This paper argues that the United States should adopt a national health care plan, examining the major obstacles and justifications for such a reform. It surveys the rising cost of insurance and the growing number of uninsured Americans, the unchecked power of health maintenance organizations and preferred provider organizations over patient care, and the failure of the Clinton Health Security Act of 1993. The paper draws on comparisons with other nations' systems and the administrative efficiency of Medicare to support a publicly administered universal risk pool, and concludes that special-interest influence must be reduced before meaningful, equitable health care reform can be achieved.
The paper effectively uses comparative policy analysis: by pointing to Canada's system and the administrative efficiency of traditional Medicare, it grounds its normative claims (that a national plan should be adopted) in empirical evidence from functioning models. This move from "what works elsewhere" to "what could work here" is a standard technique in public-policy argumentation.
The paper opens with a framing statement about health care as big business, then proceeds through a problem-identification section (insurance costs and the uninsured), an analysis of HMO/PPO power, a historical case study of the Clinton HSA, a constructive section proposing a publicly administered universal risk pool, and a conclusion that returns to the opening theme of market dominance. This funnel-and-return structure gives the argument a clear arc from problem to proposed solution to systemic barrier.
Health care in the United States is a big business. As such, a national health plan threatens the bottom lines of gigantic health maintenance organizations, and they have fought national health care consistently. They fight a plan that could cause their demise but would ensure the increased health and well-being of millions of Americans. It is time we stopped letting big business set the agenda for the health of the American people.
The Clinton administration's plan for national health care reform did not become law, but it opened the door for argument and debate about health care reform in the United States. Many experts and citizens still believe a national plan for health care should be instituted in America. How to institute a workable and viable plan is still being debated, but given the state of health care in America today, something must be done to ensure that Americans have access to good-quality health care they can afford.
One of the major problems facing Americans today is the cost of insurance. Many small businesses say providing insurance for their workers is their number-one source of worry and concern. The cost of providing insurance has risen steadily over the past ten years and continues to rise at alarming rates. This rise in premiums causes more small — and even medium and large — businesses to either cut back the health insurance available to their employees or forgo insurance altogether, which creates an ever-widening gap between the insured and the uninsured.
According to Physicians for a National Health Program (PNHP), over 42 million Americans are currently uninsured (Editors), and that number does not include the many more who are underinsured. This means that millions of Americans cannot afford to visit a doctor when they are ill. Furthermore, if their illnesses become life-threatening and they do seek medical care, the cost will either eventually be written off by the medical provider as uncollectible — which raises prices for everyone with insurance — or it will create a crushing financial burden for the uninsured person. Often, people without insurance simply do not seek medical care or advice until their disease is too far advanced and treatment is no longer viable. This means that people in our country die every day because they do not have access to medical care, and this is not acceptable for a wealthy and prosperous nation.
Another problem facing Americans is the ability of current health plans to determine the type and quality of health care their patients receive. In testimony before Congress, Dr. Donald J. Palmisano described just some of the power wielded by large health plans:
"The antitrust laws have been interpreted to allow health plans such a high degree of leverage that an appropriate balance of interests no longer exists in the market for health care delivery and finance. As a result, the power of health plans to determine the kind of health care that patients receive is virtually unchecked. While health plans have achieved many significant accomplishments, it is not healthy for any interest group to have virtually unlimited power over an issue as significant and sensitive as the kind of treatment needed by an individual with an illness or injury" (Palmisano).
In addition, these gigantic Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) also have the control and power to decide what type of medical care a physician may give a patient. In many states, they even limit what physicians can tell patients about the services covered by the plan and what services a patient might need but the plan will not cover (Palmisano). As managed care plans continue to limit physicians' abilities and the care they can provide, the entire medical community tends to turn inward rather than searching out new techniques and methods. Research, and with it medical breakthroughs, tends to diminish, with meaningful innovation left only to the few physicians unaffiliated with constricting health plans.
Some experts argue that a national health plan would shift public health from its traditional focus on infection and sanitation to a community-based issue, and this tension is one reason a viable national plan has not yet been achieved. As one scholar observes: "The leap from public health, with its traditional focus on the control of infectious diseases, sanitation and other public goods, to community is a short one. The leap to community from other forms of health care, however, which have traditionally focused — probably to too great an extent — on the autonomous individual patient's preferences, values, and wishes, is large indeed" (Goold 98).
Our country may have a long way to go to enact health care reform in the guise of a national health care plan, but if we are to create a thoroughly healthy society, everyone — regardless of income — must have the ability to maintain a healthy lifestyle and receive high-quality health care when they need it. As research has shown, creating a national health care plan faces numerous obstacles. Experts agree that meaningful reform will require deep cultural and political change:
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