Introduction
Unlike other European nations such as Germany, Spain, Italy, the United Kingdom, and France that accord free health care to all their citizens, the United States has been incapable of doing the same to its citizens (Senn 302). A report compiled between 1997 and 2009 from the National Center for Health Statistics reveals that the number of both uninsured and underinsured Americans is less than those who are insured (CDC/NCHS 1). Therefore, these uninsured Americans hesitate to seek medical attention when unwell due to their inability to foot the medical bills. The medical bills have been too high to be met by the citizens; however, this situation has taken too long without the government taking an initiative until within the first quarter of 2010 when President Obama took the initiative to endorse PPACA. Whereas non –profit-making health organizations needed more funding to enable them to expand and extend their services to more customers, it was an opportunity for insurance firms to make lucrative gains. This led to a dramatic change of the national health care facility, which in turn led to most insurance firms being in control of national health care as they continued to increase medical bill charges.
In the past, the government had attempted to adopt the European free medical care, a move that led to the establishment of Medicare and Medicaid for the elderly and disadvantaged in 1965. Unfortunately, only a small fraction of the entire American population could access and benefit from these initiatives. This free universal health care program was too exorbitant to be extended to all citizens; indeed, a couple of factors have led to almost half a billion Americans not affording health care. These include modifications in the nature of health care earlier on in the century, inaccessibility of state-funded health care programs, and the surge of private-based health insurance companies.
Defining Health Care
Degrees of injury and sicknesses in a population are determined by meals, shelter, smoking, and drinking habits of people, whether where they live is encompassed by crime or risky traffic congestion, and a host many other things. These illnesses and injuries could be the entry point for a health care system. Its attempts to solve the problems are its output, and the general outcomes are health results. From this view, it is clear that two separate healthcare plans could be equally necessary for dealing with disease and injury through the population’s health in one could be worse compared to the other due to its problems being worse to start with. A holistic definition of healthcare should therefore concentrate on wellness and not just curing disease. What to be included in a medical model of healthcare depends on three factors. First, we have effectiveness. If people imagine that a certain type of care is not possible, they may not readily embrace national policies to pay for it. However, effectiveness is difficult to quantify and at times, some people feel uncomfortable paying for other people’s dues. Secondly, there is a necessity where new enlightenment can alter treatment from the meaning of healthcare.
Meanings of necessary care also change as society transforms. A long time ago, long-term care was a family affair due to geographical closeness in families and people could not live too long to be a burden. When people were not so many, physical therapy was not so much of an issue but it is currently a greater part of medical spending. Despite similarities in national social trends, value for health care differs from nation to nation and according to the plan in the United States. Thirdly, there is insurability. Insurance operates in such a way as to protect people and not raise a need for the same. Any kind of injury or sickness may not guarantee someone compensation. The case is even tricky in the cases of mental health and dentistry. In all these cases, it is clear that insuring will certainly raise demand and cost (White 23).
Health care and Insurance in the United States
In the United States and other regions, private health insurance began being established by charging a certain rate to all community members. With the advancement in time, that plan has been overtaken by market rivalry in the United States. In addition, those who benefit from taking risks such as the young, healthy employees may regard community rating as a form of sponsorship from them to other people. An emerging problem is whether insurance companies should charge people based on risks, at a community level or based on their capability to pay. Although income-based subsidies may be supported based on personal reasons, in most communities, support for the commodity involved determining support for subsidies.
The United States and other nations have very elaborate subsidies that depend on the income for their healthcare costs. Although they possess very outspoken values in the name of rights and cohesion, egotism is also a factor; and although people’s health conditions are prone to change more than their financial situations, few pays are secure with most citizens unable to depend on their incomes to help them survive an uncertain economy. Still, someone who can provide for their personal health needs may find it challenging to do the same for either children or even parents. Basing subsidies on people’s pay will therefore put them in a position to be able to protect not only themselves but also their loved ones. People contribute a lot for the elderly and the needy in the hope that when they become either needy or older, they will be sponsored.
Medicare and Medicaid systems in the United States
In the United States, Medicare is a program that enhances shared savings for the sake of high medical bills during old age similar to the way social security encourages pension savings. Medicare does not incorporate personal interests or community understanding. There are exorbitant requirements that Medicare does not cover. These include eyeglasses, drug prescriptions, and hearing exams and aids (Raffel and Barsukiewicz 34). If a given commodity is affordable like across-the-counter medication, it is availed in the market. If a type of treatment is not effective then nobody may be ready to save for it. Of the 99% of the insured Americans, 96% of them are insured through Medicare. However, the Medicare program is not effective causing about 70% of the elderly folk to supplement it with private-based insurance. Medicare allocates about 80% of its total amount to medical expenses. The remaining 20% can only be given to the doctor upon demand. Legal extra charges are not encouraged (White 37). Medicare allocates only 29% of its collection to its beneficiaries who are mainly families. It has become a form of insurance for long-term care that can only be accessed by individuals who have expended almost all their property except the house. Part of Medicaid funding is also available to both the non-elderly disabled and the elderly.
Medicare plan seems to be more liberal compared to other programs. Almost all states provide required facilities such as pharmaceuticals, specs, and dental services, among others. However, states appear to limit the use of this plan by asking potential recipients to fill complicated application forms, and the availability of Medicare facilities to beneficiaries is restricted by some factors. One of them is inadequate providers in areas of the needy since few doctors choose such places as their workstations. Secondly, states normally charge lower than what providers will be given from either private insurance or Medicare.
Budgetary effects of Medicaid and Medicare
In the 1980s, Medicare and Medicaid led to budgetary deficits due to an increase in the number of their beneficiaries (White 39). Congress took several measures to minimize the pace at which Medicare cost was growing but kept growing relative to the rest of the financial plan. Changes in health care became a chief budgetary agenda due to these incidents. While the government played its role to regulate its costs than the private sector did, logistics such as population growth and the need to balance private payments with public payments caused the impact to spill over to the next century.
Payment issues
A comprehensive health care financing plan entails the one who is paying, the amount being paid, and how it is being paid. In most nations, service providers like doctors may be paid either per service or per medical prescription. Another approach is paying a physician for a total of all services provided annually. This may be part of a hospital’s budget and salary for the doctor. In between, the doctor receives part-time pay. Overall, cumulative the level of payment is the less knowledge the payers have concerning what they are spending. This makes overseas anxious especially when there are civil servants who are keen on record keeping. However, it is also difficult for providers to exaggerate values in a cumulative system. Another issue regards whether a similar charge should apply to all services of a particular type. For instance, a visit charge to a physician may be twice the return fee.
In Europe, free health care is facilitated by several factors. These include the general economic surrounding, socio-economic issues, the triumphing governmental support, the health care framework, and consumer attitudes (Senn 302). In most of these European countries, the government plays a bigger role in meeting the medical expenses of their citizens. Based on the American experiences, it is often asserted that medical organizations can only be sustained through their ability to focus beyond gains, provision of required levels of care, laying emphasis on teaching, engaging in research, enhancing care for the needy, and providing required autonomy for the doctor.
Towards the end of the twentieth century, America was involved in an extensive deliberation over the need to overhaul the nation’s health care system. Contrary to many other countries, the shortcomings of the American health system were two-fold: too much health care costs and the inability of most Americans to meet required health care (White 1). However, agreeing on the remedy for these shortcomings was a daunting task. Hillary Clinton’s attempts to marshal five hundred health scholars in Canada to explore the possibility of coming up with an ideal health care system attracted so much criticism internationally. It was argued that several countries had taken too long to come up with a perfect health care facility, which never materialized (White 1). What Americans needed therefore was not necessarily a perfect health program but rather one that was better than what was being offered at the time. If this is to be the goal, then measures exist to meet the desired goal. What is interesting is that most of the other developed countries offer universal health care facilities to their citizens at a cost lower than that offered by the United States. It could have been therefore prudent for the United States to learn from the measures that other nations have taken and modify them to suit its own situation.
Some Americans argue that they cannot learn from the way other nations have devised their universal health care systems. Such an argument overlooks the fact that many things from culture to technology are a result of the diffusion of ideas across borders. Individuals who encounter similar problems for similar reasons can turn to help from some of the similar responses. In the same way, many of the American institutions have been modeled around examples from other nations. For instance, the American management of factories was emulated from Japan. In the same vein, health care is not a separate concept in the United States than it is in other countries. Although the provision of a universal health care facility is costly, it is intertwined in technology and sociology related to it. In most developed nations, there is an ever-increasing partition of medical labor due to an increase in specialized knowledge. Hospitals have graduated from simple health organizations that provide palliative care for the needy to organs of advanced technology. Even though there are variations in most countries about modes of treatment, research, and innovations in one country may be found to be relevant in another in another one.
Technology transforms organizations and tasks in nearly the same way. For instance, new kinds of anesthesia have made it possible to carry out surgery outside the hospital, challenging the hospital’s supremacy. Doctors regard themselves as experts and defy regulation. They have come up with mechanisms that counter similar threats in different nations such as the mushrooming medical clinics. Other role players in the health care system like economists and nurses concur that doctors have a greater influence. It is a political choice as to whether the United States will come up with a system that will guarantee health care for all citizens. Other nations had to overcome some of the challenges that America has been currently facing. These include for example doctors’ concerns about their independence and smbusinesses’sses opposition to government taxes. Despite the oppositions being strong in other nations as it is in the United States, they eventually managed to do it but the United States has not yet.
Proposal to Financing Healthcare
In the United States, debates on how to provide funds for health care hinge on whether insurance companies can offer different costs for different people and how to sponsor people who cannot be able to meet the costs. Clearly, this design requires an evaluation of each person’s earning and a different brief financial support to each family or individual that is helped. The United States government should come up with something similar to what the international community is offering. For instance, internationally, a bigger percentage of healthcare costs are not met by individuals contributing towards insurance the way do before purchasing other commodities. They submit their funds towards a certain system. Their contributions are based on regulations that are meant to compare costs to the ability to both pays and bring together sufficient funds to pay for the resulting health care. If all people adhere to these regulations, there should be no need for separate, individual subsidies. The amount to be contributed is based on the ability to pay in either of the two ways. One is not to charge a fixed price, but a fraction of wages. This could either be revenue paid to the government or premium submitted to an insurance company. In most cases, the contributions are made by both the employer and the worker, just as it is done in the American tax towards the government social insurance programs.
The second technique is to meet the expenses of the health care facility through the government revenue. Since these financing emanates from taxes that are dependent on income, then effect is not different. Those with higher salaries pay more while those with lower pays contribute less. Like is the case in other countries, the amount to be contributed should be related feebly to the family size. Both single individuals and double – income families should help cover those single income families that have children (White 6). The same regulation should similarly apply to the young and the old. Since payments are determined by people’s earnings, those who earn meagerly at the start of their careers may not pay the same as those who have worked for long. In all these scenarios, the general guidelines of contribution are that people in the course of a normal life, one sponsors others at some point and is also sponsored at some other time. Contributions towards healthcare remain dependent on income throughout someone’s lifetime.
Proposal for providing high quality care
The American plan of funding health care leads to a decline in the quality of care for one category of people: the uninsured (Smith, Wertheimer and Fincham 21). Approximating these effects is not easy since individuals who are not treated are not attended to by someone who could approximate how best they could have been treated (White 55). Yet careful statistics indicate that those who are not insured take about 60% and 70% of ambulance and inpatient services annually respectively. This means that those without insurance are at a higher risk of losing their lives when hospitalized than their insured counterparts. This is because the uninsured may not be readily attended to. It should be noted here that a health plan that does not unveil insurance to its potential beneficiaries has neglected a palpable step for providing quality health care. Other dealings could concentrate on controlling the quality of providers. The most suitable step is licensing. State governments have the mandate to dispense these measures. Most states delegate their mandate for quality control to professional entities. Revoking a doctor’s license to his duties is not common. Another effective regulation could be to pull out hospital staff privileges, but this too is seldom.
Conclusion
Problems with provision of quality universal health care to the American citizens have been around for quite a while. Whereas it may not be easy to come up with a perfect plan for health care, an improvement than the one the United States has had for years is possible. The past American leadership regimes have been unwilling to borrow a leaf from other European nations that have come up with a successful health care system. This should not have been the case since technology and information easily diffuse across borders to buttress a nation’s economic, political, economic, and social structures. Private insurance has not fully met the needs of all. Medicare and Medicaid programs have their own constraints, even to the national budget. To alleviate these challenges, restructuring in financing, insurance, and legislation should be the way forward.
References
Centers for Disease Control and prevention (CDC). “Lack of health insurance and type of health coverage.”Lack of health insurance and type of health coverage. 2010. Web.
Raffel, Marshall and Barsukiewicz, Camille. The U.S Health System: Origins and Functions. OH: Cengage Learning. 2010. Web.
Senn, Hans-Jorg. Tumor prevention and genetics. Berlin: Springer Verlag. 2005. Web.
Smith, Michael, Wertheimer, Albert and Fincham, Jack. Pharmacy and the U.S Health Care system. Binghamton: Pharmaceutical products press. 2010. Web.
White, Joseph. Competing solutions: American Health Care proposals and International experience. Washington D.C: Bookings institution press. 1995. Web.