Healthcare Issues, Systems, and Policies America, Once

Healthcare Issues, Systems, And Policies

America, once the global leader in the health of its population and among the nations with the highest quality and most readily available healthcare services, has now fallen behind almost twenty other countries, including some that only became industrialized in the last third of the 20th century, and with substantial assistance from the United States. While most other so-called "First-World" nations have already embraced several fundamental concepts that appear to be the most efficient trends in modern healthcare delivery, the U.S. is still mired in problems associated with the failed model that is responsible for the continuing decline of healthcare quality (on the scale of entire populations), availability, and (especially) affordability. That is not necessarily completely, but largely, a function of a systemic failure in contemporary American politics: private-sector lobbying of elected public officials who actually write legislation.

Population Growth and Demographic Issues

With respect to the relationship between and population growth and healthcare systems in other nations, the U.S. is substantially unique in the underlying challenges.

That is because the healthcare systems in most other nations need only continually grow and otherwise adapt to accommodate increasing populations. The U.S. population is also continually growing (and this is another independent challenge on its own); but the main problem is the specific demographic changes in the population rather than raw population growth (Kennedy, 2006; Tumulty, Pickert, & Park, 2010). In the U.S., the Social Security System established after the Great Depression, and government healthcare programs (i.e. Medicare, Medicaid, and Veteran Services) introduced a few decades later were structured to rely on the productive lifetime contributions of working people to fund the care of the previous generation that is no longer entirely self-sufficient, partly because American healthcare increased the average lifespan in the post-war era (Reid, 2009).

Today, the proportion of working adults and the elderly who are partly or wholly dependent on Social Security, other forms of public assistance, and on Medicare and Medicaid is undergoing a dramatic change that will probably require certain reductions in services or restricted or postponed eligibility if those government programs will continue to be sustainable for U.S. healthcare and economically beneficial rather than harmful in the long-term (Dykman, 2008). In principle, that is attributable to the Baby Boom that occurred in the first two decades of the post-World War II era. The tremendous population growth between 1945 and approximately 1964 is directly responsible for the fact that today, three decades later, individuals are reaching retirement age at a much greater rate than individuals reaching the age of entrance into the workforce (Carey, 2009).

The Impact of the Influence of Industry Lobbyists on the Legislative Process

No doubt, there are numerous significant problems within the healthcare industry and delivery systems that must be addressed by meaningful and comprehensive changes to American healthcare. However, there is an even more fundamental problem that is much more general than its effect on healthcare specifically: the political lobbying process. Nevertheless, its influence over healthcare funding and affordability lies at the heart of problems that must be solved as an absolute prerequisite for any truly meaningful approach to healthcare reform.

The most basic economic facts about the American healthcare system are that healthcare costs amount to approximately $2.2 trillion annually, which means it is already poised to reach a staggering 40% of our entire GDP very soon (Tumulty, Pickert, & Park, 2010). As many as 40,000 or 50,000 Americans die annually because they lacked access to appropriate healthcare services. The American healthcare system relies almost exclusively on its private-sector health insurance industry that rakes in approximately three-quarters of a trillion dollars annually, amounting to almost one-third of the total cost of healthcare that is strangling this nation economically. Meanwhile, even the public healthcare programs that (admittedly) require fundamental restructuring perform (in essence) all of the same (i.e. administrative) services at an approximate total cost of less than three percent of the cost of the healthcare services it actually delivers (Dykman, 2008; Kennedy, 2006).

The principal reason that the cost of private healthcare continually escalates is that it is thoroughly dominated by the private health insurance industry. Without any meaningful competition from what the Obama administration once referred to as the public option that the President inexplicably (or unnecessarily, depending on one's perspective) abandoned eventually, private health insurers have been free to raise their premiums virtually at will, or as the market will (have no choice but to) bear. By inundating members of both houses of Congress with lobbyists, that sector (just like the investment and banking sectors) employs approximately six lobbyists per legislator (Kennedy, 2006).

The relationships and tacit mutual understandings that are generated through this political lobbying process routinely produce legislation that is economically beneficial to the industries represented by lobbyists and (in effect) also stifles any legislative changes that would limit or threaten the profitability of the healthcare and health insurance industry. In addition to the direct effect of premium increases on healthcare costs, the complete dominance of private healthcare by the health insurance companies (and certain inefficiencies in Medicare and Medicaid) contributes indirectly (but substantially) to the cost of healthcare by encouraging providers to increase their fees for services, since their actual patients pay for such a small percentage of services furnished to them. The predominance of the "Don't worry, it's covered" mentality promotes the unnecessary duplication of service, lack of emphasis on preventative medicine, and price inflation throughout American healthcare. As a result, the direct cost of healthcare (without insurance) is impossibly expensive and approximately 50 million Americans lack access to healthcare (except for healthcare rendered as emergency services) because they cannot afford health insurance (Tumulty, Pickert, & Park, 2010).

Comparison to other Nations

Canadian healthcare is modelled after the British National Health Service (NHS) system (Reid, 2009) under which socialized nationally-subsidized healthcare services are available to the entire population at no direct cost. As in many European nations with entirely socialized healthcare programs, in the British-based model, physicians and other healthcare providers are paid substantially in relation to the health of their patients rather than by the number of services they deliver. They are also penalized for unnecessary duplication of services that could have been prevented by better coordination among and between multiple service providers. That is another systemic problem throughout American medicine in both the public and private sectors. Also like other nations with universal health systems, there are problems of relative unavailability (or inconvenient or delayed) access by virtue of demand in relation to providers in Canada (Reid, 2009).