Foundations of Public Administration

      The upcoming election has brought dormant policy issues to the surface. Health care, The American Policy, is one of the chief issues on the table. Health care in the United States is provided by countless diverse organizations. Health care facilities are largely owned and operated by private sector businesses. Health insurance for public sector employees is primarily provided by the government. 60-65% of healthcare provision and spending comes from programs such as Medicare, Medicaid, Tricare, the Children's Health Insurance Program, and the Veterans Health Administration. Most of the people under 65 is insured by their or a family member's employer, some buy health insurance on their own, and the rest are uninsured. Decent health care should to be a basic right, not something that depends on the job one holds. The current health care system of private insurance and government programs simply is not working. Of all the countries surveyed in a recent poll, Americans were the least likely to report relative satisfaction with their health care. Healthcare is the country’s largest economic sector, accounting for over $2 billion in annual expenses—four times larger than national defense! Yet millions cannot afford to take care of their health needs. Every year, 1.5 million families lose their homes

to foreclosure due to unaffordable medical costs. The serious problems that need vital resolution are the absence of access to healthcare, the high cost, an apparent lack of fairness in the system along the lines of race and class, and ineffectiveness in improving the overall health of the populace. Additional key contributing issues include declining patient choices; the increased control in healthcare decisions by managed care companies as they seek to further limit access to care; frustrated, overworked medical practitioners; nurses departing from the medical profession in masses; and quality of care issue. The U.S spends more than any other country in the world. In just the past year; a full 25% of residents did not visit the doctor when sick because they could not afford it. 23% percent skipped a test, treatment, or follow-up recommended by a doctor. Another 23% didn't fill a prescription. No other country is even near to this sort of income-based regulating. 19% of Americans were unable, or had serious problems, paying medical bills in the last year. Comparatively, no other country was even in the double digits. Most of residents don't have a regular physician. One might expect, given the cost of medical bills, that the care would at least be more crucial and convenient. But it's not so. Americans are least likely to report a doctor or general practitioner they routinely see. Americans are furthermore, most likely to say their doctor doesn't know important information about their medical

history, which has obvious implications for care quality, medical errors, etc. Another contributing factor is the shift from “non-profit” to “for-profit” healthcare providers, such as the growth of for-profit hospital chains. Furthermore, the large amount of uninsured people is significantly contributing to rising costs because conditions that could have been detected, treated and prevented in their early stages go undetected and later develop into full-blown crises. These then require more expensive procedures that may even include intensive care or emergency room treatment. Only 30 percent of Americans report that they can access a doctor on the very day they need one, a full 67 % of Americans -- more than in any other country -- say it's difficult to get care on nights, weekends, or holidays with resorting to the emergency room, where care is costlier and, if the injury is not grievous, less efficient. Hospital emergency rooms are pushed past capacity, as the number of emergency visits increased to 120 million a year in 2006, up from 90 million ten years earlier. At the same time, the number of hospital emergency departments dropped by 7%, according to the 2009 National Report Card on the State of Emergency Medicine. Millions of sick people who cannot afford medical care are urgently pouring into emergency rooms, which by law cannot deny the individuals treatment. Every year, hospitals turn millions of dollars in unpaid bills over to collection agencies. The U.S. healthcare system is

financed by premiums, the collection of cash paid for health insurance. At the same time, healthcare providers must be reimbursed for services dispensed. The responsibilities for these are shared by insurance companies and the government. In many cases, insurers make payments straight to the healthcare providers instead of to the applicants; this depends upon the type of plan chosen. Both individuals and businesses pay income taxes to the government, which fund programs such as Medicare, Medicaid and other government-funded health insurance programs. The government also uses money from taxes to reimburse providers for services to members of government programs. The federal government significantly supports employer-sponsored insurance because employees receive this as a tax-free benefit, and employers are able to deduct health insurance benefits as a cost of doing business. The size of the funding is estimated to be approximately $100 billion annually. Federal spending on healthcare in 2005 alone totaled $600 billion, a massive one-quarter of the federal budget. Health care spending is expected to reach nearly 20% within the next 10 years, which is unmaintainable. Major companies and municipal governments are passing more of the cost of health care to their employees. Most companies and local governments will not be able to meet their obligations to health care to retirees. Many small businesses, especially in the service sector, do not even provide health insurance to their employees.

Most companies and city governments have not set aside enough money to meet health care obligations to retired employees. More and more companies will shift their manufacturing to other countries, as they will not be able to sustain health care costs for their employees. There is a steady rise in bankruptcies amongst individuals as well as companies due to the cost of health care. Lifespan probability at birth in the USA is 50th in the world, below most developed nations and some developing nations. The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the maximum in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study). The Commonwealth Fund categorized the United States last in the quality of health care among similar countries, and records U.S. care costs the most. A 2004 Institute of Medicine (IOM) report said: “The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population. A 2004 OECD (Organization for Economic Co-operation and Development) report said The U.S. spends a higher percentage of its Gross Domestic Product (GDP) on healthcare than other industrialized countries; in 2003, it was 15%, versus an average of 8.6% in the OECD nations. With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured)

coverage of their populations by 1990. The 2004 IOM report observed "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." A 2009 Harvard study estimated that 44,800 excess deaths occurred annually due to lack of health insurance.

      The U.S. Census Bureau reported that 49.9 million residents, 16.3% of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1% of the population, in 2009). According to the World Health Organization (WHO), the United States spent more on health care than any other nation in 2008. A 2001 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies and in 2007, 62.1% of filers for bankruptcies claimed high medical expenses. During the past eight years, insurance premiums have nearly doubled, resulting in health insurance moving farther out of reach for millions. Burgeoning medical bills are increasingly leaving families drowning in debt. Barack Obama and Joe Biden have proposed a plan the "Affordable Care Act" that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference. The Obama-Biden the "Affordable Care Act" will promote public health. It is a universal health care reform plan that will grant affordable health insurance to all Americans. This means that Americans who have the means to pay for private health insurance will still do it, while those who don't make

enough will be provided aid. This system of health care will work like to Medicare and existing employer-provided healthcare plans. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters. Americans will be presented with the choice between affordable and free health care choices and more expensive private health care choices. It will be up to every American to look at the individual needs of themselves and their families and pick the right health care option for them. In March 2010, President Obama gave a speech at a demonstration in Pennsylvania explaining the importance of health insurance reform and asking Congress to hold a final yay or nay vote on reform. After going through several changes the "Affordable Care Act" was signed into law by President Barack Obama on March 23, 2010. This Act reformed certain aspects of the American Health Care system, but there was still more work to do. In June 2012, in a 5–4 decision, the U.S. Supreme Court found the law to be constitutional. The law includes health-related provisions that take effect over several years, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level, subsidizing insurance premiums for people making up to 400% of the federal poverty line ($88,000 for family of 4 in 2010) so their maximum out-of-pocket payment for annual premiums will be on sliding scale from 2% to 9.5% of

income, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, forming health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research. The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats. Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options. The 2010 Acts require insurers to cover more costs, requiring that at least 80% of premiums must be spent on medical care or quality improvement and requiring full coverage for screenings and immunizations. Some insurance schemes had been considered inadequate. Beginning in 2014, the new health care policy will ban insurers from denying coverage to sicker applicants, or imposing special conditions such as pricier premiums or payments. Health care expenses are focused with the most expensive 5% of the population accounting for half of total health care spending, though the bottom 50% of spenders account for only 3%, which means

that insurers' gains to be had from avoiding the sick significantly overshadow any probable gains from managing their care. As a result, insurers devoted resources to such avoidance at a straight cost to effective care management which is against the interests of the insured. Instead of providing health security, the health insurance industry have begun to compete by becoming risk differentiators, looking   to insure only those with good or normal health profiles and excluding those considered to be or probable to become unhealthy and therefore less profitable. Also starting in 2014, the law will require uninsured individuals to buy government-approved health insurance. This requirement is expected to reduce the number of the uninsured from 19% of all residents in 2010 to 8% by 2016.   Some experts believe that the 8% figure of uninsured are expected to be mostly illegal immigrants (5%), with the rest paying the fine unless exempted. Whether or not the information is completely accurate is unclear based on currently available data. Some analysts have argued that the insurance premium structure may shift more costs onto younger and healthier people.         Roughly $43 billion was spent in 2008 providing unreimbursed emergency services for the uninsured and the Act's supporters claimed that increased the average family's insurance premiums. Some argue that expanding insurance coverage may lead to better health, while other studies claim the opposite. Nevertheless, many of these studies

fail to reveal that new health care policy that is responsible for the "expanded coverage" will likely benefit the much larger people that have diabetes, hypertension, chronic kidney disease and a host of other long-term medical conditions. A cost effective American health care system will develop as long as politicians and policy makers do not clutter up their search for solutions with their ideologies. They will have to swallow their pride too, and acknowledge that they have repeatedly misled the population by claiming that America has the best health care system in the world. They have to surpass maintaining their personal power, suppress their egos, and take a good look at the best practices of the health care systems of the other rich nations. They must do this in order to develop and implement a health care system that provides adequate and quality health care for all people. America has to start with a new method to developing a health care system, one that is superior and more cost effective than existing systems in the world. America has the resources to improve the health care system, because it has the finest health institutions and hospitals. There are plenty of brilliant minds wise and ethical, and it has a bureaucracy for processing information already in place. Nevertheless, despite this, the current health care system has not only become money driven, it has become obsolete as well. Health care should be based on need rather than on ability to pay, but there can

be limits on what 'basic health care' is covered. Any person can pay top-up insurance to cover an emergency, waiting list, or any other special requirement that may not be immediately available or is rationed under the 'basic health care' provided. The government members should study the health care systems of other rich countries and evaluate the best health care practices amongst them. The world is full of alternative models, totally functioning organizations that can be viewed as little experiments, the conclusions of which should advise the policies. If the American system outperforms its competitors, than the government should strengthen what sets America apart and pushes the USA ahead. If America under-performs, the government should take a hard look at whether the systems really is superior. Adding to the misery, by 2015, the National Coalition on Health Care projected that the government will double healthcare spending to $4 trillion per year, or 20% of the nation’s budget. With millions of uninsured people unable to access proper healthcare, overstretched hospitals and escalating costs, America’s healthcare system is collapsing.

      With the 2010 plan, patients would gain assured coverage access, choice, and improved care; those with potential heart disease would particularly benefit from universal coverage because they would have access to preventive care. Businesses could concentrate on business, not benefits. Even those contributing toward employees’ coverage for the first

time would benefit thanks to healthier employees. Insurers would benefit by receiving payments that are based on the severity of patients’ conditions. Physicians could spend time on patient care rather than administrative tasks. It is time for policy makers to take action. A new health care system must be implemented, one that is inclusive and fair, and provides for each and every person in the nation. Knowledge, facts, and lessons learned from the experiences of people in America, and in other nations, are out there. Action must be taken on the most important domestic issue of all, creating a universal health care system. It is time to try what Canada and most European countries already have: a national, government-run health care system. The system would work much like Medicare, except that everyone would be entitled to coverage, regardless of age, income or job status. Like Medicare, you would pick your own doctor, but the government would get the bill. This is the only way to solve the problem of the uninsured, once and for all. There is no need to the existing health care system and start over. The U.S. already has the best high-tech medical centers in the world and insurance programs in place that cover 85 percent of Americans. The government can just extend those proven programs, public and private, to cover more people. Employers can receive financial incentives to cover more of their employees. The federal government already has some semi-effective health programs for the elderly

(Medicare), the poor (Medicaid), low-income children (CHIP) and its own employees. If the eligibility for those plans is expanded, more people will be covered. Gradually expanding the current system is the most practical way to cover more people without breaking the budget. The main problem with the healthcare system is that costs keep going up. All the other problems in the health care system stem from this and won't be solved until real choices are given .That means reducing regulation and using free market competition to allow insurers to offer a wide display of plans. The policy makers should also embrace managed care, which watches expenses carefully and has already slowed down the increase in health care costs. By moving further in the direction of managed care, and adopting medical savings accounts, which encourage individuals to save and shop around for health care, cost can be decreased and coverage can include more people.

                                               References

Gold, S. D. (1992). One approach to tracking state and local health spending. Health Affairs, 11(4), 135-44. Retrieved from http://search.proquest.com/docview/204621093?accountid=32521

Goodman, A. (2009). President obama's health plan and community-based prevention. American Journal of Public Health, 99(10), 1736-8. Retrieved from http://search.proquest.com/docview/215087874?accountid=32521

Health insurance coverage in the united states: 2011. (2012). Medical

Benefits, 29(20), 6-9. Retrieved from http://search.proquest.com/docview/1086326387?accountid=32521

Hurst, J. (2000). Challenges for health systems in member countries of the organisation for economic co-operation and development. World Health Organization.Bulletin of the World Health Organization, 78(6), 751-60. Retrieved from http://search.proquest.com/docview/229587125?accountid=32521

Levit, K. R., Olin, G. L., & Letsch, S. W. (1992). Americans' health insurance coverage, 1980-91. Health Care Financing Review, 14(1), 31-31. Retrieved from http://search.proquest.com/docview/196974255?accountid=32521

Lisa, D. T. (2002). Commonwealth health corporation, the healthcare pioneer of six sigma: Six sigma intensified - is 99% good enough...? Quality Congress.ASQ's   Annual Quality Congress Proceedings, , 297-300. Retrieved from http://search.proquest.com/docview/214388775?accountid=32521

Obama, B. (2010). Remarks by the president on health care reform. Vital Speeches of the Day, 76(4), 183. Retrieved from http://search.proquest.com/docview/746599625?accountid=32521



References

Reid, P. S., & Borycki, E. M. (2012). Factors influencing healthcare consumers' search for healthcare associated infection information on the world wide web. Clinical Governance, 17(2), 134-140. doi: http://dx.doi.org/10.1108/14777271211220844

Steele, M. (2009). The president's health care plan. Vital Speeches of the Day, 75(9), 395. Retrieved from http://search.proquest.com/docview/221464522?accountid=32521