health care industry in America today is suffering greatly. It is suffering from spiraling costs, decreasing availability of qualified personnel, increasing demand for its services, and uncertainty relative to its future. Some of these problems are the result of mismanagement, lack of foresight, an aging population, and, perhaps greed but regardless of the causes the solutions must be determined and the present political climate makes this difficult.
The Obama administration recently passed and enacted new health insurance legislation whose aim was to improve the state of health care in America. Although not directly aimed at the delivery of health care but at the availability by increasing the number of individuals with health insurance, the debate over said legislation highlights the problems inherent in the industry. Indicative of the concerns that Americans have regarding the state of health care in America was the publication of a CBS News / New York Times report in June of 2010 outlining these concerns. The report found that 9 out of 10 Americans felt that the American health care system required fundamental change and that 36% favored a complete overhaul (Roberts, 2010). These are outstanding results, yet, how to resolve this perceived need brings widespread disagreement.
Against this background, any discussion regarding the future of the American health care industry must concern itself with these perceptions. Health is the one concern that unites all Americans but the solutions are what divide us.
Medical care in the United States has changed dramatically in the past fifty years. While Americans may waited hours to see their physician in the 60s and 70s, today Americans view their own time as being every bit as valuable as that of the physician. Gone are the days when consumers viewed their physicians as god-like characters. Loyalty has been displaced by skepticism and distrust. Physicians blame this transformation on the insurance companies and the involvement of the federal government in the health care industry while the insurance companies and the government blame it on the poor quality of service provided by the medical industry and the spiraling costs.
In the process of addressing the problems besetting the American health care system a variety of approaches have been suggested. For purposes of simplification, these approaches will be divided into four basic types. The first type will be identified as socialized medicine and is characterized by the system that is currently in operation in Great Britain. Their system involves a single payer format where the caregivers, that is, physicians, nurses, and therapists, are salaried by the system. The second type, which is the form presently available in Canada, is identified as socialized insurance. Under this system the care givers are not salaried but, instead, are paid a fee for each service they provide. Like the British form, the Canadian system is driven by the single payer method of payment so there is no interruption of service when an individual changes jobs. The third type involves a requirement that everyone must purchase health insurance of one form or another. This type of system, identified as a mandatory insurance system, is typified by how the German health care industry is operated. This system involves a hybrid mixture of private and public insurance companies that utilize a complicated payment plan that provides coverage for everyone while retaining active involvement by the private insurance industry. Certain aspects of the Obama health insurance plan are similar to the German mandatory insurance system. Finally, there is the type of system that has been operational in the United States. This system which will be identified as the voluntary insurance method does not cover everybody and has many payers and providers and there is no standardized method of payment or the delivery of services.
The recent debate that resulted in the enactment of the Obama health insurance brought to the forefront each of the types of insurance plans in effect throughout the world and highlighted the deep seeded disagreements in the American system. No one involved in the process that resulted in the enactment of the Obama health care plan possesses any illusion that what was enacted is a perfect plan. Instead, it has been viewed by its proponents as a positive step forward but a work in progress (Sullivan, 2010)
The Obama health care plan has framed reform in the United States in terms of expanding available coverage and beginning to enact regulatory reforms in how rates are set by the private health insurance market. Additionally, the plan also places cost control measures on how Medicare and Medicaid are administered.
The most obvious change or reform is the expansion of the health care coverage so that nearly every citizen in one form or another will be provided coverage. Attempts at adopting a single payer system like what is presently in place in Great Britain and Canada were soundly defeated and the system that emerged resembled the German system. Under the Obama plan, every U.S. citizen will be required to purchase subsidized insurance. This represents a profound change in the American health care system but there are other changes that have been made that will change the system even further.
Currently only 35% of American businesses offer their employees health insurance coverage. Under the Obama plan all businesses with more than 50 employees will be required to purchase insurance for their employees or face stiff fines. This requirement, plus the fact that everyone not covered by their employer, will be required to purchase government subsidized insurance and you have a huge increase in the number of individuals now seeking health care.
Beyond the changes in the availability in health coverage there are also changes on the horizon in regard to how the health care insurance industry will be administered. The changes that are forthcoming are the elimination of industry practices that restrict coverage to those with pre-existing conditions and the placement of lifetime insurance limits. The insurance companies fought these provisions aggressively but because of the passage of the Obama plan must now restructure their underwriting in order to cover these situations that they were previously able to avoid.
Even with the passage of the Affordable Care Act (the Obama plan) the American health care system will be forced to adopt other changes in order to satisfy consumer needs. As mentioned earlier, the American consumer's attitude toward their personal physician and the health care industry in general has been altered substantially over the past several decades. Today's consumer expects a much higher level of service. The bar has been raised and the consumer no longer will tolerate being treated the way that they were in the past.
For years the American public has considered their health care system has being the best in the world. As a result of this perception, Americans have been willing to absorb higher costs and other inconveniences but as more and more information has become available as a result of the debates over the health insurance issue the public has been exposed to the fact that the quality of American health care is not what everyone had believed.
Part of the problem in measuring the quality of health care is in defining what constitutes quality care. Because measuring quality is difficult and reasonable minds can disagree as to what constitutes quality no matter what standards are used there will still be disagreement as to how the United States measures up against other nations. Using, however, the parameters used by most individuals to gauge the quality of care the United States does not measure up well against other nations. The U.S. life expectancy is at or below the average in comparison with other industrialized nations; it ranks among the lower third of industrialized nations in terms of infant mortality; and, it has the highest death rate from conditions such as diabetes or heart disease that could have been prevented or treated successfully (Nolte, 2008). These results are startling provided the high cost of medical care in the United States and the availability of technology that is not available elsewhere in the world. It is also important to note that these results have remained consistent over the past several years and that, in fact, the United States' results have actually been deteriorating.
Complicating matters further is the fact that consumers in the United States are also dissatisfied with how the nation's physicians have participated in the health care system not only in the delivery of such services but also in how they have participated in attempts to control health care costs. Compared with physicians in other countries physicians in the United States are more apt to complain that any attempts at controlling health care costs will ultimately threaten the quality of care. Adopting such position creates the impression among the public that American physicians are motivated by greed and not public service. Interestingly, however, studies also reveal that American doctors are much more critical of their health care system than physicians in other nations such as Australia,…