Essay 3

Protect Our Environment and Health by Keeping Our Community and Waterways Clean Today

Please come and help address our annual community clean-up needs on May 11 at city hall. Together we can host a gathering and find better solutions to the litter we pick-up every year. Let’s clean-up our community in a way that has never been done before in the past and establish environmental regulations of our own even within our households to combat illegal dumping and protect our environment. Although the City of Aleknagik has an annual clean-up drive for our roadsides we need to extend our clean-up bases because our natural lake beaches, wild creeks, and pollution in our lake need attention, too!

Did you know that you may have helped to eliminate or contribute to a cycle of trash that is twirling in the Great Ocean Pacific estimated to be the largest garbage dump in the world that measures from the coast of California to Japan and is 90 feet deep? Shocking, isn’t it? Believe it or not, it’s true. Fabien Cousteau refers to it as the “Great Pacific Garbage Patch.” Fabien’s famous grandfather Jacques Cousteau dedicated his life to protecting the world’s oceans and sea life (Cousteau). With this same sentiment, perhaps we as a community can work together and pull our resources to help clean our waterways before it becomes a health hazard to us and the animals we depend upon for survival.

We know our lake runs through the Woodriver system to Nushagak Bay and onto the Bering Sea which of course is part of the Great Pacific Ocean. The earth is covered by 70 percent of life giving water and includes our lake and river systems from our region in Alaska. The environment we live in is fragile and we have been appointed as caretakers of this vast and beautiful part of the world we live in. Let’s get together and plan a clean-up that focuses on our lake, creeks, and riversides. This effort will not be in vain as we help protect our natural food sources that depend on fresh water free from debris as we do.

The largest sockeye salmon harvest in the world comes from Bristol Bay. We need to give back to our environment because our livelihood comes from our waterways the nursery of fisheries. The belugas and seals depend upon our waterways to be healthy. What sort of debris may be found in the twirling “Great Pacific Garbage Patch” I mentioned earlier? Well, nets, fishing nets are choking and killing sea mammals. And, 90 percent of the garbage there is plastic! If I remember correctly our clean-up seems to meet that percentage easily when we are picking up trash along roadsides. The plastic bags are numerous especially around our landfills.

We can meet our clean-up needs and address most of these issues with little cost to the city and community members. By using resources we have in place now like our Alaskans for Litter Prevention and Recycling Grant, we can extend our use of the grant and include our waterways. The Tribal Environmental Program and our Bristol Bay Area Health Corporation can also assist with our efforts to clean-up our community and waterways. I suspect that there are other potential agencies to guide us in the areas of what, how and when the best time to do a clean-up specifically for waterways would incur. We all know that the best time to address this effort would probably be in the fall when the water levels are low enough to span the lake fronts and reach debris on the bottom of the lake. In the meantime, we can continue do our annual clean-up along roadsides, at our landfills, and in our yards until we have a good grasp of a waterway clean-up and how we can best tackle that attempt.

We all contribute to the debris we see around us and it is up to us to see that we clean-up after ourselves as our parents taught us to do at an early age when we cleaned our rooms and did our chores. In the same manner, it is our responsibility to pass on to our youth what our parents passed onto us and continue to be environmental role models so hopefully their children will carry this knowledge into the future and share what we learned and did to keep our environment around us clean. In this case, we are taking back what we unintentionally or intentionally left on the land, along our riversides, in our lakes, and in the environment; garbage. Our livelihood and the animals depend on a healthy environment to prosper. Let’s make sure we are doing our part and not contributing to the debris in the Great Pacific Ocean, and not creating a garbage dump of our own in our waterways that are so crucial to all every living thing well into the future.

Works Cited
Cousteau, Fabien. Interview with Oprah Winfrey. “The Great Pacific Garbage Patch.” 22 April 2009. <http://www.oprah.com/article/world/environment/pkggoinggreen/20090422>

Step 5: Research Project Final Draft

Universal Health Care or Healthcare Reform: What Do You Think?

The World and America examines its health care systems and discover startling numbers about health care costs and how the delivery of health related services are affecting many people. I have an interest in universal health care and healthcare reform in view of the fact that so many American citizens either do not have health insurance or health care coverage does not meet medical care needs. Today, there is a trend to go to the emergency rooms for health care given that most hospitals cannot refuse to serve the public. Notice I use two different ways to spell health care/healthcare? In the same sense, there are two approaches to health care systems that are well-known in the world today, namely, a universal single-payer system, and the private-public, government insurance system. Although America spends more on health care than any other country in the world, health care reform is necessary because healthcare costs continue to rise, healthcare coverage is expensive for individuals, government, and employers and citizens need access to affordably, equitably, and cost-effective healthcare.

A survey found that 45.7 million Americans were without health care coverage in 2007 or 15.3 percent were uninsured compared to 253.4 million Americans with health insurance according to the U.S. Census report on Income, Poverty, and Health Insurance Coverage in the United States (19). The 253.4 million Americans with health care coverage are covered by private or government health insurance. As of April 16, 2009, there are 306,203,220 million people in America according to our population clock established by the U.S. Census Bureau. How does America define health care insurance, and what are the percentage numbers that cover each type in 2007? There are different types of health insurance plans. Private insurance includes any private plan 67.5 percent, employment based 59.3 percent, or direct purchase plans at 8.9 percent (21). Government insurance coverage reflects any government plan which is at 27.8 percent in the same survey with Medicare at 13.8 percent and Medicaid at 13.2 percent. These percentages help us understand the people covered and at what cost.

The military government health care also provides health coverage and is much more complicated because it has different kind of payers involved. There is the Comprehensive Health and Medical Plan for Uniformed Services/Tricare (CHAMPUS), and Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) as well as the Department of Veterans Affairs which only covers a mere 3.7 percent, surprisingly enough. I thought the military health care coverage would have been much more and was really taken back that only a small percentage is represented (21). The percentages given in 2007 do have me question. For example, through an employer you can benefit from a group policy, but also directly purchase additional coverage where the need is lacking for your particular circumstance. Also, depending on income and dependents, there could be government or state health care coverage as well. Actually, it is possible to have multiple coverage’s or cross over coverage that is not identified in this report; however, does provide information on percentages of each area unique to the American health care system and industries.

There has been interest and consideration in America for many years about developing a universal single-payer system like Canada or Britain because it could provide health care for all and reduce administrative costs to the health care industry and government among other factors. Americans are afraid of change; feel it may lead to an invasion of privacy; limit or eliminate health care choice; burden the tax payers and government with higher costs; are all of great concern if the undertaking to develop a universal single-payer system is implemented.

There is a proposal for a universal health program in Connecticut for residents by 2014 (Fox). The cost to implement the idea to "provide all residents access to their choice of health coverage and care regardless of their employment status, age, or pre-existing conditions," would cost the state an estimated $950 million in 2014. The initial costs to implement the program were not available. However, the plan could save individuals and employers approximately $1.7 billion by 2014 according to Juan Figueroa, President of the Universal Health Care Foundation of Connecticut. But, Keith Stover a lobbyist and spokesman for the Connecticut Association of Health Plans, says universal health care proposals "are cumbersome, expensive, and politically difficult." The neighboring state of Massachusetts that adopted a similar plan went over its health budget which cost the state $153.1 million more than expected. The policy proposal will be presented to Governor Rell and the State Legislature this session for consideration.

Canada outlaws privately financed purchases of core medical services since it provides a publicly financed health care system which is a third rail of its political system (Krauss). Because patients waited for months, even years to be treated, Dr. Brian Day, President, and Medical Director of the Cambie Surgery Center and his team of doctors are advertising to patients they don't need to wait any longer. Against the country's policy, Dr. Day has taken the position that his clinic will provide the medical services and treatment needed by Canadians and plans on opening more private hospitals in Toronto, Ottawa, Montreal, Calgary, and Edmonton. Willing to defend his position to open these clinics in court, a ruling by the Supreme Court found that Quebec provincial ban on private health insurance is not constitutional where the public system fails to deliver reasonable services. Now, the country may allow private hospitals to subcontract for services unable to be dealt with in a timely manner under the public system. At the time of this article, legislation was to be introduced to address the private health services and insurance, but private doctors across the country did not wait for the changes in the law.

If you are interested in some of the pros and cons and/or arguments for and against universal health care, check out this website: http://www.balancedpolitics.org/universal_health_care.htm. Joe Messerli asks, “Should the government provide free universal health care for all Americans? Why or why not?” He seeks your opinion. You’ll find a list of pros and cons that speaks to each area of concern about the uninsured, unaffordable healthcare for individuals and businesses, medical professional issues, government mandates, and transition into a universal healthcare system (1-5). His grass roots effort to better understand the issues is very interesting and the website is periodically updated as issues and concerns arise.

U.S. President Barack Obama’s approach to health care reform is similar in that he held a White House Forum on Healthcare Reform in Congress and invited all stakeholders to begin discussions on the concerns and issues by those who play an integral part in our healthcare system in America. On March 5, 2009 a press conference covered some dialogue on how to address healthcare reform from democratic and republican lawmakers, medical professionals, and different interest groups in America.

In January 2009, President Obama shared his plan and separated it into three parts:

Quality, affordable and portable health coverage for all;
Modernization of the health care system; and
Promoting prevention and strengthening public health.

President Obama’s plan is to use the health system’s strength and build upon the State Children’s Health Insurance Program which was “ratcheted down by President Bush.” Additionally, a measure that was opposed by President Bush to authorize the federal government to negotiate bulk prescription-drug purchases for those on Medicare proved to save a lot of money in the Veterans Health Administration estimated at $30 billion savings purchasing generic drugs instead of the brand-name pharmaceuticals. The health care policy as a whole was analyzed by a nonpartisan research firm in Falls Church, Virginia, and the number of uninsured of 26.6 million would be reduced to 22.3 million by 2010. However, the independent firm also discovered that it would cost the United States $1.17 trillion from 2010 through 2019 with an annual spending cost projection at $60 billion to $100 billion after implementation (Lewis 26-27).

The Children’s Health Insurance Program that was scheduled for reauthorization in March 2009 has now been enacted as of February 4, 2009, and will become effective on April 1, 2009. President Obama’s comments during the signing of the act called it a “down payment on my commitment to cover every single American.” The Children’s Health Insurance Program Reauthorization Act of 2009, extension of CHIP funding is as follows:

FY 2009, $10,562,000,000
FY 2010, $12,520,000,000
FY 2011, $13,459,000,000
FY 2012, $14,982,000,000

The numbers are astronomically amazing and time will only tell if and when the funding numbers will reduce the 45.7 million Americans uninsured. I am not sure what kind of percentage this funding will cover since it only represents children’s health care needs. But, Peter R. Orszag, Director of Office of Management and Budget, knows what the long-term fiscal path is and what the United States projections are in health care and how they are determined. In his commentary, Beyond Economics 101, he identifies two primary sources of spending Medicare and Medicaid and mentions Social Security, and references other spending as well. The focus projections indicate that Medicare and Medicaid costs will continue to rise. Why? Because the “cost-per-beneficiary” will be a lot different in the future since people are living a lot longer now than in the years past (73).

Surprisingly, the high cost medical centers versus the lower cost hospitals do not show any significance in the health care outcomes where same services are provided; it just costs more or less. Certainly more research is needed to assess these differences and better understand the issues. Perhaps it’s how individuals are cared for or the kind of facilities that are utilized at the time services are provided. Suggesting a “three-step approach” to better care, and the opportunity to reduce costs by providing incentives that also reduce inefficiencies to healthcare, for example, offering subsidies for a universal IT system is a start and could begin to help understand why America spends $700 billion per year on health care costs or 5 percent of the Gross Domestic Product (Orszag 74-75).

Apparently, a Harris survey funded by the non-profit Commonwealth Fund surveyed Americans and found that they wanted to see the healthcare system make some major changes. The results spoke to the negative experiences, such as, not being told about medical tests taken and how patients had to track down results even after numerous requests were made. Patients felt that some medical services were not necessary or duplicative and offered no health benefit. This confirmed a dissatisfaction that coordinated effort to communication included “barriers to accessing care.” Underperformance was identified as well and targeted a comparative measure of “quality, efficiency, and equity” (Levin 4). A majority of Americans really want to see major changes to the healthcare system now in place and this plays a major role in supporting the idea of a universal single payer system.

A report suggests some ways and options to improve the healthcare system through projections and various scenarios are improved information, payment reform and public health (see Figure 1). The illustrative examples given include promoting health information technology, which the Congressional Budget Office suggests, educating patients for better decision making, positive incentives for wellness programs and healthy behavior including strengthening primary care and care coordination as well. This report mentions how universal coverage can work with a blend of private and public group health insurance (Zablocki 122).

During this research, I learned about the problems the United States would face if it adopted a single-payer system and how it would impact our health care options compared to what the Canadian healthcare system offers. The differences in the pricing models, prescription drug coverage, administrative costs, are areas that will need to be considered (Halvorson 82-84). We can achieve universal healthcare by using a combination of mechanisms similar to the European countries by what best meets the citizens’ needs and not government.

The insurance industry spoke in opposition to a system that offered coverage for all. The insurance industry now paints a different picture with lessons from California when it modeled legislation after Massachusetts, but failed due to key issues not being addressed by labor unions and the business community. Because health reform continued to be on the horizon and unavoidable, Blue Shield of California, Health Net, Kaiser Permanente, CIGNA, and others along with labor unions and, California Medical Association, AARP, decided it was worth building a coalition to meet the challenge with workable legislation. However, odd-bedfellows like Blue Cross of California, labor unions, single-payer advocates, small-business groups, and the tobacco industry lobbied against the bill and “sealed its fate” (Bodaken 670).

Bruce Bodaken, Chairman, President, and Chief Executive Officer of Blue Shield of California, in San Francisco, writes (at that time) Sen. Barack Obama, Presidential Democratic Nominee proposes a far more aggressive healthcare proposal, the universal coverage proposal. If this approach happens he suggests the following should be taken into consideration:

Respect the industry’s economics and maintain their economic viability;
Understand the competitive dynamic and require an equal or level playing field;
Think through the transition since we know it will be disruptive;
Rely on expertise such as the insurers;
Demand shared responsibility on a percentage of health plans with all sectors involved;
Stop demonizing health plans and help achieve consensus.

These lessons Bodaken references goes on to say that, “If we want a seat at the table as our future is being shaped, we need to exhibit a willingness to embrace change and a commitment to look out for the public interest. If we start the debate in a defensive crouch we might just end it flat on our backs. But if we extend a hand of cooperation, odds are good that it will be grasped.” Certainly, this message did not fall on deaf ears as now President Obama has called on all players to assist with health care reform.

There seems to be a collective effort on all parties involved in the health care industry and a willingness to share that responsibility, although cautiously, and determine how best to meet specific individual medical needs without jeopardizing the economic engine in America (Lutz 150). I began this research with two approaches that had been sought for decades. Now it appears that these corroborations are paying off. As lessons are learned from different approaches with a combination of solutions now and in the past, I have no doubt that our health care system will get better, be sufficient, provide immediate access and, yes, become the best health care system in the world, but not without enormous effort and sacrifice. This argument over universal health care and healthcare reform is actually coming to a compromise, slowly inching to each goal of a system broken by unmet need.

The uninsured surely are from different socio-economic populations and the solutions to meeting the health care needs of all will no doubt continue to be a “cumbersome, expensive, and politically difficult” area for everyone involved (Fox).

America and the world still have a long way to go in order to reach the goals to provide health care to everyone in need. It’s not just about health care, but about research and being prepared for pandemics and dealing with diseases proactively. Yes, and it is costs, too. When we see World Health Statistics that report 89 countries or 90 percent of the world’s population for the first time provide estimates of “logarithmic scale” that due to health care costs 2.3 percent or 150 million people suffered financial catastrophe, and this only represents those whose out-of-pocket expenditures were spent at or above 40 percent of a total household’s income that led to their health related catastrophic financial consequence. And, this survey did not even take into consideration anyone who needed health care and did not have the money to receive health care. Astonishing, isn’t it? Especially when as of this date, April 16, 2009, the World Population Clock clocked at 6,773,775,755 trillion. In the United States only 0.1 percent of the Nation’s health budget is spent on research even if it would help us identify areas of concern or that need attention nationwide or for that matter worldwide (32). Are we ready to address outbreaks and emergencies sufficiently? Well, that’s another project.

“The World Health Assembly of 2005 called for all health systems to move towards universal coverage, defined as “access to adequate health care for all at an affordable price.”

Works Cited

Bodaken, Bruce G. “Where Does The Insurance Industry Stand On Health Reform Today?”
Health Affairs. May/June 2008, Vol. 27, Number 3: 667-674. Academic Search Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 12 Mar. 2009. < http://search.abscohost.com>

Gordon, Tracy. “Hartford Hears Health Care Proposal.” New York Times 18 Jan. 2009
<www.nytimes.com/2009/01/18/nyregion/connecticut/18healthct.html>

Halvorson, George C. “Understanding the Trade-offs of the Canadian Health System.”
Healthcare Financial Management Oct. 2007, Vol. 61, Issue 10: 82-84. Master FILE
Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK.
14 Mar. 2009 <http://libapps.uaf.edu:2060>

Krauss, Clifford. “Canada’s Private Clinics Surge as Public System Falters.” New York Times.
28 Feb. 2006 <www.nytimes.com/2006/02/28/international/americas/28canada.html>

Levin, Arthur A. “From the Director…People Want Major Changes in Health Care, Survey
Shows.” Healthfacts. September 2008. Vol. 33, Issue 9. Alt HealthWatch.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009. <http://search.abscohost.com>

Lewis, K. “Incremental Change, Rather Than Wholesale Reform, Expected From New U.S.
President Barack Obama.” Canadian Medical Association. January 6, 2009: 180(1). Medline. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009. <http://search.abscohost.com>

Lutz, Sandy. “Happy Together: Consumer Expectation for a Public-Private Healthcare
System.” Journal of Healthcare Management May/June 2008, Vol. 53, Issue 3: 149-152. Academic Search Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks,
AK. 10 Mar. 2009. <http://search.abscohost.com>

Mcintyre, Diane et al. “Beyond Fragmentation and Towards Universal Coverage: Insights From
Ghana, South Africa and the United Republic of Tanzannia.” Bulletin of the World
Health Organization 2008; 86: 871-876. Health Source – Consumer Edition. EBSCOhost. University of Alaska Fairbanks Lib, Fairbanks, AK. 14 Mar. 2009.
<http://search.abscohost.com>

Messerli, Joe. “Should The Government Provide Free Universal Health Care For
All Americans?” 16 Feb. 2009. <http://www.balancedpolitics.org/universal_health_care.htm>

Orszag, Peter R. “Beyond Economics 101: Insights Into Healthcare Reform From the
Congressional Budget Office. Healthcare Financial Management Jan. 2009, Vol. 63, Issue 1: 70-75. MasterFILE Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 14 Mar. 2009. <http://search.ebscohost.com>

President Barack Obama. “President Barack Obama Holds a Dialogue with White House Forum
On Health Reform Participants.” FDCH Political Transcripts March 5, 2009.
MasterFILE Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 10 Mar. 2009. <http://search.ebscohost.com>

U.S. Census Bureau. “Income, Poverty, and Health Insurance Coverage in the United States:
2007: 19-22. 14 Mar. 2009. <http://www.census.gov/prod/2008pubs/p60-235.pdf>

Zablocki, Elaine. “New Report Proposes Health Care Savings Plus Increased Value.”
Townsend Letter for Doctors & Patients. May 2008, Issue 298. Alt HealthWatch.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009. <www.search.ebscohost.com>

Step 4: Research Draft 2

Universal Health Care or Healthcare Reform: What Do You Think?

The World and America examines its health care systems and discover startling numbers about health care costs and how the delivery of health related services are affecting many people. I have an interest in universal health care and healthcare reform, in view of the fact that so many American citizens either do not have health insurance or health care coverage does not meet medical care needs. Today, there is a trend to go to the emergency rooms for health care given that most hospitals cannot refuse to serve the public. Notice I use two different ways to spell health care/healthcare? In the same sense, there are two approaches to health care systems that are well-known in the world today, namely, a universal single-payer system, and the private-public, government insurance system. Although America spends more on health care than any other country in the world, health care reform is necessary because healthcare costs continue to rise, healthcare coverage is expensive for individuals, government, and employers and citizens need access to affordably, equitably, and cost-effective healthcare.

A survey found that 45.7 million Americans were without health care coverage in 2007 or 15.3 percent were uninsured compared to 253.4 million Americans with health insurance according to the U.S. Census report on Income, Poverty, and Health Insurance Coverage in the U.S. (19). The 253.4 million Americans with health care coverage are covered by private or government health insurance. As of April 16, 2009, there are 306,203,220 million people in America according to our population clock established by the U.S. Census Bureau. How does America define health care insurance, and what are the percentage numbers that cover each type? There are different types of health insurance plans. Private insurance includes any private plan 67.5 percent, employment based 59.3 percent, or direct purchase plans at 8.9 percent (21). Government insurance coverage reflects any government plan which is at 27.8 percent in the same survey with Medicare at 13.8 percent and Medicaid at 13.2 percent. These percentages help us understand the people covered and at what cost.

The military government health care also provides health coverage and is much more complicated because it has different kind of payers involved. There is the Comprehensive Health and Medical Plan for Uniformed Services/Tricare (CHAMPUS), and Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) as well as the Department of Veterans Affairs which only covers a mere 3.7 percent, surprisingly enough. I thought the military health care coverage would have been much more and was really taken back that only a small percentage is represented (U.S. Census Bureau, Current Populations Survey, 2007 and 2008 Annual Social and Economic Supplements). The percentages do have me question. For example, through an employer you can benefit from a group policy, but also directly purchase additional coverage where the need is lacking for your particular circumstance. Also, depending on income and dependents, there could be government or state health care coverage as well. Actually, it is possible to have multiple coverage’s or cross over coverage that is not identified in this report; however, does provide information on percentages of each area unique to the American health care system and industries.

There has been interest and consideration in America for many years about developing a universal single-payer system like Canada or Britain because it could provide health care for all and reduce administrative costs to the health care industry and government among other factors. Americans are afraid of change; feel it may lead to an invasion of privacy; limit or eliminate health care choice; burden the tax payers and government with higher costs; are all of great concern if the undertaking to develop a universal single-payer system is implemented.

There is a proposal for a universal health program in Connecticut for by 2014 (Fox). The cost to implement the idea to "provide all residents access to their choice of health coverage and care regardless of their employment status, age, or pre-existing conditions," would cost the state an estimated $950 million in 2014. The initial costs to implement the program were not available. However, the plan could save individuals and employers approximately $1.7 billion by 2014 according to Juan Figueroa, President of the Universal Health Care Foundation of Connecticut. But, Keith Stover a lobbyist and spokesman for the Connecticut Association of Health Plans, says universal health care proposals "are cumbersome, expensive, and politically difficult." The neighboring state of Massachusetts that adopted a similar plan went over its health budget which cost the state $153.1 million more than expected. The policy proposal will be presented to Governor Rell and the State Legislature this session for consideration.

Canada outlaws privately financed purchases of core medical services since it provides a publicly financed health care system which is a third rail of its political system (Krauss). Because patients waited for months, even years to be treated, Dr. Brian Day, President, and Medical Director of the Cambie Surgery Center and his team of doctors are advertising to patients they don't need to wait any longer. Against the country's policy, Dr. Day has taken the position that his clinic will provide the medical services and treatment needed by Canadians and plans on opening more private hospitals in Toronto, Ottawa, Montreal, Calgary, and Edmonton. Willing to defend his position to open these clinics in court, a ruling by the Supreme Court found that Quebec provincial ban on private health insurance is not constitutional where the public system fails to deliver reasonable services. Now, the country may allow private hospitals to subcontract for services unable to be dealt with in a timely manner under the public system. At the time of this article, legislation was to be introduced to address the private health services and insurance, but private doctors across the country did not wait for the changes in the law.

If you are interested in some of the pros and cons and/or arguments for and against universal health care, check out this website: http://www.balancedpolitics.org/universal_health_care.htm. Joe Messerli asks, “Should the government provide free universal health care for all Americans? Why or why not?” He seeks your opinion. You’ll find a list of pros and cons that speaks to each area of concern about the uninsured, unaffordable healthcare for individuals and businesses, medical professional issues, government mandates, and transition into a universal healthcare system (1-5). His grass roots effort to better understand the issues is very interesting and the website is periodically updated as issues and concerns arise.

U.S. President Barack Obama’s approach to health care reform is similar in that he held a White House Forum on Healthcare Reform in Congress and invited all stakeholders to begin discussions on the concerns and issues by those who play an integral part in our healthcare system in America. On March 5, 2009 a press conference covered some dialogue on how to address healthcare reform from democratic and republican lawmakers, medical professionals, and different interest groups in America.

In January 2009, President Obama shared his plan and separated it into three parts:

Quality, affordable and portable health coverage for all;
Modernization of the health care system; and
Promoting prevention and strengthening public health.

President Obama’s plan is to use the health system’s strength and build upon the State Children’s Health Insurance Program which was “ratcheted down by President Bush.” Additionally, a measure that was opposed by President Bush to authorize the federal government to negotiate bulk prescription-drug purchases for those on Medicare proved to save a lot of money in the Veterans Health Administration estimated at $30 billion savings purchasing generic drugs instead of the brand-name pharmaceuticals. The health care policy as a whole was analyzed by a nonpartisan research firm in Falls Church, Virginia, and the number of uninsured of 26.6 million would be reduced to 22.3 million by 2010. However, the independent firm also discovered that it would cost the United States $1.17 trillion from 2010 through 2019 with an annual spending cost projection at $60 billion to $100 billion after implementation (Lewis 26-27).

The Children’s Health Insurance Program that was scheduled for reauthorization in March 2009 has now been enacted as of February 4, 2009, and will become effective on April 1, 2009. President Obama’s comments during the signing of the act called it a “down payment on my commitment to cover every single American.” The Children’s Health Insurance Program Reauthorization Act of 2009, extension of CHIP funding is as follows:

FY 2009, $10,562,000,000
FY 2010, $12,520,000,000
FY 2011, $13,459,000,000
FY 2012, $14,982,000,000

The numbers are astronomically amazing and time will only tell if and when the funding numbers will reduce the 45.7 million Americans uninsured. I am not sure what kind of percentage this funding will cover since it only represents children’s health care needs. But, Peter R. Orszag, Director of Office of Management and Budget, knows what the long-term fiscal path is and what the United States projections are in health care and how they are determined. In his commentary, Beyond Economics 101, he identifies two primary sources of spending Medicare and Medicaid and mentions Social Security, and references other spending as well. The focus projections indicate that Medicare and Medicaid costs will continue to rise. Why? Because the “cost-per-beneficiary” will be a lot different in the future since people are living a lot longer now than in the years past (73).

Surprisingly, the high cost medical centers versus the lower cost hospitals do not show any significance in the health care outcomes where same services are provided; it just costs more or less. Certainly more research is needed to assess these differences and better understand the issues. Perhaps it’s how individuals are cared for or the kind of facilities that are utilized at the time services are provided. Suggesting a “three-step approach” to better care, and the opportunity to reduce costs by providing incentives that also reduce inefficiencies to healthcare, for example, offering subsidies for a universal IT system is a start and could begin to help understand why America spends $700 billion per year on health care costs or 5 percent of the Gross Domestic Product (Orszag 74-75).

Apparently, a Harris survey funded by the non-profit Commonwealth Fund surveyed Americans and found that they wanted to see the healthcare system make some major changes. The results spoke to the negative experiences, such as, not being told about medical tests taken and how patients had to track down results even after numerous requests were made. Patients felt that some medical services were not necessary or duplicative and offered no health benefit. This confirmed a dissatisfaction that coordinated effort to communication included “barriers to accessing care.” Underperformance was identified as well and targeted a comparative measure of “quality, efficiency, and equity.” (Levin 4). A majority of Americans really want to see major changes to the healthcare system now in place and this plays a major role in supporting the idea of a universal single payer system.

A report suggests some ways and options to improve the healthcare system through projections and various scenarios are improved information, payment reform and public health (see Figure 1). The illustrative examples given include promoting health information technology, which the Congressional Budget Office suggests, educating patients for better decision making, positive incentives for wellness programs and healthy behavior including strengthening primary care and care coordination as well. This report mentions how universal coverage can work with a blend of private and public group health insurance (Zablocki 122).

During this research, I learned about the problems the United States would face if it adopted a single-payer system and how it would impact our health care options compared to what the Canadian healthcare system offers. The differences in the pricing models, prescription drug coverage, administrative costs, are areas that will need to be considered (Halvorson 82-84). We can achieve universal healthcare by using a combination of mechanisms similar to the European countries by what best meets the citizens’ needs and not government.

The insurance industry spoke in opposition to a system that offered coverage for all. The insurance industry now paints a different picture with lessons from California when it modeled legislation after Massachusetts, but failed due to key issues not being addressed by labor unions and the business community. Because health reform continued to be on the horizon and unavoidable, Blue Shield of California, Health Net, Kaiser Permanente, CIGNA, and others along with labor unions and, California Medical Association, AARP, decided it was worth building a coalition to meet the challenge with workable legislation. However, odd-bedfellows like Blue Cross of California, labor unions, single-payer advocates, small-business groups, and the tobacco industry lobbied against the bill and “sealed its fate.” (Bodaken 670).

Bruce Bodaken, Chairman, President, and Chief Executive Officer of Blue Shield of California, in San Francisco, writes (at that time) Sen. Barack Obama, Presidential Democratic Nominee proposes a far more aggressive healthcare proposal, the universal coverage proposal. If this approach happens he suggests the following should be taken into consideration:

Respect the industry’s economics and maintain their economic viability;
Understand the competitive dynamic and require an equal or level playing field;
Think through the transition since we know it will be disruptive;
Rely on expertise such as the insurers;
Demand shared responsibility on a percentage of health plans with all sectors involved;
Stop demonizing health plans and help achieve consensus.

These lessons Bodaken references goes on to say that, “If we want a seat at the table as our future is being shaped, we need to exhibit a willingness to embrace change and a commitment to look out for the public interest. It we start the debate in a defensive crouch we might just end it flat on our backs. But if we extend a hand of cooperation, odds are good that it will be grasped.” Certainly, this message did not fall on deaf ears as now President Obama has called on all players to assist with health care reform.

There seems to be a collective effort on all party’s involved in the health care industry and a willingness to share that responsibility, although cautiously, and determine how best to meet specific individual medical needs without jeopardizing the economic engine in America (Lutz 150). I began this research with two approaches that had been sought for decades. Now it appears that these corroborations are paying off. As lessons are learned from different approaches and a combination of solutions now and in the past, I have no doubt that our health care system will get better, be sufficient, provide immediate access and, yes, become the best health care system in the world, but not without enormous effort and sacrifice. This argument over universal health care and health care reform is actually coming to a compromise, slowly inching to each goal of a system broken by unmet need.

The uninsured surely are from different socio-economic populations and the solutions to meeting the health care needs of all will no doubt continue to be a “cumbersome, expensive, and politically difficult” area for everyone involved (Fox).

America and the world still have a long way to go in order to reach the goals to provide health care to every one in need. It’s not just about health care, but about research and being prepared for pandemics and dealing with diseases proactively. Yes, and it is costs, too. When we see World Health Statistics that report 89 countries or 90 percent of the world’s population for the first time provide estimates of “logarithmic scale” that due to health care costs 2.3 percent or 150 million people suffered financial catastrophe, and this only represents those whose out-of-pocket expenditures were spent at or above 40 percent of a total household’s income that led to their health related catastrophic financial consequence. And, this survey did not even take into consideration anyone who needed health care and did not have the money to receive health care. Astonishing, isn’t it? Especially when as of this date, April 16, 2009, the World Population Clock clocked at 6,773,775,755 trillion (www.census.gov). In the United States only 0.1 percent of the Nation’s health budget is spent on research even if it would help us identify areas of concern or that need attention nationwide or for that matter worldwide (32). Are we ready to address outbreaks and emergencies sufficiently? Well, that’s another project.

“The World Health Assembly of 2005 called for all health systems to move towards universal coverage, defined as “access to adequate health care for all at an affordable price.”



Works Cited

Bodaken, Bruce G. “Where Does The Insurance Industry Stand On Health Reform Today?”
Health Affairs. May/June 2008, Vol. 27, Number 3: 667-674. Academic Search Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 12 Mar. 2009. < http://search.ebscohost.com>

Gordon, Tracy. “Hartford Hears Health Care Proposal.” New York Times 18 Jan. 2009
<www.nytimes.com/2009/01/18/nyregion/connecticut/18healthct.html>

Halvorson, George C. “Understanding the Trade-offs of the Canadian health system.”
Healthcare Financial Management Oct. 2007, Vol. 61, Issue 10: 82-84. MasterFILE
Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK.
14 Mar. 2009 <http://libapps.uaf.edu:2060>

Krauss, Clifford. “Canada’s Private Clinics Surge as Public System Falters.” New York Times.
28 Feb. 2006 <www.nytimes.com/2006/02/28/international/americas/28canada.html>

Levin, Arthur A. “From the Director…People Want Major Changes in Health Care, Survey
Shows.” Healthfacts. September 2008. Vol. 33, Issue 9. Alt HealthWatch.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009
http://search.ebscohost.com

Lewis, K. “Incremental change, rather than wholesale reform, expected from new U.S. President
Barack Obama.” Canadian Medical Association. January 6, 2009: 180(1). Medline.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009.


Lutz, Sandy. “Happy Together: Consumer Expectation for a Public-Private Healthcare
System.” Journal of Healthcare Management May/June 2008, Vol. 53, Issue 3: 149-152. Academic Search Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks,
AK. 10 Mar. 2009.

Mcintyre, Diane et al. “Beyond fragmentation and towards universal coverage: insights from
Ghana, South Africa and the United Republic of Tanzannia.” Bulletin of the World
Health Organization 2008; 86: 871-876. Health Source – Consumer Edition. EBSCOhost. University of Alaska Fairbanks Lib, Fairbanks, AK. 14 Mar. 2009

Messerli, Joe. “Should the Government Provide Free Universal Health Care for
All Americans?” 16 Feb. 2009. <http://www.balancedpolitics.org/universal_health_care.htm.





Orszag, Peter R. “Beyond Economics 101: Insights into healthcare reform from the
Congressional Budget Office. Healthcare Financial Management Jan. 2009, Vol. 63, Issue 1: 70-75. MasterFILE Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 14 Mar. 2009. <http://search.ebscohost.com>

President Barack Obama. “President Barack Obama holds a dialogue with White House Forum
on Health Reform participants.” FDCH Political Transcripts March 5, 2009.
MasterFILE Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 10 Mar. 2009. <http://search.ebscohost.com>

U.S. Census Bureau. “Income, Poverty, and Health Insurance Coverage in the United States:
2007: 19-22. 14 Mar. 2009. <http://www.census.gov/prod/2008pubs/p60-235.pdf>

Zablocki, Elaine. “New Report Proposes Health Care Savings Plus Increased Value.”
Townsend Letter for Doctors & Patients. May 2008, Issue 298. Alt HealthWatch.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009.http://search.ebscohost.com

Step 3: Research Draft #1

Universal Health Care or Healthcare Reform: What Do You Think?

The World and America examines its health care systems and discover startling numbers about health care costs and how the delivery of health related services are affecting many people. I have an interest in universal health care and healthcare reform, in view of the fact that so many American citizens either do not have health insurance or health care coverage does not meet medical care needs. Today, there is a trend to go to the emergency rooms for health care given that most hospitals cannot refuse to serve the public. Notice I use two different ways to spell health care/healthcare? In the same sense, there are two approaches to health care systems that are well-known in the world today, namely, a universal single-payer system, and the private-public, government insurance system. Although America spends more on health care than any other country in the world, health care reform is necessary because healthcare costs continue to rise, healthcare coverage is expensive for individuals, government, and employers and citizens need access to affordably, equitably, and cost-effective healthcare.

A survey found that 45.7 million Americans were without health care coverage in 2007 or 15.3 percent were uninsured compared to 253.4 million Americans with health insurance according to the U.S. Census report on Income, Poverty, and Health Insurance Coverage in the U.S. (19). The 253.4 million Americans with health care coverage are covered by private or government health insurance. As of April 16, 2009, there are 306,203,220 million people in America according to our population clock established by the U.S. Census Bureau. How does America define health care insurance, and what are the percentage numbers that cover each type? There are different types of health insurance plans. Private insurance includes any private plan 67.5 percent, employment based 59.3 percent, or direct purchase plans at 8.9 percent (21). Government insurance coverage reflects any government plan which is at 27.8 percent in the same survey with Medicare at 13.8 percent and Medicaid at 13.2 percent. These percentages help us understand the people covered and at what cost.

The military government health care also provides health coverage and is much more complicated because it has different kind of payers involved. There is the Comprehensive Health and Medical Plan for Uniformed Services/Tricare (CHAMPUS), and Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) as well as the Department of Veterans Affairs which only covers a mere 3.7 percent, surprisingly enough. I thought the military health care coverage would have been much more and was really taken back that only a small percentage is represented (U.S. Census Bureau, Current Populations Survey, 2007 and 2008 Annual Social and Economic Supplements). The percentages do have me question. For example, through an employer you can benefit from a group policy, but also directly purchase additional coverage where the need is lacking for your particular circumstance. Also, depending on income and dependents, there could be government or state health care coverage as well. Actually, it is possible to have multiple coverage’s or cross over coverage that is not identified in this report; however, does provide information on percentages of each area unique to the American health care system and industries.

There has been interest and consideration in America for many years about developing a universal single-payer system like Canada or Britain because it could provide health care for all and reduce administrative costs to the health care industry and government among other factors. Americans are afraid of change; feel it may lead to an invasion of privacy; limit or eliminate health care choice; burden the tax payers and government with higher costs; are all of great concern if the undertaking to develop a universal single-payer system is implemented.

In the New York Times, an article titled “Hartford Hears Health Care Proposal.” Written by Tracy Gordon Fox and published on January 18, 2009, regarded a proposal for a universal health program in Connecticut for residents by 2014. The cost to implement the idea to "provide all residents access to their choice of health coverage and care regardless of their employment status, age, or pre-existing conditions," would cost the state an estimated $950 million in 2014. The initial costs to implement the program were not available. However, the plan could save individuals and employers approximately $1.7 billion by 2014 according to Juan Figueroa, President of the Universal Health Care Foundation of Connecticut. But, Keith Stover a lobbyist and spokesman for the Connecticut Association of Health Plans, says universal health care proposals "are cumbersome, expensive, and politically difficult." The neighboring state of Massachusetts that adopted a similar plan went over its health budget which cost the state $153.1 million more than expected. The policy proposal will be presented to Governor Rell and the State Legislature this session for consideration.

In Canada, an article by the New York Times published February 28, 2006, titled Canada's Private Clinics Surge as Public System Falters written by Clifford Krauss reviews the prominent private hospital the Cambie Surgery Center. See: Canada outlaws privately financed purchases of core medical services because it provides a publicly financed health care system (a third rail of its political system). Because patients waited for months, even years to be treated, Dr. Brian Day, President, and Medical Director of the Cambie Surgery Center and his team of doctors are advertising to patients they don't need to wait any longer. Against the country's policy, Dr. Day has taken the position that his clinic will provide the medical services and treatment needed by Canadians and plans on opening more private hospitals in Toronto, Ottawa, Montreal, Calgary, and Edmonton. Willing to defend his position to open these clinics in court, a ruling by the Supreme Court found that Quebec provincial ban on private health insurance is not constitutional where the public system fails to deliver reasonable services. Now, the country may allow private hospitals to subcontract for services unable to be dealt with in a timely manner under the public system. At the time of this article, legislation was to be introduced to address the private health services and insurance, but private doctors across the country did not wait for the changes in the law.

If you are interested in some of the pros and cons and/or arguments for and against universal health care, check out this website: http://www.balancedpolitics.org/universal_health_care.htm. Joe Messerli asks, “Should the government provide free universal health care for all Americans? Why or why not?” He seeks your opinion. You’ll find a list of pros and cons that speaks to each area of concern about the uninsured, unaffordable healthcare for individuals and businesses, medical professional issues, government mandates, and transition into a universal healthcare system. His grass roots effort to better understand the issues is very interesting and the website is periodically updated as issues and concerns arise.

U.S. President Barack Obama’s approach to health care reform is similar in that he held a White House Forum on Healthcare Reform in Congress and invited all stakeholders to begin discussions on the concerns and issues by those who play an integral part in our healthcare system in America. On March 5, 2009 a press conference covered some dialogue on how to address healthcare reform from democratic and republican lawmakers, medical professionals, and different interest groups in America.

In January 2009, President Obama shared his plan and separated it into three parts:

Quality, affordable and portable health coverage for all;
Modernization of the health care system; and
Promoting prevention and strengthening public health.

President Obama’s plan is to use the health system’s strength and build upon the State Children’s Health Insurance Program which was “ratcheted down by President Bush.” Additionally, a measure that was opposed by President Bush to authorize the federal government to negotiate bulk prescription-drug purchases for those on Medicare proved to save a lot of money in the Veterans Health Administration estimated at $30 billion savings purchasing generic drugs instead of the brand-name pharmaceuticals referenced by this article, “Incremental change, rather than wholesale reform, expected from new U.S. President Barack Obama.” Canadian Medical Association. January 6, 2009. The health care policy as a whole was analyzed by a nonpartisan research firm in Falls Church, Virginia, and the number of uninsured of 26.6 million would be reduced to 22.3 million by 2010. However, the independent firm also discovered that it would cost the United States $1.17 trillion from 2010 through 2019 with an annual spending cost projection at $60 billion to $100 billion after implementation. The Children’s Health Insurance Program that was scheduled for reauthorization in March 2009 has now been enacted as of February 4, 2009, and will become effective on April 1, 2009. President Obama’s comments during the signing of the act called it a “down payment on my commitment to cover every single American.” The Children’s Health Insurance Program Reauthorization Act of 2009, extension of CHIP funding is as follows:

FY 2009, $10,562,000,000
FY 2010, $12,520,000,000
FY 2011, $13,459,000,000
FY 2012, $14,982,000,000

The numbers are astronomically amazing and time will only tell if and when the funding numbers will reduce the 45.7 million Americans uninsured. I am not sure what kind of percentage this funding will cover since it only represents children’s health care needs. But, Peter R. Orszag, Office of Management and Budget Director knows how the long-term fiscal path the United States projections in health care are determined (Beyond Economics). In his commentary he discusses the primary focus is on the spending of Medicare, Medicaid, Social Security, and references other spending, His projections are based on these primary sources and indicates that Medicare and Medicaid costs will continue to rise. Why? Because the “cost-per-beneficiary” will continue to rise and will be a lot different in the future. Surprisingly, the high cost medical centers versus the lower cost hospitals do not show any significance in the health care outcomes where same services are provided; it just costs more or less. Certainly more research is needed to assess these differences and better understand the issues. Perhaps it’s how individuals are care for or the kind of facilities that are utilized at the time of services provided. Suggesting a “three-step approach” to better care, and the opportunity to reduce costs by providing incentives that also reduce inefficiencies to healthcare, for example, offering subsidies for a universal IT system is a start and could begin to help understand why America spends $700 billion per year on health care costs or 5 percent of the Gross Domestic Product (GDP).

Apparently, a Harris survey funded by the non-profit Commonwealth Fund surveyed Americans and found that they wanted to see the healthcare system make some major changes. The results spoke to the negative experiences, such as, not being told about medical tests taken and how patients had to track down results even after numerous requests were made. Patients felt that some medical services were not necessary or duplicative and offered no health benefit. This confirmed a dissatisfaction that coordinated effort to communication included “barriers to accessing care.” Underperformance was identified as well and targeted a comparative measure of “quality, efficiency, and equity.” A majority of Americans really want to see major changes to the healthcare system now in place and this plays a major role in supporting the idea of a universal single payer system.

Some ways and options to improve the healthcare system according to Elaine Zablocki give projections and various scenarios on improved information, payment reform, and public health. The illustrative examples given include promoting health information technology (which the Congressional Budget Office suggests), educating patients for better decision making, positive incentives for wellness programs and healthy behavior including strengthening primary care and care coordination as well. Her letter mentions universal coverage and how a blend of private and public group health insurance can work.

I learned from George Halvorson during this research that the problems the United States would face if it adopted a single-payer system would impact options and compared to what we actually have unlike the Canadian healthcare system and what it offers. The differences in the pricing models, prescription drug coverage, administrative costs, are areas that will need to be considered. We can achieve universal healthcare by using a combination of mechanisms similar to the European countries by what best meets the citizens’ needs.

This insurance industry review speaks to the insurer’s opposition in past years to a system that offered coverage for all. The insurance industry now paints a different picture with lessons from California when it modeled legislation after Massachusetts, but failed due to key issues not being addressed by labor unions and the business community. Because health reform continued to be on the horizon and unavoidable, Blue Shield of California, Health Net, Kaiser Permanente, CIGNA, and others along with labor unions and, California Medical Association, AARP, decided it was worth building a coalition to meet the challenge with workable legislation. However, odd-bedfellows like Blue Cross of California, labor unions, single-payer advocates, small-business groups, and the tobacco industry lobbied against the bill and “sealed its fate.”

Bruce Bodaken, Chairman, President, and Chief Executive Officer of Blue Shield of California, in San Francisco, writes (at that time) Sen. Barack Obama, Presidential Democratic Nominee proposes a far more aggressive healthcare proposal, the universal coverage proposal. If this approach happens he suggests the following should be taken into consideration: Respect the industry’s economics and maintain their economic viability, Understand the competitive dynamic and require an equal or level playing field, Think through the transition since we know it will be disruptive, Rely on expertise such as the insurer’s, and Demand shared responsibility on a percentage of health plans with all sectors involved, Stop demonizing health plans and help achieve consensus. These lessons Bodaken references goes on to say that, “If we want a seat at the table as our future is being shaped, we need to exhibit a willingness to embrace change and a commitment to look out for the public interest. It we start the debate in a defensive crouch we might just end it flat on our backs. But if we extend a hand of cooperation, odds are good that it will be grasped.” Certainly, this message did not fall on deaf ears as now President Obama has called on all players to assist with health care reform.

A managing director from the Arlington, Texas, Pricewaterhouse Coopers Health Research Institute, Sandy Lutz was ready under a new presidency to discuss and deal with the consumer’s perception and provides actual circumstances on the “health system costs and inefficiencies.” The solution to work together, she points out in her article, that public-private partnerships have collectively built medical facilities that otherwise would not have been built or afforded without the effort to collaborate and work together. There seems to be a collective effort on all party’s involved in the health care industry and this willingness to share that responsibility, although cautiously, and determine how best to meet specific individual medical needs without jeopardizing the economic engine in America. I began this research with two approaches that had been sought after for decades it now appears that these corroborations are paying off. As lessons are learned from different approaches and a combination of solutions now and in the past, I have no doubt that our health care system will get better, be sufficient, provide immediate access and, yes, become the best health care system in the world, but not without enormous effort and sacrifice. This argument over universal health care and health care reform is actually coming to a compromise, slowly inching to each goal of a system broken by unmet need.

America and the world still have a long way to go in order to reach the goals to provide health care to every one in need. It’s not just about health care, but about research and being prepared for pandemics and dealing with diseases proactively. Yes, and it is costs, too. When we see World Health Statistics that report 89 countries or 90 percent of the world’s population for the first time provide estimates of “logarithmic scale” that due to health care costs 2.3 percent or 150 million people suffered financial catastrophe, and this only represents those whose out-of-pocket expenditures were spent at or above 40 percent of a total household’s income that led to their health related catastrophic financial consequence. And, this survey did not even take into consideration anyone who needed health care and did not have the money to receive health care. Astonishing, isn’t it? Especially when as of this date, April 16, 2009, the World Population Clock clocked at 6,773,775,755 trillion (www.census.gov). In the United States only 0.1 percent of the Nation’s health budget is spent on research even if it would help us identify areas of concern or that need attention nationwide or for that matter worldwide (32). Are we ready to address outbreaks and emergencies sufficiently? Well, that’s another project.

“The World Health Assembly of 2005 called for all health systems to move towards universal coverage, defined as “access to adequate health care for all at an affordable price.”



Works Cited

Bodaken, Bruce G. “Where Does The Insurance Industry Stand On Health Reform Today?”

Health Affairs. May/June 2008, Vol. 27, Number 3: 667-674. Academic Search
Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 12 Mar. 2009.
< http://search.ebscohost.com>

Gordon, Tracy. “Hartford Hears Health Care Proposal.” New York Times 18 Jan. 2009
<www.nytimes.com/2009/01/18/nyregion/connecticut/18healthct.html>

Halvorson, George C. “Understanding the Trade-offs of the Canadian health system.”
Healthcare Financial Management Oct. 2007, Vol. 61, Issue 10: 82-84. MasterFILE
Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK.
14 Mar. 2009 <http://libapps.uaf.edu:2060>

Krauss, Clifford. “Canada’s Private Clinics Surge as Public System Falters.” New York Times.
28 Feb. 2006 <www.nytimes.com/2006/02/28/international/americas/28canada.html>

Levin, Arthur A. “From the Director…People Want Major Changes in Health Care, Survey
Shows.” Healthfacts. September 2008. Vol. 33, Issue 9. Alt HealthWatch.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009
http://search.ebscohost.com

Lewis, K. “Incremental change, rather than wholesale reform, expected from new U.S. President Barack Obama.” Canadian Medical Association. January 6, 2009: 180(1). Medline.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009.


Lutz, Sandy. “Happy Together: Consumer Expectation for a Public-Private Healthcare
System.” Journal of Healthcare Management May/June 2008, Vol. 53, Issue 3: 149-152. Academic Search Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks,
AK. 10 Mar. 2009.

Mcintyre, Diane et al. “Beyond fragmentation and towards universal coverage: insights from
Ghana, South Africa and the United Republic of Tanzannia.” Bulletin of the World
Health Organization 2008; 86: 871-876. Health Source – Consumer Edition. EBSCOhost. University of Alaska Fairbanks Lib, Fairbanks, AK. 14 Mar. 2009

Messerli, Joe. “Should the Government Provide Free Universal Health Care for
All Americans?” 16 Feb. 2009. <http://www.balancedpolitics.org/universal_health_care.htm.

President Barack Obama. “President Barack Obama holds a dialogue with White House Forum
on Health Reform participants.” FDCH Political Transcripts March 5, 2009.
MasterFILE Premier. EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 10 Mar. 2009. <http://search.ebscohost.com>

U.S. Census Bureau. “Income, Poverty, and Health Insurance Coverage in the United States:
2007: 19-22. 14 Mar. 2009. <http://www.census.gov/prod/2008pubs/p60-235.pdf>

Zablocki, Elaine. “New Report Proposes Health Care Savings Plus Increased Value.”
Townsend Letter for Doctors & Patients. May 2008, Issue 298. Alt HealthWatch.
EBSCOhost. University of Alaska Fairbanks Lib., Fairbanks, AK. 6 Mar. 2009.
http://search.ebscohost.com

Week 7 & 8: Grammar Girl Response

Comma Splices

This information was good for me as I tend to use too many commas in my writings. I also use long sentences and not really understand sometimes where I should place a period or comma. I will be wearier now when I use commas so I do not create a comma splice. I have used commas without complete sentences as discussed by Grammar Girl. This must ruin the way the reader reads especially those who love to read and have an excellent understanding about grammar and the common errors to avoid. I don’t like using short sentences because it seems so childish. I believe that using commas help you along with your sentences especially if you are trying to explain how to do something. For example, read the document, if you agree, sign, and date it in front of a notary, then, mail the document certified return receipt to this address, that address, and remember to keep a copy for your records. Well, after I reviewed the sentence, I believe the grammar is okay. I wonder what Grammar Girl would do? I enjoyed her explanation on comma splices, and will promise not to do those kinds of mistakes knowingly, but I am only human. I am not an English teacher or Grammar Girl, but I can sure aspire to do my best and follow these golden rules. My writing skills must improve and my grammar as well. Thanks to you both for helping me understand the comma splices and how to look for them. Did I just make a bunch of comma mistakes? Just when I thought I understood them. I must be nervous. Thanks again.

Week 7 & 8: Reading Response 3

GOODMAN/The Culture of Thin Bites Fiji

1. What is Goodman’s argument? How does she build it around Becker’s study while not limiting herself to that evidence alone?

Ellen Goodman’s argument is “eating disorders are a cultural byproduct.” The study she used and built her essay around was by using other similar situation consequences such as the Columbine High massacre that gives the audience more to think about other than just body images. She speaks to other harmful ideas that may influence the way we think or may desire to become. The argument that harm doesn’t come from television is proved in these two examples. She does well in her transition in what we learn and how we learn it as well as considering the significance in what we absorb through the television. The way we look, act, and portray our own self sends a presuppose message or the stereotype perceptive.

I liked that she showed a picture along with this article. To me it portrays the significance of such a sacrifice to become thin. Well, to see a beautiful woman who obviously may be suffering from an eating disorder like anorexia or bulimia is sad. I remember learning a little about these disorders and they are real and cause death. I wonder why some people are more apt to them versus others. Certainly the images that are displayed on the television, and the successes of the people, send a message to the young especially what is considered the norm. The reality is we all share in receiving some sort of message or messages being sent from television. Whether it’s a commercial trying to entice us to purchase a new fangled item or indirectly as Ellen Goodman presents in her essay.

Week 7 & 8: Reading Response 2

Making a Visual Argument: How Others See Us

1. What’s your response to each of these paintings? Is it primarily visceral – a feeling in the gut, emotional, intellectual, or some combination of these? Why, in your opinion? Is one of these categories of response more important? Why or why not?

Anispas P. Delotavo Jr.’s painting “Europe Gave Us Shakespeare and Beethoven; American Gave Us Jesse James and John Wayne, 2003” was amazingly real. I thought it was a picture. Because I do not have any background on art my view of the painting will not be examined as such. When I first viewed the visual, it displayed to me how America was established, and continues to hold that gun in place for America. It also symbolizes that America is ready to come against any opposition in the world as well. Strikingly interesting, but what was the painter really portraying? To me it is a mixed message, maybe because of my background.

Zaid Omar, Misconception, 2002.
Strangely enough, when I first viewed this visual, and without reading why the painter created it, I too saw a two conflicting views, but with the wars against Indians. I mean, I saw it from the top to the bottom and looked at it as the Indians once roaming freely, then, formed to group on reservations, misconception occurred, and only a few really make a difference to the strong forces of American government. Isn’t that odd? Not really, because it shows to me that visuals can relate to your own background or knowledge of conflict. On the other hand, it showed a breaking away from strong forces of government to freedom which in this case must have been the point. How weirdly fascinating!

Jibby Yunibandhu, At Home with the Braves, 2003. Photograph by Prach Kongsubto Rohitchan.
Here again, I viewed the picture without understanding the intent first and was surprised to learn what it really meant. The vision I saw was an Indian woman sending a message that although a white woman may have created the American flag, it was the Indian that sat in its place first and helped in part to create this symbol, The American Flag. The picture pictured in the picture is not clear to me, but it looked like feathers were in front of the flag that helped me come to that conclusion. I see how what was really meant by this picture that this Thai citizen was embracing American and showing that America is made up of different threads of life.

In all these settings, I was surprisingly disproved by my own thoughts and suggestions of each of these exhibits. I certainly had a feeling of a combination of feelings from yester history to today’s society. America’s image is that one of freedom for all, but other countries may not view these exhibits as it intended to do. Freedom by force, perseverance, and hope imply here to the globe, but not all may see it this way as I viewed them each in a different state of being with the Delotavo Jr. Painting portraying the most effective intellectually and globally.