Future of Healthcare into the United States - Essay Example

Future of Healthcare: Public/Government Health Care Introduction The aim of this study is to examine the government health care in the United States. Public health seeks to promote health behaviors such as exercise, healthy eating, prevention and treatment of disease to improve lives and health of the communities (Emanuel, 2014). The system is designed to finance most, or all cost of the health care needs through public managed funds. The right to access the health care is in a well-established rule that applies to the entire population benefiting from the funds or receiving it benefits (Clay, 2011). Most developed countries such as the United States have established public health care as an intervention to manage and control illnesses, injuries and other health disorders through disease surveillance, and encouragement of health behavior, environment and the society. It was intended to improve the accessibility of health services through private and public insurance health care provision to all Americans (AcademyHealth, 2011). Although introduction of Patient Protection and Affordable Care Act in 2010 has addressed various challenges facing the health sector the reform has its share of challenges, risks, and opportunities for the people and the state. Historical Development and Current State of Health Care The drive to increase government involvement in health care administration in the United Stated State can be traced in 1912 following the presidential candidate on the Progressive Party ticket Theodore Roosevelt call for creation of a national health insurance scheme to replicate that of Germany (Emanuel, 2014). After the Great Depression, the proposal gained attention in 1932 when Wilbur Commission, a governmental panel observed that millions of American residents lacked access to affordable medical cover (AcademyHealth, 2011). They suggested a medical group practices and prepayment scheme where the group would contribute finances to cover the members. The intention was to provide every American with medical cover. However, the system experienced myriad challenges partly because of inadequate funds the state was facing and partly because the American Medical Association (AMA) failed to endorse government-run healthcare. These led to the failure of legislation to support the proposal. Another attempt to provide a ten-year health care for all Americans was put across by President Harry Truman in 1945. However, the effort was thwarted by AMAs warning of the detriment of socializing medical care and subsequent opposition by the Congress (Brill, 2015). However, these proposals set the ground for subsequent political debates to harmonize healthcare for all Americans through government sponsored the medical scheme. The government Spirit to replace out-of-pocket payment for medical services was kept high by the escalating number of citizens who were purchasing some forms of health insurance cover. Also, in 1962 President John F. Kennedy expressed the government’s plan to offer medical care to Social Security beneficiaries (Brill, 2015). This was government’s exercise of the constitutional power to advance common welfare. President Lyndon Johnson approved legislations establishing Medicare and Medicaid on July 31, 1965 to provide comprehensive medical care to persons aged 65 years and above as well as disabled and the poor persons (AcademyHealth, 2011). However, medical scheme turned into a political issue in 1968 following the sharp increase in the cost of healthcare across the nation as a result of these programs. In 1971, a proposal demanding employers to cater for a certain amount of health insurance got an endorsement from President Richard Nixon. However, Senator Ted Kennedy came up with a conflicting Health Security Act, which engaged the federal government as the worldwide single-financier health scheme (Brill, 2015). This Act became a political landmark for the prolonged political career of Ted Kennedy. In 1976 President Jimmy Carter endorsed “a comprehensive national health insurance system with universal and mandatory coverage.” However, the effort was recoiled by the great recession that faced United States immediately after Carter assumed office (AcademyHealth, 2011). Since then no changes were effected until in 1986 when the Congress enacted the Emergency Medical Treatment and Active Labor Act that called for hospitals to monitor and stabilize all clients in the emergency rooms. The Act also suggested effecting of the Consolidated Omnibus Budget Reconciliation Act (COBRA) that required employees to reimburse payment by group health plan for a maximum of 18 months after their discharge from their jobs (Emanuel, 2014). Medical Catastrophic Coverage Act (MCCA) was signed into a bill in 1988. It protected elderly persons from the financial crisis as a result of disability or illnesses. It established a maximum limit on hospital expenses, prescriptions drugs and doctors for Medicare beneficiaries (Chernichovsky & Leibowitz, 2010). It was financed wholly by surtax levied on all Medicare beneficiaries across the nation. However, the class of affluent people raised concern that surtax resulted in duplication of benefits for which most of the beneficiaries were receiving prior to enacting the MCCA. Consequently, the Congress repealed this program in 1989 (Chernichovsky & Leibowitz, 2010). President Bill Clinton expressed his desire to establish competitive universal health care in 1993 that would enable private insurers to compete in the firmly controlled market. Under this plan everyone would get health insurance cover and pay for the cost irrespective of whether they are employed unemployed, but the government would subsidize the insurance cover for the poor citizens (Chernichovsky & Leibowitz, 2010). The plan targeted those who did not have any other health insurance cover whatsoever. The Clinton plan aimed at providing comprehensive health care services associated with emergency care, hospitalization, laboratory and diagnostic tests, prenatal care, durable medical equipment prescription drugs, health education classes, home health aides, rehabilitation, mental health, abortion, substance abuse, hospice care, office visits, prosthetic devices, preventive dental care for children and vision and hearing care (Clay, 2011). President Bill Clinton signed a bill into law to establish State Children’s Health Insurance Program (SCHIP) to provide health insurance cover for children from families with uncertain income but higher than the threshold required to qualify for Medicaid. The SCHIP program provided cover to over 7 million children and 600,000 adults in 14 states (AcademyHealth, 2011). President George W. Bush approved Medicare Modernization Act in 2003 to modify the Medicare to include a prescription drug in the coverage. The Democrats viewed the move by President Bush as a political strategy intended to destroy Medicare, which was created by the Democrats (Clay, 2011). Therefore, Democrats leaders led by Senator Edward Kennedy stepped up the campaign to defend Medicare against attrition by the supporters of Republican Party. This gave Democratic presidential candidate Senator Barack Obama a political mileage in 2008 through his promises to reform health care to provide health insurance cover for about 47 million Americans who could not afford any form of health insurance (Discoverthenetworks, N.d). His concern was to establish a medical system entirely administered by the federal government. It was realistic for the reformers to the health care system to structure the reform for implementation on an incremental basis. The House of Representatives passed Affordable Health Care for America Act on 21 March 2010 amidst strong opposition from the American people since the house was dominated by Democrats (Clay, 2011). The party was blamed for engaging in corrupt deals such as giving subsidies of the healthcare to the states to win the support of the senators. The new legislation aimed at extending health insurance cover to over 32 million Americans who were not previously subscribed to any health insurance. The bill proposed various approaches through which they could achieve these goals (Clay, 2011). Some of these suggestions include government subsidies to health care insurance that would reduce the cost of Medicare by $455 billion, increasing tax on medical-device companies, encouraging citizens to purchase government-subsidized health care insurance, all insurance companies must accept applications from the clients irrespective of their pre-existing medical conditions, extension of health insurance cover, banning of policies with annual and lifetime limits on health-care services (Clay, 2011). In addition, a fine of $2,000 per employee would be imposed on employers with more than 50 employees in case the company did not pay for health insurance for their workers so that they continue receiving federal government subsidies, the extension of Medicaid to cover childless adults up 26 years of age, and an inclusion of self-employed uninsured citizens to the health care insurance plan through government subsidies and extension of income base requirements as a qualification to 400 percent from 133 percent of poverty level (Clay, 2011). However, the consequences of the AHCAA were estimated to increase the public spending on health care by about $222 billion in a span of 10 years (Shortell, Gillies, & Wu, 2010). This was contradicting the decision of implementing the scheme that was to reduce the cost of medical care. Also, some critics argued the legislation would be dominated by the federal government. Other opposing opinions were the federal government would not be able to control medical cost as expected hence they would fail to sustain the plan. However, there was some hope that the legislation would increase medical coverage for most of the Americans as initially intended (Shortell et al., 2010). Challenges and Issues of Public Health Care System Prior to Health Care Reform Prior to the execution of health care reform the US had one of the most expensive and inefficient health care system among other developed nations (Chernichovsky & Leibowitz, 2010). The government relied on technologically demanding medical practices that drove the cost of such services high while the outcome of the system was inferior. Additionally, most the people especially the poor, children and those with pre-existing conditions denied access to Medicaid and Medicare (Chernichovsky & Leibowitz, 2010). Lack of integrated system and inability to promote a maximum combination of individual medical care with group health measures were the primary cause of the inefficiencies. Furthermore, this fragmentation of health care delivery system resulted in cost shifting as insurer’s struggled to transfer cost to other financiers, cost imbalances between initiatives of public health and medical care spending. For example, Medicaid covered person’s retired persons after attaining the age 65 years and above or the people with disabilities (Clay, 2011). On the other hand, Medicare focused on the people who were in employment thus leaving most people who were unemployed and could not manage to pay for private insurance. Furthermore, Medicare did not provide comprehensive medical cover for all health services since members were required to subscribe to specific health services they qualified for while the rest were settled by out-of-pocket payment (Shortell et al., 2010). The health care system required sharing of financial responsibilities between employers and the employees (Brill, 2015). There was pressure to balance employee deductibles and services they used with the focus shifting to high value and low priced service providers. Additionally, employers pre-arranged with fewer providers to maximize benefits and reduce cost. Another issue was to provide coaching programs to persons with the chronic disorder to prevent their conditions from worsening (Chernichovsky & Leibowitz, 2010). All these endeavors aimed at minimizing consumption for health care services through cost reduction and maximize profits and efficiency. There were increasing numbers of enrollees for health insurance with different schemes such as Medicaid, Medicare plan, etc. based on affordability, accessibility and quality that facilitated the government to intervene to promote harmoniously delivery of health care services to the citizens (Brill, 2015). The introduction of Affordable Care Act imposed mandatory rule for employers with over fifty permanent employees to insure their workers or face penalties (AcademyHealth, 2011). Furthermore, employees who did not qualify for any of the public health insurance cover were legally obliged to purchase private health insurance or face a penalty of 1% of their income or $95 annually whichever is greater. However, the government provides subsidies to the poor people to ensure affordability. It was the need to end these inefficiencies and increase affordability and accessibility of the health care services that led the federal government to introduce reforms. The major focus was to amalgamate the existing private health insurance scheme with public health system to rebalance expenditure between group and private health services while channeling investments to savings with maximum long-run yields (AcademyHealth, 2011). The proposed reforms would provide comprehensive health care scheme bringing together both provide and public partners to increase efficiency, affordability and accessibility of the health care services. This scheme would be inclusive of all persons irrespective of their age, employment status, disability status, pre-existing conditions, etc. Specific Challenges of Public Health Care After Reform The implementation of reforms in health care is likely to experience myriad challenges. For example, the rising cost of chronic illnesses can and cost of providing medical services will increase the burden to the taxpayers (AcademyHealth, 2011). The government commits to subsidize the cost for even people who could afford to pay for themselves. Also, considering the greatest burden is borne by the rich they are likely to sabotage the system by using their powers to influence the implementation of the scheme (AcademyHealth, 2011). Considering the government cannot ignore the class of affluent because of political consequences it is unlikely that the government can achieve its objectives efficiently. There was another issue whereby the providers tailored services for different groups. This formed the basis for discrimination since most people of color was disqualified from the scheme (AcademyHealth, 2011). Potential Risks and Benefits The implementation reforms in the public health care in the US have advantages and challenges. Some of the potential benefits include increased health insurance coverage for more Americans (Shortell et al., 2010). It is likely to eliminate the abuse insurers with regard to limits on the eligibility of applicants, increased resources and effort to improve health sector through research and data collection hence reducing disparities. For example, since the enactment of the Act the reform is expected to provide cover for 32 million Americans who did not have any insurance cover in a span of ten years (Shortell et al., 2010). The full implementation of Affordable Care Act is expected to take place in the year 2019. The expansion of Medicaid coverage will increase the number of those covered by 16 million persons (Chernichovsky & Leibowitz, 2010). Furthermore, the Act will provide health insurance plans that will include treatment for mental and substance use. Through the integration of private and public health care systems, more patients and psychologists are expected to benefits from collaboration between primary care and other medical practitioners. The Act establishes research institutions through funds set for improving the health care system. The innovation of health care will improve the quality, accessibility and affordability of the services to more Americans (Discoverthenetworks, N.d). Also, there is the advantage of collaboration between private and public players that can result in efficient use of resources. The reforms will contribute towards the elimination of racial discrimination that was rampant when care providers could tailor services for different ethnic groups. The entire process of reforming health care system is political in nature hence exposing the health care system is significant risks (Discoverthenetworks, N.d). The implementation of reforms is likely to experience political elements as a result of opposing views between Republicans and Democrats. There is another risk that providers may lose incentives to offer quality care because of lack of competitiveness, and this can affect the entire sector significantly. Finally, there is the likelihood of the inability of the government to control the rising cost of providing affordable, accessible and quality care (Shortell et al., 2010). There is also a challenge of integrating private and public providers because of their different motives. This is because provide partners are profit oriented and without adequate financial incentives it is not easy to deliver quality services (Brill, 2015). On the other hand, public players work to implement public policies, and they can pursue their objectives with less financial motivation. However, their goals are affected by political issues facing the country (Chernichovsky & Leibowitz, 2010). Therefore, bringing the two parties together to pursue common goal can be quite challenging. Conclusion The improvements of the US health care system led to the establishment of Patient Protection and Affordable Care Act, which became law in the year 2010 whose implementation started in 2014. The focus of this reform was to expand eligibility for Medicaid, provide incentives to businesses to provide their employees with health care benefits, restrain insurers from setting annual coverage limits and denial of coverage for persons with pre-existing illnesses, minimizing out-of-pocket payment ranging between 2% and 9.5% of their income and increasing affordability of medical insurance through government subsidies. Although there still challenges facing the public health service such as inability to control cost and quality of public health care, political interferences, and the failure to properly coordinate private and public service providers there are several potential benefits to the state, providers, and the general public. Some of the benefits include the elimination of discrimination in services on the basis of gender and race, effective utilization of national resources, increase health insurance coverage and improved funding for research and innovations. Reference List AcademyHealth, (2011). The Impact of the Affordable Care Act on the Safety Net. Available at https://academyhealth.org/files/FileDownloads/AHPolicybrief_Safetynet.pdf Brill, S. (2015). Americas Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System. Random House Publishing Group. Chernichovsky, D. & Leibowitz, A. A. (2010). Integrating Public Health and Personal Care in a Reformed US Health Care System: Am J Public Health, Vol.100(2): 205–211. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804624/ Clay, R. A. (2011). American Psychological Association (APA), Health-care reform 2.0. APA and psychologists across the country are working to ensure psychology’s place in the nation’s new health-care system, Vol 42(10). Print. 46. Available at http://www.apa.org/monitor/2011/11/health-care-reform.aspx Discoverthenetworks, (N.d). Government-Run Health Care in the United States http://www.discoverthenetworks.org/viewSubCategory.asp?id=615 Emanuel, E. (2014). Reinventing American Health Care: How the Affordable Care Act will improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error-Prone System. USA: Public Affairs. Shortell, S.M, Gillies, R. & Wu, F. (2010). United States innovations in healthcare delivery. Public Health Reviews, Vol. 32:190-212. Available at http://www.publichealthreviews.eu/show/f/26 Read More