HealthCare Reform Issue

It's really frustrating for me to see many people comment on the health care issue without any concept of the realities the system is facing. The notion that we have the best health care system in the world is dependent on how you measure "best". So, in order to educate the masses a little more about the facts here is some information from one of my papers on the issue. Please take into consideration when evaluating this information that I am for healthcare for all. Of course I have sources for all this information if you are so inclined to check my research itself, just ask.



I. Access



It is well known that there are approximately 47 million Americans uninsured in the United States and of the insured many are underinsured. Currently, the fastest growing segment of the newly uninsured is the group that has been earning in excess of $75,000. These approximately 800,000 individuals lost their health insurance when they lost their jobs or were priced out of the market because of rising cost of health insurance. In addition most Americans "covered" by some form of health insurance still worry about its continuation should they or a close family member become seriously ill and some are "locked" into employment for fear of losing existing coverage.



A further problem is the decrease in employer-sponsored health insurance coverage. Between 1991 and 2003, the proportion of full-time employees participating in employer-sponsored health plans at medium-sized and large firms plummeted from 83% to 65% and in 2006 just over one-half of workers employed in the private sector participated in employment-based health plans. Furthermore, the Institute of Medicine ("IOM") estimates that 18,000 people between the ages of 25 and 64 die each year because they lack health insurance making lack of health insurance the sixth-leading cause of death among people under age 65. This fact alone makes the lack of health insurance shocking and menacing problem.



II. Rationing



For the most part, Americans support universal health coverage with increasing support. In addition, the lack of action on the federal level has lead to increasing action at the state level. Currently there are 3 states which have enacted universal coverage and 12 states which propose universal coverage. However, the biggest argument against universal health care in terms of access is rationing. Rationing occurs when limited resources exist and not everyone will have actual access to the care they need in a timely fashion.



A common myth which exists in the United States is that we do not already ration our health care. The most obvious way in which we ration health care is between those who have insurance versus those who do not have insurance. Even for those who do not have insurance and seek medical attention in emergency rooms, they are more likely to put off seeking medical attention until the problem has become severe and less likely to receive follow-up care.



Using rationing as an argument against universal access also presupposes that rationing of care is unnecessary or immoral. Even opponents to universal health care understand that rationing occurs and is necessary in a system with limited resources. However, the disagreement occurs when deciding who should be responsible for rationing care; the individual or government bureaucrats. Opponents to universal health care argue that the primary way in which it is rationed in the United States is by individual choice and that in an ideal system, rationing would be by patient choice wherever possible. However, an ideal system does not exist and even those with insurance lack the power to make health care decisions because they are limited by their insurance providers. Even more so, those without insurance lack the power choose or even gain access to any health care. The opponent's arguments place a negative emphasis on the health bureaucrats making rationing health care decisions and fail to address the impact of insurance bureaucrats making rationing of health care decisions. Nor do they propose any measure which would help achieve the ideal system allowing patients make these decisions without interference from one source or another (government or health care corporations).



III. Quality of Care



A common view prevalent in the United States is that we have the best health care system in the world; a view that has increasingly come under attack. In our current system, there are between 44,000 and 98,000 deaths from medical errors a year and a 2000 report on the epidemiology of medical error estimated that about 1 million preventable injuries occur to U.S. patients each year; these include transfusion errors, adverse drug events, surgery on the wrong side, and mistaken identity. In addition, our system frequently fails to provide basic services such as immunizations or prenatal, primary and preventative care. The average ranking for the United States on 16 health indicators in a 1998 comparative study of 13 countries was twelfth, second from the bottom and in another study of 11 western countries, the United States was ranked last with respect to its primary care base and its per capita health care expenditures (the highest), while ranking poorly on public satisfaction, health indicators, and use of medication. Furthermore, "[a]lthough American medicine has produced many "miracles," we are not the undisputed leader in medical innovation, only in the costliness and ubiquity of high-technology medicine."



Similar to access, rationing is an argument used against universal health care in terms of quality. The argument posits that because of limited resources, the quality and type of care will be reduced in order to preserve costs. For example, currently in the United States, the elderly and disabled have a privileged position with respect to health care in the form of Medicare. But in other countries, where the entire population is part of the same government-funded health care plan, the elderly are usually pushed to the end of the rationing lines. For example, in Britain, it is extremely difficult for an elderly patient to get kidney dialysis, a kidney transplant, or any other transplant. However, studies have shown that in the United States, when transplants are rationed, income, race and sex play a factor. It is clear when resources are limited rationing is necessary. Furthermore, whenever rationing becomes a factor tough decisions must be made. Is really so bad to approve transplant for a 25 year old versus a 75 year old when the resources are limited? These types of questions are already being faced with limited resources in our current system and will continue to be necessary in any new system.



Furthermore, another argument is that the most up-to-date medical technologies may not be available either because there is not adequate equipment or because there will not be enough money to run the equipment. However, a RAND study found that "for most care that has been studied, there are large gaps between the care that people should receive and the care they do receive. This is true for all three types of care (preventative, acute, and chronic). It is true whether one looks at overuse or underuse. It is true in different types of care facilities and for different types of health insurance. It is true for all groups, from children to the elderly." The current system in the United States fails the majority of the population when they do not have access to the most basic services, let alone the most up-to-date medical technologies, resulting in poor quality of care as a nation.



IV. Cost of Care



Health costs are increasing at an alarming rate, with sixteen percent of our gross domestic product being spent on health, about twice the average for other rich countries. The resulting costs of lack of insurance and underinsurance to individuals and society are high. Uninsured individuals lose between 65 and 130 billion dollars annually in the form of increased morbidity and premature mortality. The IOM estimates that communities nationwide spend 35 billion dollars annually on uncompensated care for the uninsured. In addition, when an uninsured individual cannot pay for expensive health care, society picks up the costs. An IOM report on the effects of uninsurance states, "[t]he unreimbursed costs of caring for uninsured Americans are ultimately paid for by higher taxes and high prices for service and insurance. Local communities tend to bear the main economic burden of subsidizing service delivery, while the costs of public insurance are more broadly spread across state and federal budgets." In addition, about 1.5 million families who file for bankruptcy can be attributed to the result of medical expenses.