U.S. health care policy debate comes down to expectations, cost and access

By Mike Porter

To better understand the ferocity of the debate over health care policy reform in the United States is to first consider the “national psyche” about health care, according to a Virginia Commonwealth University professor with more than 20 years of health care policy experience.

Americans expect a health care system that offers individual choice, favors free enterprise over government involvement and grants access to the latest medical technology, says Carl Ameringer, Ph.D., professor of health policy and politics, and coordinator of the graduate program in Public Administration in VCU’s L. Douglas Wilder School of Government and Public Affairs.

“The majority of Americans are happy with what they have,” Ameringer said. “And they fear or are very concerned about losing what they have.”

But Ameringer says a health care “status quo” isn’t financially sustainable because increasing costs are making it harder for employers and employees to purchase health insurance at affordable rates. 

“The rising costs of health care restrict access because people cannot get insurance at a reasonable price,” Ameringer said. “And once premiums go up, then people are unable to afford insurance and we end up with more people without insurance.”

Opponents in the debate even disagree on the actual number of Americans without health insurance, which is estimated in the tens of millions.  

“We don’t want to deny health care to anybody – whatever our collective psyche is.  And so, I think people would like to see costs get under control and would like to do something about people who don’t have access to insurance in this country.  And I think that’s what spurs the reform effort,” Ameringer said.

While details seem to change quickly, Ameringer says the basic framework as proposed by the Obama Administration and by Congress remains intact and builds on existing health care programs, rather than a government takeover as some people fear.

“I think it’s viewed by the larger population as a complete overhaul of health care administration, while what’s being touted is an incremental approach,” Ameringer said. “Programs already in existence such as Medicare and Medicaid, especially Medicaid, and the children’s health insurance programs in the states can be expanded to cover more people.”

Ameringer says another way of covering more people is through an insurance network or insurance exchange as pursued by the state of Massachusetts. 

“And the notion of an insurance exchange is to have a competitive environment where individuals who lack insurance can purchase it from private carriers and perhaps even a government-run program, which of course is the one that raised concerns of folks across the country,”  Ameringer said.

He says that in Massachusetts, a sliding scale allows people to buy insurance, an idea which could be expanded nationwide if an insurance exchange idea is approved.

Criticism comes largely from two fronts; people who oppose the administration politically and free market economists who say a national system of health care could be achieved with less government interference.

Ameringer served as Assistant Attorney General and deputy counsel to the Maryland Department of Health and Mental Hygiene, participated on Governors’ Task Forces in Maryland and Wisconsin, and consulted for the University of Maryland School of Law. He also has testified on numerous occasions before the Maryland State Legislature.

He wrote “State Medical Boards and the Politics of Public Protection”and “The Health Care Revolution: From Medical Monopoly to Market Competition.”