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
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