(HN, March 27, 2012) - As the US Supreme Court takes up a controversial healthcare reform bill - the signature campaign issue of President Barack Obama's 2008 election promises - the fate of US citizens healthcare system remains in the hands of just 9 people.
After two days of hearings at the high court where lawyers on both sides are presenting arguments, the Justices appear closely divided along ideological lines with the majority of questions to the Obama administration's lawyer being about whether Congress had the power to require people to buy medical insurance; the main sticking point of the law.
The court will hear a third and final day of arguments on Wednesday. 26 of the 50 states and a small-business trade group are challenging a law they say would essentially define where the limits would be on US federal power if people opposed to insurance were forced to buy coverage.
The court's ruling on the insurance requirement, which takes effect in 2014 according to current law passed by the US Congress in 2010, could decide the fate of the massive multi-part healthcare overhaul meant to improve access to medical care and extend insurance to more than 30 million Americans.
Outside the venerable Washington, DC courthouse, thousands of people demonstrated for and against the law which many in US politics call "Obamacare". After the three day presentations, the Court is scheduled to take some time, and release its decision on whether or not the law is constitutional sometime in late summer; making the healthcare issue a central campaign theme again in November 2012 US presidential election.
A hard fought US Republican candidate race has been playing out for months between former US state of Massachusetts Governor Mitt Romney, former US House of Representatives Speaker Newt Gingrich, former US Senator Rick Santorum, and US Congressman Ron Paul - all of whom have significant professional experience with the healthcare issue.
But for the US public, the physicians community, and the American insurance industry the delay in deciding where the healthcare system is going is troubling and for many, means the - expensive - difference between life and death.
The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Annual U.S. healthcare spending totals $2.6 trillion, about 18% of the annual GDP, or $8,402 per person according to the US Department of Health and Human Services.
A New York Times/CBS News poll showed that a narrow majority of Americans oppose the individual mandate, 51% to 45%, but strongly supported other provisions of the law covering pre-existing medical conditions and allowing young adults to stay on their parents' health insurance plans. Roughly 15% of Americans lack insurance coverage, a factor in life span which contributes to an estimated 45,000 deaths a year.
HEALTHCARE IN OTHER COUNTRIES
In other countries, the decision to create a universal or government supported health care system has been an easier one, long decided upon.
32 of the 33 developed nations of the world have universal health care, with the United States being the lone exception. The following list, compiled from World Health Organization sources, shows the start date and type of system used to implement universal health care in each developed country; and a `universal health care plan' can mean having both public and private insurance and medical providers.
These are in order of date of system: Norway, 1912, Single Payer; New Zealand, 1938, Two Tier; Japan, 1938, Single Payer; Germany, 1941, Insurance Mandate; Belgium, 1945, Insurance Mandate; United Kingdom, 1948, Single Payer; Kuwait, 1950, Single Payer; Sweden, 1955, Single Payer; Bahrain, 1957, Single Payer; Brunei, 1958, Single Payer; Canada, 1966, Single Payer; Netherlands, 1966, Two-Tier; Austria, 1967, Insurance Mandate; United Arab Emirates, 1971, Single Payer; Finland, 1972, Single Payer; Slovenia, 1972, Single Payer; Denmark, 1973, Two-Tier; Luxembourg, 1973, Insurance Mandate; France, 1974, Two-Tier; Australia, 1975, Two Tier; Ireland, 1977, Two-Tier; Italy, 1978, Single Payer; Portugal, 1979, Single Payer; Cyprus, 1980, Single Payer; Greece, 1983, Insurance Mandate; Spain, 1986, Single Payer; South Korea, 1988, Insurance Mandate; Iceland, 1990, Single Payer; Hong Kong, 1993, Two-Tier; Singapore, 1993, Two-Tier; Switzerland, 1994, Insurance Mandate; Israel, 1995, Two-Tier.
Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.
Two-Tier: The government provides or mandates catastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.
Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals, and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.
---HUMNEWS, with research from WHO, Wikipedia, NatGeo.