Why the Current American Health Care System Does Not Work and Why It Should Be Changed

The preference for minimal government oversight and ideas of individualism are responsible for the way American health care system is structured. However, access to health insurance and health care has been a pressing issue in this nation for a long time; rated by the WHO as one of the worst among industrialized countries, the United States’ health care system is too costly and fails to cover everybody. Despite president Obama’s attempt to bring about change, many continue to question the effectiveness of the Patient Protection and Affordable Care Act the concerning both costs and overall coverage. The issues regarding health care reform directly affect the feasibility of the American Dream because adequate health care and insurance are necessary to full citizen participation and it is the government’s responsibility to provide access. I believe that given this nation’s strong anti-statist values it will be difficult to implement a federal health care policy; therefore it is more feasible for states to create health reforms like the one in Massachusetts and ensure universal health care.

In 2007, the US health system presented many problems concerning the amount of people who were both uninsured and underinsured and the fast rise of insurance premiums causing many Americans to report debts and problems due to medical bills (Commonwealth Fund Commission, 232). The cost of American health care is inarguably one of the major setbacks of the system; it is the highest amongst those of other industrialized nations but not necessarily more effective. For instance, a case study in the town of McAllen, Texas, shows how the overuse of medicine and the “fee for service” incentives available to doctors can really drive up the cost of medicine. McAllen is one of the most expensive health care markets in the country where most doctors focus less on preventive care and more on running extra tests, services and procedures out of fear of malpractice, influenced by differences in training, or simply to make a few extra dollars. (Gawande, 340-342). Although the situation in McAllen might be an extreme example, it does not fail to explain how the “culture of money” partly affects the cost of health care system. Unlike systems such as Canada and Japan, the American government plays a minimal role in bargaining down prices or setting price standards, this lack of control allows doctors and medical institutions to often purchase the latest technology, but not the most efficient (Klein, 256). Nevertheless, doctors are not to be labeled as the villains because private insurance companies add to the problem by expending a quarter and a third of their revenues on administrative costs (Weissert and Weissert, 350).

The high number of uninsured Americans (45 million in 2007), is another disconcerting fact regarding the downfalls of the American health care system; it is unfortunate that in an industrialized nation, once considered the most powerful in the world, people are often forced to put their career dreams on hold in order to gain access to employer based insurance. This has a negative impact on the nation’s economic and political development because people who could create the latest technological innovations are “locked” at Wal-marts and the likes. Low income uninsured families like Greg and Loretta, who struggle to keep their children healthy, lose all faith in the American dream and essentially become a burden for the rest of society. Some argue that good health is a personal responsibility, and yes eating a burger everyday will obviously have negative impacts on a person’s health and they should be held accountable for those poor choices. Consequently, some would blame Greg and Loretta for their unfortunate condition, but the question is; how can their children be expected to become productive citizens if they lack basic health care? The American Dream encourages individualism, but individuals cannot perform to the best of their abilities if they lack the necessary tools to do so.

In 2006, the state of Massachusetts passed an “ambitious” health care reform that improved access to care and lowered the rate of uninsured working age adults; in spite of its high costs, this plan exemplifies how reforms at the state level can perhaps be easier to implement and regulate, consequently having successful results. The plan is essentially composed of three parts: expansion of the state’s Medicaid progress (establishing income-related subsidies), creating new private insurance plan open to individuals, and lastly it requires that both individuals and employers participate in the health insurance system or pay a fine. Furthermore, it provides individuals with the alternative to buy from private insurers if they do not have access through an employer (Long, 321). Mixing public and private markets achieves near-universal and gives citizens options.

Two of the most important elements of this reform are the certainty of having access to coverage in the case of unexpected unemployment and not having to worry about rejection due to pre-existing conditions (Kaiser Family Foundation, 325). The economic downturn has and continues to hurt many families, many jobs are uncertain and health insurance is no longer secure, therefore by making sure citizens continue to have access to health coverage, the state of Massachusetts is essentially contributing to the overall development of the nation’s economy. When people are not worried about paying astronomical medical bills, they have more time and money to spend on purchasing houses, cars, etc which ultimately results in consumerism and more profits. Lastly, the Massachusetts provides citizens with high quality care that allows them to make regular doctor visits and access specialists, tests and medications as needed (Kaiser Family Foundation, 328). This approach is similar to the preventive care practiced in countries like Great Britain; essentially it is more beneficial for both the doctor and the patient to treat any conditions before they get out of hand.

Although the Massachusetts health care reform has proved to make significant improvements, like any other reform it has its downsides which may lead people to focus on the inequities and overlook the success. For instance many Massachusetts residents believe that more education about key aspects of the health reform would help better understand how the programs work. Residents are specifically interested in income limits to qualify and how to apply for coverage (Kaiser Family Foundation, 331). It is expected that citizens have questions about newly implemented programs and that they may not understand specific medical, political or economic jargon, but this is not a major concern because education can be easily provided. On the other hand, some would argue that the high cost of this plan is indeed a significant problem which must be addressed; nevertheless Massachusetts legislators are aware of the cost and are working to stabilize the finances. Firstly, they want a new payment of method that rewards prevention and effective control of chronic disease instead of paying according to the quantity of care provided. Secondly, the commission is looking to reimburse physicians for episodes of care rather than individual visits. Health experts agree that if Massachusetts is able to implement this changes, it will be as “audacious an achievement as universal healthcare” (Sack, 334-336).

Today, the future of president Obama’s Patient Protection and Affordable Care Act is somewhat uncertain. Republicans want to repeal it and skeptics argue that it is not going to solve the existing problems. Although this reform promises desirable aspects like overall coverage and cost reductions, the results are solely based on projection, making it difficult to guarantee that it is going to be successful. The Massachusetts health care plan has already been implemented and proved to create significant improvement. Essentially this model presents an effective alternative for health care reform and it celebrates the values of anti-statism by allowing states to make their own decisions.

Works Cited
Commonwealth Fund, “Why not the Best: Results from the National Scorecard on US Health Performance”. July 2008
Gawande, Atul. “The Cost Conundrum”: What a Texas town can teach us about health care. The New Yorker 1 June 2009
Kaiser Family Foundation, “The Uninsured: A Primer”. October 2008
Klein, Ezra. “The Health Nations: How Europe, Canada, and Our Own VA Do Health Care Better”. The American Prospect. 7 May 2007
Long, Sharon K. “On the Road to Universal Coverage: Impacts of Reform in Massachusetts at one year”. The Commonwealth Fund. June 2008
Sack, Kevin. “Massachusetts Faces Costs of Big Health Care Plan”. The New York Times. 16 March 2009

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Health Care and the Affordable Care Act 2010

Since the first open enrolment period to register under the Affordable Care Act (ACA) has now expired this is a good time to look back and reflect on the state of health care before the Act and to see what changes were made by the new law.

BEFORE THE ACA

Before 2010, health care was a system of competing private insurers which failed to control costs and provide access to quality care for the American people.

45 million Americans did not have health coverage and 76% of them said it was because they could not afford it.

Those who had individual plans found them to be more expensive and with less coverage than those available through employers.

But those with employer insurance were not without their fears as expressed by the saying “I’m just a pink slip away from being uninsured and one sickness away from bankruptcy or even death”.

We can remember the horror stories of the insurance companies’ abuses such as refusing to pay for treatments that people with plans needed, driving away longtime policyholders, refusing coverage because of pre-existing conditions and charging higher premiums for women than men.

The consequence was that 45,000 people died yearly because of lack of health coverage. Of these one person died every 12 minutes. Contributing to this was the eroding medical safety net for the disadvantaged while better quality of care was afforded those who could afford it (HARVARD GAZETTE – New study finds 45,000 deaths annually linked to lack of health coverage, by David Cecere, September 17, 2009).

These deaths exceeded those caused by many common killers such as kidney disease.

Added to these grim figures was the fact that medical bills was the number one cause of personal bankruptcies and America spent more than twice as much per capita on health care than other developed countries and did not provide superior care.

THE AFFORDABLE CARE ACT

When President Obama became President in 2008 he set about reforming the system and gave us the ACA.

Under the Act you are no longer dependent your job in order to have health insurance. It requires insurance companies to sell you a policy regardless of your health and they can’t cancel it or raise it because you get sick.

The Act contains provisions to provide easier access to ACA coverage.

For example, you may qualify for a subsidy that reduces the policy’s expense. Subsidies in the form of tax credits are available to people with adjusted gross incomes within certain limits and there are 4 groups of plans to suit different income levels.

If you do not qualify for a subsidy there is a ceiling on what the insurance companies can charge; for example if you are over 60 you pay a maximum of three times more for similar coverage than people in their 20’s.

To prevent free loading (taking the benefits without contributing to the costs) you are required to have coverage or else pay a penalty.

All in all Americans have more peace of mind and are better off today because nearly 6 in 10 Americans can get coverage for $100 a month or less, insurance companies must cover essential benefits and must publicly justify rate increases of 10% or more.

The problem with the ACA is that it retains the private insurance industry and leaves prescription drugs to the vagaries of the free market without any competition from the government.

A better option would have been to adopt the single payer system in which the government pays all the medical bills for everybody. We already have the basis of such a system; it’s called Medicare.

ACA VS MEDICARE

President Obama deserves much credit for trying to fix the health care problem and for giving us the ACA. 7.1 million people now have health insurance which they did not have before and added to that are another 2 or 3 million who joined their parents’ plans.

However the profit motive still exists. Premiums went up under the ACA to accommodate profits for insurers and the government gives premium subsidies to offset the increase. A more cost effective way to do it would have been to eliminate the element of profit and prevent the profit-taking middle man (insurer) from getting between the patient and the provider.

The point here is that universal health care at low prices is incompatible with the policy of maximizing profits which is the aim of private insurance.

Instead of building the ACA on top of a failing private system Medicare should have been extended to include everybody and coverage increased from 80% to 100% of costs.

It would work for everybody since it has worked for seniors for nearly 50 years and is projected to be solvent through 2024 (based on present expenditures and income).

Medicare for all would also have avoided the inept roll out of the new law and the contentious issue of employer and individual mandates which only helped to make the ACA less popular.

According to Dr. Johnathon Ross of the Physicians for a National Health Program, it would have saved $400 billion a year, covered all the uninsured, eliminated co-pays and deductibles, allowed complete choice of provider and improved coverage for all. For example in 1995 Taiwan replaced private insurance with one based on Medicare and coverage went up from 60% to 100% with no growth in costs.

The ACA cannot do these things. The Institute of Medicine (IOM) report of 2004 entitled “Insuring America’s Health” noted that individual and employer mandates with premium subsidies (the ACA) cannot provide universality, continuity, affordability and access to equitable care but Medicare for all would (PHYSICIANS FOR A NATIONAL HEALTH PROGRAM – Will the ACA achieve universal equitable coverage? by Johnathon S. Ross, winter 2013).

Lastly, Medicare for all could co-exist with the private sector such as in Canada, France and Australia where private providers practice independently for patients that can afford to pay.

CONCLUSION

Perhaps in recognition of the IOM report the ACA will allow states to experiment with other types of reforms including Medicare for all in 2017. Vermont has already implemented this with the help of a waiver and there are 22 other states considering it. Maybe when it works in Vermont other states will follow.

Victor A. Dixon
April 5, 2014

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