Healthcare Issues in the United States
The World Health Organization (WHO) declared, in its 1948 constitution, that the “enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being,” health being the “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 2001). In other words, if the WHO standard is utilized as a yardstick, governments the world over, in performing their mandated duties, should ensure that their citizens have access to health care not only when they get sick. More importantly, people should be able to see their doctors for routine examinations for the purpose of averting preventable diseases. Being one of the leading industrialized countries in the world, the United States is also among the richest. As such, everybody expects it to meet the WHO standards effortlessly. What this means is that Americans should enjoy “the highest attainable standard of health.” Unfortunately, statistics prove that this is not the case in America today. As things stand, many Americans die without even seeing a doctor because they have neither money nor medical insurance to take care of their medical or hospital needs.
As of 2005, 46.6 million Americans could not afford to see their doctors for the simple reason that they had no health insurance to defray their medical expenses. Even more alarming was the fact that the uninsured Americans did not only come from the ranks of the unemployed and the underemployed. They also included those who were regularly employed. As a matter of fact, out of the 1.3 million Americans who lost their health insurance coverage in 2005, more than 500,000 were workers who had employer-sponsored health insurance in 2004. This unfortunate development occurred in spite of the fact that the real median income of American households increased by 1.1% for the very first time since 1999 while the rate of poverty stayed put at 12.6%. In other words, many working people lost their health insurance in 2005 despite earning more than the previous year (U.S. Census Bureau, 2007).
This seeming discrepancy forces one to ask the inevitable question: Why can’t Americans afford to pay for their health insurance if they are receiving more? The answer is simple: the spiraling cost of healthcare in the country.
Currently, health care delivery in the United States leaves much to be desired. It does not take a specialist in the field to perceive that the health care system in the country is being governed by a highly unregulated industry which has failed to effectively and efficiently deliver health care services to majority of the people. It has also developed into a lucrative investment area which is being controlled by investment houses, private health insurance companies, and medical care providers. Even the health professionals who have pledged to look after the well-being of the people have joined the fray. In other words, everybody connected with the healthcare industry have been enriching themselves except the supposed beneficiaries. No matter how one looks at the issue, the spiraling cost is the culprit.
The different sectors of society responded to this deplorable situation differently. Although there is unanimity of opinion that the rapidly increasing healthcare costs is what deprives many Americans of their access to healthcare, they could not agree on the cause of the increase in healthcare costs. There have been some suggestions that a market monopoly has emerged in the healthcare industry. In his article entitled “Beyond Dollars: The Real Cost of the U.S. Health Care System,” Adams (2005) blamed the rapid increase in the cost of health care in the United States to a “system [which] is essentially operated like an organized crime ring, where the aim is to maximize profits, not to serve the public good.” He stressed the fact that the indifference exhibited by the Food and Drugs Administration in emphasizing preventive medicine, as well as its tendency to cast doubt on, or even suppress, alternative medicine, made possible the emergence of a market monopoly which is lorded over by pharmaceutical companies, health care providers, investment houses, and even health professionals (Adams, 2005).
He added that this market monopoly is further aided by the government’s tolerance of the massive marketing efforts being launched by manufacturers of disease-causing foods and groceries like soft drinks and other junk foods, thereby giving birth to a disease prone American society. He explained that this inefficiency in the system of health care in the country not only triggered the dramatic rise in the cost of health care, but has also started driving away investors. In fact, he claimed that businesses are now starting to look elsewhere not only for cheap labor but also cheaper health care cost for their employees. He identified destination countries in Asia like South Korea, the Philippines, China, Taiwan, and Thailand. He specifically referred to Taiwan where, according to him,
Working citizens are covered for merely $20 per month (in U.S. dollars). That $20 per month pays everything: Dental, maternity, prescription drugs, surgical procedures, imaging tests, you name it. Co-pays are stunningly affordable too. A $50 cash co-pay gets a citizen a collection of prescription drugs that easily exceed $1,000 in retail cost here in the U.S.
Adams also pointed out that while preventive medicine has been proven to entail lower costs, this is not being done in the United States since “there’s no money in prevention. Our current system of for-profit medicine only rewards the treatment of sickness. And thus, by its very nature, it precludes any incentive for the promotion of health.”
If Adams identified market monopoly as a major cause of the rise in health care cost, there are some who consider the fierce competition raging in the health care industry to be the primary cause of the rapid increase in the cost of health care, including the cost of health insurance premiums. These people strongly believe that in the mad scramble for profits and market share, the health of the people, which is supposed to be the basic concern of the industry, is oftentimes ignored in favor of profits. Mahar (2007) claimed that “too much competition and too little collaboration have created a fractured health care system, riddled with redundancies, weighed down by high administrative costs, and shrouded in confusion.”
Sharp increases in administrative and overhead costs, according to Mahar, result when hospitals start competing among themselves to attract more patients in their search for more profits. This fierce competition has already reached a point where hospitals outdo one another in providing facilities and conveniences which used to be offered only by hotels. Some of these amenities are needlessly luxurious lobbies, five-star accommodation and service, and first-rate interior decorations. Some hospitals have even started offering valet parking and other amenities not primarily associated with patient care. All of these add-ons increase the rates in hospitals not only for rich patients who are the ones using them but also for poor patients (Mahar, 2007).
The absence of proper coordination, collaboration, and the presence of redundancies which are common products of competition also result to higher health care cost. An example of this is a case where hospitals and clinics figure in a race to offer specifically sought-after and profitable services such as diagnostic imaging and dialysis. The resulting scenario would be that three, four, or even five clinics and hospitals located near each other end up having identical equipments and facilities, thereby offering basically the same services to patients coming from the same service area. If only these hospitals and clinics do not compete with each other more than they should collaborate, a better, more efficient health care delivery system could be achieved at a much lower cost for everybody (Mahar, 2007).
Adams blamed a market monopoly for the problems besetting the health care industry. Then Mahar pointed an accusing finger at the fierce competition and lack of collaboration among hospitals and other players in the industry as the principal causes for the rapid rise in health care costs. As if these two opposing views alone were not enough to confuse the public, a third concept joined the fray. According to this third notion, the real culprit is neither a market monopoly nor the intense market competition. Rather, it is the rise in the prevalence of risk factors such as obesity and a parallel rise in treated conditions like hypertension, diabetes, and mental disorders, coupled with “changes in clinical thresholds for treatment, and innovations in treatment” of diseases (Thorpe, 2005).
Thorpe (2005) explained that about 27% of the rise in health care spending between 1987 and 2002 could be attributed to the rise in population risk factors such as obesity and a parallel rise in treated conditions like hypertension, diabetes, and mental disorders. He cited as an example of a change in clinical threshold for treatment the case of treating hypertension. According to him, prior to 1980, a patient would be treated only for hypertension if he or she had a blood pressure reading of 160/95. By 1980, the threshold was lowered from 160/95 to 140/90. This means that in 1980, people with blood pressure readings of 140/90 were already made to submit themselves to treatment. This inevitably resulted to more patients, more spending, and therefore, more profits. By pointing this matter out, Thorpe (2005) effectively suggested that lowering thresholds for treatments were not the result of new medical discoveries but were merely done for profit. When the threshold was further lowered to 120/80, this resulted to even more spending and more profit because it was believed that around twenty-three million American adults had blood pressure systolic readings of 130-139 and diastolic readings of 85-89. In other words, a person who had a blood pressure reading of only 130/85 was already told to submit to treatment (Thorpe, 2005).
By innovations in treatment, Thorpe referred to new technologies and procedures being employed by health professionals. A case in point is infant delivery. Increases in spending occurred with the advent of “a wealth of new technologies (such as neonatal intensive care, incubators, steroids, and ventilators) aimed at improving survival rates among low-birthweight babies.” In other words, parents of underweight babies could now be charged for the additional services (Thorpe, 2005).
These three views are perhaps divergent but each showed merit. It is therefore safe to conclude that the driving force in the rapid rise in the cost of health care in the United States was actually a blend of the causes as perceived by Mahar, Adams, and Thorpe – with each view reinforcing the other two. What is more important at this point is the fact that statistics show an actual decline in health insurance coverage among employed Americans. The rate of decline becomes more evident the smaller a company gets. The main reason for the drop in coverage has been attributed to the great discrepancy between the increase in salary and the rise in health insurance cost. According to Carroll (2007), the Robert Wood Johnson Foundation reported that from 1998-2003, about three million eligible workers from the private sector declined the health insurance offered by their employers because they could no longer afford to pay for their share of the premium. On the other hand, economist Elise Gould of the Economic Policy Institute said that about 8 million workers opted to forego health insurance in 2005 because of the increase in cost. Carroll also quoted Marisa Milton of the 250-member HR Policy Association, who echoed Adams when she said that: “Just as a competitive issue, this is something that will be a real problem for many companies in our membership as they compete with manufacturing or work forces in countries that do not have these issues” (Carroll, 2007).
While salaries rose by a mere 20% since the year 2000, the cost of health insurance premiums increased by a whooping 87%. Workers were only paying an average annual premium of around $1,619 for a family coverage in 2002. By 2006 the average premium for the same coverage had soared to $2,973, or a difference of $1,354 a year. Part of the reason for this increase in the employees’ out-of-pocket cost is the growing trend among employers to reduce their share in the health insurance premium and increase that of their employees’. This was established by a survey conducted by the Kaiser Family Foundation where most of the employers covered revealed that they were not giving up on health insurance – merely increasing employee share. This development led Drew Altman, Chief Executive Officer of Kaiser Family Foundation, to remark that “we’re gone from an era of managed care to an era of people pay more” (Carroll. 2007).
The sorry state of the system has forced majority of Americans to demand for a complete overhaul, the prevailing sentiment strongly favoring the adoption of a universal healthcare to cover all Americans regardless of their economic status. And the majority could probably be right in thinking that only a universal health care system could save Americans from an appalling situation of spiraling costs and increasing number of uninsured. Consider once again the data released by the United States Census Bureau on August 29, 2006: while the real median income of American households increased by 1.1% and the rate of poverty stayed at 12.6%, the number of the uninsured rose to 15.9%, registering an increase of 0.3 to reach the gigantic total of around 46.6 million Americans as of 2005 (U.S. Census Bureau, 2007).
The concept of a universal health care program came to the fore with the release, by the Cambridge Health Alliance (CHA), of the findings of a Canada-U.S. Survey of Health conducted jointly by Statistics Canada and the U.S. National Center for Health Statistics during the period from November 2002 to March 2003. The survey found that a universal health care program could improve the health of Americans. According to the findings of the survey, “A single-payer national health insurance system would avoid thousands of needless deaths and hundreds of thousands medical bankruptcies each year.” In comparing health care between Canada (which has a single-payer system of health care), and the United States, the CHA found that cost has proven to be a bigger barrier for Americans than Canadians, as far as health care accessibility is concerned. Seven percent of U.S. respondents to the survey “reported going without needed care due to cost” while only 0.8% of the Canadian respondents said so. Heavily favoring a universal health care/single-payer health care system, the study found that
U.S. residents were less healthy than Canadians, with higher rates of nearly every serious chronic disease examined in the survey, including diabetes, arthritis, and chronic lung disease. U.S. residents also had more high blood pressure (18% of U.S. residents versus only 14% for Canadians). U.S. rates of obesity and sedentary lifestyle were higher, with 21% of U.S. respondents reporting obesity versus 15% of Canadians (Cambridge Health Alliance, n.d.)
The Canadian experience attesting to the superiority of a single payer universal health care system and reinforced with the evidence so far gathered against the health care system now prevailing in the country, should be enough to convince the federal government to start seriously considering the viability of the single payer universal health care system. Earlier, it was already disclosed that 29 industrialized countries had already adopted the concept of a universal healthcare as early as the 1990s. Of these 29 countries, 28 opted for a single-payer, universal healthcare system while Germany chose to have a multi-payer universal healthcare system. The United States remains the only industrialized country in the world who has not yet decided to adopt a universal healthcare system (Battista and McCabe, 1999).
In arguing for the universal healthcare, Battista and McCabe (1999) revealed that as of 1960, the United States was ranked 12th in infant mortality. In 1990, the country was occupying rank 21 and by 1999, it was ranked 23rd in the world. The United States suffered the same fate in life expectancy: 1st for both men and women in 1945 but by 1960, only 13th for women and 17th for men. The most humiliating performance of the country appeared to have been in the field of immunization where it was ranked 67th in 1999, a notch below Botswana who was in rank number 66. They also cited the studies which were made by the General Accounting Office together with the Congressional Budget Office showing that a single payer system would save the country as much as $200 billion every year (even if every uninsured American is covered) because of a much lower administrative cost (Battista and McCabe, 1999).
It appears that just like the rest of the industrialized world, the United States should have adopted a universal healthcare system as early as the 1990s when it started turning out the degrading figures cited above. Now, more than a decade later, the political leaders of the country are yet to see the wisdom of the system which have been benefiting peoples from lesser countries.
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