Universal health care systems and implementation

Universal health care system also termed as single-payer system in intended for all individuals irrespective of their financial standing. No procedure is considered perfect for the universal or single healthcare system. Several nations are adopting various procedures for attaining the objective of providing insurance facilities to its individuals. Soviet Union is considered as the premier nation engaged in guaranteeing the system of universal health care to its citizens. After prolonged efforts in the sphere of nationalization of medicines in the recent past, it is evident that no other countries practicing nationalization of medicines have accomplished so much achievement as that of Soviet Union. Several developed countries including Canada and UK have adopted the single universal health care system. (Cherner, 1990)

But in America, health care facilities as a matter of right is not granted to all its citizens and it is the only developed country to do so. (Frenkel, 1998)) Irrespective of the present expenditure to the tune of 14% of GNP on medical care, U.S. do not provide some sort of universal coverage. As per the reports of the World Health Organization, the huge uninsured population constituting about tens of millions is considered as one of the highest in comparison to any other developed nation. The quality of health care provisions also is moderate in comparison to other countries. Among the 181 WHO rankings U.S. is placed at 35 which is only two ranks above Cuba. Presently, the health insurance provisions are seen as a mix of private employment based insurance and government safeguard for the weaker sections in regard to due consideration to the elderly people. The Health insurance involves a multi-billion dollar dealings along with a strong backing. (Marks, 2003) As a consequence of this the United States puts forth gloomy data on health care among the other industrialized nations.

In comparison to Canada, the United State presents a bewildering rate of child death, high surgical death and low life span. (Nelson, 2003) The span of life increases with enhanced medical facilities. It is forecasted that increasing number of Americans are susceptible to chronic diseases of old age and will necessitate prolonged home care and in most of the cases will necessitate prolonged institutionalized care. However, it is evident that the country is not prepared to effectively handle this possible occurrence. No policy formulators ever think of the inevitable occurrences and the growing requirements which Medicare and Social Security face. Still the problem is inevitable with growing population. Presently, the long-term care is met out of the personal savings or by Medicaid that assists only the eligible population in terms of lower income and assets. The private insurance on the other hand seems to assist only a fraction of the population estimated to be about seven percent of the total necessitating prolonged care. (Cadette, 2004)

The deficiencies in universal health care seem to threaten the public health scenario. The health conditions left unattended more specially, the contagious and infectious diseases like tuberculosis and HIV infection more often spreads from personal confinements to become more costly and fatal public exigencies. The lack of a system emphasizing on universal health care is viewed as incremental in the price of the health care of every individual in America. This is so because the uninsured people are deprived of the low-cost preventive services of early intervention and left untreated up to the point of time till which it is generated to become expensive. These uninsured individuals are subject to non-reimbursable medical needs in the hospitals with enhancement of costs of health care for everyone. Besides, the prevalence of multiplicity of the health insurers entails the provision of health care costly, in terms of huge administrative expenses necessitating costly operating expenses, unnecessary paper work and maintenance of costly billing departments. (Universal Health Care: June 2001 Summary of Recommendations)

In comparison to Canada, the United States depicts a low rate of accessibility to primary care doctors than Canada. However, Canada represents the same proportion of acute care bed to population as that of in United States. According to U.S. General Accounting Office, in terms of gratification by the patients, quality of health care and end results, Canada seems to excel in health care system in comparison to United States. Americans usually are charged 40% less per capita than that of the Canadians. It has been estimated that more than 240 million people in the United States have already been covered by the health insurance in United States through different sources. About 63% of them have been covered by the insurers of their family members. A million more people are covered by the government programs and approximately 14% of the citizens are covered through the Medicare. It has been estimated that about 11% are insured through Medicaid and the State Children's Health Insurance Program (SCHIP) and the military programs cover about 3%. More or less 8% of the people resort to private individual health care or health insurance. Irrespective of these facts still a million people do not seem to have health insurance coverage. (Nelson, 2003)

According to the report of the year 2000 by the U.S. Census Bureau, about 15.5% of the total population constituting 42.6 million Americans was lacking public or private health care coverage in the year 1999. The report further emphasized that irrespective of the Medicaid and the federal state health care program for poor, handicapped and old about one third of the all the poor population are left without assured health care. The mass includes a portion of adult population, housed or homeless without having children and poor families. According to a report on the study by the federal Interagency Council on the Homeless made in the year 1999 it has been estimated that more than 55% of people are deprived of both public and private health care provisions. Most of the projects on Health Care of the Homeless (HCH) emphasizes that about 80% of their patients are left uninsured. Irrespective of coming out of the network of community-bases health care providers inclusive of HCH projects, health centers, free clinics and public hospitals, only one sixth of total uninsured population seems to have been served by them. (Universal Health Care: June 2001 Summary of Recommendations)

And those people who do not have health Insurance are vulnerable to increasing risks of financial loss and inadequacy in health care access. Broadly speaking, lack of insurance coverage hinders effective use of health care facilities and services and leads to higher expenditure on medical programs. Several measures have been undertaken by the policy formulators for enhancing the health insurance coverage, in terms of extension of the tax inducements to the individuals and employers, expansion of Medicaid and SCHIP, reformation of rules regulating private insurance and making the employers mandatory to offer health coverage. Formulation of cost effective policies with regard to expansion of the health coverage necessitates data on the size and features of the uninsured people. This is due to the fact that many people seem to gain and loose coverage in due course as a part of their uninsured spells. The number of uninsured citizen in United States has increased to 40 million constituting about 16% of the non-elderly population. (Nelson, 2003)

However, such estimate is considered to be overestimations of the uninsured people through out the year and is only an approximation of the number of people at a point of time. The most reliable data in this regard is available up to the year 1998 which depicts that 21 million to 31 million non-elderly Americans constituting 9 to 13% are estimated to be uninsured. The trend of relationship between uninsured people at a particular point of time and that of the population uninsured through out the year seem not to have changed prominently, however, since the year 1992, the factors attributed to the inferences are very limited. A comparison of the data is attempted in the study of SIPP data revealing that about 14.8% of Americans including the elderly were uninsured at a point of time in 1992 while 7.6% were uninsured through out the year. However, the SIPP figures depicted about two-to-one ratio in the year 1998 which is 16.6% versus 9.1%. (Nelson, 2003)

The survey reports depicting the number of Medicaid coverage collected through primary data seems to be lesser than the number indicated by the program administration. It is also not transparent about the fact of the size and implications for estimates of uninsured which is graver than the fact of undercount. The fact of underreporting of Medicaid coverage seems to occur for various factors. The dishonor attached to the fact of involvement in a public assistance program dissuades the people reporting correctly about their coverage. Moreover, the people covered under Medicaid wrongly think of availability of another type of coverage like private insurance. The misinterpretation of the people covered under the Medicaid program is due to the fact of ambiguity in the designation of the programs by the private plans or absence of the terminology of the Medicaid in the state plans. Due to the fact of limitations of administrative data being used as the benchmark it is essential that the estimation of the size of the Medicaid undercount is to be made with caution. Irrespective of the fact of the correctness of the estimates they are not capable of indicating a corresponding error in the count of the uninsured due to the fact that the Medicaid enrollees not reporting about the Medicaid coverage may report on another type of coverage. (Nelson, 2003) study depicting similar conclusions that of the Medicaid administrative records in Minnesota reveals that a vast majority of Medicaid enrollees who did not report being covered under Medicaid reveals their coverage under another source of insurance. It has been estimated that about 2.9 million children eligible of Medicaid were left uninsured at a given point of time in 1994, the year for which data are available. The statistics indicates about 33% of the total uninsured children which constitutes about 17% of the children eligible of Medicaid. For most of the children the eligibility for Medicaid and at the same time being uninsured is considered only as a temporary occurrence. Most of these cases seem to be in the process of transformation from their coverage under one source to another i.e. from private source of coverage to Medicaid. Besides, a temporary shortfall in family income often also makes them eligible for Medicaid temporarily. Irrespective of the fact of their eligibility to the Medicaid about 1 million children are found to be uninsured during the year 1994 even though they are found eligible for Medicaid. (Nelson, 2003)

It is surprising to note that the wealthiest nation in the world has been failed to ensure universal health care coverage. This is the concern of all the debaters on health care and insurance more particularly during the time of elections. The policy of employer-based health system that links the insurance to the job is the prime concern for the voters. It is not true to presume that Americans are not interested in the coverage of 41 million uninsured. The Kaiser Commission on Medicaid and the Uninsured attached the corresponding costs at less than $69 billion per annum, envisaging only an additional 6% of the health spending is not considered insoluble. There is no unanimous conclusion among the public and the politicians on in the health industries as to the best way to solve the problem. It is estimated to have insurance coverage for the 85% of the population and 92% of voters in the election of 2000; hence the political leaders are little interested in solving the problem. (McNamee, 2004)

Robert J. Blendon, a specialist on polling and public attitudes on health care at the Harvard University School of Public Health opined that the Americans generally expect that the richest nation in the world should find the way out to solve the problems. However according to him, at least a quarter of the population, do not seem to appreciate a single plan of universal coverage. It is seen that each of the next best choices have substantial compromises with regard to cost, freedom, quality and economic growth that makes it impossible for the voters and politicians to advocate for the second choice plan. Most are therefore, according to Blendon in favor of the mixed plans of state run Medicaid programs for extension of coverage to uninsured population, efforts for ensuring affordable insurance coverage to lower income groups and tax reductions as an incentive to prefer for the coverage. (McNamee, 2004)

The efforts to resolve the problem of health coverage with a single flawless system has long been rejected by the Americans. The plan of universal health coverage by President Harry S. Truman in 1940s has been opposed vehemently. Further efforts in this regard are considered as improvements. Lyndon B. Johnson could succeed in the formulation of the government owned and maintained health coverage as Medicare for the elderly and Medicaid for the poor. The Democratic attempt to renovate the entire system in terms of reforms of Bill Clinton in 1993 resulted in partisan rivalry and Republican victory in the 1994 election. Further improvements have been made in the subsequent decade in terms of more children coverage through Medicaid and introduction of tax favored Medical Savings Accounts with a view to enhancing the conservative vision of individual insurance. (McNamee, 2004)

Blendon pointed out that in most of the nations a particular political party is attached to a particular view point of the health system and after being come into the power they try to practice the same. In case of parliamentary form of government envisaging the same party controlling both the legislature and the executive it has become easier to implement. In post World War II days the health care provisions were considered simple, cost effective and they were in favor of diverting their tax burden from warfare to health care. Presently the Americans are considered to be more inclined towards employer based insurance even though they are dissatisfied with the reduction in coverage and increased costs. With a fraction of politically inactive population is left uninsured, it necessitates strong economic disturbance to generate enough fear for prompt political action against losing insurance coverage. (McNamee, 2004) prolonged study of the Congressional Budget Office and private consulting firms has propounded a single payer, nation wide insurance coverage system in America irrespective of opposition to this policy. (Marks, 2003) The universal health care program became popular during the Presidentship of Bill Clinton. The proposal of the President initiated strong election discussions in favor of the system as a solution to the problems in the present health care system of the United States which showed that there were several uninsured citizens in the country. (Feinn, 2003) Many merits and demerits are attached to the single health care system in America.

Strong supporters of the Canadian single payer health care system, Dr. Steffie Woodhandler and Dr. David Himmelstein, renowned physicians of Cambridge Hospital analyzed the universal health care and published in the New England Journal of Medicine. A comparison was made on healthcare system in United States envisaging multiple insurance companies and government programs paying the bills, with that of Canada, where in only the government is paying the bills ensuring universal coverage. In consideration to the larger population of United States they estimated an excess spending of $209 billion in U.S. over that of Canada envisaging more efficient administration in States. According to them the larger spending by the America is attributed to enhanced costs like advertising by competing companies and health care providers. Henry Aaron, an economist of the non-profit Brookings Institution emphasized on the exaggerations made by the physicians in consideration to the difficulties involved in comparing countries having different systems. (Kowalczyk, 2003)

The opponents of the Universal health Care system argued that the system would reduce the standard of care to lower levels which would obstruct the well-off sections from receiving better facilities. Many political disadvantages are attached to the system of single-payer health care by its adversaries. It is conceived that persuading the lawmakers and their subsidiaries to make government finance of the health care system through enhanced taxation is not an insurmountable task. Moreover, the flexibility in the political situations adversely affects the health care policy and would result in budgetary adjustments. The adverse impact would be seen in large scale unemployment of private sector as a consequence of the closing down of insurance companies. (Theoretical Models for Delivering Health Care, 2004)

It is however, considered that most of the unemployed are skilled and educated enough to search out alternative job prospects and suitably trained to be adjusted in the health care programs. The payment to physicians basing on a negotiated fee for service plan in line with Canada is viewed as curtailment of incentives for health care providers to regulate expenses. Moreover, it is often difficult to completely wipe out the adverse and inaccurate perceptions of a single payer health care system. The stigma attached to public care health systems in terms of long queue, inefficient bureaucracy, limited alternatives, and low quality health care are to be found with such a system. (Theoretical Models for Delivering Health Care, 2004)

The adversaries of Universal Health Care point to the difficulties involved by the people traveling from Canada to U.S. For medical treatment facing stringent medical procedures. Privatization of the system is also being considered by some Canadian provinces. This has been supported by the arguments of attracting the contributors including health insurers who are in favor of privatization. The argumentation is more apparent when the Americans seem to have worried much about losing health benefits. The concern is more in view of the reduction in health programs for the poor by the states as a measure to balancing their budgets and increasing medical expenses. Some viewed the single payer system as apportionment of care, increased bureaucracy and oppressive of innovation. (Marks, 2003) However, these are opposed by the supporters of the single payer universal health care system.

According to the advocates of the Universal Health Care system the present bureaucratic structure of health care in America is ineffective in relation to increased costs and burden on the people while comparing the country with Canada. (Woolhandler; Himmelstein, 1991) According to the supporters of the single-payer system universal health insurance is a necessity for promoting quality care. Since quality needs to be based on population, the conservative descriptions of quality care need to be expanded to include the deepest of limitations of quality which includes the denial of care. Hence the most significant requirement for access is insurance in relation to health. (Schiff G, Bindman A, et. al, 1994)

The supporters further view that the provision of the services would be more complete for a portion of the additional cost. Presently about 26 cents per dollar expenditure on health care in U.S. is apportioned towards meeting the expenses on paper work and administration. Single government insurers when implemented as a replacement of private health insurance companies, entails saving of about $200 billion dollar annually in the U.S. Dr. Richard Brown a member of Physicians for a National Health Program opines the single payer system to be the only economically feasible system. (Marks, 2003)

The single payer health care system envisages payment of medical costs and financing of the health care provision for the entire population by a single authority that is the federal government. The resources for the purpose are mobilized through enhanced taxation. The job of the government thus in this sphere is primarily involved in collection and allocation of monetary resource for the purpose. The other aspect of the health care are left unregulated by the government. The advantage of the single-payer system stems from the fact of extending benefits of the medical coverage to the entire population irrespective of the age, health, employment and socio-economic status. The expenditure on health care will eventually be reduced as a result of central bill processing that decreases the operating costs. (Theoretical Models for Delivering Health Care, 2004)

As a result of this a large portion of the administrative expenses will presently be found surplus to be spent on actual treatment of the patients. Increase in economies of scale through bulk purchases as well as easy accessibility of the government to the facilities will also entail decreasing costs. Conversely, reduction in the revenue of the pharmaceutical companies may also result in reduction of innovations, research and development and curtailment of pace of technological advancement. The patients would be at the liberty to find out the appropriate physicians and the physicians on the other hand would be free to find out the appropriate treatment for their patients. The impact of profit motive in the health care arena would be wiped out. The prime focus will be on caring the patients rather than the commercial motive of profit maximization. (Theoretical Models for Delivering Health Care, 2004)

The studies made by the Congressional Budget Office, the General Accounting Office (GAO), the Lewin Group and the Boston University School of Public Health reveals that the universal system would not involve more cost than that is spent on the health care presently. According to the estimates made by the General Accounting Office, the United States would save 34 billion dollar in insurance operating cost and 33 billion dollar in hospital and administrative costs by shifting to the single payer system. The savings are seen as avoidance of the expensive treatments to the sick by provision of timely attention. The cost of extending service to the newly insured patients is considered to be about 18 billion dollar. The cost of providing supplementary services to the newly insured individuals as a result of avoidance of co-pays and deductibles would be about 46 billion dollar. However, the single payer universal health plan is not considered as socialized medicine. Under the system of socialized medicines the government has to own the health care institutions and the personnel in the institutions viz. The nurses and doctors are treated as government employees. (Myths & Facts about Single-Payer Universal Health Care)

Contrary to this the system of single-payer universal health plan safeguards private ownership and employment. The Medicare and socialized medicine both are common at this juncture. The uniqueness in the single-payer universal health plan lies in its placement of all health care risk in a common pool ensuring universal coverage. The Canadians involved in a single payer system are associated with their primary care physicians more often than that of the Americans. The availability of doctors per head in Canada is more in comparison to that of in United States. The cost of medical services in Canada is considered to be 33% less than that of in United States. The 50% of the cost savings in Canada is attributed to reduction in insurance operating costs and administrative expenses. The other half of the saving is out of the allocation of money for payment of expensive equipment so that there is low excess capacity and duplication. It is estimated that about ninety-six percent of Canadians have a preference to their own health care system over the one prevalent in United States. (Myths & Facts about Single-Payer Universal Health Care)