Healthcare systems, policy, and practice

National healthcare system in the U.S. has come under attack recently with President Obama devising new plans to uproot the existing system and introduce reforms that would allow healthcare access to wider section of American population. The problem with American healthcare system is its inability to cover everyone and the section it doesn't cover is an overwhelming 45.8 million people.

This is a serious issue for a country where elderly population is consistently increasing leading to a serious healthcare crisis. The prices of drugs have gone up alarmingly causing a major shift in sources of supply. While few years ago most people would purchase their prescriptions drugs from within the United States, a significant portion is now purchasing them across the border. This is putting pharmaceutical industry at a risk too while putting additional strain on healthcare industry in general. But the drugs being prescribed are available at a very high price in the United States while the same drugs are much cheaper in Canada. People without adequate health insurance are required to pay enormously on prescription drugs. This is a serious concern for tens of hundreds of people in the United States.

I believe that healthcare should be made more affordable for every citizen in the U.S. There is some major flaw in the system which is depriving millions of people of quality healthcare. This flaw exists in the way healthcare insurance works in the country. We can adopt a single-payer system like Canada, in combination with multi-payer system, which would allow more people to access quality healthcare and inefficiencies emerging from multi-payer system existing alone can be effectively reduced.

The fact that is most surprising and yet disturbing is that United States spends heavily on healthcare. In 2003, U.S. invested 15.3% of GDP in healthcare sector. This expenditure is likely to increase to 18.7 in next few years (Machlin, Carper, 2006). The U.S. spends more than any other western industrialized country on healthcare and yet many of its people are totally dissatisfied with the system. There is an urgent need to make the system more efficient, less expensive and to provide adequate coverage where it is needed the most. Drugs must also be subsidized in order to make it easier for those without insurance to purchase them. The pharmaceutical industry claims that it spends a large amount on research and development and the quality of their drugs is what causes additional increase in prices. However this claim is not accepted by the public, which is disappointed with a system that has otherwise been ranked the best in the world.

US healthcare system is subject to intense debate. On the one hand are those who feel this system is the best in the world, while on the other extreme are those who are completely disenchanted with healthcare laws, provisions, coverage and facilities. Healthcare expenses in the U.S. are paid by individuals and/or by insurance providers. These insurance providers fall into carious categories including Medicaid, Medicare, private insurance and employer sponsored coverage. According to a survey and research, it was found that Americans spend a hefty amount on healthcare every year out of which private insurance provides the widest coverage. It was reported that in 2004, private insurance covered 42.8% of the total expenses; out of pocket payments were estimated at 19% while Medicare and Medicaid covered 10.9 and 10.6% respectively. (Machlin, Carper, 2006)

Despite some important sources of funding available, United States still fails to provide healthcare coverage to every citizen. It is said that despite such heavy spending, U.S. is sadly the only developed country with the exception of South Africa that doesn't provide healthcare to all its citizens. At the center of this issue lies the rather confusing and inefficient insurance system, which leaves many people, puzzled, to say the least. We have Medicare, Medicaid, divided into some categories and while you may qualify for one, you may not for the other. Similarly there is military, veteran and private employment insurance. Sadly however these sources of funding are not enough. Many people are still uninsured and it has been reported that people with inadequate healthcare insurance or no insurance are likely to die younger and live an unhealthy life compared to those with health insurance.

It is believed that a single payer system may be the answer to many of our healthcare insurance problems. With a clear, transparent and single source of funding, government will have a better picture of how much insurance is being paid, who is being covered and what percentage is still not covered. With a multi-payer system, agencies might not be fully aware of the extent of uninsured population in the country. This single payer system is working quite effectively in Canada and in 1991 reports were published that indicated that a similar system might be more economically feasible for the U.S. due to reduction in administrative costs. It has also been said that single payer system would not completely eliminate other sources because that source would provide the most basic coverage to all citizens. The rest would be covered through private insurance. But the advantage here is that at least every single person will have some healthcare insurance, which would reduce the burden of making out of the pocket payments. "In 1970, U.S. And Canadian mortality rates calculated along income lines were virtually identical. But 1970 also marked the introduction of Medicare in Canada -- universal, single-payer coverage. The simple explanation for how Canadians have all become equally healthy, regardless of income, most likely lies in the fact that they have a publicly funded, single-payer health system and the control group, the United States, does not." (Dressel, 2006)

Bernasek (2007) reports that United States is currently paying $6,102 approx per person on healthcare each year- a rate that is much higher than other industrialized nations. It is also significantly higher than Canada where each year $3,165 approx is spent per person on healthcare. Single payer system is the answer to this alarming rise in cost of healthcare in the U.S. Examples of other countries indicate that a single uniform source of funding can cover every citizen while reducing government expenditure on the whole. The large amount of paperwork required in the hospitals and other healthcare facilities can to the burden of exorbitant administrative costs. This kind of paperwork was virtually absent in other countries. The author further explains that cost of this kind of unnecessary paperwork accounts for 31% of healthcare-related administrative costs and can be eliminated with the help of a single payer system and more effective way of maintaining records.

US Physicians' working group for single payer National health insurance claims that, "Only a single comprehensive program, covering rich and poor alike, can end disparities based on race, ethnicity, social class and geographic region." ("Working Group," 2001)

But is single-payer system completely flawless? The answer is no. why it does help millions in Canada and Britain afford quality healthcare, it also placed undue constraints on doctors and may result in compromised care. Secondly while it has its benefits, it may still not be enough as Barbara Perkins explains: "A single-payer system would probably be necessary, and it would have to abolish fee for service payment system. Neither of these [huge accomplishments] would be sufficient, however, to achieve equity and appropriateness." (p.162)

Even Canadian citizens agree that while the healthcare insurance system works for most of them, they often have to wait hours and days to see a doctor or a specialist. This is due to time constraints restricting doctors and slowing them down considerably. Another major problem is lack of genuine care and compassion. With a single payer insurance system, officials may actually not genuinely care about a patient or the decision made by their doctors. Goodman et al. (2004) explain, "Many American doctors have endorsed the single-payer idea, in part because they envy the Canadian doctors' ability to pratice medicine without managed care type, third party interference. What they overlook is that, at least from a budget perspective, Canadian officials have no reason to care what decisions doctors make." (p.3)

Single-payer insurance system has worked well for many countries. It has been one of the most enviable features of healthcare system in Canada. But the system does come with its share of flaws or problems. We have already discussed some problems; however there is another issue which cannot be ignored. And that is the issue of supply of doctors and long waiting periods.

Since the countries with national healthcare insurance are providing medical care to all citizens, they do have their way of controlling costs. The most important method is imposing variety of limits. (Goodman, p.3) They strictly limit the supply of doctors and this means fewer doctors become specialists and hence there is a long waiting period to see these specialists. Goodman et al. (2004) notes: "…in countries with national healthcare insurance, people wait. They wait in the offices of general practitioners. They wait to see specialists. They wait for surgeries." (p.3)

Despite its problems and issues, single-payer system is still a reasonably good answer to healthcare insurance problems in the U.S. However there are some changes we might need to introduce in order improve single-payer system and to minimize the problems associated with national healthcare insurance. Instead of completely replacing it with multi-payer insurance system, countries like South Africa and Australia have adopted another measure. This measure is meant to improve single-payer system while still fully retaining it. These countries have introduced expansion in the role played by private insurance companies. This means while everyone has access to healthcare with single-payer system, if they still need additional benefits, they can buy private insurance. Preker et al. (2) explains: "Expanding the role of private insurance alongside a universal single-payer insurer is one way of balancing the tradeoffs between single and multi-payer insurance systems….Private insurance coverage can accommodate consumer needs that are not met by the single-payer insurer." (p. 312)