U.S. Domestic Health Care System

The US health care largely applies the ‘out of pocket’ approach in the funding of health care services. The federal government only provides health care to approximately 27% of the total population which comprises of the poor, children and the aged. (Brock B, 2005). The employers provide insurance to their employees by paying a certain proportion of their income to insurance companies as premiums but since this is not compulsory a large proportion of the population especially from the minority races is not covered.

The focus of this paper will be to offer a best solution to the challenges in the current health care system in the US as well as offering a global comparison. Various aspects are to be checked anytime the evaluation of a health care system is being done. The World Health Organization (WHO) defines a good health care system as one where good health of all the citizens is maintained. A country is said to have a good health system when the health status of people across the varying age groups is in the best possible condition.

It should also meet the people’s needs as well as their expectations in terms of the quality of the care provided. WHO further noted that three major issues that is the cost, people’s response regarding the services provided as well as how accessible the system is to the people are to be used to determine what is right and what is wrong with the health care system. (University of Maine, 2001). A good health care system will register a higher rate of satisfaction level among all her citizens despite their ages, races, ethnicity, and economic as well as social orientations.

Indicators of a good health care system will include low infant mortality rates as well as high disability adjusted life expectancy rates. The cost of health care ought to be fair in the sense that it should not be costly and unaffordable to the citizens. (University of Maine, 2001). Using the WHO indicators to evaluate the US health care system we can deduce that so many things are wrong with the system and it consequently needs to be reformed. The US system is the most expensive when compared with other developed nations both at the individual as well as the national level.

A study by the University of Maine established that in the year 1998 US spent $ 4178 on health care a figure more than twice what most OCED countries spent. Switzerland which ranked second spent $2794 a figure slightly above half what the US spent. (University of Maine, 2001). The high cost in the US health care is attributed to the high administrative costs. Varying bureaucratic procedures in the US government as well as in insurance companies aggravate the costs due to too much paper work while approving as well as submitting claims. (Byrne M and Rathwell T, 2005).

Another factor blamed for the aggravated costs include the advancement in technology as new medical techniques come at a higher price. The health care system is highly capitalized and health care providers are motivated by the profits they gain in the field making it difficult to ensure efficiency in the provision of health care. Private health care centers or hospitals have registered a higher growth than the public hospitals all attributed to the intensive commercialization of the health care sector. This trend adversely affects the sick and poor.

When profits are the main incentives in the health care system liabilities will be avoided as much as possible. As a way of escaping liability the insurance companies are very selective in their admission strategies. They will avoid the unhealthy people as their profits will be jeopardized and this sees the poor and unhealthy people who are in most need of the insurance cover unable to access the much desired services or care. (Brown E, 2005). Critics further argue that the quality of the health care provided may be compromised in the highly commercialized health care system.

A health care provider for instance a doctor may prescribe a certain medication to a poor person on the basis of their affordability while it may not be the best treatment for them. When care is based on the ability to pay rather than the needs of the patients then the quality will definitely be affected. The UN declaration of human rights article no 25 clearly stipulates that all people regardless of their gender has the right to the highest attainable standard of mental and physical health care. (http://www. unhchr. ch/udhr/lang/eng. htm).

According to a research by commonwealth fund approximately 37% of adults in the U. S forego medical care due to cost by not taking prescribed drugs or not visiting the doctor at all Denying people their rights to basic and very essential services the basis of their income or social status is unethical. Provision of essential services should be unison and not on the basis of economic well being of individuals. Various states have responded differently to the problem of underinsurance and the lack of insurance that characterizes the US health care system.

Florida has for instance introduced diversified cover that varies depending on what is covered as well as on one’s location. This approach ensures that inequality in terms of accessibility and affordability are minimized. (Caputo M, 2008) The only advantage of a capitalistic health care is the fact that it encourages competition which in turn promotes innovation. Innovations in a highly competitive market ensure quality improvement. The expensive health care hinders people from seeking preventive measures to diseases and they have to result to the curative approach which is quite expensive.

This way the vicious circle of costly health care is maintained. The failure to seek early intervention ensures that conditions that could have been easily treated or handled in their initial stages become overwhelming. Curative approach is more expensive than preventive approach to health care. Diseases are cheaper to treat before they advance or deteriorate necessitating the need for intensive care services. The increasing aging population that has a higher demand for health care services is also to blame for the high costs of health care system in the US. (University of Maine, 2001).

The problem of inaccessibility is a serious one in the US, the Institute of Medicine of National Academies noted that lack of insurance in the US causes the death of approximately 18000 preventable deaths each year. The institute suggests that the health care system should therefore be made universal, sustainable, continuous and affordable to all if these deaths were to be prevented. This would be a positive move towards ensuring effectiveness, efficiency, timeliness, patient focused as well as equitable health care. (National Academy of Sciences, 2008). Annie E.

Casey Foundation website indicates that the poor uninsured and underinsured suffer drastically from the illnesses and they attain little or no treatment at all. This makes them feel left out by the same society they claim to be part of. They lack proper transportation, have poor housing and sanitation and ultimately some die from disease that could have been treated if early intervention was sought. The minority groups register a higher prevalence or rates in diseases like TB, HIV, sexually transmitted diseases, depression, obesity, diabetes as well as low child immunization. (Annie E.

Casey Foundation, 2007). Poor accessibility in the US health care system is attributed to the fact that insurance where coverage is on employment basis is optional while a small proportion that is the poor, aged, military and the disabled have Medicaid or government insurance. Increased insurance rates due to the high cost of health care precipitates or rather sees the employers raise the amount of money they deduct from their employees leaving them with reduced disposable incomes. Some employees end up withdrawing the insurance benefits in totality worsening the health care accessibility.

Critics argue that it is a big embarrassment for the US failure to offer affordable and accessible care but the reality is that as the talks continue the poor continue to feel the pinch. Their life expectancy rate is lower than that of the other Americans and they generally lead unhealthy lives. The overall cost of the health care due to the inequality levels is transferred to other members of the society or the taxpayers as well as those in the private insurance. This cost shifting tendency has larger consequences to other people in the society apart from the poor.

At the end of the day the whole society will bear the burden. A large number of the employers will tend to avoid offering health care cover to their employees as this translates to their increased costs of operation. Further more even those who offer do not offer comprehensive coverage leaving people with complex conditions like heart transplants with no where to turn to. There is consequently the constantly dodging of the poor from one place to the next. This sees their medical conditions worsen to more unmanageable levels. (Place D, 2005).

The infant mortality rates in 1996-8 were 7. 2 per every 1000 still births, a rate though low among the developing countries is high among the developed nations. This rate could be explained by the differences in accessibility across the racial lines. The infant mortality rates for the African Americans and the whites is different courtesy the high inequality levels. Inequalities in terms of one’s economic status and the accessibility to health care system are also evident in the US health care system. In 1998, the infant mortality rate for black children was 14.

3/1000 live births while the white’s was 6/1000 live births. The mortality rates also vary across varying states. (University of Maine, 2001). The US health care system was ranked the 24th position by WHO when the number of healthy years that one is expected on average in a given population was used. This position could be blamed on differences in accessing health care especially the preventive care. (University of Maine, 2001). A research by Commonwealth Fund Commission termed the US health care system as poor in terms of in quality, efficiency and cost.

It blamed it for deaths that could have otherwise been prevented if quality and timely care was offered. (Karen Collins, Dora Hughes et al, 2002) The Commonwealth Fund International Health Policy Survey estimates that approximately 42. 6 million people in the US either lacked the health insurance or were uninsured. The acquisition of health care services for these people was very difficult and these people suffer drastically even from diseases that could have been prevented. . (Commonwealth Fund International Health Policy Survey, 2004).

With minimal wages that are barely enough for the basic needs leave alone the expensive health care some will opt for the over the counter medical prescription and will only seek proper medical check ups as a last resort. This tendency can be bore witness by the high numbers of patients seeking the emergency care services which are very expensive both for the nation as well as the individual. People in low paying jobs which in most cases do not offer employer based insurance are not eligible to Medicaid which is quite unfair or unfortunate given the high costs of health care.

(Cook, 2004). Place in ‘The healthcare crisis: as the number of uninsured grows the money disappears, noted that an expensive health care system could have negative effects on the country. Investors may opt to locate their industries in countries where universal or cheaper health care is provided as then their costs in terms of medical cover for their employees would be drastically reduced. (Place, 2004). As a way of eradicating the prevailing wrongs or inefficiencies in the US health care system universal health care should be adopted.

Universal health care entails the government catering for the health services of most of her citizens. Critics claim that achieving universal health care would be beyond reach as it would lead to increased costs of health and that health care provision is not the responsibility of the government. The government should only provide for the means to acquire income and people should use their incomes to finance their health care. Universal care would ensure that three major aspects of evaluating health care that is cost, accessibility and satisfaction by citizens are boosted.

Health care remains a very critical issue in any government and in the US it is a highly politicized issue. Liberals argue that it would be wise to make it universal emulating other developed countries who have applied it successfully. Critics may argue that universal health care is expensive or even unaffordable but since it has been tested and proved to be successful in other countries it could be embraced in the US too. (Krugman P and Wells R, 2006).

Introduction of the universal health care would see to it that the over 40 million Americans who are either uninsured or under insured access quality and timely health care. As the saying goes ‘a healthy nation is a wealth nation’ this would be a great achievement in the US. Preventable deaths which are correlated with the inaccessibility to health care would also dwindle significantly. The cost of health care would also reduce by a large magnitude since the unnecessary administrative costs linked to private insurance would be eliminated.

With high accessibility levels in the health care as well as the reduced costs people would embrace preventive care rather than curative care. The infant mortality rates would significantly decline due to the fact that more minority races would access quality and timely health care. The accessibility levels unlike in the current system where those with chronic conditions or even in need of continued care are discriminated would be boosted. (Place D, 2005).

Financing the universal health care would be through a single payer system although all parties would be at liberty to chip in its financing. Such parties include Non Governmental Organizations (NGOs), individuals as well as businesses and their assistance would be vital given that the government has minimal resources but in the presence of very many wants or needs. Taxes form a large proportion of the federal government’s source of revenue and to ensure equity or fairness in financing universal health care taxes would be based on the people’s ability to pay.

The burden felt by the poor would be minimal. This way they would be able to access health care as well as use their now higher disposal incomes to purchase other important goods or services. (Physicians for a National Health, 2008). When taxes are based on the ability to pay it means that the relevant authority will use the respective wage clusters to identify what percentage of the income is to be spent on health care. The taxes are to be progressive in the sense that a higher income will translate to a higher amount of tax paid towards covering the provision of health care.

Universal health care would ensure that there is a higher accessibility level. Health insurance in this system would be provided by the government to all her citizens. Minority groups who are the most affected by current health care system would benefit the most in this system. It would be beneficial to the society at large due to the fact that their economic well being would not influence their accessibility to health care services. The cost of health care would be reduced drastically as the ideal health care would erase loopholes that make health care very expensive.

Eradicating the middlemen as well as the private insurance companies from the scene will have a positive effect in as far as cutting the cost of health care is concerned. (Mossialos O, 2005). One’s economic well being in such a system would not determine the kind of care they were to be offered. Instead, their medical needs would be addressed first. Again, services accessed would be comprehensive as they would include long term care, mental, dental and vision. For the case of the extreme poor citizens the government would chip in to cater for all their health needs.

The children would be fully covered as they are a special population in the society. To ensure that the quality of the health care was not compromised despite the fact that capitalistic tendencies would be erased, the government ought to establish a strategy where there is increased innovation. This could be possible thought the setting of standards to ensure that the quality care is offered. Federal and state government investment would also invest more in expensive and modern medical equipment which would in the long run be beneficial in the overall provision of health care.

Investment in research and innovation would also be vital in ensuring that the quality of care provided in the universal health care system was not compromised. To motivate the care providers now that profit incentives would be diminished, the government can attach the specific payment for the care providers using variables like one’s expertise, education as well as experience. Those who perform extremely well could be rewarded and this form of appreciation would boost innovation. The US is already spending too much finances on an ineffective health care system at a low expense she can afford the universal health care.

The future of Medicaid and Medicare is bliss. Currently it is viewed as ineffective due to the fact that it only caters for a very minimal percentage of the needy population. Increased commitment on the part of the government would ensure that it effectively replaces the private health insurance to support all Americans in ensuring a healthy nation. US can afford universal health care as it is already spending more on an ineffective health care system. The cost aggravates as it is done in various stages.

The Medicaid is also ineffective because it only caters for a very minimal percentage of the needy population. It ought to cater for those unemployed as well as those employed but without the health insurance. Effective universal health care would ensure that the high mortality rates among the minority groups are reduced and the life expectancy levels would be higher and at a uniform or rather equal rate. The Medicaid would ensure coverage for all children. The major problem facing the Medicaid and the Medicare programs are the minimal finances.Increased funding for instance through debit financing would improve their efficiency.


Annie E. Casey Foundation. 2007. Health. Retrieved on Retrieved on 6th march 2009 From http://www. aecf. org/OurWork/Health. aspx Cook D. 2004. Medicaid’s future foretold by Medicare Modernization Act. Journal of medical Association. Karen Collins, Dora Hughes et al 2002. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Retrieved on 6th march 2009 from http://www. commonwealthfund. org/usr_doc/collins_diversecommun_523. pdf? section=4039

National Academy of Sciences. 2008. Insuring America’s Health: Principles and Recommendations. Retrieved on 6th march 2009 from http://www. iom. edu/CMS/3809/4660/17632. aspx Place D. 2005. The health care crisis: as the number of uninsured grows, the money disappears. America (NY). Physicians for a National Health. 2008. Single-Payer National Health Insurance. Program. Retrieved on 6th march 2009 from http://www. pnhp. org/facts/single_payer_resources. php. University of Maine. 2001. The US health care system: Best in the world or just the most Expensive. Retrieved on 6th march 2009 from

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