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Universal Health Care - Literature Review
Universal Health Care
Universal health care is a hot-button topic for many people, especially since "Obamacare" was passed into law. However, there has been some discussion of a health care bill of some kind for the United States for many years before President Obama took office. The debate is nothing new, but there are two sides to the issue - both of which are very significant in what they have to offer when it comes to making a decision as to what would be best for the American public and the health care that they need both now and in the future.
As far back as 1989, Relman was addressing the issue of universal health insurance. He stated at that time that universal health care was a notion whose time had come, and that something needed to be done to protect the American people from the expense of medical care and the lack of treatment that many people without insurance were forced to endure. They had few choices, and there was little that they could do to make things better for themselves - so many of them were relying on the government (Relman, 1989). But was the government system a good one? Could it provide everything that these people actually needed in order to survive and thrive in an era where medical care was becoming more expensive? According to Relman (1989), the National Leadership Commission on Health Care was planning a proposal for universal health insurance by the end of 1988.
As of the time of Relman's writing, that proposal had not yet been made available. Other issues had been addressed and other writings had been created in regard to the health care debate, but the Commission's proposal remained elusive. That disturbed Relman (1989) because of the lack of health care that so many people were experiencing and the (seeming) lack of desire for the government to do anything about the issue. Was health care going to become something that only the rich could afford? This question was also asked by Asch, et al. (2006) and addressed by Veugelers & Yip (2003). Both of these studies consider the issue of socioeconomics as it relates to health care. While they are similar studies on a similar issue, they are far from identical in nature.
For example, Asch, et al. (2006) put forth the information that adults within the United States actually receive only about half of the medical services that are recommended for their age, condition, health problems, and other factors. Of course, this is not something that is necessarily seen across-the-board. Some groups are at greater risk than others for being denied care or for simply not being able to get the care that they need. Older people, poor people, those who are uneducated, women, and minorities are among the groups who have the most difficult time getting proper health care (Asch, et al., 2006). All of those groups do have exceptions, but they are generally not well-treated by the medical community. As Asch, et al. (2006) looked at those groups, it became very easy to see that there were large numbers of people represented there, and that many participants in the study could be classified into more than one group, making it more difficult to assess just exactly how many people were at risk for sub-standard medical care.
Interestingly enough, Asch, et al. (2006) found that insurance (or a lack thereof) did not play a significant role in whether a person received good-quality health care. The demographic information that belonged to the patient was more significant when it came to the kind of care they received. Women received more preventative care and less acute care than men, and older people received less care in general than younger people (Asch, et al., 2006). While these issues make sense when considered broadly, they are still important to address from the standpoint of insurance and how it did not appear to be directly related to the quality of care that any person in any demographic group received. That way, however, only true among patients who had at least minimal access to care and who had seen at least one medical professional one time in the previous two years.
Veugelers & Yip (2003) studied a similar issue to Asch, et al. (2006), when they looked at whether universal coverage for health insurance would reduce the disparities that were seen in the quality of care. During that 2003 study, Veugelers & Yip concluded that universal health care would give people of a lower socioeconomic status more access to health care, and thus allow them to be on more equal footing - from a health standpoint - with people who had more money (and, therefore, better access to care). However, Veugelers & Yip (2003) also concluded that there would not be a difference in mortality between the two groups if there was universal insurance. This was due to the fact that people who did not have insurance would generally wait until they were very sick and go to the emergency room instead of going to the doctor at more regular intervals.
That put them at risk for health problems that went untreated for some time, and did not allow them to purchase medications that they were told by their doctors that they needed. With universal access to health care, the mortality numbers would be more even between the two groups. Specialist services are widely underused in lower socioeconomic classes, though, and there is no real way to tell whether universal health care would correct that issue, or whether it would only add to the problem because it would not be covered fully and would not allow people with less money to see specialists - even though they would have more access to hospital services and general practitioners.
Overall, Asch, et al. (2006) followed up on what Veugelers & Yip (2003) addressed when it came to a lack of insurance and a lack of medical care. The main differences between the two studies was that Asch, et al. (2006) looked at the demographics of the issue and Veugelers & Yip (2003) looked more strictly at the economics. Both studies drew different conclusions, however. Veugelers & Yip (2003) indicated that there would be a benefit to providing insurance to a lower socioeconomic class so that they could see the doctor more often, for less urgent issues. By doing that, they would lower their mortality rate. Conversely, Asch, et al. (2006) found that there was not enough of a disparity among different demographic groups for insurance to make a significant difference in how the people who were studied were treated. While that seems difficult to accept, each study was conducted using standard methods and reached appropriate findings.
Another question that has to be addressed, however, was posed by Lu and Hsaio (2003). Their study was interested in determining whether universal health care would actually make health care as a whole unaffordable. Health care is currently very expensive, and when insurance companies have to cover people with preexisting conditions for the same rates as healthy individuals and doctors and hospitals are required to treat many more people than they did previously because more people have insurance, there will have to be compromise somewhere. Many theorists believe that compromise will be made in the way of higher rates and medical care that is actually much more expensive - but that expense will be passed on to the insurance companies and the government, not to the people who are seeing their doctors. Higher insurance rates may be seen in order to compensate for that, of course, and those rates will be passed on to the people who need the medical care and to anyone who has insurance, whether they use that insurance or not.
In order to explore the issue, Lu and Hsaio (2003) looked at the health care system in Taiwan. There were fears that it would become unmanageable and that it would be impossible for it to work in the long-term because of the cost. However, over time it was found that the costs of covering the uninsured - even those who were unhealthy - was actually offset by a savings on health spending overall and a lower health care inflation rate (Lu & Hsaio, 2003). That was certainly good news for Taiwan, as its National Health Insurance (NHI) program has a satisfaction rating of 70%. While the U.S. And Taiwan are very different nations, Lu and Hsaio (2003) do provide information that can be used by the United States in its own desire to have a universal health care system that works for everyone and that allows all Americans to get healthcare while not having to go bankrupt in order to attempt to get insurance or medical care that might otherwise be highly costly.
Before the current "Obamacare" bill was passed, Pauly (2008) was arguing that it would be valuable to mix…[continue]
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