Form health care reform legislation that could not only have lowered the cost of the health care and high quality services, but also create an affordable health care coverage for all the Americans.
In United States, health care costs have been raising with a high rate. Though some experts maintain that the high costs are not a major problem, many disagree with their view due to the fact that majority in the society are affected by the same. For instance, employers suffer greatly due to high employees’ health care costs, the government’s budget is highly strained and lastly the ability of individuals to access health care services is greatly reduced.
Personally, I have experienced problems due to high health care costs. A friend of mine who did not have any social relations due to reasons best known to him got sick and developed a tumor that necessitated a surgical operation. He went to hospital and out his savings; he was able to pay the deposit that is usually charged before any medical procedure is carried out. However, he could not have afforded to pay the total cost incurred after being discharged. He had no medical insurance to cater for his medical bills because with his meager wages from a part time job, he could not have afforded to pay the insurance premiums. As his friends, the only thing we could have done is to organize for a fundraising since most of us were not formerly employed. It was a tough struggle trying to solicit for funds from individuals having enough problems of their own. Nevertheless, we eventually managed to pay the bills and our friend was fully discharged from the hospital.
Such a problem is more complicated to be solved by some cost containment strategies discussed. For instance, creation of a free market to reduce the health care costs can offer little or no help to the problem described above. In addition, increased patient cost sharing which is also based on free market cannot offer much help to the situation. However, some containment strategies that can help reduce the insurance premiums can be very helpful since my friend would have been in a position to pay for his own insurance premiums. Therefore, the containment strategies that can help most citizens need not to be focused only on lowering the costs directly but also on helping individuals both employed and not employed pay for their own insurance cover.
Question 2
In my opinion, the main aim for the development of Managed Health Care in America was to reduce the cost of providing health care to Americans and improve the health care system by offering a variety of programs that one could choose from depending on their income. According to Aspling et al (2005), this managed health care was needed because the Medicare program and the cost of health care had become increasingly expensive especially to the elderly and the poor. At the beginning, the system received a lot of support as many businesses started offering it to their employees and by 1993, the adoption of the plan had grown to 50% as it had managed to control costs in various settings. Aspling et al (2005) record that the plan was able to cut cost for the first two decades since its introduction with the national expenditure per capita dropping from 5.0-6.9(%) in 1991 &1993 to 2.0-2.2(%) in 1994 &1996. Private sector that offered the same recorded the highest decrease in annual expenditure per capita which ranged from 12.5% in 1988 to 4.8% in 1997. Later in the late 1990s, oppositions to this plan began to arise with some physicians opposing the fact that insurance providers were choosing hospitals for their clients. These disagreements led to poor services and eventually consumer dissatisfaction forcing some private providers to withdraw from the plan. With time, the managed care began to decline and it was unable to control costs which it was initially formed to do. Annual expenditure per capita rose creating a scenario which is a major focus of the health care debate in America today.
Question 4
The Absence of a Free Market Creates High and Rising Costs
Since the high costs in the American health care system is a problem to every person, policy makers have come up with different policies and ideas that can used to reduce health care costs. For instance, studies of Bodenheimer (2005) indicate that absence of a free market leads to high and rising health care costs. To some extent, that may be true because as the author states, patients may have an opportunity to seek for the services with low costs. The employers can also be in a position to seek for the health care plans and programs for their employees that are friendly. The author maintains that the forces of demand and supply can help reduce the health care costs. However, the strategy can only be helpful to a certain extent and for some limited time. This is due to the fact that the problem of high health care costs results from a wide range of factors inclusive but not limited to external factors outside the health care system, growing number of the aging population, increase of insurance cover and the fact that the prevalence of disease has changed. Unless such and many other factors related to high health costs are addressed, creating of a free market may only have less or no significant impact.
Question 5
The main focus of the Senator Baucus plan was mainly to form health care reform legislation that could not only have lowered the cost of the health care and high quality services, but also create an affordable health care coverage for all the Americans. Though the plan is similar with some of the congressional plans, it is also different in some ways. Both plans are aimed offering affordable health care to citizens by ensuring that the available health care programs benefit most of the individuals. However, although the Senator Baucus plan is more expensive to implement than the congressional plans, it is predicted that it is going to be more benefitial since once implemented, it can reduce the total number of uninsured Americans. In addition, unlike the congressional plans, Baucus plan is aimed at creating new state insurance market places, a situation that will allow individuals not only to shop for better plans but also to make comparisons (Herszenhorn 2009).
Question 3
A National Health Program for the United States: A Physicians’ Proposal
The main aim of the plan was to reduce some of the problems that were already present in the health care system. This was to be achieved through various strategies like covering every individual under one but comprehensive insurance cover. The proposal was also aimed at paying for the hospital and nursing home costs annually in order to cover for all the operating costs. It may have had many benefits but one major benefit is that it was to act as a cost containment strategy to be achieved through saving on improved health planning, bureaucracy and billing. Nevertheless, the proposal has some drawbacks because it mainly addresses the financial barriers and leaves out other barriers like geographical and ethnic barriers to health care. In addition, there is a great likelihood that some of the patients will still be necessitated to seek emergency care and due to this, some of the physicians may resolve to increase their income by increasing services that are not necessary. Finally, in spite of the fact that insurance will cover all patients including the Aids patients, there would still be the need for both expanded prevention and research. Nonetheless, the proposal is still aimed at addressing such draw backs (Physicians for a National Health Program, 2010).
Question 6
There are a lot legislative health care reforms that have been established with a main aim of improving the consumer access to health care and delivery services as well to reduce the big share of the federal health care costs. For instance, the Health Insurance Portability and Accountability Act enacted in 1996 was designed to protect and ensure health insurance protection for employees and their families especially after losing their jobs. In addition, a legislative act like Balanced Budget Act of 1997 was enacted with a main focus of saving around $ 115 billion dollars in a period of five years. Such legislative efforts and many more can interact very well with congressional efforts since they complement each other and contribute to the common goal of providing quality and affordable health care services (Chitty, 2005).
References
Bodenheimer, T. (2005). High and Rising Health Care Costs. Part 1: Seeking an Explanation. Retrieved on 20th August 2010 from:
http://www.annals.org/content/142/10/847.full
Chitty, K. K. (2005). Professional Nursing: Concepts & Challenges. St. Louis, Elsevier Health Sciences.
Herszenhorn, D. (2009). Baucus Releases Senate Health Care Proposal. Retrieved on 20th August 2010 from:
http://prescriptions.blogs.nytimes.com/2009/09/16/baucus-releases-bipartisan proposal/
Physicians for a National Health Program. (2010). A National Health Program for the United States: A Physicians’ Proposal. Retrieved on 20th August 2010 from https://www.pnhp.org/publications/a_national_health_program_for_the_united_st tes.php?page=4
Aspling, D. L., Lagoe, R. & West, P.G. (2005). Current and future developments in managed care in the United States and implications for Europe. Retrieved on 20th August 2010 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079919/
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