Monday, December 19, 2011

Problems And Solutions Of Health Care In The United States Of America

Problems And Solutions Of Health Care In The United States Of America
Legal and Ethical Issues in Health Services - Module 08 Final Research Paper

Student Name:
Desdery J. Masao
Date of Presentation:

 The healthcare system in America is a mess; although the medical needs of the very poor are covered adequately by Medicaid, Medicare and SCHIP vast middle class Americans do not have access to the affordable healthcare. About 46 million uninsured Americans (majority are middle class), have no health insurance at all. (  The current economic recession has worsened the healthcare problem. Millions of people who are suddenly unemployed and underemployed have lost their employer-based insurance or are simply not able to afford the premiums and other out-of-pocket healthcare expenses. I will  take position in this paper that healthcare in America should be considered a basic human right; that we can learn from the healthcare experiences and systems in other countries, such as Switzerland and the new Obama Administration seems to be headed in the right direction, but needs to do more. This paper identifies five problems of current healthcare and offers eleven specific proposals that will do much to revive our ailing healthcare system and make America great.

Problem of Health Care In The United States Of America:

Not every one has access in the healthcare. Uninsured can be classified in four categories. First, people in the middle-class who are not eligible for Medicaid/Medicare and cannot afford healthcare costs. Second, people who have healthcare insurance but are left out due pre-existing conditions, and cannot qualify for Medicaid/Medicare. Third, people who get their health care insurance through employer (majority of insured) but are now unemployed or wont become eligible for health insurance by new employer because of probation period. Fourth, mental health patients who must pay high premiums that are limited in the amount of care they receive.

In the United States the majority of people get healthcare insurance from their employers. The Elderly get health insurance through a government funded program called Medicare. Low income families get healthcare coverage through a government funded program called Medicaid; children get health insurance through the Children's Health Insurance Program Reauthorization Act, which expands the State Children’s Health Insurance Program (SCHIP). A small number of people who are not eligible for any of these other programs purchase their individual healthcare policies from private companies at very high premium rates. The rest are left out as uninsured, and that number is growing fast, that  is why to reform American healthcare system is issue number one to Americans on the matters that concerning healthcare. (

First problem of the current American healthcare system is high rate of unemployment. Unemployment is one of the problems that cause many to be uninsured. Recent recession that has caused about 6+ millions of American to lose their job cause a big threat to our current healthcare system. For example, unemployment affects the healthcare because majority have employment related healthcare insurance, when they become unemployed the employer withdraw their health insurance immediately because it is expensive. The results are that healthcare costs skyrocketing.

Second healthcare problem is mental healthcare patients who must pay high premiums that are limited in the amount of care they receive. Mental health is a problem that our current health care system is facing. Recently mental health is growing to become an area of concern because if outpatient mental health program and substance abuse treatments (most of the time is mental health associated) were more accessible and affordable,  we could avoid a lot of tragedies that took place in our communities; such as columbine shooting, Virginia Tech shooting and recent Binghamton NY shootings. Because these individuals and their family members could have reliable and needed access to treatment weather is outpatients or in-patients treatment. At first, they were considered to have personal problems; in the end, they became tragedies for the----- and communities and society as a whole. Mental health care is in an imminent danger to the community and it should be considered that way in the related institutions for public safety. (Dominic Hodgkin, Constance M Horgan, Deborah W Garnick, Elizabeth L Merrick. (2009)

Third healthcare problem is the Patent Protection Act. This act protects pharmaceutical and drugs corporations to have total monopoly of their products/drugs for good seventeen years. This monopoly results to Americans pay high price of drugs that are very cheep in other countries including our next door neighbor, Canada. Another problem of the Patent Protection Act is that many countries, including India, China and South Africa don’t respect it, yet they produce generic medicines from the brand-name American medications.

Fourth problem of our healthcare is the restrictions on preventive care and lack of access to the physician or clinics for the uninsured. In the United States, individuals, who are uninsured and not eligible for public healthcare services and cannot afford to buy private insurance, go to the hospital for they get hospital emergency room services. {McKenzie, 2008 p. 410-5}. By law, hospitals are required to treat everybody equally. Due to sky-rocketing healthcare costs the vast number of uninsured people cannot afford to see physicians and there are not enough public clinics for them; therefore, they go to the ER. Because are not insured and hospitals have to treat them, hospitals end up carrying the bad debt by charging insurance companies more to treat insured patients. The result is that the insured premiums for those who have insurance, forcing some of them to drop insurance coverage altogether. It is a vicious cycle, particularly in the current bad economy.

            Early diagnosis and preventive health care services, that can easily be accessed in the clinics and physicians’ office, are not costly than it is to treat diseases in the ER. These two factors can become very problematic and to address them the current system need to be overhauled.

            Fifth, is the high cost of using physicians to provide medical care that BS Registered Nurses, Nurse Parishioners and Registered Physician Assistants can perform; but under the current health care system are restricted.  These restrictions contribute to higher costs of healthcare in America, because physicians’ service are expensive than the above mentioned healthcare professional.

            Managed care initially was created established to hold down costs and assurance of comprehensive healthcare to all by just a single uniform premium. This was to be done by managing physicians and insurance companies from charging higher cost for lesser services. Today we have witnessed that managed care failed us because we are still facing raising costs and restrictive healthcare system of our time. Because the initial goal and objective of managed care have failed, it has contributed to Americans now to experience higher healthcare cost and increasingly restrictions on healthcare than ever before.

Reform for cost containment and managed care of United States healthcare system is long overdue. Many family members, middle class and poor, are filing for bankruptcy because of outstanding bills they cannot afford. The raising cost of healthcare in the Unites States is not proportional with wages. Cost of living is going up every day, the economy is declining due to the current recession, and many people have lost hope. Because uninsured patients don’t have access to the clinics and physicians, they don’t get annual physical check-ups, early, diagnoses or preventive treatments. These early intervention services are much cheaper through clinics and primary physicians than waiting for full blown-disease that requires expensive Emergency Room treatment. When the uninsured have only the ER as an alternative, then healthcare management raises its premiums to insured people to cover the cost crated by the uninsured frequent use of ER services. Prevention is better and cheaper than cure trying to treat dieses later on.

Other Nations and Obama’s Approach on Healthcare:

According to Managed Care Weekly Digest, p.59, on December 2008 about one-half (57%) of Americans polled were fearful that they will not be able to afford health insurance or seek medical attention when they need it. However, reducing costs in health care reform is the first health priority. Americans wanted President Obama to reform healthcare and expand health care coverage by making it affordable to many who are falling through the cracks in the current healthcare system. Also the poll shows that healthcare reform is the first priority among health care industry leaders as well. (

American healthcare system is a little bit of everything compared to other major democratic and capitalist nations of the world. The spirit of American healthcare is driven by the free market, which has failed many so far. That’s why the public outcry for comprehensive healthcare reform cannot be ignored by politicians in Washington anymore. Some parts of the American healthcare system have been adopted from other democratic, capitalist countries. For example a PBS video clip indicated that American healthcare offered to veterans is like the UK’s National Health Service (NHS) system; that offered to seniors on Medicare is like Taiwan’s healthcare system; that offered to working Americans with insurance is like Germany’s healthcare system; that offered to the millions of American without insurance is like healthcare system in poor countries/third world. ( Americans are wandering why their healthcare system is failing them. Recently, the increased fear of recession and number of unemployed has caused many to urge reform of the healthcare system as part of the economy recovery plan.

I agree with Nigel Hawkes that in UK “health has got a very, very high political profile” similarly to the United States’ health care issues, healthcare is the system that should be run by the government and foundered by taxation because healthcare is a fundamental human right. ( History has proved that no one can trust healthcare entirely in the free-market without having regulations and government oversights. Because physicians, insurance companies and drugs corporations are interested in making excessive profit, puts the health of people in danger. Therefore, it's a big test of any government to see how well it can make healthcare system work, to operate healthcare as a free market entity.

Those who are in favor of universal healthcare want to see healthcare to be considered as a right. This will require the injection of a lot of money into healthcare, and opponents will become interested to see how well the tax payers money is spent. Hence, it will create oversight on programs, and this will help prevent the make healthcare system from wasteful-spending. America  should consider I adopting multiple systems that are already working in other democratic capitalized countries (such as UK, Switzerland, Taiwan, Germany and Japan) and replacing current system that leaves millions uninsured. Both Republican and Democrats can improve healthcare and act as watchdogs on one another while benefiting their constituencies.

Also I agree with the video clip from the sick-around the world, when Switzerland president who was once opponent of the 1994 reformed healthcare that covers all people now and makes healthcare as a right, that a strong democratic nation should initiate good health for its people. Switzerland’s healthcare system was like American but in 1994 they reformed their healthcare and today it is an outstanding healthcare in the world. For example their insurance administrative costs are 5.5% and in the US is about 22% average. In Switzerland since 1994 reform no body go bankrupt due to medical bills, the drug companies make good profit (not super profit like Americans) and are still in the top-10 leading drug companies of the world. Yet Switzerland people are healthy and covered in spite that it was once under healthcare system that is in American today. I like what Switzerland president said, that the free market system cannot entirely work in the healthcare system because it will diminish solidarity and make its society to loose equal access to the healthcare system. Something that took place in Switzerland in 19980s and early 90s and they had to reform it because healthcare is the basic value of its people. Ironically, that is what has been taking place here in America for long time.  (

Nevertheless, during 2008 presidential campaign I don’t recall any candidate called healthcare as a right even when their constituency asked them plain question if healthcare was a right or not, all they did was dodge the question. This left me and many who are concerned with the raising cost of healthcare wander that how could the government make a criminals to have a right to an attorney paid for by taxpayer and not make healthcare to be a right to all as it affect sick innocent taxpayer and communities at large? I believe that it is a common sense to have healthcare as a right that can be insured to all with oversights. For example the recent out-break of swine-flu virus that spread and killed hundreds in Mexico and as of April 29th killed the first person outside of Mexico, a toddler in Texas. ( This pandemic will affect many, insured and not insured, without their fault but medical treatment will be upon their personal responsibilities and can affect their lives and their families dramatically. If one cannot pay medical bills in America they file bankruptcy and become very limited to the financial opportunities, they are almost handicapped. This is not right; no one calls for disease, and government it should be there to assure its people safety and good living standards.

But I was touched to hear, on March 27th of 2009, President Obama’s response to a question at a town hall meeting.  Someone asked “I want to know from you if the things like preexisting conditions and preventive medicine, if they are a symptom of what's going on in our health care system, then what is the problem? and how do you address it?” President Obama answered as follows: -

Well, I'll talk to you about preexisting conditions, because this is something that I talked about during the campaign; it's something that touched on me personally. My mother contracted ovarian cancer when she was 53, and she died six months later. It's one of those cancers that typically is diagnosed very - at late stages; it's hard to catch early. She was at the time working… And so she had insurance, but when she was diagnosed and the medical bills started mounting up,-this insurance company started saying that this is a preexisting condition, so maybe we don't have to reimburse you. And we had to spend a bunch of time fighting with these insurance companies about this issue. Now, eventually we were lucky we got these costs approved…. But I still remember watching her - you know, she's sick, she's going through chemotherapy, and she's on the phone arguing with insurance companies. And she's lucky she had insurance. There are tons of people out there who, once they've had one heart attack, once they've been diagnosed with diabetes, once they've got some form of chronic illness; from that point forward it is almost impossible for them to get health insurance. And if their employer, especially if it's a small employer, wants to give them health insurance, the costs are so prohibitive that they can't do it even if the employer wants to help….if you've got a preexisting condition you're not going to be excluded but you're going to be able to obtain health insurance. And if you can't obtain it through a private plan then there is going to a public plan that is available in some way to give you insurance, (PRESIDENT SPEAKS)

In his answer President Obama also said that his Administration has seen some indication that insurance companies will be willing to provide insurance coverage to every American if under healthcare reform everyone is mandated to buy health insurance. He said for those who cannot afford to buy from the private companies, the government can pay for them or provide them with affordable insurance. His overall goal is to make healthcare insurance affordable and without pre-existing conditions, just like automobile insurance.

My Approach On Healthcare:

After considerable research and thought, I have came up with a eleven point solutions to reform our healthcare system so that everyone will be covered with dignity and healthcare is a fundamental right to all citizens.

First, I think that healthcare it should be a right based on fundamental principles of human rights. Every one should be required to have health insurance just like it is in the auto insurance. This provision will make insurance companies and drugs corporations to act more humanly when come to healthcare matters.

Second, Government should use its purchasing power by selling insurance in the free markets so that it can create competition; and people should have choice and bargain power. They can either purchase their healthcare insurance from the government or from private companies, as they see fit according to their demands.

Third, insurance companies should be mandated to cover everyone regardless of pre-existing conditions. Also citizens should be mandated to buy insurance just like it is in the auto-insurance, but with tight oversights.

Fourth, both governmental and private healthcare insured people (every one) should be covered for unlimited diagnosis, preventive cares and treatments. However, Americans should be allowed to buy extra coverage of their choice from private insurance, such as cosmetic and other extras; but they will have to pay for it depending on free market value.

Fifth, for poorer (who cannot afford), elderly, and children who covered by governmental programs that are currently in place (Medicaid, Medicare and SCHIP).  If private insurance can offer them good reasonable benefits at cheaper price and more benefits than they are getting from the government, then they should have a choice to go to the private insurance and government should pay for their premiums.

Sixth, Americans who are not eligible for government run programs such as Medicare, Medicaid and SCHIP they will required paying premium of their purchased insurance, depending on the markets. I’m not for free-healthcare system that is run by government like Canadian healthcare system.

Seventh, government should make Pharmaceutical Corporation to compete with other national and international drug companies here at home. This is to eliminate Patent Protection Act/Laws because currently they are giving American drugs corporations a total monopoly of selling drugs in America and this contribute to drive the cost of healthcare higher than usual. The reason is to encourage competition by removal of monopolization of drug corporations because it will drive down the healthcare costs.

Eighth, government should subsidize drugs, vaccines and other health related research and studies by incentives. If they remove Patent Protection Laws drugs price and healthcare cost will come down and government will save a lot of money from Medicare, Medicaid and SCHIP.  We are not loosing much because Patent Protection Laws are not followed or honored by other countries, such as India, China and South Africa. They make their own generic medication from brand name American medicine without any benefit to Americans. Then why American should suffer from these Patent Protection Laws

Ninth, allow Americans to import drugs from other countries so long they are monitored and passed by Food and Drugs Administration’s safety standards. This process will allow a true competition among Americans companies and more choices to Americans, something that will drive the cost of healthcare down.

Tenth, for Medicare, Medicaid and SCHIP programs, federal government should set a own price that it is willing to pay physicians. The risk is that some physicians might refuse government price. But government can incentivize physicians to accept to government’s price by offering to pay off their student loans and giving similar inducement under the National Service Act.

Eleventh, government should allow qualified Registered BS-Nurses, Registered Nursing Parishioners and Registered Physician Assistants to do more procedures that don’t require specialists or physicians. By removing physicians’ monopolized services will reduce healthcare burdens, because physicians are charging very high costs in our current healthcare system. Because the scarcity of physicians makes them charge more than it should be and that makes healthcare costs higher than usual. For example most preventive care and minor diagnosis and or treatments don’t require physicians, especially in the clinics.

The health care professional and patient relationship is very crucial and sensitive. Most of us are pursuing our education to attain a dream career in the occupation that pays good money; but very often these careers come with responsibilities that need personal commitments that have social meaning that is apart from personal satisfactions. Healthcare professionals are vested great powers that are responsible to the safety of other individuals and community at large. Therefore legal and ethics issues on the healthcare industry are the moral guidelines that both professionals and individuals should be abide with in any community. If that is the case, then healthcare should be a right to every one regardless of his or her religion, race, gender, nationality, political affiliation and or social class. I urge politicians, CEOs of the Insurance and Drugs Corporation, Healthcare professionals and their constituencies to act with manner and ethics while reforming the current healthcare that has failed many that way history can not repeat itself. Humanity in the healthcare profession is to subject my own attitude, choices, preferences and tastes to the standards which currently and partially define the practice. We have to learn to recognize what is due to whom; we have to be prepared to take whatever self-endangering risks are demanded along the way; and we have listen carefully to what we are told about our own inadequacies and to reply with the same carefulness for the facts.” (Tong, R. 2007, p.39)


(Managed Care Weekly Digest, p.59) Marketing and Licensing Agreements; Three-Quarters of Americans and Industry Leaders Want Health Care Reform in President-elect Obama's First term. (2008, December). Managed Care Weekly Digest,59.  Retrieved February 22, 2009, from ProQuest Health Management database. (Document ID: 1602207751).

McKenzie, J. F., R. R. Pinger, et al. (2008). An introduction to community health. Sudbury, Mass., Jones and Bartlett Publishers.

Tong, R. (2007). New perspectives in health care ethics : an interdisciplinary and crosscultural approach. Upper Saddle River, N.J., Pearson/Prentice Hall.

Dominic Hodgkin,  Constance M Horgan,  Deborah W Garnick,  Elizabeth L Merrick. (2009). Benefit Limits for Behavioral Health Care in Private Health Plans. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 15-23.  Retrieved April 30, 2009, from ProQuest Psychology Journals database. (Document ID: 1638227241).

PRESIDENT SPEAKS AT 'OPEN FOR QUESTIONS' TOWN HALL. (2009, March 27). US Fed News Service, Including US State News,***[insert pages]***.  Retrieved April 30, 2009, from General Interest Module database. (Document ID: 1668346901).

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Anonymous said...

I think every one need to know that Pr-existing condition is the groud for denied health insurance. Insurance are big business, for money and profit. If you have chronic disease or a condition that will make you use health-care services frequently, they dont want you. It is simple like a Bank that don't want lend money to someone who has bad credit or filed bankrupt because the bank money is not secured. Now, most of healthcare facilities and insurance when they treat Medicaid and Medicare patients they do what we call "Cost Shifting" and that is what raises tax-payer spending on these programs.

My opinion is let's have clinics in the cities, tows and neighborhoods that people can regularly go for diagnosis and treatments, and major hospitals can be referral institutions when specialty is needed, for those who can afford to pay big-bucks hey, be my guest and use the Major Hospital for whatever you see fit cause you are paying for it from your pocket, not from Tax payer or insurance pools that are shifting costs from other insured by raising fee rates; that is what we have now. These clinics are affordable and cost friendly with payment plans. This will alleviate the burden of using ER as clinic. Using ER as clinic for flue shots, small fever, cough and early diagnostic centers is like using Five Star Hotel as an Apartment when someone is evicted.

Fatherhood Blogger said...

I think you said it right. What you said will be possible only and only if everyone will be responsible and take part by doing his/her share. The problem is in the money making businesses, ethical and moral issues tend to walk by the window, that's why we have oversights in the Wall-Street such as SEC. I think Free markets for now can readjust and states have choices/options on how to set-up these exchange market that can reflect free markets. To have clinics in the neighborhood, towns, and cities is the good idea, we do have urgent care but not enough to easy the load of ER. Health-care issue is complex, and for sure there is not going to be a uniform way of implement a single plan because that is not how it works in the free society where every one has a choice and free will to have services available, free markets are the true answer and the will of the investors in these markets can make a huge difference.