U.S. healthcare system overview and key issues

U.S. Healthcare: The Need for Universal Coverage

The insurance industry as a business makes its profits when it can deny coverage to consumers. Individuals have home insurance 'just in case' they are afflicted by flood or fire, and the industry hedges its bets, receiving a payment from its customers in the hopes that nothing will occur. But in the case of healthcare, what is good for the insurance industry is not necessarily good for society. If a worker is sick, this costs the industry money, and it is in the healthcare insurance industry's interest to deny that worker coverage. It is also in the industry's interest not to give insurance coverage to very sick people with preexisting conditions, even if it is in society's interest that these people stay well as possible, so they can work. Increasingly, the U.S. healthcare system is becoming dominated by the business needs of the insurance industry, where the sick pay more than the well, or can get no coverage at all, just like "someone who drives a sports car and has received twenty speeding tickets in the past two years pays a much higher annual premium than a soccer mom with a minivan," even though a worker's ill health is not his or her fault (Gladwell 2005, p.3).

Take the example of a real estate agent who makes $60, 000 a year. A cancer survivor, she has joined the ranks of uninsured Americans, one of the 6.8 million who have lost all coverage since 2000 (Pear 2007, p.1). Healthcare consumers are a captive audience, forced to pay high prices or do without necessary medications and treatments. "Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases...There are no cheaper equivalents for these drugs," for some of the medications used to treat multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers "so patients are forced to pay the price or do without....[the] result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes" (Kolata 2008, p.1.). Insurance companies said they did so to lower the costs of health care for the other recipients: "The more the sick person pays, the less the healthy person pays," although traditionally, the idea of insurance was to spread the costs of paying for the sick" (Kolata 2008, p.2)

Americans spend $5,267 per capita on health care every year, almost two and a half times the industrialized world's median of $2,193; the extra spending comes to hundreds of billions of dollars a year" (Gladwell 2005, p.1). Despite this extra spending, Americans go to the doctor less than people in other Western countries, get admitted to the hospital less frequently than people in other Western countries and for shorter durations of time for the same condition, are (according to the polls) less satisfied with our health care than other Westerners, American life expectancy is lower than the Western average, childhood-immunization rates in the United States are lower than other Western countries, and infant-mortality rates are in the nineteenth percentile of industrialized nations (Gladwell 2005, p1)..

Unsurprisingly, given the sorry state of healthcare, which costs most Americans more for less coverage than anywhere else in the world, reforming the system has been a topic of intense debate amongst the current presidential contenders. Hillary Clinton proposes that every American should be required have coverage, as most health care analysts agree that mandated coverage is necessary, so that the care and contribution of the healthy can effectively balance out the care of the sick. Obama would not require individuals to have coverage, merely require all children to have health insurance, and require employers to offer employee health benefits or contribute to the cost of the new public program. McCain, much in the tradition of Bush before him, says that he would provide tax credits to individuals to buy insurance ("2008 Candidates Health Care Proposals: A side-by-side summary," Health08.org, 2008).

The McCain proposal would do little to eliminate high co-pays, however. One of the arguments for co-pays is that it discourages the overconsumption of medical care, the so called moral hazard aversion: "twenty-dollar co-payment for a visit to the doctor, or when your plan includes an annual five-hundred-dollar or thousand-dollar deductible, it's not simply an attempt to get you to pick up a larger share of your health costs...Yet, when it comes to health care, many of the things we do only because we have insurance -- like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care -- are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health care system a good deal of money" (Gladwell 2005 p.2).