Healthcare Reform
No subject has had more economic and social impact on more Americans than healthcare. This
subject has been debated for decades by lawmakers, healthcare professionals and regular Americans for
the latter part of this century. The US healthcare system is fiscally the largest in the world. As such, it
offers the world's most cutting edge medical research and development. From new forms of
medication to life saving technology, no other healthcare systems is as advanced. There have, however,
been a growing number of trends that have brought into question the US healthcare systems
sustainability and accessibility to the general population. In response to this, new legislation has been
enacted in the hopes that healthcare may not only maintain its competitive edge in research and
development but also become more accessible to all. Although healthcare as a whole is an extremely
complex subject, its discussion will be broken down into manageable sections and analyzed.
New Legislation and its Impact on Healthcare Reform
In March of this year, the U.S passed its first and largest universal healthcare initiative. This bill
was meant to address many of the problems identified in our current healthcare system. Although
heralded as a sweeping and permanent reform, the bill itself was enacted through a process called
budget reconciliation. This form of legislation is intended for budgetary purposes and disallows
legislation not directly affected by revenue. Due to heavy opposition to healthcare reform in its early
stages, congressional leaders were prompted to enact healthcare legislation that fell within the
perimeters of budgetary reconciliation. The benefits of this maneuver were that congress only required
a simple 51 vote majority in order to pass the bill rather than the 60 vote majority needed without
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reconciliation. The drawback of passing legislation through a budgetary vehicle is that budgets are
subject to finite time frames. As such healthcare reform is subject to the same finality that its
corresponding budget is, making it a less permanent form of legislation. This finality may play a part
in the systemic effects of reform over time.
Our Healthcare System's World Standing
Many of the critics of the US system of healthcare do so by comparing disparities between our
system of healthcare and those of other developed nations. According to the World Health
Organization, the US ranks 37th in the administration of healthcare in the world. Conversely, other
developed countries are at the very top of the list of providers of healthcare. (WHO 2010). France for
example is ranked as the WHO's top provider of healthcare, and boasts some of the best longevity and
live birth statistics. In fact the US's live birth and other key statistics are some of the worst in the
developed world. This has been a troubling trend for a country with such vast medical resources. This
significant gap between research and development versus accessibility of care has caused many to
examine the viability of utilizing other systems of health administration. The French system of
healthcare, one very similar to our newly enacted system, relies on an eclectic mix of private insurers,
cooperatives or insurance exchanges and tax funded government subsidies. As a result of this
combination of systems, the French enjoy healthcare coverage for most of its citizens, and boasts
some of the world's best longevity and birth rate statistics. This mix of insurers was designed to
augment private sector insurance through subsidies meant to bridge the gap between the insured and
uninsured as well as disperse the risk of insuring the gravely ill and elderly. In addition to subsidies,
French legislators have regulated their market with cost restrictions and mandates for the availability
of healthcare providers. Although a top system, French healthcare has been riddled by growing
inflation as the demands of a rapidly aging population takes its toll. This has been due in no small
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part to the overuse of clinics and hospitals and a growing culture of fee for service treatment. The latter
gives incentive to healthcare professionals to provide sometimes unnecessary treatment in order to
increase profits. Systemically this can balloon healthcare costs and artificially drain insurance and tax
revenues. Another point of reference on healthcare administration is the Netherlands. Dutch healthcare
has been highly regarded as spear heading efficiency for its dual system of insurance. In it there is a
robust private sector subsidized by a single payer system. According to the European Observatory on
Healthcare Systems the Dutch make this system more efficient by having primary caregivers act as
“gatekeepers”, both practicing preventative medicine and referring patients to specialists on a need
need basis, thus avoiding possible wasteful spending. Ironically, the Dutch model has had mixed
reviews, as many underprivileged sectors remain without access to proper healthcare.
Economics of Healthcare
Although healthcare represents a sizable part of our economy, understanding its economics can be
very tricky. An example of this on a legislative level is Medicare. It has been said many times that
Medicare is an entitlement on the verge of bankruptcy, and an example of a failed public healthcare
scheme. Its solvency and future, however are in some ways subjective. Although current projections
predict near future insolvency, Medicare like many other government programs is subject to an
adjustable budget and cost cutting measures. Claiming its structure is flawed in perpetuity is akin to
saying that budgetary shortfalls have doomed the Department of Defense to future insolvency. It is
inconceivable that we would not adjust the D.O.D's budget to ensure its future viability in a dynamic
economic climate. So too is it questionable that we lack the ability to adjust medicare's and other
budgets to ensure long term viability. As a whole, the US spends more per capita than any other nation
on earth on healthcare. (W.H.O 2010). Given its abysmal live birth rate and the inaccessibility of many
to healthcare, this this can be quite confusing. Healthcare in this country, as with most other economic
sectors, is based on a free market system. In it consumers are empowered to make purchasing decisions
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based on several options. Consumers are empowered to make purchasing decisions with
the expectation that the open market will foster competitiveness and fair pricing. Strangely, domestic
healthcare cost has outpaced GDP by +2.5% and continues on an inflammatory track far wider than the
economy. (Mckinsey 2008). In addition, US patients pay out of pocket costs at a rate of 17% of
medical expenditures. This compared to Britain which has a 3% rate of out of pocket payment. (Reid
2008). With a free market system and the most cutting edge medical research and development, this is
puzzling. Some of the answers to this quandary lie in the nature of healthcare. In the US, it has been
estimated that 1/3 of patients recommended for heart bypass do not need it and that 17% of actual
bypass patients either saw no benefit to the surgery or were exposed to unnecessary risk.(Gibson 2010).
Such insight is helpful in understanding our free market's ability to perform well in the healthcare
arena. A closer look at domestic healthcare shows a blaring problem in the customer mentality. The
average American pays about 10% of their medical bills out of pocket. This causes an insensitivity to
price and dulls the motivation to shop for the best value. In addition, 50% of Americans have
health insurance through their employer. These plans almost never offer a choice of insurers, and if
they do, the choices are extremely limited. This is due to the fact that insurance companies conduct
localized monopolies in specific markets. As such a resident of one state cannot seek insurance from
another state, as their options are limited to their home state only. These restrictions in options mixed
with a dulling of price sensitivity has led the healthcare consumer away from moderating prices and
toward complacency. The effects of this have been the unchecked rising of the cost of healthcare.
According to the Mckinsey Institute, healthcare prices are most inflated by the use of outpatient
services. Mirroring advances in non invasive medical treatments, patients have been treated on an out
patient basis with more regularity than ever. This form of of treatment represents a cost saving measure
in the short term, but long term effects of empty hospital beds is a higher cost per patient ratio for in
patient services. The result of this higher cost of admission and convalescence is a commensurate
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increase in the cost of giving birth and treatment of serious illness. Without less cost effective
healthcare options, many patients who cannot manage their medical burdens simply file for bankruptcy
protection. As with all parts of the private sector, losses of this kind are recouped by higher hospital
costs and insurance premiums, driving up the overall cost of healthcare.
Possible Solutions
The US is the only developed nation that has no set manner of healthcare management. (Reid
2009). For this reason, capitalism and its inherent aversion to social prerogative have left millions
without proper care. Add to this out of control medical inflation, and our new healthcare bill was
formed. This bill, although not without flaws, may very well rein in some of the wastefulness and
misuse in our system, while protecting and even enhancing individuals choice. One of the bill's
main ways of doing this is the inclusion of people of all medical conditions into the system; the cost
offset by mandatory health coverage for all. This maneuver is meant to preempt the escalation of
costly serious illness while supplying a diffuse enough premium base to handle a higher claims. In
addition, the healthcare bill handles the perennial problem of waste and fraud by more strictly
overseeing and funding entitlements such as Medicare. In doing so, the bill helps to curtail the
dangerous practice of fee for service, and guides medical care towards illness prevention and
adequate care giving. In all, a healthcare system as rich as ours in innovation and talent should not
be diluted but allowed to flourish in a responsible fashion. It is clear that we cannot use a strictly
“laissez faire” capitalist model when dealing with healthcare, as the management of health
intrinsically carries heavy social ramifications. We also must recognize that healthcare delivery in
the private sector fosters innovation that cumbersome bureaucracies simply cannot. Healthcare reform
promises to apply serious budgetary oversight in order to control cost and availability, while still
allowing ingenuity to grow.
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Outline
I. introduction
ii. Background information
a. Importance of healthcare Reform
b. Dominance of Our System of Innovation
c. Accessibility
1. Legislation dealing with accesability
iii. New Legislation and its Impact on Healthcare Reform
a. How the bill was enacted
1. Temporary nature of the bill
b. Drawbacks of the legisation
1. Budgetary reconciliation
iv. Our Healthcare System's World Standing
a. Other developed nations
1. Our ranking in health delivery
b. France
1. France's systemic performance
2. France's systemic drawbacks
c. The Netherlands
1. Dutch systemic performance
2. Dutch systemic drawbacks
v. Economics of Healthcare
a. Portion of our economy
1. Analogy of Medicare's sustainability
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b. The free market and Healthcare
1. Medical inflation
2. Insensitivity to pricing
c. Outpatient treatment
1. Higher per patient cost
vi. Possible Solutions
a. Larger premium pool
b. Cost controls
c. Allowance of preexisting conditions