What is it that makes Americans overly enthusiastic about reforms to health care? A statement like “don’t alter the benefits of my Medicare” and “everyone ought to have access to top of the line health care, regardless of the cost” are, in my opinion, insufficient and uninformed statements that suggest a lack of comprehension of our health system’s history, its present and future resources , and the financial challenges America will face in the future.
As we look around, we are all wondering if the health system has reached what many call an “episode of crisis. Let’s try to remove some of the tension from the discussion by examining briefly how the health care system in this country came into existence and how it has changed our beliefs and attitudes regarding health care. As a starting point, we can look at the advantages and disadvantages of the Obama administration’s health reform plans. Then, let’s take a take a look at the theories that are being proposed by Republicans?
Access to the latest healthcare facilities is something we all agree is an excellent thing for our nation. The experience of suffering from the effects of a serious illness is among of the biggest challenges that we face and facing it without the resources to cover it is a real frightening thought. As we’ll discover, once we have the facts, we’ll realize that reaching this goal isn’t simple without our personal contribution.
These are the topics I’ll explore to attempt to make sense of what’s happening with American health care , and what actions we can take personally to improve the situation.
Let’s first get an understanding of the history behind American healthcare. This isn’t meant to be a comprehensive study of that past, but it can give us an understanding of how the health care system as well as our expectations of it developed. What factors drove costs to be higher and higher?
Let’s begin by turning towards how the American Civil War. In the war, outdated strategies and the destruction caused by modern weaponry that were in use at the time combined to create horrific outcomes. Not widely known is that the majority of the deaths of both sides weren’t due to the actual fighting, but rather what transpired after the infliction of a battlefield injury.
The first thing to note is that the evacuation of wounded patients was carried out at a snail’s speed which led to significant delays in the treatment of injured. Furthermore, many wounded were treated with surgery for wounds, as well as related surgeries or amputations of the affected limbs, which frequently led to the development of massive infections.
You could be able to recover from a wound, only to be killed at the hands of medical practitioners who even though they were well-meaning, their actions were frequently fatal. The high death tolls could also be blamed on everyday illnesses and ailments in a time where antibiotics were not available. There were around 600,000 people died from various reasons, more than two percent from all of the U.S. population at the time!
We’ll skip the beginning into the second half of 20th Century to gain some perspective and to get us to more contemporary times. Following the civil war, there was steady progress in American medical practice, both in the understanding and treatment of specific ailments, the development of advanced surgical techniques and medical education and training.
For the most part, the only thing doctors could provide their patients was an “wait and look” method. Medical doctors could manage bone fractures , and was increasingly attempting surgical procedures that were risky (now generally carried out in clean surgical settings) however, there were no medications yet in use to treat serious diseases.
The majority of deaths were caused by untreatable diseases such as pneumonia, tuberculosis measles, scarlet fever and/or their associated complications. Doctors became more aware of heart and vascular diseases as well as cancer, but did not have any treatment to treat these ailments.
This brief overview of American medical history will help us understand that up until a few years ago (around in the 50’s) there was hardly any techniques to treat major or minor illnesses. It is a crucial aspect we must understand; “nothing to treat you with” implies that doctor visits could be relegated to emergencies. In this scenario, the costs of treatment are cut down.
The fact is there was not much for doctors to offer , and consequently, there was nothing to stimulate the cost of health care. Another factor that slowed down costs was that the medical treatments offered were paid for out-of-pocket that is, through individual’s own resources.
There was never a health insurance policy, and definitely not health insurance provided from an employer. With the exception of those who were fortunate enough to find the way to a charity hospital, the cost of health care were entirely the responsibility of the person.
What does health insurance have in relation to health expenses? The impact it has on health care costs is until today, massive.
The idea of health insurance for individual and families became an option for companies to avoid wage freezes and to keep employees following World War II, almost instantly, an enormous amount of money was created to cover health insurance. The cash, in the form of the huge amounts of dollars in the health insurance pool, helped the development of an innovative America to expand the research and development of medical professionals. More Americans were insured, not just through private, employer-sponsored health insurance, but also through the increase in government-funded health insurance that led to Medicare in 1965 and Medicaid (1965).
Additionally, funding was made available for a broader range of veterans health benefits. Finding a cure for nearly anything has been extremely profitable. This is the main reason behind the wide array of treatments available to us today.
I am not trying to say that medical breakthroughs are bad. Consider the millions of lives saved, extended, improved and improved in productivity because of. However, as a funding source has increasing to its current size (hundreds in billions each year) the pressure to increase healthcare costs is inevitable.
Doctor’s advice and the majority of us want and have access to the most recent medical technology, which includes medical devices, pharmaceuticals, instruments for diagnosis and surgical procedures. The result is that there’s more health care that we can invest our money in and, until the last few years, most of us were covered by insurance, and the expenses were paid for by a third party (government or employers).
Add excessive and unrealistic public demand for treatment and access and you have an “perfect storm” that is causing ever-increasing healthcare costs. The situation is only getting worse.
Let’s now look at the most important questions that will take us to a thorough review and hopefully a better understanding the health reforms being discussed being discussed in the media today.
Does the current trend in U.S. health care spending long-term sustainable? Is it possible for America remain competitive in the world with 16% of the money that accounts for 20 percent of our national gross production, is spent on health care? What are other industrialized nations paying for health insurance, and are they even near the same amount? If we include the politics of an electoral year in the discussion the information needed to determine these questions becomes vital.
It is essential to put some time learning about the health care system and figuring out what we think about it. With the right knowledge, we can wisely assess whether certain proposals in health care could be able to solve or even worsen the issues. What can we do about the issues? What can we do as individuals to help to solve the problems?
The Obama health plan for health care is complicated, certain, but I’ve not seen a health insurance plan that’s not. Through a myriad of programs , the plan seeks to address the issues of) increasing the percentage of American who are covered by sufficient health insurance (almost 50 million people aren’t) and b) controlling costs in such so that the quality of healthcare and access to healthcare is not negatively affected.
Republicans want to accomplish these same fundamental and broad goals, however their plan is portrayed as being more market-driven rather than a government-driven approach. Let’s examine how the Obama plan will accomplish to achieve these two goals. Be aware, of course the plan was approved by Congress and is set to begin to begin to take effect in 2014. That’s the direction we’re taking now as we try to improve health care reform.
Through the insurance exchanges and the expansion of Medicaid, the Obama plan significantly increases the amount of Americans who are insured through health insurance.
To fund the cost of this expansion, the program requires that everyone has health insurance, with a penalty to be paid in the event that we fail to adhere to. The plan is said to provide money to states to help those who are added to the state-based Medicaid programs.
To offset the increased costs, there were new taxes enacted for the purpose of covering the increased costs. One is the 2.5 percentage tax on all new medical devices. Another increase in taxes on dividends and interest income of the wealthier Americans.
Obama’s Obama plan also employs concepts such as evidence-based medical accountable care organizations research on comparative effectiveness and reduced reimbursements to health care service providers (doctors or hospitals) to manage costs.
The insurance mandate outlined in the first and second points above is an important objective, and many industrialized nations other than the U.S. provide “free” (paid for through very high corporate and individual taxes) health insurance to the majority or all of their citizens.
It is crucial to remember however that there are plenty of restrictions that the majority of Americans are not prepared culturally. This is the most controversial feature in the Obama plan: that of the health insurance requirement. It was the U.S. Supreme Court recently was asked to hear arguments as to the legality for the insurance mandate the result of the petition of 26 state attorneys general which claimed that Congress had overstepped its authority pursuant to the commerce clause in the U.S. constitution by passing the mandate.
The issue is that if there is a chance that Supreme Court should rule against the mandate, it’s generally accepted to be a sign that the Obama plan in its current form is likely to fail. It is due to the fact that its primary objective of providing health insurance coverage to everyone would be severely restricted should it not be completely halted with a similar decision.
It is obvious that the tax rates mentioned in the third point above are not popular with the entities and people who have to pay these taxes. Pharmaceutical companies, medical device companies hospitals, doctors, and insurance companies have all required the option of having to “give the gift of” something that could bring in new revenue or lower costs within their areas of control.
For instance, Stryker Corporation, a large medical device firm has recently announced at a minimum 1,000 employees being cut partly to help pay these fees. This is also happening with other medical device companies as well as pharmaceutical companies too.
The decline in high-paying jobs in these areas as well as in the hospital industry will likely increase as old cost structures have to be addressed to meet the lower rate of reimbursement for hospitals. In the next 10 years, certain estimates place the cost reductions for doctors and hospitals at half a trillion dollars . this will flow directly into and affect companies which supply doctors and hospitals with the most modern medical technology.
All of this is not to suggest that efficiency gains are not achievable through these changes , or that no jobs will not be created, but this could be a painful transition for a time. It aids us in understanding that reforms to health care will impact us both positively as well as negative.
The Obama plan is aimed at changing the manner in which medical decision-making is taken. While basic and clinical research are the foundation of nearly everything that is done in modern medicine doctors are a creature of habit, just like we are and their education and daily experiences influence how they approach diagnosing and treating our ailments.
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In the realm of evidence-based medical care and the concept of comparative effectiveness studies. Both seek to create and use databases of health information from electronic records as well as other sources to provide more accurate and faster doctors with feedback on the results and cost of the treatment they provide.
There is a lot of medical waste in the present, which is estimated to be around 1/3 of the more than 2 trillion dollars in healthcare expenditure annually. Imagine the savings likely to be realized by reducing unnecessary tests and procedures that don’t compare with treatments for health which are more documented as efficient.
Today, the Republicans and other political parties don’t typically support these views since they generally describe them as “big state control” of my and your health healthcare. To be fair regardless of their political views those who know anything about the concept of health care recognize that having better data to meet the needs discussed above are essential in ensuring that health care efficiency and patient safety as well as costs heading in the proper direction.
A brief summary of what Republicans and other conservatives consider health reform. I think they’d believe that the costs should be brought under control, and that more not less Americans need access to health insurance regardless of their financial ability.
The main differentiator is that these people believe that competition and market forces as the best way to achieve the efficiency and cost reductions we’re looking for. There are numerous strategies to create greater competition between health insurance companies as well as health healthcare service providers (doctors as well as hospitals) in order that the customer will begin to drive costs down through making the right choices.
This is true for many sectors of our economy, but this model has demonstrated that the benefits are not real in the context of health healthcare. The main issue is that the choices for health care aren’t easy for people who are aware and connected. The general population is not as educated and we’ve been taught from a young age to “go to the doctor” whenever we believe it’s necessary. We also have a tradition of culture which has given a lot of us the notion that health care can be found everywhere and that there is no reason not to avail it, regardless of the reason and even more, we are all convinced that there’s no way to alter the cost of health care for ensuring its accessibility to people with serious issues.
This article was not meant to be a comprehensive analysis, as I had to be concise in order to grab my readers’ attention. I also wanted to give room for discussion about the ways we can help solve some of the issues. It is important to realize that the funds available for healthcare are not indefinite.
Any changes made to provide greater insurance coverage and better access to health care will be more expensive. We must come up with the funds to cover these costs. While we must lower the price of procedures and medical treatments, and also limit the availability of non-proven or undocumented treatments since we have the most expensive health systems in the entire world. And we aren’t always the most effective results when it comes to longevity or stopping chronic diseases early than is needed.
I believe that we must make an overhaul in how we view healthcare, it’s accessibility and costs, as well as who is responsible for paying for it. If you think that I am about to suggest that we need to arbitrarily and dramatically reduce the cost of health care, then you’re incorrect. This is for our fellow citizens – the cost of health care must be protected and preserved to those who are in need. In order to get this money, those who don’t require it, or are able to delay it or even avoid it must be proactive. We must first convince our elected officials that our country needs to continue public education on the benefits of preventive health practices.
This should be the top priority and has helped decrease the amount of U.S. smokers for example. If the prevention approach was to become a reality and become a reality, it is reasonable to expect that the number of people who require health care due to the many lifestyle that cause chronic disease would decline drastically. Millions of Americans suffer from these illnesses much earlier than they did in the ago, and a large portion of it is due to poor lifestyle choices. This alone could make it possible to save a lot of money to cover the health care expenses of people in desperate need of medical attention, whether because of an crisis or a chronic illness.
Let’s get into the initial issue. The majority of us aren’t willing to to implement simple wellness techniques in our lives. We don’t exercise , but we give a variety of excuses. We don’t eat well, but we give a variety of excuses. We smoke, or drink excessively and offer a variety of reasons how we cannot do something about these harmful personal health behaviors.
We do not take the advantage of health checks which examine blood pressure, cholesterol levels and body weight, yet we make a variety of excuses. In the end, we ignore these aspects and the outcome is that we fall victim earlier than we should to the ravages of chronic illnesses like heart issues as well as diabetes and the high pressure. We are forced to see specialists for these and other routine issues because “health treatment is available” and we believe we are not responsible to reduce our dependence for it.