Necessity for Healthcare Reform in the US - Research Paper Example

Health Sciences and Medicine 30 March Necessity for Healthcare Reform in the United s Introduction For many years, the governments that have ruled the United States have had the desire to change the system of healthcare in the nation. The main aim is to make healthcare affordable and accessible to everyone living in the United States. According to Kronenfeld, Jennie and Kronenfeld, Michael, “healthcare reform is one part of US health policy that has occupied an important place in the country’s domestic policy agenda, and its importance within that agenda has been growing during the last thirty-five years” (5). However, part of the desire only came to be fulfilled during Barack Obama’s reign as president of the United States. Although President Obama’s government has made great steps in beginning the healthcare reform process, the nation still has a long way to go. This is especially true due to the fact that most of previous efforts to reform the system have failed, making it hard for the dream to be achieved. Nevertheless, further healthcare reform in the United States is inevitable. In the entire globe, the United States healthcare system is the most expensive. The cost of healthcare began to rise in the 1970s, and it was during this time that the population began to question the system. At the time, the United States healthcare was the most expensive in the world. Thomas notes that “the costs were high and they were increasing much faster than those in other sectors of the economy” (89). It had all along been presumed that healthcare provision resources were infinite and the issue brought about the realization that what could be spent for healthcare provision had to be controlled. Although efforts have been made over the years, the system remains the most expensive. In fact, a 2007 report showed that the best of care is not provided although the US health care system was still the most expensive in the world (Tanner n.p.). The current system of healthcare in the United States is a market-based one and on top of that, administrative costs are really high. The fact that the system is market-based makes healthcare a service that can only be purchase by those that need it. Proper training and supply of specialist and investment in modern medical technology are other factors that increase the overall costs of healthcare. This is because they make the means of healthcare provision costly. According to Odu, “over $1.6. trillion is spent on healthcare annually, amounting to over 13% of the Gross Domestic Product of the United States” (95). By 2020, it is projected that the United States total spending on healthcare will double meaning that almost a quarter of the nation’s economic resources will he to be spent on healthcare. Apart from lowering the costs of services and medicine, insurance costs also need to be lowered to salvage the situation. Just like the high costs of healthcare, inequality in the sector began some decades ago. In fact, issues surrounding healthcare access and equity began in the 1960s, an ear which is famously regarded as the golden age in American history. It had been noted that some individuals in the United States population were not partaking in the golden age. In the 1970s, “issues of access and equity that were first voiced in the 1960s reached a point where they could no longer be ignored. Large segments of the population appeared to be excluded from mainstream medicine” (Thomas 88). The healthcare sector has continued to fall short of the people’s expectations. Not all people can be able to afford proper healthcare and the fact that the United States leaves individuals to secure their healthcare has only made matters worse. Those that can afford it enjoy the privileges that come from the fact that they have the money, while those that lack it suffer from lack of access to quality healthcare. The inequalities that exist can be divided into unequal distribution of healthcare by gender, race, ethnicity and social class, by region and inadequate health education for rural parents and inner cities. Efforts to reform the healthcare system in the United States began as early as the 1800s as the nation struggled to come with some form of social insurance. During the late nineteenth and early twentieth century, sick insurance was not compulsory and voluntary funds were high, but the then United States federal government did nothing and left all such issues to states which in turn left them to voluntary and private programs (PNHP, “A Brief History”). During the early twentieth century, the Progressive Era began and reformers made efforts to improve workers social conditions. At the time, Theodore Roosevelt was the United States president and although he believed in the importance of health insurance for the good health of Americans, he did not do much as major efforts came from outside his government (PNHP, “A Brief History”). At the end of the Progressive era, it can be said that increasing national efficiency was the goal behind efforts made to prevent diseases through an income maintenance program. In fact, the movement was more focused on social insurance rather than healthcare reform. Drake points out that “the US healthcare industry was in its infancy; major medical interventions were extremely risky; and wages lost during the patient’s illness, not the cost of healthcare, was the primary concern” (2). From the time of the Second World War to the 1960s, efforts were made to provide access to medical care to lower income groups and reduce the risks of these individuals falling sick through medical care financing. While the employed now had access to affordable health care, the issue of making health insurance available to everyone rose. At the time, the costs of healthcare were fair. The efforts bore fruits in 1965 when the health insurance program for the elderly and poor was passed (Drake). The two groups of people were active advocates of a national health Insurance. The passage of the universal health insurance program eased the political pressures that existed during the time. According to Drake, “Starr’s third phase, which occurred in the 1970s after the implementation of the Medicare and Medicaid programs added a ‘program of cost control and institutional reform as well as the universal coverage’ objective envisioned in the previous phase” (2).The existence of the health insurance program for the elderly and poor had gradually led to increase costs of healthcare. Due to the high and increasing costs, people raise their voices to have the costs placed under control and began questioning the system. The government made efforts to control the rising costs, but the success was only limited. In the 1990s, President Bill Clinton had the desire to reform the healthcare system (Drake 3). In fact, it can be said that his efforts to reform the system were an extension of past objectives on the same. During the time, it was virtually impossible to make healthcare a part of the national social insurance program as the federal budget deficit was really huge. All the while, the public had grown really dissatisfied with the overly high costs and this med the issue a public debate during the 1990s. The meaning of reform changed during this time as it no longer meant changing healthcare delivery and the system of financing by coming up with a new system, but rather improving the then system by changing it and removing the defects in it. From the review, it can be seen that no past reform efforts in the United States healthcare system succeeded. When Barack Obama got elected as president of the United States, he was able to take a great step towards reforming the system. Tate notes that “on March 23, 2010, President Barack Obama signed into law a sweeping reform of the nation’s healthcare system, handing down to the American people with a stroke of his pen the Patient Protection and Affordable Care Act” (3). It is for this reason that the act is famously known as ObamaCare. The act stands as the most remarkable piece of social legislation given that other legislations had failed to succeed for so many years, and it is the most debated given its huge impact in the lives of all Americans. The enactment of the Affordable Care Act completely restructured healthcare delivery in the United States. Although the most important provisions of the act got to be in effect from 2014, prior to this, the Affordable Care Act had already “began the process of expanding access to care, correcting widespread abuses and inequities in the health insurance markets, improving the quality of care, enhancing preventive care, and facilitating the emergence of new healthcare delivery and payment systems” (Selker and Wasser 9). During the time that the act was passed, there were numerous social and economic pressures in the American society, as the number of Americans who were underinsured or uninsured was rapidly increasing, the cost of healthcare was increasing and so were healthcare expenses as a percentage of the Gross Domestic product, chronic illnesses were rising in numbers and affecting more people, and America was realizing weaknesses in their healthcare system every passing day. It is important to note that health care reform in the United States is not easy. The structure of the government makes the enactment of major policies really difficult. Over the years, the federal government has increasingly become involved in healthcare. Division of powers usually leads to lack of consensus between officials on the Democratic side and those on the Republican side. According to Kronenfeld, Jennie and Kronenfeld, Michael, “the presence of two different legislative bodies, the House of Representatives and the Senate, only compounds the difficulty of having healthcare reform legislation enacted” (7). The main reason reforms began in the healthcare system of the United States is because quality health care ought to be available to everyone. This is one thing that has been forgotten as more attention is paid to other factors such as financing and controlling costs. Rather than a lot of attention being paid to the quality of healthcare that is provided to American citizens, the focus has shifted to issues surrounding politics, payment systems and consumer financial responsibilities among others. Sultz and Young assert that rather than quality of healthcare, the most challenging and most debated issues in the United States are “controlling the rising costs of healthcare and dealing with the estimated 47 million Americans who are uninsured or underinsured” (227). The affordable care act in itself is not enough for the healthcare needs of Americans. In 2013, Americans spent $2.8 trillion on healthcare and the amount is increasing every year (ObamaCare Facts, “Health Care Facts”). In fact, despite being extremely helpful and being an effective program, ObamaCare has increased regulatory requirements and bureaucracies making it incomprehensible to Americans and an increase in these factors continues to make it expensive on top of being complex. ObamaCare as a single effective healthcare program in a huge nation with a huge population is not enough to reform the flawed system. Healthcare is a right and not a commodity to be purchased. Further healthcare reform in the United States is a necessity that cannot be delayed anymore. Reforms should begin in the health insurance industry. The market structure of the current United States health insurance “hinders the US health system’s ability to reach the policy goals of expanding health insurance coverage and containing health care costs” (Austin 2).Originally, the United States health insurance market was structured in a way that prohibited competition among insurance providers. Things however changed and with time commercials insurers entered the market. This brought about change as “Blue Cross Organizations, which had been sheltered from competition by exclusive territory and free-choice-of-hospital rules, were now engaged in head-to-head competition with commercial rivals” (Austin 6). Additionally, particular individuals and groups claims experience got to be ignored as the Blue Cross community rating principle was adopted by commercial insurers. Discriminatory practices are a common phenomenon in the US health insurance industry. This issue rose in the 1970s when policyholders were divided by health insurance companies according to factors such as race, sex, occupation and age and insurance rates were set according to the same criteria. Discrimination on the basis of a person’s health status still exists although it is not as serious as it was previously. Disabled Americas and those with particular medical conditions are charged more by insurance companies. The Genetic Information Nondiscrimination Act (GINA) was enacted to curb discrimination of insurers by insurance industries on the basis of their genetic information. However, the act only prohibits discrimination for health insurers. Pascuzzi, Izzo and Macilotti note that “it does not prohibit discrimination in other insurance contexts, notably life insurance, disability insurance, and long-term care insurance” (68). The United States system of healthcare is not fully transparent and accountable. For this reason, insurers usually know what a particular service or drug has cost them after seeing their bill. Physicians are also not aware of the prices of healthcare so although they might want to choose the least expensive options for their clients, they cannot do so. This way, choices are made blindly. In the United States, “consumers divert resources from their desired expenditures into health care because of its high cost” (Remenyi 136). Consumers need to know what they are paying for and the different costs of services. On top of this, physicians need to be more informed so that they can be able to help patients make more informed decisions. Fraud is still an issue in the United States health care system. Fraud in the industry is perpetrated by both individuals and entities. Hammaker defines fraud as “the diverse and often ingenious means by which people gain advantages over others through deliberate false suggestions, concealments, or misrepresentations of truth” (44).According to Gerber and Jensen, those who perpetrate fraud in the United States health care industry target the large and growing pool of health care finances that is available through public and private insurers and money on the chequebooks of consumers (126). Deliberate submission of false insurance claims to providers is the most common type of fraud. According to statistics, “estimates are that at least 3 percent to roughly 10 percent of the total healthcare reimbursements are fraudulent” (Hammaker 45). Others are self-referrals, nursing homes abuses, false sales and purchases of medical equipment, misrepresentation of services, unperformed and unnecessary tests charges and double billing. Elimination of wastage usually helps save a lot. It is a fact that “an estimated 40 % of US healthcare spending is wasted on inefficiency, duplicative or unnecessary tests and treatment, error and complications that result from lapses of quality” (Protzman, Mayzell and Kerpchar 47).this makes it clear that the current process of health care provision in the United States is characterized by a high level of wastage. The sad reality is that the wastage is paid for by the taxpayer and this is the reason behind the high costs of medical care above all other resources. The money could be used on other things and Americans can live better lives. The small change that has been made in the United States health care industry by President Obama’s administration is a great step but more change is paramount. This is because the act does not do enough in reforming the system. If no measures are taken, it is predicted that costs of healthcare and inequality in the system are going to increase in the near future, which will make it even more difficult for any changes to be effective. The United States healthcare system today is not as broken and flawed as it was before the introduction of ObamaCare, but gaps of improvements still exist. Such gaps include high costs of insurance, discriminatory practices in the industry, lack of full accountability and transparency, fraud and wastage. Tackling these issues will go a long way in salvaging the situation of health care in the United States. Works Cited Austin, D. Andrew. Market Structure of the Health Insurance Industry. Collingdale, PA: DIANE Publishing, 2009. Print. Drake, David F. 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West Palm Beach, FL: Humanix Books, 2012. Print. Thomas, Richard K. Society and Health: Sociology for Health Professionals. New York, NY: Kluwer Academic/Plenum Publishers, 2003. Print. Read More