Care In USA: Understanding The American Health Care System

Health care in the USA outline
* Introduction
* Current health care system in the US
* History of the US health care system and its evolution
* Understanding the American health care system
* Structures of service delivery
* The healthcare debate
* The recent healthcare reforms in the US
* The Affordable Care Act
* Some of the mixed outcome of the Obama care
* Why is Obama care so controversial
* Discussions on government programs.
* What exactly is single-payer health care
* Some of the notable benefits of single payer system
* Conclusion
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Health care in the USA
The US health care system is considered to be one of the largest, but complex among all industrialized countries. Many developed countries prefer a universal health care coverage system. The American health system has undergone major reforms in the recent years, the health sector still faces numerous challenges due to the structure of care delivery. One of the recent legislation enacted mandating health care coverage to every citizen, under the Medicare is not effective to reach to everyone. The health system is fragmented, health care service delivery through a multi-payer system is becoming expensive to manage.
The recent health care reforms have addressed some of the healthcare gaps, including access to care, however, health care costs in America have increased considerably over the years despite major health care reforms being implemented. A multi-payer system health insurance system seems to be ineffective. Can a single payer system address the challenges within the health care system and provide all Americans with quality heath care? A single payer system is considered the best option to provide health care coverage for every citizen.
It is not easy to understand how the multi-payer system works in America, 48 percent of US healthcare spending comes from private funds, with 28 percent generated from households, while the other 20 percent comes from private businesses (Shi and Singh 78). The federal government accounts for 20 percent of spending while the state and local government account for 17 percent (Shi and Singh 78). Even though health care is financed by the public, the services are delivered privately (Shi and Singh 79).
So far, among the 283.2 million citizens of America, only 89 percent have some insurance. Private healthcare providers cover 66 percent of workers. 115.4 million people, which accounts for 36 percent, receive coverage through the federal government programs of Medicare and Medicaid (Shi and Singh 83). The major concern is how to distribute resources equally. In America, few individuals are covered by more than one government plan and 32.9 million people are yet to obtain health insurance coverage (Moses et al. 1948).
The main debate on health care reforms in America is, whether the government should provide health care support to every citizen through a single platform and how much should the government provide. Even though legislators have advocated for a single payer system operated at the national level versus the current multi-payer insurance plan, a single payer system can become a burden to taxpayers is not implemented properly, based on the history of the American health care system.
History of the US health care system and its evolution
During the earlier centuries, medical care was not easily accessible because there were few British trained medical professionals. By the eighteenth century, three states of New Orleans, New York, and Philadelphia, founded major hospitals (Moses 1949). However, hospitals like the Royal Hospital in New Orleans was expensive for residents. Religious and charitable institutions operated many hospitals; the government did not focus much on health care provision (Moses 1950).
The civil war became the turning point for the American healthcare sector, the federal government and state governments started constructing hospitals to attend to the wounded soldiers (Moses 1950). The government offered public sanitation services to minimize the spread of common diseases like cholera. By the twentieth century, healthcare in the US significantly improved with the system being operated by multiple groups (Moses 1950).
The first major achievement recorded in the healthcare sector occurred in 1965, with the introduction of Medicare and Medicaid. President Lyndon Johnson enacted a policy aimed at reducing poverty and promoting equality as part of his commitment to address inequalities (Moses 1951). The enactment of Medicare and Medicaid saw millions of Americans having the proper insurance coverage for the first time in history (Shi & Singh 112).
However, these two programs have not adequately addressed the health care needs of every citizen. With numerous debates focusing of its disadvantages more than the advantages (Shi, and Singh 111). The government attempts to expand Medicare and Medicaid programs have been met with mixed reactions. The government finds itself in a difficult position to expand these two programs due to several controversial issues among different interest groups in America (Shi, and Singh 110).
Understanding the American health care system
The health care is financed through a complex mixture, including public payers, the federal government, the state, the local government, private insurance, and individual payments. There has been no single national system providing health insurance in America (Béland et al. 51). The US depends on employers who voluntarily offer health insurance coverage to employees and their dependants. The government programs only cover senior citizens, the disabled and people living in low-income areas (Béland et al. 54).
There are major differences in insurance coverage based on the different sources of funding. Limited coordination between the public and private programs have hindered effective health care delivery (Jiang et al. 115). Certain individuals have both and private and government insurance coverage, while others are not covered at all. Other citizens not fully covered by government programs can access health care services in public clinics and public hospitals or can receive service from private providers who offer charity services paid by other individuals (Jiang et al. 116).
Structures of service delivery
America's health care services are delivered through different structures at the local levels and national levels. Hospital operations largely depend on community resources, community preference and are dictated by prevailing market trends (Shi and Singh 116). Physicians can establish their practice anywhere, and there are limited health plans at the federal level. Having lived in the inner cities, not many people can afford to pay for monthly insurance premiums to access health care services (Shi and Singh 118). The federal and state offer funded programs that only provide primary care using a fee-for-service system. For individuals without any coverage, the municipal and county public health departments offer limited primary care services within public health clinics (Shi and Singh 119).
Most hospitals are privately owned by nonprofitable institutions; the remaining are owned by the government and private profit-making organizations. Most physicians are in private practice; they see patients in their offices and admit patients where they can easily serve them better (Maynard et al. 687). Even though physicians offer stand-alone services, physicians have merged to form larger groups for their practice, making them influential in the decision-making process (Maynard et al. 689).
Patients are required to pay some amount on a monthly basis for their health insurance coverage to ensure that they are well covered and can easily access health care services. Insurance providers cover millions of patients; therefore, insurance agents can negotiate with service providers to reduce the fee (Maynard et al. 689). Since they need to negotiate for better terms, insurance companies collaborate with doctors to agree on patient visits within their networks (Maynard et al. 691).
Even though people pay some amount on a monthly basis, insurance companies cover for services considered necessary by the doctor; they avoid covering other complex conditions. Most insurance companies try to keep the cost down while covering the necessary health care services (Woolhandler et al. 587). The majority of the American citizens are covered by private health insurance. Those under the age of 65 years and their dependents can obtain private health insurance through employers or by purchasing non-groups health insurance (Woolhandler et al. 589). Not all companies can offer health insurance; majorities of uninsured individuals in Americans are employees and their dependants (Woolhandler et al.590).
The healthcare debate
Even after the American health system has undergone major reforms, the endless debate is about the best structure for service delivery to minimize the existing health disparities. A multi-payer system has not been effective, that is why the health care debate is slowing shifting towards a single payer like the national health insurance system. The first proposal was made by Dorthea Dix in 1854 when the bill for the benefit of the indigent insane was proposed (Filc et al. 111). The bill passed both houses of Congress; however, the bill was disallowed by President Franklin, who argued that social welfare should not be part of the federal government responsibility (Filc et al. 113).
The US was expected to adopt a nationalized system like other developed countries. The US by then, President Theodore proposed a similar health care legislation, but his motion was defeated as politicians argue that it was not a workable process (Filc et al. 114). Those who supported a nationalized health care system argued that the federal government has the responsibility to ensure that all citizens are healthy (Filc et al. 115). They further argued that money spent on emergency cases for those without any medical coverage was so high (Filc et al. 115). Even though the proposed single platform, where everyone will be covered, did not keenly analyze cost implications, cost implications were not considered during these debates.
A unified system is ideal because it gives the government a greater bargaining power with pharmaceutical companies, hospitals, and other service providers to reduce some of the costs of care (Reid 113). Despite all these benefits, the long American history of wariness of federal power has affected the decision making process when discussing health care reforms. Naturally, America has a weak federal government and a strong state government to shield people against dictatorship (Reid 114). Even though the situation has changed over the years, Americans still prefer limiting the federal government powers. If health care is to be nationalized, I foresee a situation where the system will be more bureaucratic and patients would have limited choices, as stated by (Reid 115). Nationalizing health care is a process that would limit people's choice making it less individualized. Having a larger health care system would become expensive, resulting in higher taxes (Mikkers et al. 121).
The recent healthcare reforms in the US
Health reforms in the US focus on controlling the increasing health care costs. The various cost control strategies of the federal, state, local government, and private payers have not been effective in my view. Despite all the efforts, the health care costs have escalated, that is why health care reforms is a priority of the public agenda. The debate about reforms in the health care system revolves around cost, accessibility, and availability, hence the introduction of the Affordable Care Act (Meadowcroft 153).
The Affordable Care Act
The Patient Protection And Affordable Care Act, known as the Obama care was passed into law in 2010. With many insurance companies being private, many people were left without from the medical coverage (Rudnicki et al. 351). Many people in America cannot afford to pay for health care coverage, while others are against buying insurance because private companies avoid covering those with pre-existing conditions (Rudnicki et al. 351).
The Obama care is more of a single payer model; the Affordable Care Act has expanded Medicaid eligibility. Those without employer insurance are required to purchase health insurance, and health exchanges have been set up to help people find suitable insurance coverage at a subsidized rate (Geyman 209). Under the Patient Protection And Affordable Act, more than 11 million Americans are covered compared to the previous system (Geyman 209).
Despite all the provisions in the ACA, politicians have criticized the Act even after passing through the two houses of Congress (Geyman 211). There have been repeated attempts to in court to stop the legislation from being implemented, with most of them failing to go through. Repealing the Obama care has resulted in a major debate on health care reforms, making it one of the endless debates in healthcare reforms in the world.
Some of the mixed outcome of the Obama care
Obama care has expanded medical coverage through Medicare; Medicare is a uniform national insurance program targeting senior citizens and disadvantaged individuals. Medicare is the largest single insurer, covering more than 13 percent of the population (Jacobs 81). Medicare is a single payer system because it covers all the elderly, which accounts for 31 million people and people with the disability, including those with kidney failure, approximately reaching more than 3 million people (Geyman 220). The Medicare program looks viable and can effectively address some of the health care concerns in America.
Medicare is a program funded by a combination of payroll taxes, federal revenues, and premiums. Medicare comprises of two sections, one of the coverage under part A comes from payment of a payroll tax during an individual period of working. The second section where payment is obtained voluntarily through premiums (Geyman 222). With the expansion of Medicare, health care expenses have increased at a faster rate compared to how the government is generating revenues (Jacobs 85). The program might become difficult to run in the next coming years
In the coming years, the aging population will increase with fewer workers to support all healthcare beneficiaries. Under Medicare, some individuals cost share, but in reality, Medicare pays less than one-half of total expenses of the elderly (Cohen 209). Patient under Medicare has a supplemental health plan or self-purchases because Medicare cannot cover some of the illness. The elderly spend a considerable amount of their after-tax incomes on health expenses (Cohen 210). Insurance plan run by the government targeting the poor covers more preventive expenses, acute and long-term care services. It covers 25 million people, which comprise of 10 percent of the entire US population (Cohen 211). These are some of the concerns that make Medicare ineffective to reach out to a larger population.
Medicaid is funded by the federal and state government (Cohen 211). The federal government contributes the same as what state government contributes, meaning that the funding varies from one state to the other (Schultz 184). For one to be eligible for Medicaid, an individual need to be poor, aged, disabled, pregnant or a parent of the dependant child. Mother and dependant children are about 68 percent of those benefiting from Medicaid (Schultz 186). The elderly are about 13 percent, the blind; the disabled from 15 percent of the American population while other form 4 percent. The fact that the state has defined eligibility levels based on a maximum income and asset levels, 60 percent of the American population can be considered as being below the federal poverty definition, yet they are excluded from Medicaid (Schultz 188).
Some non-disabled adult under the age of 65 years of age, who are poor with high medical expenses are not eligible, and even those individuals with asset above state-defined criteria cannot access medical insurance coverage due to certain limitations (Schultz 189). Furthermore, Medicaid is public programs; there are a significant number of middle-class elderly individuals eligible for medical coverage in nursing homes (Schultz 189). The fact that they intentionally transfer assets to their children exhausting their income on nursing home expenses makes them eligible (Schultz 191).
Discussions on government programs.
According to research findings, under government-funded programs, uninsured individuals receive limited health services compared to insured individuals. Services are offered using various sources, varying depending on the community. The federal, state and local governments support public facilities providing care to the poor (Rice et al. 8). In some cases, the government pays private providers to take care of those in need of care services and cannot afford (Rice et al. 9). However, the government public health expenditure supports mostly preventive health care services like vaccination, cancer screening programs and childcare services (Rice et al. 10).
Even though these services are available, the poor need to pay some fee, which varies. Some providers offer subsidized care services to uninsured people. Subsidized services affect hospital operations because it results in bad debts. Hospitals spend 5 percent to charity (Shi and Singh 87). It is not easy to estimate charity care among physicians, but studies estimate that physicians offer billion worth of free services annually from reduced fee services (Shi and Singh 87).
The fact that there are 6,7000 hospitals in America that includes 5,880 acute care hospital, 880 specialty hospitals and 340 federal hospitals ...