Health Care Reform Policy in the 21st Century

Is health care a human right, or a market commodity? Regardless of one’s opinion about the morality of health care, many informed Americans agree that the current heath care system of the United States is on a fast downward spiral. There is urgency in the unified call for future American policy makers to tackle the fundamental problems of the current system and implement real reform. This system is running out of room to slap on the “feel-good-now” band-aids which incrementally and temporarily fix and cover up the visible problems without ever really addressing the fundamental issues.

What would fundamental reform look like? That question depends on how long it will take the universal health care supporters and private health care supporters to realize that neither one of them are going to come out on top. If politicians really want to save the health care infrastructure of this country, then they must cooperate and embrace mediation. The following proposal is a carefully studied reform plan which attempts to promote as many benefits from both private and universal thought as possible while keeping opportunity cost at a minimum. The plan incorporates a system of checks and balances between the government and the private realm of health care while ensuring that every citizen has coverage and access to emergency and primary care. Before discussing the proposal, it is vitally important to understand why the current system is failing. Most health care policy experts consider these 3 areas of criteria of high importance when evaluating health care systems: access, cost, and quality (Jost, 11).

The criteria of access begs the question, is health care available to all those who need it? According to 2005 U.S. Census Bureau estimates, 47 million Americans lack health insurance. This does not include the millions more with very poor coverage or those who are inconsistently insured (Jost, 17). The American tendency toward stereotyping leads many to assume that the uninsured are unemployed, lazy, unhealthy due to lifestyle choices, poor financial planners, or a combination of all of these. In reality, 80% of the uninsured are employed or live in the household of the employed. They are mostly low wage, part time, seasonal, or work for small businesses (Gawande). Interestingly, 17% of the employed uninsured make more than $75,000 a year; evidence that the coverage crisis does not only affect the poor (Jost, 33).

Incremental or “band’ aid” solutions involve state sponsored programs like the State Children’s Health Insurance Program (SCHIP) which is supposed to insure that all children receive good medical attention. The problems associated with SCHIP are similar to the problems with Medicaid; many are eligible, but few are enrolled for numerous reasons that the programs have little or no control over. There are bureaucratic barriers; lack of enrollment education efforts on the part of the states because they lose money; the Deficit Reduction act of 2005 requires proof of citizenship (apparently Congress is okay with the discrimination of children); and some states require a child to be “desperately poor” which excludes many children of the struggling working class. SCHIP leaves an estimated 21 million American children with significant access problems (Estes and Harrington,408)

The Emergency Medical Treatment and Active Labor Act ensures public access to emergency services regardless of ability to pay or insurance coverage. However, the patient will still be billed the expenses and the Act does not extend to preventative, primary, or chronic care. Sixty percent of the uninsured are not receiving primary care and waiting until their condition worsens to the point where they require a visit to the emergency room (Estes and Harrington, 44). Sadly, the mostly poor uninsured is the most likely group to need medical attention. An alarming 2005 study by the Institute of Medicine reveals that nearly 18,000 adults die prematurely per year because they lack insurance (Jost, 23).

The insured do not escape the coverage crisis. Insurance companies exist to make profit, not to heal the sick. Companies deny thousands coverage because their fine print include rules about pre-existing health conditions, exclusion of certain high risk occupations, hidden fees, large coverage gaps, complicated networks of hospitals and providers, and other schemes to weasel out of paying (Messerli).

A man writes on an online message board concerning American Health Care policies:

On a personal note, my wife and myself have no access
because of pre-existing conditions, which make insurance premiums unaffordable.
As a result of our situation, my Russian born wife is presently in Russia
receiving needed medical care which is not available to us in America. The
uninsured try many different approaches to secure medical access, Many times
with little or no success. My wife cannot comprehend this situation, simply
because in Europe medical access is a right, not a privilege as it is in
America. If this crisis is allowed to continue, we will be on the verge of
insanity when we speak of health care reform in America. There is absolutely no
excuse for such injustice in a country that prides itself on human right issues
around the world. (Maintenance Professional in North Carolina. " The Health Care
Problems Archive: A Collection of Problems with the U. S. Health Care ")

Insurance companies are failing the American people. Free markets are supposed to serve the best interests of the public. Instead, they are making access to health coverage nearly impossible for millions of Americans and rigging the system which their customers buy into; all in the name of profit.

The second criterion of cost is the force behind the downward spiral of health care in the United States. Policy experts ask if the cost of healthcare is reasonable given the country’s resources. The price the United States pays for health care is approaching $2 trillion a year; 16% of the Gross Domestic Product (Jost, 23). The U.S. spends more on health care than anything else and more than any other country in the World (Estes and Harrington,46). All the new and frequent advancements in medical research and technology have caused prices to rise at a ridiculous rate of 7.9% per year (Jost, 23). High prices encourage investments into new technologies which have dramatically improved people’s quality of life. On the down side, the rising costs are the insurance companies’ excuse for their sky rocketing premiums and increased restrictions and the government’s inability to keep up with its Medicare and Medicaid programs. As the Baby boomer generation prepares to retire, the burden of the rising costs of health care will fall upon subsequent generations (Cohn).

The sky rocketing costs can most clearly be seen in the dramatic decline of employee sponsored coverage while public sponsored care has not increased fast enough. Employee benefits are useful because the employer is able to purchase health care for its employees much cheaper than the individual worker could on his or her own (Jost, 43). Due to the sky rocketing cost of health care, many employers can no longer afford to offer their employees top notch care or follow through on health reimbursement arrangements (HRAs) which are smart individual accounts for health care (Gawande). Increasingly, Americans are depending less and less on their company to provide adequate coverage and are having to invest in the non-group market (individual) or decline to participate in health insurance altogether (Jost, 44). Meanwhile, funding for public programs like Medicare and Medicaid are being dried up by the booming costs the government has to pay to support the entire health care infrastructure and all its waste (Gawande).

Most non-group markets have extremely high premiums and co-payments, no mental, prenatal, or maternity coverage. In some states, an individual is better off uninsured than investing in these flimsy plans. The popular and most affordable Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans leave serious coverage gaps and have many restrictions. Two in five insured Americans experience a huge financial burden in the case of a medical emergency. Some have their credit ruined, house taken away, and aren’t able to rent apartments or purchase cars because of their ruined credit. (Jost, 44)

Breann LaManna is your typical 11-year old little girl; she loves Hannah Montana
and playing with her friends and little brother. At first glance, no one would
ever be able to tell that this little girl has been through an ordeal that most
people will never have to incur; Stage III Hodgkin’s disease, a rare form of
childhood cancer. She has been through agonizing chemotherapy and radiation
treatments, long hospital stays, and in many ways she has had to grow too soon.
It all began when nine year old Breann’s parents Maria and Chris took her to
see a doctor about a persistent and worsening cough due to what they believed
were allergies. A chest X-ray discovered a 13-centimeter mass on her aorta,
without any time to spare, she was admitted to Memorial Sloan-Kettering Cancer
Center in New York and administered seven rounds of chemotherapy and fourteen
rounds of radiation. Her father reminisces, “that’s where the whole roller
coaster began. People can't really relate unless you actually go through that
experience. It's terrible, and also with the health insurance that just denies
and denies." The LaManna’s insurance company at the time, AETNA, denied any
coverage of the treatments, stating that Sloan-Kettering wan not in their
network of coverage. Sloan-Kettering is one of the best hospitals for Breann’s
condition. Her parents were not going to put money and their insurance’s network
rules over their daughter’s chance of survival. As a result, the LeMannas
acquired over $140,000 in medical bills. Her mother tearfully explains, "When
you're thinking you can lose your child, the last thing you're worrying about is
a preapproval (to a hospital), Breann was stronger than I was. You feel like the
world is closing in and she'd make you laugh. She was definitely a fighter.”
Little Breann beat the cancer and she has been cancer free for over a year now.
Currently, the LaMannas have been working with legislators to establish Breann's
Law, which forces insurance companies to provide the funds for the treatment
center that provides the best care for a child battling a catastrophic or
potentially fatal illness. "We're trying to rattle the cage and make people
aware of it. I couldn't understand how she could do it because I couldn't do
it," said Chris. "She's really an amazing individual. The health insurance
company destroyed us financially, but we won because we have Breann here. We
want to help the next family so they can worry about the welfare of their child
without worrying about how they're going to pay for it.”( Michels)

The LaMannas are not alone in their ordeal. Hard working American families with medical debt the size of an average home mortgage are not hard to come by. In fact, about half of all bankruptcies in the United States are primarily due to medical debt. After such a difficult ordeal, why should these families have to carry such a financial burden? Especially since many have invested in the American health insurance market and have been denied. As more and more health insurance horror stories like the LaMannas family’s comes to light, it becomes apparent that health insurance in the United States is a gamble, not an investment for “peace of mind” as it should be.

The third criterion of quality, asks whether or not the country provides acceptable care which achieves the best possible outcomes and whether it keeps avoidable medical errors to a minimum. 44,000 to 98,000 Americans die every year from medical errors (Goodman and Fisher). More people die from medical malpractice in the United States then from AIDS or Breast Cancer (Jost, 51). The U.S. lags behind other developed countries in implementing electronic health information that would allow health care providers to better organize and keep track of patient information. Privacy issues often thwart attempts for a shared electronic health database. Comparatively, the United States does provide excellent care to many people and many other developed countries struggle just as much with medical malpractice (Goodman and Fisher). Some of the best doctors in the world are trained and practice in the United States and people from all over the world come to the States to receive life saving treatment.

The United States ranks relatively high in other criterion considered such as; freedom of choice, respect given to patient in their ability to make decisions and their right to privacy, and innovative research into medical problems and cures. However, based on all of the criteria, the United States ranks 15th out of 25 countries; hardly the “best in the world.”( Jost, 59) Here is the outline of a plan that contains the potential to carry the United States health care system to the number one spot where it belongs:

Implement a private and public sector of heath care much different from the ones in current existence. The private sector would be available to those who do not wish to participate in government run health care. This will accommodate the expectations of the rich: short waiting times and comfortable accommodations. Similar to parents who choose to send their children to private schools, yet still pay taxes for public education; those who buy into private healthcare will still pay taxes that go toward public health care.

The public sector will be based off of France’s socialized health care system. Income level will be ignored so that every citizen will be given a basic coverage plan by the government funded by a new social security fund. The basic coverage plan will cover emergency and primary care for everyone. Depending on tax brackets, the coverage will extend to other areas such as pharmaceuticals, dental, vision, and specialists. The exception to this is America’s children who will receive full and complete coverage no matter what financial background they come from. Also, to inspire more people to enter the nursing and doctoral professions (which there is a severe shortage of) the government can provide a program where they pay for medical/nursing school in exchange for a certain amount of years spent working in the public sector of healthcare.

In order to keep competition flourishing, the government should invest in private healthcare companies and pharmaceuticals in exchange for their commitment to follow certain regulations in promoting fairness within their coverage plans, open networks, and to keep premiums reasonable (Shimkhada, Peabody, Quimbo, and Solon). Those who are in higher tax brackets must take the initiative to purchase private insurance for the coverage that the government will not extend to them outside of primary and emergency. This may not seem fair, but private insurance allows for nicer facilities, more freedom of choice in health care provider, and more personal attention. Public facilities outside of primary and emergency care will be monitored by unions to ensure competent health care providers are giving adequate care. Primary and emergency public care facilities will be top notch and co-operated by private providers to ensure quality.

A collaborative and all inclusive electronic patient health record will also be implemented to avoid the abuse of prescription drugs, enable health care providers to provide the best course of medical action to the patient, and avoid errors.
Cost control and funding the new system will be tricky, but a lot of wasteful spending will be eliminated by fundamental changes within the system and getting rid of a lot of the profit making. Taxes may need to increase (the conservatives will throw a fit), but it is not a bad price for a healthier America which is more productive and beneficial for society and the economy anyway.

Public health initiatives and research into alternative therapies should receive more support from the government. Alternative and complementary treatments are less expensive and often times come with less risk and side effects then contemporary medications and procedures. Also these treatments consider the whole person: mind, body, and spirit. Other countries like India and China use traditional medicine just as much as contemporary and citizens often rely and trust the traditional more. Outreach programs to educate and equip citizens against harmful activities to their health such as tobacco, unprotected sex, and obesity have been shown to have a positive effect.

This is a plan that satisfies universal health care supporters by mandating that the government provide basic emergency and primary care for all its citizens while also satisfying those favoring private insurance by not doing away with the health care market and profit motivation and competition. The most important aspect of the plan is that it provides care for every citizen regardless of social class or situation.

The United States is the only wealthy industrialized country without a universal health care plan. A universal system of health care allows health care providers to concentrate on healing patients rather than insurance procedures and fillings. It opens doors and opportunities for those who could not afford to practice preventative medicine and wellness before. Another benefit is that universal plans close the health and care gap between the wealthy and the poor because a person’s life and welfare should not come with a price tag. Negative aspects of a universal system include the well known inefficiency of the federal government, the end of profit motives and competition which drive better services, research, and technology. Universal health care does not mean “free” healthcare; it will come out of the public’s pockets one way or another which means that people who take good care of themselves will have to pay for people who make poor health decisions. A complete transition from the United State’s current system to a universal system will create too much loss because of the magnitude of the industry. A lot of people will lose their jobs; there will be disorganization, lost files, and much confusion. Finally, where is the accountability for health care providers? To whom will negligence and malpractice lawsuits go? (Messerli)

Privatized health care when allowed to run on its own with no government interference will inspire competition which sparks better services, technology, efficiency, comfort, and choice menu. The trouble is that this system without any checks seems to make the rich obscenely rich and exploits the working class. A very large gap develops between the quality of life saving care received by the poor and by the rich. (Messerli)

When coming up with a reformed plan which lies somewhere in the middle of socialized care and private care, policy makers need to avoid making the mistakes of the past. When Bill Clinton attempted to push his health care reforms through Congress, there was very little bipartisan cooperation and he failed. (Estes and Harrington, 39)

Although, Gallup polls since 1937 show Americans in favor of greater government role in healthcare. (75% of public in 1992), (Estes and Harrington,31) our government has failed in creating intense long lasting reform. The American democratic system is one of the hardest to promote change. At times, congressional rules can call for as much as a 60% senate approval of reform legislation, not to mention it only takes one senator to filibuster a piece of legislation. Also, the medical./industrial/insurance complex appears almost too strong for the government to tackle. They are heavily involved with and pour tons of money into lobbying, advertising, campaign donations, and public relations. (Gawande) The private sector of health care will not go away anytime soon.

The United States needs a president who will work with both parties so that change can happen. Policy makers and legislators need to give up their stubborn opposing stances and compromise with each other to obtain the best comprehensive plan for health care possible. Some analysts predict that if no action is taken by 2013, 56 million Americans will not be insured and the United States will be spending a whopping $3.36 trillion a year on health care. (Jost, 102) The American people must back political candidates who are willing to mediate and compromise for a healthier America.

Works Cited

Cohn, Jonathan. "What’s the One Thing Big Business and the Left Have in Common?" The New York Times 1 Apr. 2007. 23 Apr. 2008 http://www.nytimes.com.

Estes, Carroll L., and Charlene Harrington. Health Policy Crisis and Reform in the U.S. Health Care Delivery System. Sudbury, MA: Jones and Bartlett, 2008.

David C Goodman, Elliott S Fisher. (2008). Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription. The New England Journal of Medicine, 358(16), 1658-1661. Retrieved April 23, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1464139441).

Gawande, Atul. "The Obama Health Plan." The New York Times 31 May 2007. 22 Apr. 2008 http://.nytimes.com/.

Jost, Timothy S. Health Care: At Risk a Critique of the Consumer-Driven Movement. Durham and London: Duke UP, 2007.

Maintenance Professional in North Carolina. " The Health Care Problems Archive: A Collection of Problems with the U. S. Health Care " HelathCareProblems.org. 10 Sep. 2005. 21 Apr. 2008 http://www.healthcareproblems.org/.

Michels, Chelsea. "Chiropractor to Raise Funds for Local Girl's Medical Bills." APP 17 Apr. 2008. 22 Apr. 2008 http://www.app.com/.

Messerli, Joe. "Should the Government Provide Free Universal Health Care for All Americans?" Balanced Politics. 17 Apr. 2008. 22 Apr. 2009

http://www.balancedpolitics.org/universal_health_care.htm.

Shimkhada, Riti, John W. Peabody, Stella A. Quimbo, and Orville Solon. "The Quality Improvement Demonstration Study: An example of evidence-based policy-making in practice. (Research)(Report)." Health Research Policy and Systems 6.5 (March 25, 2008): 5. Academic OneFile. Gale. Clemson University. 23 Apr. 2008 .