Public Health Law and Policy - Essay Example

MPH522 Public Health Law and Policy Mod 5 Case Assignment Introduction The advantages and disadvantages, at least for the United s, of public health spending are debatable. We are a country that spends more on healthcare than any other country, insures fewer people, and have outcomes worse than at least 15 other countries in the world. We are one of only two countries in the world that does not have healthcare provided to every member of the country and the other is South Africa. This has got to make one ask whether there is more than needs to be spent on healthcare or does it need to be more ethically spent? National healthcare spending in the United States is expected to be $2.4 trillion in 2008. It is expected to increase to $4.4 trillion in 2008. Based on all projections, however, there is an expectation of high enrollment and growth in Medicaid and Medicare spending over that time. (Sisko, Truffer, Smith, 2009). Physician Medicare payments will remain constant between 2010 and 2018. Under the current law, there is expected acceleration of national healthcare spending starting in 2011 will increase by 7.2% by 2018. By payer Medicare spending is projected to increase by 8.1%, Medicaid by 6.9% and private health insurance by 5.8%. Out of pocket expenses is projected to grow 3.8% and prescription drugs are expected to increase by 3.5%. Hospital spending is expected to increase by 7.2% and physician services by 6.2%. As we all become greatly concerned over numbers like these, Stuart Altman (2003), tell us that in his opinion, higher spending growth rates are not necessarily destructive. He laws that higher costs are usually offset by lower wages for workers who enroll in employer-sponsored health plans. He does admit that higher costs in public programs are somewhat different because increased spending means increased taxes which then distorts the economy. Higher costs also increase the ranks of the uninsured (Altman, Tompkins, Ellat, 2003). Henry Aaron (2003) agrees with him in that he feels that the GDP could be 20% without causing reduced expansion in other parts of the economy. Advantages There are, of course, many good reasons for healthcare spending. Some of those are technology but most of them are the overall health and happiness of the people of the United States. Keeping people healthy is important in the sense that they are more productive and more happy when they are healthy. There are many issues that need to be death with at this time including obesity, smoking, teen pregnancies and many others. Programs to help these people understand and take care of their disease states are funded through healthcare spending budgets. Without having healthcare spending, there would be no Medicare, Medicaid or subsidized care for anyone (Fuchs, 2010). Public Health business is driven by healthcare spending as they are part of the Federal and State budgets. According to Smith, Minyard, & Parker, (2007) core business for public health is driven by population need, evidence of effectiveness, and a statewide strategy that is informed by local input and finances must be maintained in order solve these issues. The public health service is a safety net for many with the WIC program being noted here. If WIC were not available, there would be many malnourished babies and mothers as they would not be able to afford the formula and foods that are provided. At this point in time, with the increasing numbers of unemployed and under employed public health needs are greater than ever before and the expenditures that help care for these people in preventing disease and providing vaccines is very important to all of us. Disadvantages U.S. healthcare spending is already at $7,000 per person, this is 1/4 of what is spent on national defense. Insurance payments continue to increase rapidly and prior spending has not decreased those. American workers are at a disadvantage because they pay more and get less for their insurance. Premiums paid by employers is making it extremely difficult to continue to supply insurance to workers. There are 125 million in the United States that have chronic diseases and 60 million with multiple conditions (Barrett, 2009. Dr. Barrett feels that pharmaceutical companies, mainstream medicine and healthcare systems are the reason for increased expenditures and because of their own advantages, they have assured along with the American Medical Foundation that spending methods are not changed. He feels that the spending itself is not the issue the issue is how the spending occurs. This writer believes that we would all agree with that. Ethics In this country like many others, we have populations at risk. Those include high risk mothers with low birth weight babies and high infant mortality rates, patients with HIV and Aids, teen pregnancies, the chronically ill and disabled, those limited in mobility, the mentally ill and disabled, drug and alcohol abuse, abused, neglected and homeless just to name a few. There are many at risk because of age, race, and income (Away, 2003). Many would say, well why should we pay the cost of caring for these people, as they do not contribute. In some ways, that is the chicken and the egg concept. Many of these people might contribute if they were healthy enough to contribute. However, there are other issues here. Like noted in the beginning of this paper, this is a rich nation and yet we are one of two countries in the world who do not provide healthcare for all of the people of a country. Do not all of our standards indicate that we should be the greatest good for the greatest number of people? Yet in the United States of America, health disparities abound and many get no care at all. The rich receive excellent care with the best technologies and even more than they could ever need as they do many elective procedures while the poor do not get the basics of care and certainly will never be on a transplant list. Hurley (2001), states that there is a wide variety of ethical arguments when it comes to healthcare spending. He feels that there are four arguments that are logical use when discussing this subject. Those include the ultimate purpose of a human life or human society, the role of health and its distribution in society in advancing this ultimate purpose, the role of access to or utilization of health care in maintaining or improving the desired level and distribution of health among members of society, and the role of public financing in ensuring the ethnically justified access to and utilization of health care by members of society. (pg. 234). It is obvious and well proven in this country that a private healthcare system is unable to provide care to everyone which provides part of the argument as to why it is important to have healthcare spending. What is being distributed with this money. It is health. Health is the commodity that is being purchased with this money for the public. Is not everyone deserving of health? Therefore, the ethics of the right for the most becomes healthcare spending for all. There is an example that comes to mind of two patients I once saw in the ICU which shows the disparity and ethics of these kinds of decisions. Two patients . One is 59 years ole, prior stroke, transferred to the hospital from a nursing home. Patient has Medicare. The other is a 27 year old young man with severely damaged kidneys from chemicals he has been working with and needs dialysis and kidney transplant. He is uninsured. The 59 year old womans heart stops, the do a code on her and do chest compressions all the way to operating room where they replace the valve in her heart. She is then on full time dialysis and 40 days later, she is still in the ICU and the physician takes her and puts in a pacemaker. The patient remains in the ICU and her costs are now over 1/2 million dollars and she has not improved at all. The young man on the other hand is discharged once he is stable. He does not get on the dialysis list, nor does he get on the transplant list because he has no way to pay for such expensive care. So, the cost of this healthcare is high. Should it be spent? It is not a matter of the fact that it should not be spent. It is a matter, again, of how it was spent. Solution So what is the answer? Do any of us know? Certainly healthcare spending has to occur, the advantages are greater than the disadvantages but possibly the expenses being used on large healthcare facilities is not the right thing to do. Community health clinics and public health interventions may be where the money should be spent. There are many great models of care out there with good evidence base that keep patients in the community rather than in a hospital . At this point in time, the many programs and services that are out there to address the health and healthcare of vulnerable populations is underdeveloped and not well organized. The amount of red tape and the numbers of hoops that are required to jump through for many of the vulnerable populations to receive any amount of care at all is continuing to get greater. Remembering that many of these people are chronically if not acutely ill and do not have the energy needed to manage this kind of paperwork. More community oriented health policy needs to be built (Aday, 2007). These policies and interventions are strong methods in which this country might provide healthcare for the many in a more fair and ethical manner. The Federal Government has passed the new healthcare reform bill which should provide healthcare for all. It will be interesting to see, with the numbers of special interest groups that we have in the country, how those funds are really spent. It will be interesting to see in 5 years, if anything has changed or if the money spent is just larger and spent in the same way. In conclusion, there are huge disparities in healthcare in this country. The rich get any care they want and need while the poor and those at risk get little. There are advantages and disadvantages to healthcare spending though this writer believes it is mostly advantage. There are also many ethical issues involved throughout the issue of building a new program and in managing the old. This writer hopes that there will be relief soon for those that need it. Resources Aday, L. (2007). At Risk in America. 2nd ed. Jossey, Bassey: Boston. Hurley, J., (2001). Ethics, economics, and public financing of health care. Journal of Medical Ethics. 27. 234-239. Miller, H. (2009). Cost of healthcare disadvantages U.S. industrys global competitive position. available at http://www.pch007.com/pages/zone.cgi?a=47832 Sisko, A., Truffer, CH., Smith, S. (2009). Health spending projections through 2018: recession effects add uncertainty to the outlook. Health Tracking. 24. 346-357. Smith, A., Minyard, K., Parker, C. et.al. (2007). From theory to practice: What drives the core business of public health? Journal of Public Health Management Practice. 13(2). 169- 172. Stuart, A., Tompkins, C., Eilat, E. (2003). Health care spending: an analytical forum.Web Exclusives. Project Hope/Health Affairs. Read More