It is believed that the US health care system is among the best in the world, due to the freely available medical technology and the facilities employed by this technology. On the other hand, America’s healthcare system is believed to occupy a larger portion of the budget than is necessary. The organization of the system includes both private and public insurers like in many other countries of the world. It is said to be a multi-payer system, while a single is payer system is a system where one player in the sector caters for the healthcare needs of the entire population; in this case the government. In a multi player environment, individuals can opt to buy private insurance.
The statistics of 2003 indicates that 62% of the non-elderly Americans used private insurance sponsored by the employer and 5% purchased their own insurance (Private Non Group). 15% of the population used public insurance programs such as Medicaid, and 18% of the population remained uninsured. Those aged 65 and above were mostly put in Medicare.
Medicare catered for individuals aged 65 and above as well as for people with disabilities. Premiums are financed by the Federal income tax, payroll tax and individuals, who remit their own premiums. The benefits of this category of Public Health Insurance and Medicare, are that they have various parts that cover hospital, physician services and also prescription drugs. Medicare coverage is however, coupled with various gaps including incomplete preventive care coverage, incomplete skilled nursing facilities and lack of coverage for hearing, dental, and sight care. Consequently, the seniors have to pay additionally 22% of their income despite the cover.
Medicaid program is designed for the low income and disabled population. Eligibility is also stretched to extremely poor pregnant women, children and the elderly. The premiums are financed through taxes by the state and the federal government. The Federal government matches by 100% every dollar spent on the Medicaid by the State. The benefits offered by the Medicaid are fairly comprehensive, including prescription. Employer-sponsored insurance is mainly the way in which most Americans receive their health insurance. Employees receive health insurance as part of their benefits package from the employer through Insurance plans administered by private companies. The premiums are financed by the employer, who pays the higher portion of the premium and the employee, who pays the remaining portion. Benefits of this type of insurance vary with the specifics of the insurance plan and the cost shared. Private non-group insurance covers the self-employed and retired population, including the people not covered by their employers due to the pre-existing conditions. The covers are administered by the private insurance companies. The premiums are financed by individuals. The benefits depend on the specifics of the health plan.
Financing of the U.S. Health Care System
Financing of the health care centers revolves around the collection of funds for the health care (in-coming money) and the reimbursement to the health service providers (out-going money). This responsibility is shared by both the private insurance companies and government. The system is therefore, that of a multi-payer. Both individuals and businesses are taxed by the government by paying income tax. Employers and employees also pay payroll tax. The government then uses the money generated from the taxes to distribute to providers who take care of patients enrolled in these programs.
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According to Organization for Economic Cooperation and Development (OECD, 2005), in 2003, the United States spent 15 % of their GDP on health care, making it the highest percentage in the Organization of Industrialized Countries. The GDP average percentage spent on health care in countries of OECD was 8.6%. The U.S. also had the highest total health spending per man of $5,635 US dollars, which was two times more than the average of OECD of $2,307. Most Americans do not have medical insurance coverage in comparison with those countries within the economic category. Americans per capita spending for instance, is higher than that of Canadian yet, more than 16 % of the American population lacks medical insurance policy.
The United States health system faces a disparity challenges for patients based on economical and racial class. According to Science Daily (2010), reporting on the American College of Physicians (ACP) findings, much of the disparity exists on the racial and ethnic stratification of the patient. Ethnic minorities and non-white Americans are prone to poor health services as compared to white Americans including cases where insurance sponsored healthcare is concerned. The ACP notes that to address the issues surrounding health disparities in health will be necessary, yet difficult task in reforming the healthcare sector in the country.
The healthcare system and infrastructure contributes to the high cost and efficiency of treatment of diseases. An electronic medical record, which contributes to effective and efficient healthcare provision, has a lower penetration in the United States than, for instance, in the United Kingdom, that is around 30 percent compared to 95 percent. According to Cogan, Hubbard & Kessler (2012), the American healthcare system, is one of the most costly in the world, yet with relative value return. The individual healthcare insurance requires people to buy high insurance with a promise to generous benefits and little or no cost sharing. The concept of paying much for better services has not shown any correlation between the cost of insurance and the outcomes for a person’s health. The Americans thus, are paying too much for medical insurance, which does not translate to better and quality healthcare that they are paying for.
In the single player system in the United Sates healthcare, providers are supposed to shoulder the burden of the administrative cost associated with the service, but for one insurer for offered services. In multi player settings, the payment is accounted for by the providers – one provider may refuse to honor a benefit, but another one does consider it. Different insurers may can have different deductable and co-payments for different procedures. This variation in the insurance is not normally told to the insured person until the service is required. This disparity causes disgruntlement among the patients when they use the health insurance system.
The high cost of healthcare in the United States has been blamed to the government for being overly involved in medical insurance policy formulation, which stifles the industry to adjust according to the supply and demand forces. The federal tax code is one example of the adverse effect of the government regulation. The code puts an exemption to tax for employer-sponsored insurance cover. This exemption has lead to an advantage of buying health insurance through the employer rather than individuals paying directly from their pockets. This has caused consumers to abuse the service, since together with physicians they perceive that the bill is been footed by someone else. The cost of healthcare in turn, has been pushed up (Kaiser Family Foundation 2005).
Another problem with healthcare insurance is the co-payment program where the insurance company pays the large part of the patient’s costs and the rest is paid by the patient. The plan is intended to discourage an insured person from abusing the cover; however, co-payment has increasingly become unfriendly to the regulations that govern the health insurance sector. The insurance companies have been increasing their copayment fee to reflect the current high cost of medical insurance. This increment has made the cost of medical care to rise beyond the reach of many average citizens. The health insurance has become extremely expensive to most people, thus depriving them from obtaining the service. This increases their risk of sustaining large medical bills they can hardly meet in case they become ill.
The rate chronic illnesses are higher in America than in other countries in the world, which increases the pressure on the healthcare resources available. High level chronic prevalence is a cost driver of healthcare in general. Some the commonest chronic conditions include heart diseases, cancers and diabetes. As more Americans suffer from chronic illness, the healthcare sector will continue to experience prohibitive costs for many of the citizens. The treatment of these conditions also poses challenges to the healthcare sector. They require specialized and prolonged treatment program that the current system is unable to cope with. The management of these diseases, such as coordination of care, requires closer monitoring and proper patient information storage for an effective treatment.
The rate of medical and lab errors in the health care system is not impressive in comparison to other developed countries. In comparison with Australia for instance, 20 percent more American patients are likely to suffer from a medical or lab error in a year. The repercussion of these statistics can be fatal, since patients can end up receiving wrong drug prescription or medical procedures that can be life threatening. The high rate of errors has lead to a high number of law suits against hospitals and physicians that drive the healthcare insurance costs up.
My perception of the role of the administration in alleviating the problems
The criticisms leveled to the United States health care system is that the government does an inadequate job in delivering health services. This means that the current private health care system does a better job as compared previously. Most studies carried out show that the U.S. ranks well in comparison to other countries in survival rates and cure of many diseases. For example, France and Cuba rank equally well as the U.S in the survival of breast and colorectal cancers in both men and women. It is contrary to the U.S., since in both of these countries, the governments takes on a bigger share of health care coverage as compared to the U.S. (Rice, 2009).
According to OECD (2005), the United States fares the worst in infant mortality rates, namely under-five childhood mortality rates, as compared to other developed countries. Years between childhood and old age are under the attack of preventable diseases in the U.S. as compared to many other developed countries. Statistics published by the Centers for Disease Control (CDC) shows that close to 45% which is almost 43 million of Americans under the age of 65 who do not have a health care coverage had to forget or delay their medical care due to high costs. One way that the American global ranking in healthcare can improve is by increasing government coverage. Extension of coverage will ensure that most Americans will have affordable access to health care providers instead of delaying or even forgoing medical care altogether.
The number of people under the healthcare cover should be increased to benefit from the economy of scale. Currently, the number of people, who are not covered, is extremely high leaving those covered having to pay a large premium. The expansion should also look on improving the whole system to make it efficient and affordable. As a result, the federal government should allow the states to design their own systems that meet their unique needs of the residents. The federal government should only provide a policy framework to steer states legislations, which fully complies with the bipartisan Empowering States to Innovative Act (Kaiser Family Foundation).
In order to improve the healthcare personnel capacity, the federal government should fund programs to ensure a well trained health care workforce to meet the current shortage. The government should also fund programs that have the potential to positively impact on the rising cost of medical services in the country. Medical societies and other governing bodies should develop rules and guidelines that are aimed at eliminating of misuses and negligence in the healthcare sector that has been known to cost lives. The government and the medical professionals should engage the citizens about how to utilize limited healthcare resources, such as insurance coverage effectively, equitably and rationally.
To achieve the goal of providing quality healthcare for all, the government should address other factors that prevent achievement of this goal. The inequities in education, job security, and environmental health should be addressed in order to boost the healthcare sector in the country. Social factors affecting health are a significant source of health disparity among the minority groups. Environmental stressors that affect and harm the health of communities should be taken care of to ease the burden of the sick on the healthcare system. The governments should pass legislations and create policies aimed at encouraging citizens to healthy living. America has a high percentage of obese population, which contributes to conditions such as heart diseases, cancers and other chronic conditions. Promoting health living both at school and at the community level can reduce the population suffering from lifestyles diseases.
The future of the Unites States healthcare is both bright and challenging. The Medicare enrollment for the year 2009 was about 68 million, 34 out of which were children, and 18 million were adults with children. The program, thus, has provided an opportunity to many Americans to access healthcare which was previously hard to achieve. However, the cost of Medicare is growing fast at 7.5 percent annually. In 2008, the federal and state financing for the program stood at $353 billion. Medicare is expected to grow at a rate of 5% of GDP by 2035. On the whole the increase should range from the current 3 % to 15 %t in 2080. States are finding it hard to keep up with the budgetary requirements of the program, while the federal government is finding difficult to keep up with the growing fiscal need to sustain the program. The operational complexities are also discouraging many providers from embracing the program.
The American College of Physician (ACP), recommends that to address cases of ethnic and racial healthcare disparity, all legal citizens should be accorded with affordable healthcare. The Social Economic Status (SES) of the ethnic and racial minority is affected by several factors such as education, occupation and income. The SES defines an individual or community social class in the society. These factors determine the access to healthcare in services in the society: majority of minority ethnic and racial minorities’ access to education and job opportunities is relatively lower than that of white Americans. Healthcare service should be detached from the social economic status of an individual to make it equal and inclusive. ACP recommends that patients with regard to race, social background, ethic or national origin, cultural and sexual orientation deserve healthcare that is of high standards and quality.
The federal government should make it possible through the legislation amendment make treatment of health insurance neutral by allowing individual to pay from their pockets and insurance to be tax deductible. This will discourage consumers and physician from abusing the employer-sponsored insurance. Alternatively, the government should introduce tax to the employer-sponsored health insurance coverage. The amendment to the insurance tax code will encourage responsible use of the health insurance by consumes and physicians, which will push healthcare insurance down.
The Medicare and Medicaid should be redesigned to reflect the needs of the patients. The Medicare system ignores the incentive of the patient. The Medicare plan copayment rates have reduced over the last 30 years by nearly half. The system can allow beneficiaries to choose the plan that offers less premium and with higher deductibles or more coinsurance. In the long run, the solution is to provide beneficiaries, who determine the support level, an ability to access healthcare.
The government should especially address the challenges faced by the federal and states governments in funding the program to lessen a burden to the authorities. Both the federal and states policy maker agree on the importance of the program in ensuring that many Americans receive healthcare services at the most affordable rates. The contention about the plan arises only on the issues of funding the ever expanding budgetary needs of the scheme. The federal government together with the states administrator should revise the plans to make it affordable and effective.
The insurance market should be reformed to allow consumers to buy insurance from federal market that is not directed by the insurance. The insurance regulation should enable people to buy insurances that give the best benefit at the right price. The current system makes the insurance companies gain rigid control on the insurance industry ignoring the concern of the beneficiaries. Many workers are reluctant to quit or change jobs in fear that they might lose their cover. The insurance companies also have a right to decide who to insure based on such discriminatory reasons as medical history of a patient. This denies many American the opportunity to receive healthcare. Youths, who are over the age of 21 and have no job-insurance cover, are locked out from using their parent’s healthcare insurance. Many Americans, especially the youths, have been denied the right to healthcare.
The healthcare sector in America has some of the most advanced resources in the world including personnel, medical facilities and tools. The spending by the government on health is also the highest globally. However, the healthcare system has not realized its full potential of providing the American people with the high quality medical care for all. Several factors have been identified as the cause of this state of affairs including training and expanding on the existing facilities to enable the sector tackle the raising cases of health complications. Medical insurance cover is one of the leading cost-drives of the healthcare sector. The health insurance needs to be aligned to those of the patients contributing to sustain it either individually or through tax. Health disparities should be addressed to make healthcare in America more equitable and effective for all. Currently, the disparity that exists between the ethnic minorities and the mainstream population is unhealthy. Many minority groups have been unfairly represented or receive inadequate healthcare relative to the majority of the citizens. The sector has been in the limelight of late due to the proposed ‘Obamacare” policy that envisages a healthcare cover for all Americans, and especially the poor and marginalized. The healthcare policies introduced by the United States government will either help ease the challenges or give rise to the new ones. The most obvious challenge, in the short term, is the escalating cost of running the Medicare schemes. In order to achieve its objectives, the Medicare policy should receive the necessary support, especially by the states administrators, who for the now are highly opposed to the plan.