First and foremost states need to eliminate the insurance regulations that drive costs up and providers out of the market. Right now the United States has the most privatized system, with the most competition—causing the highest health care costs in the world (Krugman). If states were to take more control of the insurance companies and limit the number of companies permitted, then prices would go down because competition would decrease. If health care costs were to go down then more people could afford to purchase their own health care. Presently, only nine percent of people that do not receive health care coverage by their jobs purchase health care (Health Care). If insurance were more affordable then more people would be covered. For this to occur laws would need to be modified at the federal and the state level. More incentives should also be given to companies that provide health insurance for their employees to motivate other companies to provide care to their employees as well. For example, the cost of providing health insurance for small companies costs more per employee than a large firm. Large companies benefit because they purchase more product and can negotiate better group rates. Smaller companies should try to join with other small companies to increase their negotiating powers. America needs a free-market based system that does not encourage people to rely on the government to provide all their needs, but instead allows people to become independent. Many citizens truly need assistance and many need temporary assistance due to a temporary situation and it is these people that the government should target.
Even if the cost insurance policies decrease in price, allowing more working Americans to obtain coverage through the free market, there are still issues that remain unsolved. There are still the people who are truly unfortunate and cannot afford health care such as the youth, the disabled, and the elderly. This is where a revised Medicaid and Medicare program comes into play. Medicaid is health care for the poor, and Medicare is health care for the elderly and disabled (Patel and Rushefsky, 51). The State Children’s Health Insurance Program (SCHIP), which is provided by Centers for Medicare and Medicaid Services (CMS), also needs to be improved.
Medicaid serves indigent populations, increasing their access to health care by providing them with financial assistance to meet their medical needs (Patel and Rushefsky, 52). Many hospitals, especially rural, are heavily dependent on Medicaid for their long-term financial solvency (Reiter). The states are able to provide coverage to people who are not covered under federal law. There are mandatory benefits which states must provide to this population, such as physician and hospital services, family planning consultation, care in skilled nursing facilities, diagnostic services, and screening and treatment for various sicknesses and treatment. Optional benefits include prescription drug, dental care, and nursing home care in intermediate-care facilities (Patel and Rushefsky, 54). Currently, Medicaid varies greatly among the states and does not cover a large portion of those with low incomes (Feldstein, 105). Medicaid should be reformed to include all people with low incomes through an income-related voucher, which includes a standardized set of benefits. As income increases, the voucher would decrease with the assumption that with an increased income the person can assume more of the responsibility up to a specified point. The guidelines should be fair as to protect the low-income population as well as the part-time workers. Any work should be encouraged and rewarded, not penalized by system that only covers the unemployed. An income-related approach, instead of a system based off of assets of a person which exists today, would be much more efficient and beneficial to the population (Feldstein, 106).
Another proposal is that the federal government should set stricter guidelines for the states to follow, so that drastic discrepancies that exist from state to state will be decreased. States should be given more flexibility to spend their Medicaid dollars in whatever way they find most efficient and effective for their unique populations. Also, all institutions and physicians should be encouraged and expected to provide care to this population so the responsibility would not be solely placed on public institutions.
Medicare also needs some drastic changes because of impending financial deficits (Feldstein, 79). With the aging population of baby boomers, as well as the addition of the new prescription drug benefit to offset the skyrocketing drug costs for the older population, financial solvency of the program is a major concern. Right now Medicare covers 34 million elders and 5.5 million disabled recipients, and the number of aged is expected to double during the next few decades (Feldstein, 79). Looking at these statistics something must be done to protect the retired and disabled people who are truly in need of Medicare. Many of these people have been paying into the system for years and are now living on fixed incomes at a time when their health care needs are greater than ever. Basing coverage on income and encouraging people to purchase supplemental insurance will save money, and would allow things such as prescription drugs to become a benefit. One proposal for reform would be to increase the age of eligibility to 67 from the current 65. With increased life expectancy, people could hold on to their employment-based health insurance longer. Like with Medicaid, money could be saved if part of Medicare’s pan for the elderly was income-related, utilizing the same voucher method. Right now the benefits are the same for all ages regardless of income (Feldstein, 84). Also, if Medicare was covered under social security and not two separate taxes and both systems were restructured to plan for the future as well as today's retirees, then the system would save more money to help get America out of this deficit.
The States Children’s Health Insurance Program also needs to be revised to fix the problems with uninsured children. This program provides assistance for uninsured low-income children up to the age of nineteen, with family incomes that are as high as 200 percent of the poverty level (Feldstein, 98). Lately many states have reduced enrollment in these programs because their tax revenues have fallen and they are being faced with budget deficits (Feldstein, 410). The states need to do a better job at targeting the children who are really in need of the insurance. This is also something that should be voucher based so the truly unfortunate children can receive more aid than children who already receive some type of private aid. The children of America need to be taken care of, and most say this is the most important group to insure.
Another issue that could lower the cost of health care would be to decrease the malpractice insurance of doctors, hospitals, and other medical providers. If hospitals and physicians were not held liable for every little thing then their malpractice insurance would not be so high. To cover these high insurance prices, medical specialists have to increase the costs of care. Therefore, when citizens pay for procedures they are also paying the insurance coverage of the physicians. There is such a thing as tort reform, which refers to changing or limiting the rules dealing with compensation for the wrongs and harm done by one party to another. The excesses of the legal proceedings are an important contributor to "defensive medicine”, the costly use of medical treatments by a doctor for the purpose of avoiding these proceedings (Confronting).
The United States health care system needs to be advanced in to the twenty-first century by becoming a preventive oriented system and not a treatment oriented system. While many programs have been successful, more needs to be done. Citizens need to be educated on how they can take a more active role in their personal health care. Prevention is the key and high-risk behavior needs to be controlled. Certain diseases are directly related to high risk behavior, i.e. Hepatitis C, alcoholic cirrhosis of the liver, STD's, AIDS, etc. Screening procedures, such as yearly mammograms to detect breast cancer, colonoscopies to detect colon cancer in the early stage, and PAP smears for women, should be the focus of any health plan. Obesity is a huge concern that taxes our health care system in many ways and it contributes to diabetes, heart disease, high blood pressure, degenerative arthritis, and the list goes on and on. As our society continues to overindulge, drink, and be lazy, we are going to repeatedly have the same, spending billions on treating these preventable and/or controllable diseases.
Universal health care, which Canada currently has, is a health care system managed by the government. Some democratic candidates in America want to apply this policy so everybody is insured and has equal coverage. Under these guidelines everyone has access to hospital and medical services, and they do not have to pay deductibles and co-payments. Patients have the free choice of a physician and hospital, and private insurance is not permitted for these services (Feldstein, 377). Although this sounds appealing, people have to remember where the government is getting the money from; it is coming out of the pockets of the citizens.
There are several disadvantages that come out of universal health care. The quantity of care increases with this system because the patients have no co-payments, which means patients will demand more frequent patient visits, therefore increasing patient waiting time. According to Fraser Institute report on the Canadian health care system, “Canadian patients had to wait on average twelve weeks for an MRI, five weeks for a CT scan, and two and a half weeks for an ultrasound (Feldstein, 387)”. This increase in waiting time forces policy makers to rationalize health care. Not only is there an increase in waiting time, but also there is less incentive to improve quality, a decrease in salary for the people who work in the medical field, and an increase in taxes (Leavitt). Nurses and doctors have been fleeing Canada to come to America in search of jobs. There is already a shortage of nurses and doctors and cutting their pay would only make the shortage greater. Universal health care also taxes the rich unfairly because they would be fully covering people who do not make money. There could be a better answer than Universal Health Care that still covers people, but in a more reasonable and fair way. This is why America needs an approach to health care based on a free, somewhat competitive marketplace, organized to make health care affordable to everyone.
A revised Medicare, Medicaid, and SCHIP program and a revision of insurance policies for the people and for physicians would greatly improve health care here in the United States. Universal Health Care would only help to bring down our system and economy even more. Medicare and Medicaid allow people to be taxed more fairly without having all of the problems that come along with Universal Health Care. The competition needs to exist in private practices to keep quality of health care up, to give nurses and doctors incentives, and to allow people to freely find the best possible prices for the best possible service and products available.
Health Care is one of the most important and urgent problems existing in society today. These changes need to be made so Americans can have affordable, portable, quality, and private health insurance. Although many people advocate universal health care, this is not the answer to the problems, as there are to many cons accompany it. If insurance prices go down, it will allow more people to purchase full-coverage plans. Then, the people still not able to be covered can receive reformed Medicare and Medicaid. Health Care is an important concern and it is the government’s job to take care of their people. This does not mean that people should be able to fully depend on and live off of the government, but it does mean that the government needs to allow equal opportunity for people to readily receive aid.
“Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs By Fixing Our Medical Liability System.” U.S. Department of Health and Human Services. 25 July 2002. 16 April 2008.
Feldstein, Paul J. Health Policy Issues: An Economic Perspective. Chicago: Health Administration Press, 2003.
Gardner, Deborah B. “Advancing National Health Care: Do We Dare Consider Comprehensive Reform Again?” Journal of Health Policy and Politics 25.2 (2007): 124-126.
“Health Care.” The Heritage Foundation. 2008. 14 April 2008.
Krugman, Paul. “Elizabeth Edwards Challenges McCain on Health Care Plan.” Charlotte Obseraver.com. 25 Apr. 2008. 14 Apr. 2008
Leavitt, Mike. “Reforming Health Care.” Editorial. The Washington Times. 9 July 2007. 15 Apr. 2008.
Patel, Kant, and Mark E. Rushefsky. Health Care Politics and Policy in America. Armonk: M.E. Sharpe, Inc, 1995.
Reiter, Kristin L. “The Occupational Mix Adjustment to the Medical Hospital Wage Index: Why the Rural Impact Is Less Than Expected.” The Journal of Rural Health 24.2 (2008): 148-154. 12 Aug. 2008 <>.