Bringing health care to the public - Essay Example

Bringing Health Care to the Public Bringing a standard of health care to the public is one of the biggest challenges currently facing the nation. With an estimated 46 million people without healthcare and millions more underinsured, it is time for the states to take responsibility for covering those that have fallen through the safety net. This will mean restructuring Medicaid to meet the demands of a more central health care system. It will be a task that will take money, planning, public support, and political will. Yet, failure to act will cost more in dollars as well as suffering in the long run. It's time to act to bring health care to the public. There are a few misconceptions about Medicaid and public financing of health that need to be corrected. For one, Medicaid is not a large scale, wasteful system. Rowland (2006) says, "Medicaid is not a failed inefficient rigid bureaucratic program. Medicaid does remarkably well what it is designed to do: fill in gaps in private insurance and Medicare and assist tbe poor and frail with their health and long-term care needs without undue financial burden" (p.70). This is precisely where Medicaid can fit into a state system, by filling the gap between mandated private and the poorest of our population. States would be required to mandate private insurance for everyone that was employed. Employers would be required to cover a percentage of the cost for the insurance. The people that fell below the poverty line would pay for Medicaid coverage on a sliding scale based on ability to pay. This would bring all of the people under a system of mixed private insurance and Medicaid. Employers would bear a responsibility and those that were able to pay would also bear a cost in the program. Medicaid insurance would be purchased through the major insurance providers at a negotiated favorable rate. By utilizing slightly higher deductible rates, the insurance would be more affordable and would cover catastrophic situations. Consumers would be given a choice of programs, which would necessitate educating the public. According to Buntin et al. (2006), "the information available to consumers about provider cost and performance, and about the effectiveness of treatment alternatives, is sparse. Cost information in particular is difficult for even assertive consumers to extract from providers" (p.526). A well-educated public would be a first line of defense against waste and mismanagement. Waste and mismanagement are closely tied to poor quality care. Casalino points out the need for emphasizing quality in the original business model. "During the past few years, a variety have efforts have been initiated to remedy the "profound failure" of the lack of a business case for quality in U.S. health care. Since capitation alone--even when risk-adjusted--does not create a business case, purchasers are realizing that they must reward plans and providers directly for improving quality" (2003). The system will need the support and political will to stress quality. Still more is needed to operate a large-scale health system with a standard of quality acceptable to the American public. Greater information is needed on hospital success and failure rates, infection rates, and medical errors. "A key component of any solution, however, is the routine availability of information on performance at all levels. Making such information available will require a major overhaul of our current health information systems, with a focus on automating the entry and retrieval of key data for clinical decision making and for the measurement and reporting of quality" (McGlynn 2003 p.2644). Public support will only come through an assurance of a quality program with a high quality of care. By setting modern standards for care these goals can be attained. The perception of this program will be one that will face the issue of affordability. Cunningham and Hadley (2004) state what the cost would be. "$35-$70 billion, depending on the type of coverage, universal coverage would produce levels of access for low-income people that exceed even those of communities with both the highest coverage rates and largest safety-net capacity" (p.241). However, by placing the system under state mandated control, it would also open up the possibility of additional cost offsetting measures. "The burden comes from growing costs associated with a program that has expanded dramatically in scope. The relief comes from three sources: states' ability to take what had been state, local, or private costs and obtain a federal matching payment to offset a portion of the costs" (Weil 2003 p.23). We may be able to get more for our money if it is spent wisely. If people were insured, they would be more likely to use routine services rather than overloading expensive emergency room treatments. They would also be more likely to seek help before a problem progressed to the emergency stage. By utilizing early diagnosis and treatment, the system could save billions of dollars that are spent through charity and other state funded programs. The key would be managed care. Chernew et al. (1998) reports, "Studies that compare cost growth in markets with high managed care penetration with that of markets with low managed care penetration reveal that managed care has reduced the rate of health care cost growth" (p.281). More central control would bring about greater manageability. A major issue will be the presentation of the program to be politically acceptable. America has a long tradition of free enterprise and negative portrayal of public health as 'socialized medicine' has had an impact on public perception. There is no need to tear down the existing system as Nathan (2005) says, "dismantling large systems and replacing them with new ones are nearly impossible to design" (p.1463). However, as the cost of health insurance has continued to rise, the public has become more receptive to a state or national policy. According to Blendon et al. (2006), "What concerns Americans is not aggregate spending, but the perceived negative impact on American families of their direct health care outlays (insurance premiums, copayments, deductibles, and direct payments for services" (p.511). Clearly this is an issue of political perception that could easily be overcome by presenting it as a hybrid system where there is still a freedom of choice and the medical system is still private. The medical community will also need to be brought into the political arena for their support. This can only be done by offering them a simple system with a fair compensation. Mandating participation will probably not be feasible. According to Iglehart (2003), "Low fee-for-service payments to physicians and dentists have been a consistent barrier to Medicaid participation by many practitioners. Several recent national surveys indicate that the number of doctors with any ties to the program continues to decrease. Low fee-for-service payments to physicians and dentists have been a consistent barrier to Medicaid participation by many practitioners. Several recent national surveys indicate that the number of doctors with any ties to the program continues to decrease" (p. 2143). Clearly, to get over the political hurdle will require that the barriers of low fees be removed. With the escalating numbers of uninsured and the rising rates of health care coverage, it is time to face the challenge of Medicaid coverage for everyone. By placing the programs if the hands of the states, they could design their own programs tailored to their own needs. The system would not be greatly more expensive than it currently is, as there are several ways to save money through a well managed centralized system. What needs to be answered is whether we have the political will to move forward on this issue. The American public is certainly open to considering unique solutions. Governors and local leaders have asked for some assistance from the federal government. This is an issue whose time has come and an issue that we can't afford not to address. References Blendon, R. et al., (2006). Understanding the American public's health priorities: A 2006 perspective. Health Affairs, 508-515. Buntin, M. (2006). Consumer-directed health care: Early evidence about effects on cost and quality. Health Affairs, 516-530. Casalino, L. P. (2003). Markets and medicine: Barriers to creating a "business case for quality.". Perspectives in Biology and Medicine, 38(14) Chernew, M. et al., (1998). Managed care, medical technology, and health care cost growth: A review of the evidence. Medical Care Research and Review, 55(3), 259-288. Cunningham, P., & Hadley, J. (2004). Expanding care versus expanding coverage: How to improve access to care. Health Affairs, 23(4), 234-244. Iglehart, J. (2003). The dilemma of medicaid. New England Journal of Medicine, 348(21), 2140-2148. McGlynn, E. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348(26), 2635-2645. Nathan, R. (2005). Federalism and health policy. Health Affairs, 24(6), 1458-1466. Rowland, D. (2006). Medicaid: Facing the facts. Healthcare Financial Management, 66-70. Weil, A. (2003). There's something about Medicaid. Health Affairs, 22(1), 13-30. Read More