Policy Alternatives: Health Care Reform in the US - Essay Example

Policy Alternatives: Health Care Reform in the U.S. Introduction When developing policy alternatives,one way of solving a problem is through elimination or lessening of the causal factors or the triggering factors (Cherpitel, 2009). Another way is getting ideas from the existent policy. One may view the existing policy as ineffective when it comes to solving of the problem in question. Therefore, they may want a replacement, strengthening or improvement. The paper focuses on the problem of health care in the United States. Overview According to Barr (2011) the health care system of the U.S. is on the limelight of debate. On the one hand, there are those who attest that the U.S. has the soundest health care system globally. They point out that the U.S has freely available facilities of the state-of-the-art and medical technology that really symbolizes the system. On the other hand, there are those who believe that the health care system of the U.S. is disintegrated and inefficient. They argue that the U.S. spends so much on health care than other nation states in the world; yet, it is still crippled when it comes to massive insurance, administrative waste and inequitable quality. Based on the comprehension of this debate, this paper will propose policy alternatives to help curb the problem of health care in this nation-state and try to merge the two-sided viewpoints. The U.S. Health Care System The U.S. health care system has both public and private insurers just like all other nation-states. However, the private element dominates the system over the element of public. 62% of American non-elderly received insurance sponsored by private employees in 2003. While 5% received insurance from private individual market, 15% resorted for public insurance from programs such as Medicaid and 18% remained uninsured. The elderly of age 65% and above are almost equally absorbed in Medicare (Chua, 2006). Reinforcing Public Health Insurance: Strengths and Limitations Medicare, a program of the federal government, covers the elderly (65 years and over) and some persons with disabilities. Its strength lies on the fact that Medicare is funded by the federal payroll tax (employers-employees sharing), income taxes and premiums of the individual enrollee (Chua, 2006). This expands its funding scope to boost the health care sector. Besides, Medicare covers physician services, hospital services and provides the benefit of prescription drug. This program however faces a number of limitations. When it comes to administration, the program is performed by a single entity, the government which undertakes the reimbursement insurance role. There also exists incomplete coverage for facilities of skilled nursing, coverage of preventive care and absence of coverage for hearing, vision and dental services. When it comes to Medicaid, a program that covers for the indigent and the persons with disability; there are several individuals that are left out. Legally, nation-states are obligated to cover for indigent pregnant women, elderly, children, parents and the persons with disability. In this case, many children are bereft of the coverage and myriads of people undergo through a lot before qualifying for the program coverage. Also, enrollees may not find providers who accept Medicaid due to the subsistence reimbursement rate. Basing on the strengths, it offers fairly comprehensive advantages such as provision of prescribed drugs. Additionally, there are other public systems such as the State Children’s Health Insurance Program (S-CHIP). This covers for the families that have too much money to be qualified in the Medicaid program, but whose money does not qualify them for private insurance either since it is little for that (Chua, 2006). This system has similar advantages and weaknesses as those of Medicaid. Reinforcing Private Health Insurance: Strengths and Limitations According to Stevens (2009), this entails an insurance that is employer-sponsored as well as individual market. The employer-sponsored insurance is somewhat a major way in which American citizens get health insurance. Many employers give health insurance to their employees as beneficial part. In the U.S., plans of insurance are provided by private organizations for non-profit and profit basis. The only exception is when an organization is self-sponsored when it comes to insurance administration. In that case, they pay directly for the costs of health care for their employees. In most cases, such self-sponsored organizations include the General Motors. Private health insurance is usually financed by the employees who pay part of the premiums and their employers who pay the greater part of the premium. In the year 2005, the yearly private employer-sponsored premiums of insurance amounted to $4,024 for coverage and for a four-family; it amounted to $10,880 (Chua, 2006). Basing on the strengths of this policy, some private health insurance plans cover drug prescriptions. There is also the cost-sharing framework; for instance that of between employers and employees (deductibles and so-pays). However, given that some insurance plans cover for prescription drugs, others do not cover these drugs. Besides, the cost-sharing strategy varies extensively across the organizations. Furthermore, when it comes to individual market, insurance covers for the self-employed and retired population, although in part. It also covers for some of the individuals who are unable to get insurance from their employers. These plans are usually administered by private insurance organizations. Contrary to the employer-sponsored insurance, the individual market permits health insurance organizations to decline the coverage of people underlying the existent conditions. The major drawback is that range of administration is limited to only private insurance organizations. Besides, individuals have to pay their own money for coverage. In the individual market, risk is dependent on the status of health of an individual only unlike in the employer-sponsored insurance where risk spreads amongst several individuals. Healthier patients are likely to receive low premiums, while less-healthy individuals are likely to receive more premiums. Generally, individual-sponsored insurance is relatively expensive compared to public insurance (Stevens, 2009). Non-the-less, fostering for private health insurance in the U.S. may negatively implicate the poor. Haley and Deevey (1997) find that myriads of people in the U.S. lack coverage of both private and public health insurance. Besides, the harsh public programs such as Medicaid may not meet the needs of the indigent or the near indigent. Health System Financing: Strengths and Limitations From the perspective of others, there are two forces that result in the poor health state in the U.S. These are socioeconomic factors including but not limited to lifestyle, poverty and education as well as the health care system quality. This brings out the question of how the country can afford to effectively spend on health care (Barr, 2011). This calls for the policy of financing the health care system of the country as well as organizations dealing with the overall health of the society. This entails collecting money for the health care (the going in money) and reimbursement of providers of health services (going out money). This responsibility is taken by the collaboration between the government and private insurance organizations. Myriads of individuals are either uninsured or underinsured when it comes to health insurance coverage. Increases in costs have resulted in the closure of several proprietary and voluntary hospitals. Consequently, only a substantial number of hospitals provide health care to indigent patients. Thus, this policy calls for subsidizing of premiums for poor population as well as financial assistance especially on stressed hospitals that care for a great number of medically poor individuals. All payer systems such as private insurance organizations and the government, net hospital revenue taxes, general tax revenue, and insurance premiums should be examined as possibilities (Haley and Deevey, 1997). The situation calls for a multi-faceted coordination between actors including health-service providers, individuals or businesses, private insurers and the government. The major strength of this policy is that it increases the funding of health centers and motivates health care giving. However, there can arise confusion when it comes to effective coordination; for instance, there might be duplication of resources and services. Also, targeting providers might not be the most effective approach anyway. All in all, their activities can be coordinated by the government as the central actor. Appendix 1: Summary In sum, given that many people especially the indigent in the U.S. lack public and private health insurance coverage, or face strict eligibility criteria in public programs, there is need to increase financial support of numerous organization to multiply health care provision for all populations including the poor. Haley and Deevey (1997) attest that ideal policy targets individuals but other scholars believe that this is not politically feasible. Therefore, since some insurance target individuals only, targeting providers would be more feasible to administer health care access to the indigent and would also provide equity for providers. For these reasons, it would be advisable to recommend the implementation of financial assistance to the health care players in the U.S. Appendix 2: Summary Barr, D (2011). Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America, Edition 3. Maryland: JHU Press. Cherpitel, C (2009). Alcohol and Injuries: Emergency Department Studies in an International Perspective. Switzerland: World Health Organization. Chua, K (2006). Overview of the U.S. Health Care System. Retrieved 16th December 2014 from http://www.amsa.org/AMSA/Libraries/Committee_Docs/HealthCareSystemOverview.sflb.ashx Haley, B and Deevey, B (1997). American Health Care in Transition: A Guide to the Literature.Greenwood Publishing Group. Stevens, R (2009). The Public-Private Health Care State: Essays on the History of American Health Care Policy. New Jersey: Transaction Publishers. Read More