6-12 December 2013 #684

Bringing Obamacare to Nepal

Dhanvantari by Buddha Basnyat, MD

MANDEL NGAN/AFP
IT’S OFFICIAL: US President Barack Obama signs the Patient Protection and Affordable Care Act into law during a ceremony at the White House on March 2010.
The healthcare needs of the US and Nepal are rarely spoken about in the same breath. But where health insurance is concerned, both countries find themselves in the same boat. Around 30 million Americans are not covered. Similarly, out of 27 million Nepalis, hardly anyone has health insurance.

While patients with critical illness or those involved in serious accidents receive emergency care even without insurance, for long-term ailments like cancer, heart disease, and other chronic care situations, proper insurance is mandatory in the US. An uninsured American in this sense is no different from a common Nepali patient.

Introduced in 2010, the Patient Protection and Affordable Care Act (PPACA) or ‘Obamacare’ was primarily an attempt to address health issues for the 30 million plus uninsured Americans. The main goals of PPACA were to improve the quality and affordability of health insurance and reduce the uninsured rate by expanding public and private insurance coverage. In order to be successful, the act required tremendous political will by both the Democrats and the Republicans.

However, much like our own polity, the US Congress is fraught with clannish and partisan behaviour and members as well as the general public remain deeply divided over the Affordable Care Act.A group of politicians has even gone as far as saying it will block Obamacare at any cost. Glitches in the computer system when Americans tried to enrol in the program, certainly did not help the current administration.

To outside observers and well-wishers of the US, the implementation of this bill looks like a no brainer. In comparison to other developed countries, America spends the most on healthcare and yet it lags far behind in delivering quality and affordable care to its average citizen.

The successful implementation of the Affordable Care Act will not only revolutionise healthcare in the US, but will be one of the most defining moments of Barack Obama’s presidency. Some analysts believe that if Obama is able to achieve this feat, it could even overshadow the fact that he is the first black president of the country. Earlier healthcare bills in the US such as Medicaid and Medicare (which only focus exclusively on certain groups such as the elderly) also underwent many tumultuous debates before they became law. Hopefully, Obamacare will follow a similar pattern.

Nepal, like the US, needs a universal healthcare insurance policy. Every day, across hospitals in the country, there are tragic stories of people losing their loved ones through illnesses like heart attack, kidney failure, head injury, and cancer. Even when trained and experienced healthcare professionals and state-of-the art facilities are available, the cost of treatment is beyond the reach of common citizens. Often, families are forced to sell land and jewelry just to pay the hospital bills.

When the 601 newly elected lawmakers sit down to write a new constitution for Nepal, it would be ideal if they could draft a universal healthcare insurance law into this all important document. Of course, this is easier said than done. The debacle over Obamacare in the US shows just how challenging an attempt at universal health coverage is.

The good news is that the government and health ministry are moving forward in the right direction. If our political leaders are able to ensure good quality, affordable healthcare for all Nepalis, whether rich or poor, they will be remembered for generations.

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