Healthcare Around the World
The United States of America is still the richest country in the world, but in health care the World Health Organization has it ranked as number 37 in quality and fairness (Palfreman, John, 2008). In comparison to some of the other richest, capitalist countries, the U.S.A. lags far behind in areas such as patient costs and number of people insured. In the Frontline Documentary “Sick Around the World,” investigative reporter T.R. Reid explores the health care systems of five of the other richest capitalist countries to see what the U.S.A. can possibly learn from them. It is interesting to compare his learning with the current health care law in the U.S.A., the Patient Protection and Affordable Care Act (PPACA) to see what the U.S.A. has learned and in what areas it can still improve.
Each country that Reid visits has some very positive aspects to their health care systems. Great Britian’s system encourages preventative care by paying physicians to keep their patients healthy and by the number of patients they see each year (Palfreman, John, 2008). Japan’s healthcare system keeps costs even over the entire country and allows patients to see any doctor they want to see any time, even specialists. Germany keeps its insurance companies non-profits and allows its citizens to see any type of doctor at any time. Taiwan’s system avoids administrative costs by using a smartcard to record patient data and citizens pay for insurance based on income. Finally, Switzerland does not allow insurance companies to make a profit from basic care or to reject anyone from getting coverage. Each system has an advantage that proves positive for the citizens of that country.
The U.S.A. has many problems with its current health care system, but three of the biggest problems are that so many people lack health care coverage or insurance, that insurance and drug companies are allowed to profit as much as they can from hospitals, doctors, and patients, and that administrative costs are so high. According to the Frontline video, over 47 million Americans do not have any health care coverage (Palfreman, John, 2008). One reason this is a problem is because it leaves millions of people with no way to afford basic care or even consider more in-depth elective care for problems like hip surgery. When people do not have health coverage, they avoid going to the doctor, and problems they have that were mild to begin with can become significant and dangerous. Once these problems become dangerous, people may find themselves in the emergency room, which is much more expensive than other types of care. Bills can cost thousands of dollars, leading many people into bankruptcy due to medical problems.
The problem of insurance and drug companies being allowed to profit as much as they like is fairly obvious. With no real incentive to lower costs, these companies continually raise prices for doctors, hospitals, and patients in order to increase the money they take in. The excuse a pharmaceutical company will use is that if they do not increase costs, they will no longer be able to research new drugs for the future. Insurance companies cite increasing medical costs for procedures, doctors, drugs, as well as people being covered who have pre-existing conditions as their reason for increasing costs.
Administrative costs in the U.S.A. are about 22% of all medical costs, while in systems like Switzerland, it accounts for only 5.5% of medical costs. For a 25 dollar bill, five percent does not sound like a lot, but for a hospital bill of 11,000 dollars, this means that 2420 dollars are purely for administrative work. American consumers are paying more for everything including drugs, procedures, and also for the administrative aspects of medical care. This added and unnecessary expense contributes to the overall rise of health care costs as well as the necessity to file for bankruptcy by individuals.
In order to solve the problem of people in America lacking health care coverage and going bankrupt from medical bills, the solution is to make sure that everyone has health insurance. A national insurance plan may be the best idea, but not palatable to Americans who may see it as too socialist. In other wealthy, capitalist nations such as Germany, there has been success in allowing people to choose from one of several hundred private insurers known as “sickness funds” (Palfreman, John, 2008). This idea of selecting from private insurers will be something Democrat and Republican parties can eventually compromise upon, although it will take them several years in order to have time to make all of their arguments for and against such a system. Most people will support such a system, although they must come to understand that they and their families will be much better off with no risk of unpaid medical bills, bankruptcy, or lack of a way to deal with life-threatening health problems. Americans will need to be educated through programs like Frontline’s Sick Around the World; as one commentator from Waukesha, Washington said, “I now understand the meaning behind ‘requiring citizens to buy health insurance.’ These moneys function like a tax, channeled to a singular intent” (“Discission,” 2008, para. 10). The biggest opponents of such a system will be the drug and insurance companies, because the nature of such a system will not allow them to profit as much as they did before. It is not unrealistic to believe that the U.S.A. could have universal health coverage, but it will take some time to put it into place because of the power lobbyist forces of the drug and insurance companies influencing politicians.
An essential part of being able to have universal health care is that drug and insurance companies no longer be allowed to profit as much as they like. In other capitalist countries such as Taiwan, drug prices as well as prices for every procedure are negotiated and adjusted once a year (Palfreman, John, 2008). This means that no matter where anyone goes in the country, the price is the same for seeing a doctor. With the national government behind it, drug companies will have to compromise on their prices if they want to make any sales at all within America. In other countries, people pay a much lower premium for their insurance each month, and if their income is too low or they do not have a job, the government pays the premium for them. In order to be able to do this, it is best if insurance companies are non-profit. Additionally, they must cover everyone, and not be allowed to reject people who have preexisting conditions or who are elderly. Convincing the average American that insurance companies should be non-profit would not be hard, but the big battle against this idea will come from the insurance companies themselves and the politicians they influence through lobbyists. It will be easier to convince insurance companies to accept all patients than to exist as nonprofit entities. It may be easier to deal with the drug companies if they believe that none of their products can be sold within America without an agreement to set a fair price. Controlling insurance and drug prices are essential, however, because it controls the cost of a universal health care system.
Administrative costs must be reduced as well as part of keeping down costs so all can have health coverage. One idea that seems particularly effective is Taiwan’s smartcard. A patient’s vital information, including all medical records, are kept on this card. This virtually eliminates the need for much paperwork, faxes of medical records or referrals, and so forth. Doctors and nurses have all of the information they need right away on their computers. This method keeps administrative costs far below the 22% that Americans pay (Palfreman, John, 2008). Having lower administrative costs is another essential element of making universal health care affordable for America. However, a smartcard will be a tough sell to just about everyone. Many Americans are leery of any device that records their personal information, fearing breaches of privacy or that their data will be misused. Hospitals, drug companies, and insurance companies may fight against it because that 22% represents part of their profits. Some politicians may argue against it, saying that it could eliminate jobs. Some doctors and hospitals may desire such a system because it will help them navigate the complex world of insurance policies as well as serve their patients faster.
The Patient Protection and Affordable Care Act (PPACA) “was passed by Congress and then signed into law by the President on March 23, 2010. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law” (U.S. Department of Health and Human Services, “Read the Law,” 2012, para. 1). Three major components of this law include requiring Americans to select insurance coverage that they decide is best for them, making clear rules for insurance companies to abide by, and providing Americans with options for financing long-term care services in case they become disabled.
Requiring all Americans to have health insurance represents a compromise, because Americans will have a choice over how they will be insured. If they receive insurance through an employer and they like it, they may keep that insurance (U.S. Department of Health and Human Services, “Read the Law,” 2012, Title I). However, if they are dissatisfied with an employer’s insurance, do not have a job, or are self-employed, they will have choices. They can select “the insurance coverage that works best for them in a new open, competitive insurance market – the same insurance market that every member of Congress will be required to use for their insurance” (U.S. Department of Health and Human Services, “Read the Law,” 2012, Title I). Requiring Congress to use this insurance is an ingenious way to make sure that insurance stays fair, of high quality, and affordable, because lawmakers will have firsthand experience with how well or how badly the system is working.
Making clear rules for the insurance companies to abide by is another important facet of the PPACA. A very important rule for individual Americans is that insurance companies will not be allowed to deny coverage if someone has a preexisting condition such as diabetes or cancer. Additionally, patients will now have the “power to appeal insurance company decisions that deny doctor ordered treatments” (U.S. Department of Health and Human Services, “Read the Law,” 2012, Title I). Additionally, tax credits and programs will be available to small businesses assisting them in making care affordable for “employers, employees, and early retirees” (U.S. Department of Health and Human Services, “Key Features,” 2012, para. 6).
Another important aspect of the PPACA is the Community Living Assistance and Supports Act (CLASS), providing Americans with options for financing long-term care services in case they become disabled. CLASS is an option and not a requirement for Americans. It can serve many different populations of people who are disabled, including those who are temporarily disabled to those who are permanently disabled. According to the law, “Workers will pay in premiums in order to receive a daily cash benefit if they develop a disability. Need will be based on difficulty in performing basic activities such as bathing or dressing” (U.S. Department of Health and Human Services, “Read the Law,” 2012, Title VIII). Long-term care is currently expensive, and this option will help countless Americans receive the care that they need if disabled.
Current health care reform appears to be a step in a positive direction for America. It strives to make sure every American can receive the care he or she needs, while finding innovative ways for the insurance market to remain competitive. Although being required to have insurance may bother some Americans, the law acknowledges Americans’ desire for choice by letting them decide what coverage they deem is best for themselves. Americans and the lawmakers that represent them should take a close look at the success other capitalist nations have had in providing health care for all of their citizens; that way, we can avoid paying 16% of our GDP on health care. American can bring costs into line with countries like Japan and Taiwan who both spend 8% or less of their GDP on health care (“Five Capitalist Democracies”). The biggest problem with health care reform in the U.S.A. is that it cannot happen soon enough.
Discussion. (15 Apr 2008). PBS: Frontline. Retrieved from http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/talk/
Five Capitalist Democracies & How They Do It (15 Apr. 2008). PBS: Frontline. Retrieved from http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
Palfreman, John (Producer). (2008, April 15). Sick Around the World. PBS: Frontline. Video retrieved from http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/
U.S. Department of Health and Human Services (28 Jun. 2012). Key Features of the Law. Retrieved from http://www.healthcare.gov/law/features/index.html
U.S. Department of Health and Human Services (28 Jun. 2012). Read the Law: The Affordable Care Act, Section by Section. Retrieved from http://www.healthcare.gov/law/full/