The Reformation of Health Care in the Twenty-First Century

Health care costs are spiraling out of control, and for years the United States government has been trying to devise a plan to fairly accommodate all people. Currently, forty-five million Americans are left uninsured, which reinforces the need for a reformed health care system. Health care costs are one of the most pressing issues of people working in health care today (Gardner, 124). Many politicians believe universal health care should be implemented, and although there needs to be a change, that would not be the most sensible approach to fix the current problems. Medicaid and Medicare need to be revised to better suit all people, and “free-riders” need to be stopped so that those truly in need can receive the necessary aid. There are many steps that need to be taken to reform health care, but if the free market and the government work together, the United States health care system will remain one of the best systems in the world.
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.


Works Cited

“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 <>.

First Draft of Final Paper

Health care costs have been spiraling out of control, and for years the United States government has been trying to acquire a plan to fairly accommodate all people. The current health care system leaves forty-five million people uninsured so a reformed health care system has to be put into practice. Many democrats believe we should implement universal health care, and although there needs to be a change, that would not be the most adequate approach to fix the current problems. Medicaid and Medicare need to be revised to better suit all people, and free riders need to be stopped so that the truly needy can be helped to buy insurance. Health care has to be brought into the twenty-first century and changes need to be made so Americans can have affordable, portable, quality, and private health insurance.
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 free choice of physician and hospital, and private insurance is not permitted for these services (Feldstein, 377). Although this sounds great 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 increases patient waiting time. Patients will demand a higher volume of patient visits. 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)”. 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). 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 we need an approach to health care based on a free, somewhat competitive marketplace, organized to make health care affordable to everyone.
First 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 control the insurance companies more, and limit the number of companies permitted, then prices would go down because competition would decrease.
If costs were to go down then more people could purchase their own health care. Right now only nine percent of people purchase their own health care that are not covered by their jobs (Health Care). If insurance were more affordable then more people would be covered. To make this happen laws would need to be changed at the federal and the state level. More incentives should also be given for companies that do provide health insurance to encourage more jobs to provide care for their employees. America needs a free-market based system that does not give out any more free rides, but tries to allow every citizen in the system.
If Insurance policies decrease in prices that still does not solve every issue. There are still the people who are truly unfortunate such as the youth, the disabled, and the elderly. That is where a revised Medicaid and Medicare program comes in. Medicaid is health care for the poor, and Medicare is health care for the elderly and disabled (Patel and Rushefsky, 51). The SCHIP (State Children’s Health Insurance Program), which is provided by CMS (Centers for Medicare and Medicaid Services), also needs to be improved.
Medicaid is there to increase the access of the poor to health care by providing them with financial assistance to meet their medical needs (Rushefsky, 52). Many hospitals, especially rural, are heavily dependent on Medicare for their long-term financial solvency (Reiter). The states are able to provide coverage people who where not covered under federal law. There are mandatory benefits which states must accommodate for 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 (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 those with low incomes through an income-related voucher, which includes a standardized set of benefits. As income increases then the voucher should decrease until a certain point so people do not just get all of a sudden cut off. An income-related approach, instead of a system set of assets of a person, which exists today, would be much more efficient (Feldstein, 106). I also think that the national government should take more control over the program so there is not such a drastic difference of benefits from state to state. States should also be given more flexibility to spend their Medicaid dollars in whatever way they find most efficient and effective.
Medicare needs some drastic changes because of impending financial deficits (Feldstein, 79). At the same time a new prescription drug benefit needs to be added because of the outrageous cost of prescription drugs. Right now Medicare covers 34 million aged and 5.5 million disabled recipients, and the number of aged is expected to double during the next few decades (Feldstein, 79). Something must be done to give more to the people who truly need Medicare, and maybe limit what the financially stable will receive. This will save money, allowing things such as prescription drugs to become a benefit. A proposal for reform would be rising the age to 67 than the current 65. With increased life expectancy, people could hold onto their employment-based health insurance longer. Also if part of Medicare’s plan for the elderly was income related that would save a lot of money. A voucher thing should be created for this too like proposed for Medicare. Right now the benefits are the same for all aged regardless of income (Feldstein, 84). I also believe that if Medicare were covered under social security and not two different taxes then that would also save money to help get America out of this deficit.
Another issue that could decrease the cost of health care would be to decrease malpractice insurance of doctors and physicians. If doctors and physicians were not so liable of every little thing then their insurance would not be so high. So when citizens pay for procedures, they are also paying the insurance companies of the practices. People in the medical field have to charge a lot to cover these high insurance prices. 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’s person’s party to another person’s. 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 really needs to focus on being a preventive oriented society and not a treatment oriented society. Citizens need to focus on how to prevent all of these cancers and take action. If people keep smoking, drinking heavily, and having unprotected sex then we are going to have the same problems over and over again, spending billions on treating these self-inflicted things.
Health Care is just one of the problems existing in society today, but one of the most important. There are a lot of steps that need to be taken, but if the society and the government work together, the United States health care system can become one of the best in the world. Universal Health Care is not the answer to the problems, there are to many cons that come with it. If insurance prices go down, it’ll allow more people to purchase it. Then the people still not covered can get reformed Medicare and Medicaid. Health Care is such an important issue and the government has to better help its people, and this is the best way to go about doing it.





“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.

“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 <>.

Mediated Draft

Thesis: The United States Healthcare policy needs to be altered so that it can accommodate the citizens of this country that cannot financially afford healthcare, if their situation deems necessary. It does not need to allow for Universal Healthcare because it is not realistic to give ‘free’ healthcare to a country, when in reality someone has to be paying for it. An improved program, such as Medicaid, would be an appropriate solution for the situation to allow the less financially stable to be able to insure themselves and their families.

Reason 1: There is no such thing as a ‘free lunch,’ nor should their ever be. In the United States, programs such as Welfare have given some of the population the idea that it is acceptable to live off of their government and not strive to better their lives with the opportunities for advancement offered. This is America: the land of opportunity! If people decide not to take advantage of all the opportunities this country has to offer, than why should reap the benefits, such as health care, also? If a Universal Healthcare plan was implicated, where it was only funded by the tax dollars of citizens, it would only further this ideology and hurt our nation. Universal health care, or socialized medicine, is not simply “free”, it is paid by the people’s tax money. That implies that people who have decent jobs will be paying for the insurance of people that do not have enough money to provide health care for themselves or for their families. There will also be a tax cut in things such as education and defense. In America everybody has an opportunity to have an education and to get a job that offers insurance, some people just choose not to take advantage of it. Also, if you look at Canada and Britain’s Universal Healthcare program, it is obvious that it is not a realistic solution to the healthcare problem. The Canadian Supreme Court has even admitted that "access to a waiting list is not access to health care." In Britain, 20 percent of potentially curable lung cancer patients became terminally ill while on the waiting list (Source 1).

Reason 2: It is not realistic to believe that everyone follows this ideology stated above; and some people really are just in a bad situation where they cannot obtain healthcare. This is especially true for the elderly, disabled, and youth of the United States. Statistics show that a whopping 21% of the uninsured are below the age of eighteen (Source 2). There should be a form of Universal Healthcare, such as a revised Medicaid program, that can cater to the needs of the helpless. Just because someone’s parents may have made mistakes in their
lives, which led them to not have healthcare, doesn’t mean that their children should have to pay for it by bearing the problems caused by no healthcare. By allowing assistance for people when they are truly struggling or in a time of need only, it would allow a good approach to helping the general welfare of the United States, yet would be fair to those whom work and can afford healthcare. Yet, the Medicaid program needs improvement, so that these people can receive adequate care. For example, Swanson, a practitioner from Mesquite said: “If I accepted even 10% Medicaid, I would have to close my office. Pediatricians make very low margins. I am barely in business. ... It breaks my heart I can't treat Medicaid patients because I took care of them when I was a resident" (Source 3).' It is not the responsibility of doctors to accept a health care program that does not provide them the means of financial stability, but it is the responsibility of our government to provide a health care that will benefit the general welfare of the public. There are also many nonprofit organizations, such as St. Judes Hospital, who provide health care for situations where families cannot afford it.

Reason 3: One of the biggest problems with healthcare in the United States is that insurance companies only work for the profit they receive and not the general welfare of the public. When people have taken the appropriate steps to achieve healthcare, they should not have to worry about their claims being considered ‘invalid,’ and then being denied. An infant was turned down by its insurance for cerebral palsy rehabilitation because the skill of walking was not a previous learned skill (Source 4). Incidents such as this one are reasons why the government should step into the world of health insurance and make laws regulating their prices and their claims that they reject. This would allow for everyone that makes a reasonable income to be able to afford insurance and benefit from the health care that it is supposed to provide. This is a problem that the United States government should step into and make regulations about so that these companies cannot keep hurting the United States public. This would greatly improve the healthcare system in the United States.

Conclusion: Overall, I think a Universal Healthcare would not be the best answer to the crisis over healthcare that is happening in the United States right now. I feel that a modified version of Universal Healthcare, such as a revised Medicaid program or some other program that assists in helping people pay for healthcare that are unable to do so, should be applied. In the end, giving a country’s citizens free healthcare will hurt them in regard for what they strive for in life, whereas an assistant program would ultimately be a fair option to help benefit the general welfare of the United States.

Brief on Universal Health Care

For years the government of the United States has been trying to acquire a health care system that provides good and affordable health care for everybody. Many people argue that health care is a human right and that universal health care is the answer, but that is far from the truth, it is simply a market commodity made for and by the people. If people have the money to pay or have insurance they get care, and that is the way it should be.
Universal health care, or socialized medicine, is not simply “free”, it is paid by the people’s tax money. That implies that people who have decent jobs will be paying for the insurance of people that do not have enough money to provide health care for themselves or for their families. There will also be a tax cut in things such as education and defense. Some people in our country believe that it okay to be lazy and have everything handed to them. In America everybody has an opportunity to have an education and to get a job that offers insurance, some people just choose not to take advantage of it.
Many people who come into the hospital without insurance are also the ones that are obese or have lung problems from smoking. Universal health care means the costs will be spread to all Americans, regardless of your health or your need for medical care, which is essentially unfair. Why would people who take care of themselves and make money have to pay for the stupidity of other people?
Profit motives and competition have always led to greater cost control and effectiveness. Government workers have fewer incentives to do well. They have a set hourly schedule, cost-of-living raises, and few promotion opportunities. Compare this to private sector workers who can receive large raises, earn promotions, and work overtime. Private sector workers must always worry about keeping their jobs, and private businesses must always worry about cutting costs enough to survive. The quality of health care for patients would decrease tremendously as well as their flexibility. The Universal health care system in Canada forces patients to wait over six months for a routine pap smear.
Just because some Americans are uninsured does not mean that they cannot receive health care. There are nonprofit and government-run hospitals that provide services to those who do not have insurance. It is also illegal it refuse emergency medical services because of the lack of insurance. The patient care may not be of the same quality of care, but people are never turned away.
When the government cannot run programs efficiently now, what makes people think that they will be able to effectively manage our health care system? Look our social security system, department of education, and department of transportation. There is not a government office out there that shrewdly uses their dollar as well as private sectors do. Health care is too complex for politicians to manage when they cannot even take care of manageable issue.