October 2nd, 2013 -- There is tumult in the USA over Obamacare or the Affordable Care Act (ACA) passed in March 2010. President Obama’s mission is to provide all Americans with high quality, accessible and affordable health coverage regardless of pre-existing condition, social or medical.
Republicans, in the main, are not happy. With the contending ideas boiling over in the US media, Kittitians and Nevisians are undoubtedly taking notice and making comparisons to local health care set-up.
Obamacare is designed to operationalize Universal Coverage i.e. guaranteeing access to health care services based on need. Will it succeed? The devil is the details and the unintended consequences such as increases in insurance premiums forcing employers to shift workers from full-time to part-time status. Naysayers are protesting that rather than helping poor people, Obamacare is hurting working people.
The President is standing his ground. There is unfairness in US healthcare. 15% of the population has no medical insurance. Affected persons invariably use emergency rooms for primary care rather than community health centers and private doctors. The consequences include overcrowding and long waiting times.
A landmark Institute of Medicine report in 1998 estimated up to 100, 000 deaths due to medical error. Paying for medical bills is the leading cause of personal bankruptcy with 2 million affected persons last year.
There is a bigger picture. Total health expenditure in the US accounts for 18% of GDP compared to 8 – 10% in Canada, Western Europe, Japan and Australia; and 6% in the St. Kitts and Nevis. Despite having the highest health expenditure in the world, the USA is ranked # 27 in health outcomes using the standard health system measures such as life expectancy and infant mortality.
A St. Kitts and Nevis - USA comparison is illustrative. In total, people in the Federation spend USD 900 per person per year for health care. The USA spends ten times that amount yet health outcomes are similar: life expectancy is 75 years in the Federation versus 80 years in the US; the infant mortality rate for African-Americans is the same as that for St. Kitts and Nevis (12 infant deaths for every 1000 live births).
Hence, in St. Kitts and Nevis, Universal Coverage has existed since the 1950’s compliments the taxpayer. Every resident is literally within ten minutes crawling distance of free care in a community health center.The Federation’s two hospitals are government-owned and there are no status barriers to receiving care.
Interestingly, Universal Coverage is now a cause célèbre in global health and development quarters. “Health policy experts” on C-SPAN, BBC and CNN are trumpeting features such as community health centers. Kittitians and Nevisians can safely say: “Been there, done that”. Access is based on need.
Will Obamacare succeed? Not if the Republicans have their way. They are vehement: it is the marketplace not government that will deliver the innovation and efficiency solutions. The evidence from around the world is that compassionate and progressive government policy is critical pre-requisite of Health for All. Only the government has the wherewithal to ensure the equitable distribution of national resources that ultimately redound to favourable health outcomes such as high life expectancy.
In St. Kitts and Nevis, 32% of the population has medical insurance and government is finalizing a plan to cover the remainder of the population. Obamacare is the means to the same end but is stonewalled by the representatives of people.
President Obama says he is not backing down – he too represents people. The Republicans will have to yield because, just as in St. Kitts and Nevis, health care is very dear to people’s hearts, minds and votes. Indeed, all politics is local.
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