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Universal Healthcare: Averting Crisis in the United States
A crisis is a unique moment of extreme pressure, exceptional in character and high in significance. Decisions made at the time of a crisis are qualified by the multiplicity of factors all demanding solutions at the same time. One mark of a good leader is the ability to make the right decisions during moments of crisis as well as in placid reflection. The political system of democracy is not well-suited to crises. Many voices piping up and arguing fail to develop consensus, and in spite of the good arguments of some, democratic politics cannot survive a crisis. In a crisis, only a few make the grade and emerge as leaders. The decisions facing leaders in the United States take into account the long-term goals of the world's largest economy, and also the short-term needs of three hundred million opinions. The government should solve the "healthcare crisis" by mandating healthcare for all by making insurance companies responsible for payments with state and local governments as backup.
The Obama administration is pioneering healthcare reform in America only despite a hard fight in Congress, and though the bill was signed into law in March, the implementation of The Patient Protection and Affordable Care Act ("Obamacare"), is a multi-year project, specifically targeted to reach its essential goals in 2018. Far from being in a crisis, the American healthcare system is caught up in an ideological sea change pervading the United States government. The American political system and the intricate diversity of the American people now need universal healthcare. The price of health is self-evident: anybody would pay anything to stay alive. Therefore whatever the cost, the survival of our nation depends upon the acceptance of more Americans to make some changes.
For an individual body, health can be determined by a set of quantitative measurements -- age-to-weight ratio, systolic and diastolic blood pressure, lung capacity, et cetera. Each of these metrics has a bell-shaped curve, the middle part of which we call "healthy." Similarly, social health has a region in the middle of each measurement that is accepted as normal. We have specialized doctors for emergency medicine. These medical professionals are trained to bring a patient to a stable level of life. However, policymakers do not live between emergencies. Principled leaders have a set of ideological goals that they set out to accomplish, and use the buzz around emergencies to further these goals. One policymaker has been advocating medical professionals for decades, and in that interest weighs in on the current healthcare question.
The reform bill that passed through Congress last year made healthcare seem like a crisis, but the fight for universal healthcare has been raging for decades. Howard Dean, the Democratic hopeful for the 2008 primaries, has a background in medicine and strongly supported the passage of reform legislation. His book, Howard Dean's Prescription, poses a liberal argument to support the universalization (not "socialization") of healthcare to Americans. In advocating Obamacare, Dean says that "we will have lower cost with better quality" (34). Central to Dean's recommendation is the change from a disease treatment attitude to a wellness maintenance one. This will prevent crises and institutionalize wellness rather than sickness. Rather than paying for senior citizens to move into nursing facilities, have nurses visit senior citizens in their homes. To prevent chronic illness, provide medical assistance to everyone, so the expense is diluted and effectively reduced. Focus on preventative medicine. Give doctors comparative effectiveness training to streamline procedure decision-making. Develop user-friendly information technology standards that is usable in urban and rural offices. Improve chronic disease management. All these tactics to cut medical costs overall can be implemented at any time.
A study from the Massachusetts Institute of Technology has estimated that the cost of this program is approximately $1.5 trillion paid out over ten years. Dean insists that Obamacare will provide better care with lower costs. Most of this cost is from the "federal government absorbing the costs from the balance sheets of the private sector, particularly small businesses." An initial $634 billion down payment is supposed to be paid on the coming appropriations year, borrowed from foreign investors such as China. Howard Dean proposes a gas tax to offset this cost (60-2). Though a gas tax is not a bad idea in its own right, it is irrelevant to healthcare itself. Somehow a gas tax will solve a totally different problem. Sure, taxing and spending is better than borrowing and spending, but why cannot we take a bite out of physicians' paychecks, pharmaceutical costs, and the cost of medical education? So let us not go all the way with Dean's estimation, since he seems to be trying to distract us from the physician lobby. Using comparative policy analysis, let us look at other countries' healthcare systems and understand how they pay the medical bills.
T.R Reid's account of several countries' healthcare systems reveals the broad diversity of healthcare systems around the world. Reid puts them into four categories: the Bismarck model, the Beveridge model, the National Health Insurance model, and the Out-of-pocket model. The Bismarck model is a highly-regulated welfare state, combining private health insurance plans covering everybody and not seeking profit. It is employed in Germany, Japan, Belgium, Switzerland, and some parts of Latin America. The Beveridge model influenced Britain's tax-funded system. Besides the UK, Cuba, Italy, Spain, Scandinavia, and Hong Kong use this system. The National Health Insurance model combines the Bismarck and Beveridge models, the Out-of-pocket model. With a dose of humor, Reid describes the various segments of the United States as a combination of each of these models. For example, for Native Americans, military personnel, and veterans, the United States looks and talks like the comprehensive federal funding of the Beveridge model, whereas for the 45 million uninsured Americans, Burkina Faso or rural India are closer comparisons (17-20). Universalizing healthcare in the United States involves looking toward other countries' successes and reconciling them with our practical limitations.
Medicine is two to ten times more expensive in the United States than in Britain or Germany. American physicians are paid two or three times as much as German ones, and have very low malpractice insurance obligations. However, American M.D. graduates usually owe a hundred thousand dollars in student debt, compared to zero dollars in Europe. National healthcare systems such as the British National Health Service and America's Medicare have very low administrative costs.
The most insidious part of the American healthcare system is the lack of "guaranteed issue." Only in America can insurance companies refuse carriage of sick people. The "individual mandate" corollary to guaranteed issue ensures that since everybody is paying a little, everyone can benefit. The current health reform bill requires both guaranteed issue and individual mandate provisions for insurers. Universalizing healthcare requires both these functions, since the cost is spread out by all members so the most disadvantaged have a safety net. For most working Americans, employment is the direct source of insurance. So when a worker is hit with unemployment, insurance goes with it. Unemployed workers not only lack a source of income, but also safety. While this setup goes in line with the American culture of a strong work ethic and provides an incentive for taking up employment, it differs from other countries.
If policymakers worked from long-term strategies, then we would not have to revert to crisis management. However, some of the most needed change comes about only through the transformational experience of a crisis. The benefits of working through these large-scale problems include a real review of issues that have been stewing in the background, potentially causing significant change in the foreground. Within the United States, insurance companies have been behind…[continue]
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