Health care restrictions in the United States: argumentative synthesis

¶ … health care in the United States has been the source of heated debate for a number of years. Although the publicity surrounding the issue has been considerable and made to look like it is a recent problem facing the nation, the problem, in reality, has been on the horizon for nearly a century. During President Woodrow Wilson's administration, efforts were unsuccessfully made to pass national legislation regarding the delivery of health care in the United States and the issue has appeared periodically on the national agenda ever since (Lepore, 2009). Finally, on March 23, 2010, among massive controversy, the Affordable Care Act, through the massive efforts of the Obama administration, became law.

Despite the passing of the Affordable Care Act, health care in the United States remains dismal for a large percentage of American citizens. Although there were a number of significant provisions in the Act that took effect nearly immediately such as extending the coverage of coverage for adult children on their parents' policy until age 26 and the extension of coverage for children in general, most of the bill has little or no effect on most uninsured until calendar year 2013. The fact is, that despite the fanfare and debate, the Act still leaves over 17 million Americans uninsured.

The Affordable Care Act is a step forward in the delivery of health care in America. Even the most ardent supporters of the Act would argue that it is not a panacea for what ails American health care but, assuming it withstands court challenges presently pending in the U.S. Supreme Court, it does soothe some of the problems but others remain.

The Affordable Care Act plugs some of the more obvious problems but there remain considerable other ones that need addressing. There is no shortage of available approaches to the delivery of health care in the western world and the American system has appropriately borrowed some of these ideas in formulating its own but, presently, what are the restrictions on health care that are most problematic (Shi, 2003)?

The first major restriction is the overall cost of health care in the United States. Americans spend nearly $7,000 a year per capita. Canada, which trails the United States in per capita expenditure, spends only $3,326. Proponents of the American system argue that the costs of health care may be high but that the system provides the best available care in the world. Opponents argue otherwise. The United States has one of the highest infant mortality rates and is not among the leaders in life expectancy. Critics of the American health care system indicate that both statistics belie its overall quality.

One of the other arguments offered in support of the American health care system is that the system works far more efficiently than systems such as Canada or Great Britain where long individual waits for medical service are reported or where waits for specialized services are measured in months instead of weeks like in the United States. The short wait times in the United States can be misleading. First, it must be remembered that he wait times in the United States are being compared with countries that nearly all have universal health coverage. In the United States one quarter of the population lacks health insurance coverage and, therefore, are much less likely to seek health care. Additionally, even those who are insured in the United States tend to avoid medical treatment because of the out-of-pocket costs involved. In countries where universal health care is available, individuals are seeking treatments that are completely left out of the American system.

Health care in the United States is also restricted by the fact that the available pool of physicians are not getting the job done. First, there are far too few primary care physicians available to make the system work effectively. The reasons for this are numerous but the primary reasons are the relative low pay and prestige afforded such physicians. As a rule, medical students have historically been drawn to higher paying specialties such as orthopedics or surgery with very few being attracted to the field of family practice. The result has been severe shortages in the availability of primary care physicians that are crucial to the efficient delivery of health care. Collaterally, the primary care physicians that are available are not necessarily conveniently available in a way that conforms with the American life-style. America is no longer a society where 9-5 hours accommodate its needs. America is now a society that operates on a 24 hours schedule and the medical field has not adjusted accordingly. Health care professionals, particularly doctors, have been slow to move toward providing early morning, evening and weekend availability and, as a result, the level of health care has fallen. Quite simply, a large segment of American society is highly inconvenienced by the historical 9-5 schedule maintained by most health professionals and so this segment goes without seeking treatment until their conditions worsen and, too often, are beyond treatment.

Related coincidently to restrictions on the delivery of health care is America's present fascination with tort reform. Behind this movement is the generalized opinion that medical malpractice claims are having a chilling effect on the way that physicians practice their trade. The underlying theory espoused by tort reform proponents is that physicians over treat in certain situations in order to avoid malpractice claims and leave the practice in other cases due to high malpractice insurance rates. Statistical support for these arguments, pro and con, are abundant, however, the reality of the situation is that there are a high number of malpractice claims in the United States not because we live in a litigious society but because Americans are subject to a high rate of medical error. For whatever reasons, the delivery of health care in the United States invites a high level of medical, medication, and lab errors and these errors result in a corresponding increase in costs in a system that is already world's most expensive. It is popular to blame the lawyers but eliminate the mistakes and there will be no basis for the lawsuits (Boehm, 2005).

The Affordable Care Act is intended to address the health care restrictions that have existed in the United States for decades. Unfortunately, the passage and enactment of the Act has not quieted the debate nor has it addressed the issues. The Courts are full of challenges to the Act and the debate relative to the merits of the Act continues in the media and the halls of Congress. On the pragmatic level, because of political compromises, the major provisions of the Act do not take effect until 2013 and, in the meantime, millions of Americans continue to be uncovered by health insurance and are, therefore, going without health care (Anderson, 2001).