Heath Care Problems in the United States
The US healthcare system is notable the most expensive system in the whole world. However, the system leaves approximately 50 million of its citizens without medical coverage. It also fails to provide sufficient medical cover for millions more. The system also on average providing a lower quality of in relation to other health care system around the world that spend much less.
The United States healthcare system appears to drift towards for bankruptcy; this is attributed to the constant and ever rising unsustainable costs. These costs can only be successfully restricted through legislative reforms more specifically in the payment and insurance for medical care. The legal reform is highly dependent on a favorable political environment and a sufficient support from the general public. Notable is the fact that the legal reform will not be able to achieve the required milestones, without adequate change in the medical services organization. The current movement in the US health care environment, especially in the large multi-specialty group’s hints of a reorganization of the medical care could be well under way. If the trend continues, it may not only ease the progress of the passing of legislation, but also assists go a long way in making the health care more proficient and affordable (Jacobs & Skocpol, 2010).
At present, a good number of US physicians operate a solo practice or are into small, single-specialty partnerships. The new social and economic factors are starting to make employment in vast multispecialty organizations a much more eye-catching option. Approximately, a quarter of all US medical practitioners, are now working with such groups. These have to be created by independent physician groups or hospitals (Miller & Hutton, 2010). If this number keeps on to increasing and eventually stand for the great bulk of working physicians, a brandish of legislative reforms might be commenced to transform the currently failing healthcare system. Before analyzing the way forward, it is prudent to have a look at the failures of the current system.
The US medical care system is a puzzling hodgepodge that does not make any sense to knowledgeable observers. Even though it is at extreme, the most luxurious in the world, it now leaves millions of citizens without medical coverage. It also does not adequately provide sufficient cover for further millions more. The majority people also have no capability for the cost of extended and rehabilitative care. Despite massive expenditures, the eminence of care is highly erratic. However, on it is average substandard to a lot of the developed countries who spend way less (Merino, 2011). The best practitioners, hospitals and care obtainable in the US are among the best found nearly anywhere, despite its access is disgustingly uneven. A lot of individuals receive inferior care and by far very many get nearly no care apart from when infirmity is far advance developed or when it is an emergency.
Reason for the enormous costs and inefficiency of the medical system
In my observation, by far the best account of the predicament is because the United States, together with all many of the Western states, has permitted the healthcare system to develop into a market. Also, its practitioners act as if they are in business. In the United States medical care has changed into a vast and very competitive industry, this has lead to many private investors with little or no government directive (Jacobs & Skocpol, 2010). The industry comprises of a more than $2.7 trillion. Currently, the US healthcare industry constitutes approximately 18% of our whole economy and continuously grows. However, the growth has dampened over the past two years, attributing to the effect of the recession. There was a reduction of employment-based insurance and also the capability of a majority people to have enough money to pay for care. It is expected that the expenditures will possibly resume after the improvement of the economy and renewed by the federal government to cater for medical attention.
The United States forms an obvious example of what may happen the instance medical care turns out to be a commodity in a business other than a social amenity. As the market for medical care holds opposing views to other markets, the classical market forces do not affect their normal control over players and therefore do not adequately control the supply and demand. The US medical market, specifically those who extensively control the service supply, determine the demand in the industry. Notable patient needs, in fact, do play a significant role. However, it is the practitioner who takes stipulate what services are required for diagnosis, prevention, and treatment of the need. In addition, it is the physician that the consumer (patient) relies on for the well need advice and prescription (Merino, 2011). The fees charged for such service offers payment by which most practitioners are paid provides a strong financial incentive to be considerably generous in what they recommend and the provision of services.
These facilities, paid for each particular item in service or per episode of care, such as per visit to a clinic, has high financial incentives to maximize on the quantity of their gainful services to increase the number referrals to paying patients. In addition to the direct marketing made to consumers has encouraged doctors to use their facilities to refer patient’s o their practices through offering some favors and monetary agreements. Medical products such as prescription, medication, and equipments constitute to more than 15% of all costs. It also promoted by the manufacturers similarly to commodities that are in a trade other than the appropriate as per the medical need.
Not only has the government done little to regulate the amount of services and products that are in the United States healthcare market, but has done little to control the pricing of these services. The presence of commercial competition in the industry prompted by the lack of regulation has affected the behavior, nearly all the players in the industry. Not more half of the United States health care, economy has investor-owned institution (Miller & Hutton, 2010). Most of the others other organizations, mostly known as non-profit making have a mindset of competitive business that are in competition with also see themselves as businesses competing for market share (Miller & Hutton, 2000). The thought makes them behave in such a manner similar to profit-oriented organizations that are owned by investors. Nearly all companies and numerous physicians seek to make the most of their income. The gross result is the practically unrestrained increase of the health costs.
The enormous cost is given by the over-reliance on the Medicare system in the private with respect to profit insurance plans. They number in the hundreds, however, been increasingly consolidated under considerably a few large corporations. The private plans insure or to some extent provide a billing and collecting services for over half of the entire population. This includes most the individuals covered through the courtesy of employment and the ones who have self-insurance (Merino, 2011). In addition, nearly a quarter of those above 65 have chosen to have Medicare cater for their care via private plans. This has been done in response to active marketing done by private insurers who cater for some other services not provide in Medicare services. In total, private insurance makes up an enormous and rapidly growing industry, with an approximately a gross income of roughly over $800 billion. Their net business expenses and costs vary significantly, but an average range from 15% to 25% of their premiums collected.
From the research done by the United States federal government, estimates of private insurance have added approximately over $150 billion to the cost of healthcare budget in 2012-2013 fiscal year. Despite the claims by the insurance providers to the contrary, these plans have a little or no value addition to the covers they provide. Worldwide, there is no other state that has a dependency on the somewhat unregulated private profit-oriented insurance companies. In other developed countries, like Switzerland and Germany, have private insurance plans as a core part of the entire health system. However, the plans are not based on profit and are way more regulated by government than similar plans in the US.
The Affordable Care Act of 2010
Since the crisis in the United States health care system is directly caused by spiraling costs, many of the legalization endeavors that are associated with health care are aimed at creating an extension of the current benefits in insurance and also protecting individuals covered. One of the most landmark bills is the Affordable Care Act. The bill was voted for by the Democratic-controlled Congress in early 2010. Democrats have highly praised the legislation as a major move towards solving the US health care system’s problems (Miller & Hutton, 2000).
On the other side many liberals, hold reservations on the bill. The act gives a dedication towards providing more resources towards drugs and to offer subsidies to private coverage to approximately the 16 million uninsured individuals. In addition the bill seeks to assist states to extend their Medicaid coverage and also prevent private insurance providers from refusing coverage to individuals with pre-existing condition and/or dropping coverage to those who develop conditions that require extensive care.
The majority of these benefits are scheduled to start within this year, 2014, notable is a few have already begun. The law contains fundamental advances, but it has no provisions that will aid in creating reliability in controlling the rising costs. In order to persuade the politically powerful and private insurance industry to hold up the passage of the legislation, President Osama had to include in the bill a prerequisite to all uninsured individuals buy private insurance (Miller & Hutton, 2010).
Some of the provisions in the legislation have not yet been entirely implemented, and a few inventiveness has already started with some of the private insurers testing by substituting the fee for service payment system with the new provisions. They reimburse providers for episodes of care, or egg on groups of practitioners to share in any nest egg from presumptuous of the all-inclusive care of a selected panel of patients. These professional groups, associated with more hospitals. This is called “accountable care organizations.” There are 32 such groups in the various parts of the state have a moment ago signed contracts to implement this model (Miller & Hutton, 2010). It is, however, too early to determine whether the initiatives will be able save money and its acceptability by doctors to their patients or whether they can work as expected. These efforts have been hailed by the president’s administration and individuals who believe that the modest changes in the current insurance and payment systems can control costs and also improve the quality of care.
Many are convinced through the looming national cost crisis and the possible bankruptcy of the healthcare system cannot be averted except if there are more drastic and systematic reforms, we will also have to substitute all our insurance systems, both public and private, with a one public plan that will guarantee the universal right to prepaid, inclusive care. This program must be funded by a progressive health care tax that applicable to all citizens and pay in accordance with their individual means (Miller & Hutton, 2010). The Prepaid inclusive care funded in such a way could give the government a substantial control over the total healthcare spend while leaving results on the explicit use of the available resources where it should be in the palms of physicians and also their patients. By setting the basic rate of the tax, the government could in effect be setting limits on its costs. Every medical service provided out of the system would be done at the patients’ cost.
In order to provide this form of prepaid inclusive care, we will have a reorganized medical care system that is based on private, non-profit, multispecialty group practices, in which physicians are paid mainly or entirely by salary. If a fee for service payment is to be largely or wholly replaced by prepaid, capital payment, we will need medical organizations that can accept such payment and distribute an agreed, the total percentage of physicians through salaries (Waldman, 2010). The kind of multispecialty group practice that I have described in more detail elsewhere would be the ideal organization to serve this function.
There are ample reasons and considerable empirical evidence to suggest that group practices can deliver care more efficiently than unorganized physicians in solo or small, single-specialty partnership practices who compete for income and depend on fee for service payment. Multispecialty groups usually include adequate numbers of primary care physicians who integrate and moderate the procedure based behavior of the specialists (Stavans, 2010). Most experts agree that substantial savings, as well as improved care, can be anticipated when primary care physicians collaborate with professionals in well-organized groups. Without the fee for service incentive, prepaid salaried groups of this kind are less driven to unnecessary or duplicative services. And if the system is funded entirely by government without involving bills, the costs of insurance overheads and fraudulent billing are avoided. The potential savings would be enormous; a reduction of 30% to 40% of total expenditures would be a conservative estimate.
Multispecialty practices the future
Multispecialty, physician managed group practices already exist in many parts of the US, mostly in the west, and least in the southeastern states. Some are well known, long established, and highly reputed. Only a few groups pay full salaries and most are still dependent on fee for service payment from multiple public and private insurers. However, the number of group practices in the country of all kinds and the number of physicians employed in these methods is increasing rapidly. There are at present over 400 such groups, using nearly 200 000 doctors (about 25% of all practicing physicians). These numbers are increasing at about 10% per year, according to information recently given to me by the American Medical Group Association, the organization that represents most multispecialty groups (Waldman, 2010).
conclusion, there are many reasons why so many US physicians seem to be
abandoning private practice in favor of seeking employment in large groups.
Many starting physicians have acquired large personal debts during the course
of their education and cannot afford the investment and financial risk of
setting up their practice. The supporting staff and facilities available in
group practices and the assistance they offer to the business and
administrative expenses of training are very attractive; so are the retirement
and fringe benefits. Furthermore, young US physicians nowadays are much more
interested than formerly in practice settings that allow them to share
responsibilities with colleagues and to work specified hours rather than
assuming the heavy time demands of solo or small partnership practice(Waldman,
2010). This is particularly true of women physicians, who shortly will
constitute half of the physician workforce. But physicians of both genders are
increasingly interested in a professional career that allows them more time for
family and personal affairs. Employment (full or part-time) in large groups
provides that opportunity.
Jacobs, L., & Skocpol, T. (2010). Health care reform and American politics. New York: Oxford University Press.
Merino, N. (2011). Health care. Detroit, MI: Greenhaven Press.
Miller, R., & Hutton, R. (2000). Problems in health care law. Gaithersburg, Md.: Aspen Publishers.
Stavans, I. (2010). Health care. Santa Barbara, Calif.: Greenwood.
Torrens, P. (1978). The American health care system. Saint Louis: Mosby.
Waldman, D. (2010). Uproot U.S. healthcare. Abuquerque, N.M.: ADM Books.