Domestic public policy challenges facing the United States government

Public Policy Challenge Facing the United States Government Domestically

Health Care Reform

Importance

Today, health care reform is perhaps the most critical issue facing the nation. The current situation is grim to say the least. GDP growth in America has been relatively stagnant and certainly trailing the GDP growth of the emerging markets, notably Brazil, Russia, India, and China

Not only is GDP relatively morass, legacy expenditures (Medicare, federal employee benefits, etc.) in the U.S. are rising at a rate at least matching inflation, which is also rising despite the Bureau of Labour Statistics best attempts at hiding this fact.

Legacy expenditures are important to mention within the framework of health care reform as these are rival dollars that would otherwise ostensibly go to health care delivery. However, the problem has not been expenditure on the system. In the year ending 2008, the United States spent $7,861 per person, whilst national health spending reached $2.3 trillion, and health care expenditure as a function of aggregate GDP grew from 15.9% in 2007 to 16.2%

The United States operates in a more competitive environment that will inhibit GDP growth and sustainable GDP expectations above a threshold percentage. Should health care costs continue to rise as a function of GDP, the system will cripple the government and continue trail the world in the area of comprehensive health care outcomes.

Background

The current health care delivery system in the United States is fragmented, broken and in need of serious repair. The current health care delivery system best described to be a multi-faceted, highly integrated, and symbiotic system. Collaborative efforts between insurers, providers, clinicians, alternative therapy providers, and manufacturers of chronic care medical devices & emergency care equipment do enable a system of acute and chronic services to the patient.

To address this issue, former President Bill Clinton proposed health care reform in 1993 but did not receive enough support to pass into law. George B. Bush and Health and Human Services secretary Tommy Thompson had expanded the Medicare Program to include Part D, which is the prescription drug plan for senior citizens that are covered under the government facilitated program. Additionally, Bush and Thompson sought to transform the system into a 21st century program that is subject to market economics under the hypothetical umbrella of laissez-faire economics. However, in the areas of patients' rights and HMO-reform, an agreement could not be reached in both Houses

Barrack Obama recently was able to pass a comprehensive approach to health care reform, which passed the House and Senate majority to become law. However, the states are filing law suits to prevent the outlined changes proposed within the plan. The plan is subject to repeal

Underlying Causes

The problem with these proposals is the subsequent increase in the overall tax rates to offset the cost of coverage. President Obama's health plan seeks to shift much of the obligation from employees and businesses to the federal and state government, which will increase taxes to the level of being a 'social state', similar to the United Kingdom and Scotland. The underlying causes of these issues are directly related the health care's "iron triangle," which is the relationship between the cost, access, and quality

Insurance companies control the industry in the sense of whom is receiving coverage and to what extent the hospital will be reimbursed for covered patients charges rendered for services. A profit-driven environment, the underlying cause is profit, which seeks to undermine the ability of the system to continue.

Policy Options

The options available to the federal government must address the constraints inherent within the design of the iron triangle. Currently, millions of Americans lack access to critical health care such as access to Emergency Room visits and maternity ward/obstetrics. These types of services should be available to all Americans, hence policy options should provide a means to enabling access to the ER, and for women to give birth without worrying about access to care and cost of care due to days spent in the maternity ward.

The current health care policy is rather business friendly with insurance companies wielding the power in terms of who gets access and who does not. Necessary policy changes include addressing the pre-existing conditions coverage that is really no coverage at all and the coverage of care after involuntary separation from employment needs to be addressed as well.

Quality issues with health care are certainly a policy issue when speaking about Medicare and Medicaid reimbursement and subsequent outcomes from procedures supported with federal dollars. Additionally, institutions such as nursing homes and skilled nursing facilities are often heavily supported with federal dollars and often have horrible results when speaking of outcomes measurement in areas such as pain management, and susceptibility for a DU type I-IV, which is a skin ulcer of increasing severity.

Therefore, the options must be comprehensive to address these aforementioned issues in a cost-effective manner. What the policy must not do however is add additional bureaucracy to the system or produce excessive waste onto the system. Such options should increase the availability of the types of coverage an individual with or without coverage can choose. The cost of these options should also remain affordable, such that it may not go over a certain percentage of an individual's monthly income.

Solution

The proposed solution is to facilitate a comprehensive framework to provide structure to the public health care market. The private health care market is essentially a separate matter as individuals that want to receive care at what would normally be considered to be out-of-network medical facilities, can afford to pay the difference between the insurance coverage and the hospital charge. Surprisingly, the private health care system is not broken, as these institutions are generally supported by medical research grants and additional money that comes in, such as from foreign patients that can pay out of pocket for services.