on barriers to healthcare reform sponsored by the National Academy of Social Insurance (NASI). Caper is with Maine AllCare, an organization devoted to getting universal healthcare in Maine.
The attitude of many people is "'I've got mine; why should I worry about anyone else?'" said Caper, a founding member of NASI, whose mission is to increase public understanding of how social insurance contributes to economic security.
"Or think of young invincibles, who think it's worth the risk to go uncovered," continued Caper, who was speaking by phone from Maine. "Perhaps apathy is the result of our emphasis on personal liberty and personal responsibility."
The "F" stands for fear, Caper continued -- "fear of change; the fear of losing coverage they already have; or the fear of loss of income or profitability" on the part of those working in the healthcare industry.
"I" is for ignorance, he said, making it clear that he was not equating ignorance with stupidity, rather a lack of information and understanding. "Most Americans don't understand the healthcare system and don't understand there are better ways of financing this," Caper said.
"I definitely include doctors in this group," he added. "I can tell you from personal experience that it's almost impossible to get health policy into the medical school curriculum, where the focus is rightly on clinical medicine."
And finally, there is the "G" -- for greed. "This may seem harsh [but] the widely accepted view of healthcare as just another business is uniquely American, at least in degree," he said. "I have heard some people say the healthcare system is becoming a wealth extraction machine. This view is reinforced by news stories of opportunistic pricing of drugs for chronic diseases such as hepatitis."
Satisfied With the Status Quo
Another barrier to changing the way health insurance is delivered comes from the fact that many people are satisfied with their employer-provided health insurance, said Laurence Seidman, PhD, professor of economics at the University of Delaware in Newark.
"But they don't seem to realize two things," he continued. "First, what would happen if they lose their job? And second, [they don't realize] that the rising premiums for medical care that their employers are paying is a key reason why their wage and salary growth has been so low."
But at America’s kitchen tables, or more likely, at family computers, a different story is unfolding – and enrollment success stories are popping up in the places you’d least expect.
According to new data released by HHS, more than 9.5 million people had signed up for a Marketplace plan by January 18th. That figure does not include millions more enrolled in Medicaid. Given that the Administration’s own goal was 9.1 million enrolled, this year’s Open Enrollment period is looking quite rosy. One more sign of growing interest in health care: 42% of this year’s enrollees have selected plans for the first time on the federal Marketplace.
In states where elected officials tried to position themselves as skeptics of affordable health care during 2014 campaigns, their constituents have chosen to enroll regardless, indicating a shift in political tides.
In Florida, for example, Governor Rick Scott spent millions painting his opponent as an Obamacare supporter in his race for the Governor’s seat. Since then, Florida has led the nation in enrolling residents: 1.2 million Floridians have signed up for a plan. One zip code outside of Miami holds the record of the most enrollees in the country.
Other states where anti-Obamacare in past years ran deep, such as North Carolina, Georgia, Idaho and Virginia have also seen higher than average percentages of eligible residents sign up for coverage. In North Carolina, Senator Kay Hagan lost her seat after enduring millions of dollars worth of ads pillorying her support of the ACA. The state is now 6% above the national average in percentage of eligible residents enrolled. In Georgia and Kentucky, senatorial candidates Michelle Nunn and Alison Lundergan Grimes refused to even say whether they would’ve voted for the law for fear of being tied to it. Despite their reluctance, both still lost their elections. Now, both states have seen above average enrollment percentages.