Reflexões e revelações sobre a reforma da saúde nos EUA

Apesar de ser falso dizer que havia americanos que não tinham acesso a cuidados de saúde – o estado de Massachusetts, por exemplo, já permite um acesso universal à saúde, pagando as despesas dos mais pobres – a verdade é que mais de 30 milhões de norte-americanos apenas tinham acesso aos cuidados primários que, em muitos casos, não são suficientes para combater as doenças responsáveis pela sua ida ao hospital. Vícios de um sistema de saúde privado.

Com a aprovação no Congresso da legislação definida pelo Senado, apesar de algumas alterações, no prazo máximo de quatro anos os Estados Unidos vão juntar-se ao clube das nações industrializadas que permitem o acesso (quase) universal (5% dos americanos ficam de fora desta reforma) aos cuidados de saúde.

A CNN escolheu um grupo de comentadores de diferentes quadrantes políticos para darem a sua opinião sobre a aprovação da lei. Quase geral é o consenso de que é preciso reformar o actual sistema de saúde. Existem, no entanto, algumas dúvidas sobre se este é o melhor caminho. Aqui ficam algumas das reflexões de comentadores e pessoas ligadas à saúde nos EUA.

The reality is that even though the vote is over, the fight over health care reform is not. Opponents, including the attorneys general of several states, are expected to file lawsuits asking the courts to declare the bill unconstitutional. The anger of conservative activists has been stirred to fever pitch — witness the spitting at Rep. Emmanuel Cleaver or slurs directed at Reps. John Lewis and Barney Frank during Capitol Hill protests Saturday — and it will not go away any time soon. At a time when some people feel like losing an election is living under tyranny, the passage of this health care reform bill has taken on significance far beyond the legislation itself.

Most Americans agree there are problems with the current health care system, but despite this diagnosis we cannot agree on a cure. Sunday’s party-line vote is the latest sign of a divided Washington where concepts like common ground and the common good don’t seem to drive political debates. This historic win will be followed by even more discord in D.C. John P. Avlon, comentador.

Although it’s worth celebrating that the United States is close to joining the rest of the industrialized world in providing near-universal health coverage, the health reform conversation must continue — both to improve the plight of injured patients and to ensure that the millions of newly insured have access to quality primary care. Kevin Pho, médico.

Doctors and hospitals are going to be paid less for services. Forty-six cents out of every dollar spent on medicine is paid for by you the taxpayers. Just know you’re going to pay more.

Small and large businesses are going to have to pay more for their employees’ health insurance plans. And every American is mandated to have health insurance whether we want it or not.

The elderly on Medicare will see their benefits changed dramatically. The biggest item being used to pay for the new program is more than $500 billion in cuts to the Medicare program at a time when 72 million baby boomers become eligible for it in the next decade. The second biggest move to pay for this is by raising and expanding the Medicare tax.

It is true some Americans will benefit. By 2014, according to the Congressional Budget Office, this bill will give 19 million uninsured Americans subsidies averaging $6,000 to help pay premiums and other medical charges. This is in addition to the federal government already picking up the tab for nearly 100 million Americans through Medicare (the elderly) and Medicaid (the poor, disabled and many children).

The smart people in D.C., including the president and the speaker will be long gone (as well as a bunch of Democrats who will lose in November) when the debts come due. But our children and grandchildren will be left with the tab. Ed Rollins, jornalista.

Thanks to Nancy Pelosi and a majority of Congress, millions of moms and dads will have access to quality, affordable health care for themselves and their children. An estimated 32 million people will be able to rest comfortably knowing that they are no longer a flu away from foreclosure because they lack health insurance. All of us can sleep a little better knowing that pre-existing conditions no longer preclude affordable health insurance. These are major victories.

This was a tough vote and an emotional debate. We can’t let our exhaustion limit our celebration. We haven’t had a major health care reform in nearly 50 years. What Congress accomplished this week is worth celebrating. Donna Brazile, estratega do Partido Democrata

The health care bill is a regulatory bill in this vein; it is not a social insurance bill like Social Security pensions or Medicare. It restrains the previously unchecked prerogative of the insurance corporations (like the railroad companies a century ago) to rig the market in their favor.

Both employers and insurance companies fought the passage of Social Security, lobbied for special exemptions and floated doomsday scenarios. Yet once it passed, business corporations quickly adapted. Indeed, the insurance companies decided Social Security was a tremendous boon to the sale of private insurance. Jennifer Klein, professora de História Americana na Universidade de Yale

To picture their impact, imagine a government-run automobile dealership that sells cars made by Ford, Kia and other private firms, along with government-manufactured vehicles. Legislators offer voters generous subsidies, but only if they buy cars in the government-market. All the cars are virtually identical, designed by the legislature with dubious high-cost features. Legislators might, for example, cater to lobbyists from companies that make heated seats by requiring them in every car. (Remember that the health care legislation was strongly supported by the hospitals and the American Medical Association, which will surely want something in return.)

Nevertheless, the price of the high-cost government manufactured cars could be artificially reduced by passing some of their costs to future generations through unfunded deficits. Private competitors that cannot resort to deficit financing will thus be driven out of business. Ultimately, high-cost cars and absence of entrepreneurs and competition will skyrocket costs and force government to ration cars.

Although government rationing can squeeze out some inefficiency, it is hardly benign or equitable: The single-payer UK national health system, for example, has the lowest adoption of cancer drugs among the biggest five European economies and correspondingly low cancer survival rates. Many of the UK’s affluent buy private insurance to avoid government stringency, such as those in other European government-controlled systems.

Of course, we must reform health care. But the present bill will inevitably increase costs, further weakening our economy. Tragically, although it will expand insurance coverage, it will ultimately result in rationed medical care for its beneficiaries. Regina E. Herzlinger, professora na Harvard Business School

But the perhaps less satisfying reality is that we will continue muddling along, doubling the wager while decreasing the odds that private sector innovation will keep on producing enough surplus cash to pay for public sector mistakes.

Our new health care system will certainly be much more expensive than shamelessly advertised. Some people happy with their current health plan will wake up one day to see that it no longer exists. But there will be no telegenic apocalypse, no collapse of the public finances. Instead, there will be a daily drip of deterioration, sporadically rupturing into crises and even bankruptcies on the state and local level, followed by more federal bailouts and a steady establishmentarian drumbeat of hiking taxes to cover “structural” budget deficits. Matt Welch, editor da revista digital Reason

Last week, I saw a 55-year-old truck driver who pleaded with me to discharge him from the hospital even though his face and scalp still bore clear signs of an active staph infection. For a decade he has had recurrent staph infections exacerbated by diabetes — yet could not afford insulin or a doctor because he lacked medical insurance. Now he begs me to let him leave, so that he will not go bankrupt from his medical bills.

I turn to his wife who says, “I am lucky. I have metastatic breast cancer, and I am covered by Medicare.”

One of every 10 patients I see do not have health insurance.

I see the uninsured patients, but then make up for my losses by increasing my charges to all my patients. The cycle continues: Insurers increase premiums, choking small businesses that then drop health coverage for their employees, leading more uninsured to come to my practice.

Not providing insurance is not free; the annual health care expenditure for an uninsured adult is $1,800, according to a Kaiser Foundation study in 2004.

And there is a downside to having nearly 50 million uninsured people in America. I look them in the eye, and I know this for a fact. They will die sooner. In my opinion, lack of health insurance is a chronic illness. Manoj Jain, médico.

What is clear — our health care system is terminally ill. Bold leadership is needed to redirect precious resources. Unfortunately bold leadership is just as scarce as precious resources.

There will be no new access to health care if we do not have physicians to provide it. We must reverse the trend that sees thousands of physicians leaving primary care. Bold leadership is needed to get the brightest minds back into one of the most challenging and demanding roles. We need motivated empowered physicians with a passion for health and the ability to care for a whole landscape of disease. We must treat decisively when possible, not just shuffle everyone down the road to a specialist.

Give us five more minutes with patients to deal with a second or even a third problem so they don’t access the system twice. Give us five minutes of straight talk about the impact of lifestyle on their health. Without this, I default back to putting out fires and I write another prescription.

We need “Health” Reform not just Sickness Access Reform. We are not a healthy nation. Our indulgent lifestyle of overeating and under exercising is rapidly filling the beds needed for treating disease we can’t prevent. This is exactly why we have a “Sickness Care” system. However, having the resources to treat sickness is dependent on true health care. Vance Harris, médico do Serviço de Urgência

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