Universal Healthcare & Medicine
Universal Healthcare & Medicine
Final Essay, Final Essay
Imani Sumpter
Nightingale College
Professor Kamri
Universal health care, in basic terms, means that every citizen can access basic health care services. This, however, does not mean that only the government pays for healthcare access. Most of the countries around the world that supply universal health care use a combination of public and private strategies, plans and other measures to implement this process. Additionally, in most cases, these universal healthcare providers are privately owned entities that use established facilities and supply proper equipment.
Some of the advantages when it comes to universal health care include lower overall health care costs, lower administrative costs, creates competition and a healthier workforce, supplies early childhood care, prevents certain future social costs and much more. For instance, regarding lower overall health care costs, the government controls and sets the prices of goods and services through negotiations and regulations. When it comes to lower administrative costs, doctors will only need to work with one government agency, instead of a multitude of companies. Early childhood care helps prevent crime, violence and other health issues.
There are some disadvantages to universal health care. A few of these consist of healthy people paying for sicker citizens, people have less financial incentive to stay healthy, longer waiting times, doctors may cut care to cut costs and many other factors. There would be rising costs when it comes to universal health care considering the negative effect of individuals not having a financial incentive to remain or stay healthy. This would, in turn, lead to longer wait times for medical facilities and potential overcrowding in these places. There is an extensive list of disadvantages of universal health care that need to be taken into consideration.
Though doctors in the United States may refuse to treat people who cannot pay for their healthcare services, under the Emergency Medical Treatment and Labor Act (EMTALA), hospital emergency rooms cannot ask about a person's ability to pay until after the person has been medically stabilized by a physician. Knowing this, most experts do not believe that EMTALA signifies universal health care.
In an understanding sense, universal health care is all about access to emergency and preventive health services. Under this definition, the United States favors universal health care. But this term is often constrained to refer to access to health insurance or services—in which case, the United States does not favor universal health care.
In most cases, universal healthcare coverage and a single-payer system go together, since the country's federal government is the candidate to administer and pay for a health care system covering millions of people and citizens. It is difficult to imagine a private sector entity like an insurance company having the means and resources, or even the overall inclination, to set up a nationwide health care coverage system. Therefore, it is very possible to have universal healthcare coverage without having a full single-payer system, and several countries around the world have done so. Some countries run a two-tier system in which the government provides basic healthcare with added coverage available for those who can afford coverage with a higher standard of care.
When understanding the future of health insurance in the U.S., terms such as Universal Health Coverage, Single Payer, and Socialized Medicine are often used interchangeably, but they are not the same thing. The World Health Organization’s definition of Universal Health Coverage is “that all people and communities can use the promotive, preventive, healing, rehabilitative and soothing health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”
While the term "Medicare for All" is often used to describe a program under which the U.S. government would supply coverage to all American citizens, there are different approaches that have been proposed and they would all include more robust coverage than the current Medicare program provides. These approaches have been incorrectly labeled "socialist" by most in the Republican Party, but none of the current Medicare for All proposals would incorporate socialized medicine.
Socialized medicine is another phrase that is often mentioned in conversations about universal coverage, but this model takes the single-payer system one step further. In a socialized medicine system, the government not only pays for health care but runs the hospitals and employs medical staff.
A country can adopt a single-payer approach (the government pays for medical care) without a socialized medicine approach. In the United States, the Veterans Administration system is an example of socialized medicine, but Medicare is not. The National Health Service in the United Kingdom is an example of a system in which the government pays for services and owns hospitals and employs doctors. However, in Canada, which also has a single-payer system with universal coverage, the hospitals are privately ran, and doctors are not employed by the government. They simply bill the government for the services they provide, much like the American Medicare program.
An example of socialized medicine and its implementation in society is the VA Healthcare system. The VA healthcare system is run by the government under the U.S. Department of Veterans Affairs and the Secretary of Veterans Affairs, a cabinet position appointed by the President and approved by Congress. The budget for VA is part of the federal budget. Priorities for how it is spent and what services are provided by the VA are set nationally and subject to political influence. While scandals arise from how the VA supplies care, it is a measure of how the VA is accountable to the public, while private health care organizations do not have to be transparent.
The difference in meaning among the terms universal healthcare, single-payer healthcare and socialized medicine is clear but still conflated. Therefore, in the ongoing debate over healthcare reform, started by the passing of the Patient Protection and Affordable Care Act and persisting through the "repeal and replace" tries of other administration(s), pundits have played on people's hopes and fears by carefully misusing this medical jargon and language. Commentators and Republican experts conflate single-payer with "socialized medicine," a concept vague in the popular imagination but linked to countries like Cuba—a socialist dictatorship—and Canada, which has notoriously long lines and less patient autonomy.
For universal health care to work, citizens, including healthy individuals, must pay premiums or additional taxes to pay for this type of healthcare. This funds a security health blanket for all citizens in the country. Ideally, with a health care system under government regulation, everyone will have access to quality treatments at low costs. This type of system would provide very affordable preventive care and implement necessary control of pricing and quality of drugs and medical services.
U.S. health care is not as inclusive as other developed countries. Instead, it has different models for targeted populations. Obamacare is the closest to universality the United States has ever implemented, but it falls short because of its many exemptions. Some experts have suggested that the United States should incrementally reform its current health care system to provide a government-funded safety net for the sick and the poor. This is a form of an expanded version of the ACA's Medicaid expansion while requiring those who are more fortunate health-wise and financially to buy their own policies. However, the political gridlock that has been in place over the Affordable Care Act over the last decade makes it difficult to imagine such a proposal gaining enough traction to pass. But it is technically possible to construct such a system, which would provide universal coverage while also having multiple payers.
On the other hand, a single-payer system is one in which the government handles paying health care claims, using money collected via the tax system. So, the government is the only single payer. There are currently at least 17 countries that use a single-payer system, including Canada, Norway, Japan, Spain, the United Kingdom, Singapore, Portugal, Sweden, Slovenia, Brunei, and Iceland. But single-payer systems can also be implemented without covering the entire population.
A country can have one or more single-payer programs and still not achieve universal coverage. This is what we see in the U.S., with a combination of single-payer coverage for some people, private coverage for others, and tens of millions of people who have no coverage at all. In the United States, Medicare and the Veterans Health Administration are examples of single-payer systems. Medicaid is sometimes referred to as a single-payer system, but it is jointly funded by the federal government and each state government. So, although it's a form of government-funded health coverage, the funding comes from two sources rather than one.
The United Kingdom is an example of a country with universal coverage and a single-payer system. Technically speaking, the U.K. model can also be classified as socialized medicine since the government owns most of the hospitals and employs medical providers.
Funding for the U.K. National Health Service comes from tax revenue. Residents can buy private health insurance if they want to. It can be used for elective procedures in private hospitals or to gain faster access to care without the waiting period that might otherwise be imposed on non-emergency situations.
Japan has universal coverage but does not use a single-payer system. Coverage is mainly provided via thousands of competing health insurance plans in the Statutory Health Insurance System (SHIS). Residents must enroll in coverage and pay ongoing premiums for SHIS coverage, but there is also a possibility of buying private, supplemental health insurance.
Singapore has universal coverage, and large health care expenses are covered (after a deductible) by a government-run insurance system called MediShield. But Singapore also requires everyone to contribute 8% to 10% of their income to a MediSave account. When patients need routine medical care, they can take money out of their MediSave accounts to pay for it, but the money can only be used for certain expenses, such as medications on a government-approved list.
In Singapore, the government directly subsidizes the cost of health care rather than the cost of insurance (in contrast with the approach that the United States takes with coverage bought through the ACA health exchanges, in which the cost of the health insurance is subsidized). As a result, the amount people must pay for their healthcare in Singapore is much lower than it would be under a U.S. Model.
The Canadian healthcare system is administered by the provinces with shared funding between the provincial and federal governments. It is a single payer system in that providers offering services covered by the government program generally are not allowed to receive any private payments for those services. Physician, diagnostic, and hospital care must be covered on a first-dollar basis and providers are not allowed to bill patients for amounts over the negotiated fee schedule. Additionally, specialists are not allowed to bill private patients for supplying publicly insured services – all covered care must go through the public system. However, private insurance does exist to pay for services not offered through the government plan or for some types of enhanced services.
To receive full federal funding, each province’s plan must be publicly administered, comprehensive in coverage (though what is comprehensive is left largely up to the provinces to decide), universal (all citizens and legal residents must be covered), portable across provinces, and accessible (e.g., no user fees). In addition to the public program, most Canadians have supplemental coverage from for-profit insurers, generally provided by an employer or a union, that covers vision, dental, prescription drugs, rehab, home health, and private rooms in hospitals.
There is roughly an even split between general practitioners and specialists, with most general practitioners running in private practice and being paid fee-for-service while most specialists work out of hospitals but are not employees and are also paid fee-for-service. General practitioners who work as gatekeepers and specialists who see patients without a referral receive a reduced reimbursement. Hospitals are a mix of publicly owned and private not-for-profit organizations and run under annual global budgets negotiated with the government.
By implementing a less burdensome single-payer model (rather than the separate government, private, and government-linked private health insurance mechanisms we have in the United States), governments like Japan can better streamline their national healthcare delivery.
People who are covered under employer-sponsored health plans or individual market health plans in the U.S., including ACA-compliant plans, are not part of a single-payer system, and their health insurance is not government-run. In these markets, hundreds of separate, private insurance companies handle paying members' claims.
Rather than one system, United States citizens and residents are insured under a variety of sometimes overlapping systems. The United States is also the only developed country where a considerable number of citizens can be uninsured and where a person’s employment can decide whether they have insurance and what insurance they have. As of 2015, 90% of Americans had health insurance, with 55% receiving coverage through their employer, 16% through direct purchase, 16% through Medicare, 20% through Medicaid, and 4.7% through the military. The individual sources of coverage add up to more than the total coverage because of overlaps; for example, “dual eligible” who are enrolled in both Medicare and Medicaid.
The majority of Americans and their dependents are insured through their employer, with the employer generally bearing a sizable part of the cost. Federal law requires insurance to continue to be offered to former employees, but the entire cost is bored by the insured, who often choose to not pay the premium unless they are sick. Employer-based insurance isn’t directly subsidized, but receives a “hidden” subsidy, estimated to be worth $260 billion dollars per year, due to premiums being tax exempt. This tax exemption is not available for insurance bought in the individual market.
Title XVIII of the Social Security Act was passed in 1965 and introduced Medicare and Medicaid, which have both expanded since. Medicare, which is funded by payroll taxes, premiums, and general tax revenues, provides coverage for people 65 and older and those with qualifying conditions and disabilities under the age of 65. Medicare eligible people may also buy supplemental insurance from insurance companies or heavily subsidized full-replacement insurance called Medicare Advantage.
Medicaid is an insurance program for the poor administered by the states and funded with federal and state general revenues. Eligibility for Medicaid was significantly expanded under the Affordable Care Act in 2010 for states that chose to take part. Besides expanding Medicaid, the Affordable Care Act (ACA) in 2010 introduced an insurance mandate and government-run insurance marketplace with subsidies for those without other coverage. It also cut most forms of underwriting and prohibited insurers from refusing coverage for preexisting conditions. Prior to the implementation of the ACA, the uninsured rate was 13%.
The Veterans Health Administration supplies care for nearly 9 million veterans annually. The system is an example of socialized medicine, with 1,700 hospitals, outpatient clinics, counseling centers, and long-term care facilities owned directly by the federal government and most providers employed by the government. Due to a severe limitation in resources, Congress has directed that priority in treatment is given to veterans most in need, with those with significant disabilities at the top of the list.
There is no perfect health care system. The U.S. has some of the best doctors and hospitals in the world, for those who can afford them. The extent to which medical bills contribute to bankruptcy is hard to tease out from other factors, but even those who are skeptical of the claim that medical costs cause most bankruptcies concede that they are a significant contributor.
In the rest of the developed world, by contrast, medical costs are rarely or never cited as a driver behind personal bankruptcy. There are trade-offs, of course. Patients in The U.K. and Canada often face far longer wait times for care, particularly “elective” care, than those in the U.S. Providers are generally much better paid in the U.S., which is a major driver behind our higher costs, but it also helps prevent the strikes and demonstrations for high pay sometimes seen in Germany and elsewhere. Many Americans cringe at the idea of a government bureaucrat checking up on you if you use too much care as in Taiwan or of the government directly owning and employing most providers as in the United Kingdom.
As the debate over the future of healthcare in the U.S. It is useful to remember that there are many ways to achieve universal coverage. Some countries – Canada and Taiwan – have developed single payer models to care for their citizens. Other countries such as Germany, Switzerland, and Singapore have shown that it is possible to have universal coverage through a combination of public funding, employer participation, and personal responsibility, while keeping a robust competitive market of insurance payers and medical providers.
None of these systems is without trade-offs, though. These various approaches can be useful for Americans to understand, not only to draw ideas from as we look to improve the healthcare system in our country, but also to see that cost-saving mechanisms and broadened coverage have consequences for other parts of the system. America needs to evaluate its own values as a nation to decide what, if any, trade-offs we are willing to tolerate to cover a larger percentage of our population.
References
SOCIALIZED MEDICINE: A SOLUTION TO THE COST CRISIS IN HEALTH CARE IN THE UNITED STATES Author(s): David U. Himmelstein and Steffie Woolhandler Source: International Journal of Health Services, 1986, Vol. 16, No. 3 (1986), pp. 339-354 Published by: Sage Publications, Inc.
Socialized Medicine and Mortality - International Journal of Health Care Finance and Economics Vol. 14, No. 3 (September 2014), pp. 179-205 (27 pages) Published By: Springer
Soviet Socialized Medicine and the Right to Health Care in a Changing Soviet Union - Human Rights Quarterly Vol. 14, No. 2 (May 1992), pp. 206-215 (10 pages) Published By: The Johns Hopkins University Press
UNIVERSAL ACCESS TO HEALTH CARE: A PRACTICAL PERSPECTIVE Roger M. Battistella and John M. Kuder Journal of Health and Human Resources Administration Vol. 16, No. 1 (SUMMER, 1993), pp. 6-34 (29 pages) Published By: SPAEF
