the need for a meaningful national healthcare system in the u s

The Need for A Meaningful National Healthcare System in the U.S.

            America’s healthcare industry shows us one of the most revealing contradictions in the country’s economy.  Even though America claims itself to be the world’s most advanced superpower, it is still unable to provide its entire population with healthcare and even worse, the quality of its healthcare overall is declining in many ways that will be discussed here.  Though many democratic nations provide all of their citizens with healthcare access, the United States instead tries to concentrate the control of medicine into the hands of big businesses like the insurance industry or the pharmaceutical companies.  The result is that the United States has a healthcare industry with a reputation that is getting worse, with large companies benefiting but average Americans suffering from the consequences of this.  Overall, though healthcare should be a right to all Americans, it is treated more like a luxury only available for those who can afford it, creating an industry that cannot continue on its current path and also stay effective at meeting its responsibilities.

            The parties that are the most important stakeholders in America’s healthcare industry are; the consumers of the American public; medical industry corporations such as insurance companies, pharmaceutical companies and managed care firms; publicly provided healthcare programs or facilities; and the United States government as a whole.   The current reality in the medical industry is that while the government and the corporations are sharing the profits of this situation, the medical consumers and the publicly funded, free medical programs are losing out.

            Public health is the entity with the lowest level of representation in American healthcare, with costs of healthcare not just making healthcare unaffordable for a large percentage of the population, but at the same time making up about 15% of the national GDP as a result of the same cost issues. (NCHC, 2004, p. 1) This shows that the high costs of healthcare are not because it is getting too expensive for the average American to afford.  Instead, it is because insurance companies and pharmaceutical companies are trying to get more profit from the American people.

            Truly, this points to biggest stakeholder in the current state of American healthcare.  While the U.S. economy has experienced a continuing downturn in its rate of growth between 2000 and today, the healthcare industry has grown.  On the power of “employer health insurance premiums [that] increased by 9.2 percent – nearly three times the rate of inflation”, America’s largest medical insurance companies did far better than technology and retail sectors during this time in terms of economic growth (NCHC, 2004, p. 1):

            “The California Nurses’ Association said that the world’s 13 largest          pharmaceutical companies earned $62 billion in 2004, while the 20 largest HMOs       in the United States made $10.8 billion in the most recent fiscal year and hospital           profits hit a record $26.3 billion in 2004.” (UPI, 2005, p. 1)

            This would contrast the continually slow growth of the overall economy.  Accordingly, Levit et al (2001) would indicate show that “prompted by sluggish economic growth and by faster-paced health spending, health spending’s share of GDP spiked 0.8 percentage points in 2001 to 14.1 percent.” (p. 154)  These figures show the effects on the consumer, who as a stakeholder has been excluded from a lot of the decision-making processes effecting such things as healthcare costs and the laws surrounding them.  The U.S. government, as a stakeholder as well, has devoted less of the public’s financial investment in promoting innovation than it has in lowering tax costs for large companies.  The government characterizes this priority as a way to encourage growth of large companies so that they can improve the quality of their service.  However, the effect on the average American has not been this way.  Instead, Americans are finding that the healthcare industry is getting more difficult to benefit from all the time.

            A Wall Street Journal Online/Harris Interactive Health-Care Poll indicates that on a whole, the American public “believes that reducing the percentage of uninsured Americans is the most important healthcare issue for the government to address.” (Cummings, 2006, p. 1)  This points to the biggest problem that the healthcare industry must fight, which is the economic prejudice that seems to control pricing and access to decent medical attention.  Unfair insurance practices like the high cost of premiums, the high cost of buying a share in an employer’s company coverage program and the routine unwillingness of insurance companies to cover the costs for many necessary medical treatments have all led to a situation which “causes over 45 million individuals in the United States of America to be uninsured every year.” (McLaughlin, 7)

            The problem of a lack of insurance for many is related to the problem of the cost of healthcare.  For insurance, medical procedures and prescription drugs, healthcare has been increasing in its cost for the consumer at a faster rate than any other industry.  One of the main reasons is the above-mentioned issue of insurance costs, which because of an unwillingness of the government to enforce regulation on monopolistic corporate practices, is a cause for the negative spiral of a rising expensiveness.  “Each percentage-point rise in health-insurance costs increases the number of uninsured by 300,000 people.” (Kessler, 2004, p. 1)  That, some economic experts say, has created a negative spiral where the absence of more payers entering into the insurance market is making the cost even higher for those who remain.  The consequence is that middle class Americans often struggle to deal with medical costs, especially when unexpected medical emergencies occur, even if they do have full insurance benefits.

            Even in contexts where members of the middle and working classes believe themselves to be insulated from this crisis so long as they remain employed, employers facing an over-valued market has sought all many of ways to cut costs.  Naturally, these are ways which have come at the expense of employees.  In the 1980s, as the insurance market approached its current state of out-and-out private dominance over America’s healthcare policy, “in companies without unions, employees were force to pay higher deductibles and co-payments and share the cost of premiums.  Some employers resorted to ‘churning,’ switching policies just as the waiting period for employees with large medical expenses expired.  They also reduced benefits for expensive diseases such as cancer and AIDS or eliminate coverage for these conditions altogether.” (Quadagno, 145)  Even for those who have been gainfully employed in white collar jobs, the failure of the United States to bring rising costs into check is resulting in a condition where such employees are increasingly carrying the burden.

            The presidential campaign of Illinois Senator Barack Obama offers some cause for optimism in regard to the situation facing many American employees who are carrying too much of the burden for a company insurance plan or those who are quite simply denied a coverage plan by employers.  According to a journal article published by the CATO Institute, “Obama would establish a “play or pay” system under which employers would be required to provide their workers with health insurance or pay a payroll tax to fund government-provided insurance.” (Tanner, p. 37)   This represents an illuminating path for resolution that would be referenced in the set of recommendations proposed toward the conclusion of this discussion.

            Obama’s opponent in the current Democratic primary, Hillary Clinton also offers some interesting solutions which seek to take the current problems in the national healthcare system at what she perceives to be their root.  Identifying in a study conducted, incidentally in co-sponsorship with Obama, Clinton (2006) outlined was would become the core principals of her healthcare plan, which would attempt to gradually reduce costs for all players by protecting physicians and patients from the negative push-and-pull of medical tort law.  Accordingly, Clinton asserts that “to improve both patient safety and the medical liability climate, the tort system must achieve four goals: reduce the rates of preventable patient injuries, promote open communication between physicians and patients, ensure patients access to fair compensation for legitimate medical injuries, and reduce liability insurance premiums for health care providers.” (Clinton & Obama, p. 2205)

            The contest between Clinton and Obama finds two fairly progressive candidates attempting to take on the healthcare system’s current failures by two differently nuanced but commonly oriented plans.  That they ultimately have rather similar political interests and philosophies at hand and yet have developed such markedly different approaches is suggestive of the complexity and layering of the healthcare problem facing American.  Certainly, I would find this to be so in my interviews with an acquaintance in the industry.

            The director at the Radiation Oncology Department  located in he Edward Cancer Center in Naperville, IL, Dr. Lingareddy Vasuda would be gracious enough to lend his insights to the discussion, advocating the development of any healthcare coverage plan that did not favor the value of a dollar over that of a life.  Indeed, from the unique perspective of one dealing so predominantly with individuals facing a potentially terminal circumstance, the delays, emotional stress and quality care options which are so directly determined by the nature of one’s insurance coverage can be key determinants even in life or death situations.  This reflects not only a cold and calculating context for medical coverage, even for those who do have insurance through self-pay or employment, but also reflects a remarkable strain on the U.S. economy, which stands to suffer greatly due to its failure to attend to the health needs of its children, its workforce and its retirees.  Collectively, Dr. Vasuda would disclose, these groups have been systematically reduced to assets or burdens to a structure built for the benefit of corporate entities.  Thus, as these entities force the improvement of their economic opportunities, they very gradually have closed in on a situation where all other parties, including the sum total American economy, will suffer the consequences.

            This helps to point to one of the greatest arguments in favor of the establishment of a national healthcare system, which is its overwhelming economic burden on Americans and on American companies outside of the healthcare industry.  Indeed, cost increases have been so unnaturally discordant with the pact of the economy that the healthcare industry is in particular headed toward crisis mode.  In the direction that the healthcare industry is going right now, “U.S. health care spending is expected to increase at similar levels for the next decade reaching $4 trillion in 2015, or 20 percent of GDP (2).” (Simmons, 2006, p. 1)  This hurts the consumer more than anybody else.  In many ways, these costs have already hurt many Americans and have already effected the cost of living.  However, it is clear that it will probably get much worse.  As the retirement population grows to a size that is larger than the American workforce, which many experts say will happen by about the same year as mentioned above, the industry could go through a serious depression.

            And given the shortcoming in treatment to Americans in greatest needs, such as the impoverished and the elderly, it does appear that this depression will have grave consequences for the neediest of healthcare recipients.  Of special consideration in this discussion on the need for a national healthcare are the elderly and impoverished who, due to their status within the larger framework of public health issues, generate simultaneously the greatest need and the least capacity to defend their needs. Amongst those above the age of 65 who do not regularly exercise an opportunity to see a primary caregiver, “twenty-three percent of this group selected a response indicating lack of availability, knowledge, or inconvenience of care. Other reasons given for lack of a regular source of care were ‘Do not trust doctor,’ 7 percent; and “No insurance/can’t afford,” 7 percent.” (NCHS, 1) All of these are obstacles which may be rectified by a wider availability of medical assistance, not just for already taxing conditions such as regular specialist visits and prescription drug plans, but also for more advanced coverage interests such as adequate and affordable in-home caregivers. It is therefore incumbent upon policymakers in the United States to achieve a form of federal legislation guided toward increasing the presence, adequacy and accessibility of meaningful public healthcare assistance.

            The problems of uninsured Americans and of rising medical costs, in conjunction with failures in supporting the needs of the elderly in the face an approaching imbalance in the workforce/retiree dynamic, are together creating an effect on the entire medical industry that is very problematic.  A need for doctors, hospitals and clinics to deal with the problems of high supply and drug costs often creates a situation where these facilities cannot afford to pay enough employees or to pay employees good wages.  The result of this is that many places suffer from a shortage of healthcare professionals which naturally creates a lower standard of medical attention for patients.  This is a serious problem for America’s healthcare industry as it is responsible for an overall lowering of quality for the average American, and can even be shown to raise the dangers of mortality in American hospitals.  The actual result of this economic issue of healthcare professional shortages is that, when “measured by many vital indices, the U.S. lags behind roughly two dozen other countries, according to the World Health Organization.” (Rahkonen, 2006, p. 1)  This is a very sad irony for the richest country in the world.

            One thing that is useful to know when proposing a solution is that the rise in America’s healthcare costs has not been natural.  By looking at some of the facts related the overall economy to the industry being discussed, it becomes clearer that there is an unnatural inflation to costs.  This is making hospital stays, prescription drugs, insurance plans and other costs that fall onto the consumer to rise at a rate that is higher than the rate of the cost for providing these things.  Profit margins for large companies are growing higher even while people are finding it more difficult to afford their basic medical needs.  This calls for the intervention of the government in the medical industry.  The government should pass legislation to restrict companies from exerting unfair prices on their consumers.  Also, the market should be opened up to better competition, with more companies competing and therefore offering better prices to customers.  The government has the social responsibilities to make it easier for average Americans to afford healthcare.

            There may be very negative consequences to not providing the aging baby boomer generation with good healthcare.  When this largest generation of Americans prepares to receive its Medicare benefits, it will be important that the government is prepared to support this expense.   Otherwise, the effect will be very negative for our economy.  This justifies the suggestion that either taxes should be raised, or that the tax burden should be shifted on major healthcare providers who benefit the most from the current situation.  This would increase the funding needed to keep Medicare functional and offset the negative economic effects of the retirement of this generation.

            This would also help to create the necessary funding to help improve public healthcare programs and also to invest in such socially constructive programs as public campaigns for awareness of health issues and hazards.  By creating ads about sexually transmitted diseases, spreading awareness of drug rehabilitation programs and making citizens aware of free health clinics, the government can lower healthcare costs overall by preventative efforts.

            A third solution to be enacted should be the creation and funding of various programs meant to encourage improvements and innovation.  This would mean a number of useful programs, such as the creation of scholarship programs and wage-increase incentives for healthcare professional candidates.  Nursing schools and medical universities, by creating financial relationships with healthcare facilities, can work to encourage enrollment and make easier the move from school into professional work.

            Another program would also involve the universities, where better public funding could help to improve the ability of smaller staffs to provide better care.  This would mean that the encouragement of technological and scientific innovation could be used to help create forward-thinking ways to improve our medical situation.

            A change in the way that we deal with our healthcare industry would have different effects on the many different parties involved.

            Hopefully, the biggest effect would be felt by American consumers.  The overall goal of these changes would be to help lower all of the costs that are related to medicine.  Insurance costs should be lowered to at least be more proportional to the direction of the economy as a whole, instead of at a rate this is so much faster.  Another effect should be that pharmaceutical companies, with better oversight by the government, will more honestly represent their investments into the research and development of drugs in the lower cost of medicine.

            For a stakeholder like the American government, the consequence should be a reconsideration of the way that it directs the money that it gains from taxpayers.  It is not a secret that many politicians are influenced by big companies who can invest large amounts of money into campaigns and campaign commercial.  With better laws in place to encourage proper use of public office, America’s lawmakers should be more likely to direct funding into free public clinic, into medical insurance programs for the poor and into improvements of conditions in public hospitals.

            The consequences for such major stakeholders as the insurance companies will be a change of practices.  This is something which is necessary, with the lack of restraint in these companies creating many of the economic programs in the healthcare field.  Insurance companies will need to change practices of declining paying members of full coverage for medical procedures.  It is not appropriate for Americans who pay for healthcare coverage to still be unable to pay for the treatment that they require, no matter what the medical condition is.  Also, insurance companies should be forced to reduce basic premium rates for membership as a result of the encouragement of the creation of smaller, competitive insurance companies.  This atmosphere would naturally make companies improve access for business, families and individuals who need coverage.

            And for all individuals who access America’s healthcare system, a consequence of reforms would be an improvement in the overall treatment available in hospitals and other medical facilities as a result of larger staffs, better-paid employees and improving working conditions.  All of these factors will have the likelihood of significantly helping to improve the amount of attention and the quality of attention that all patients can receive.

            In review of the information presented here, one might conclude that the suggestion of an outright shift to a universal healthcare system would be unrealistic.  Indeed, “the 1990s is mostly remembered for the failure of Clinton’s Heath Security plan.  The Clinton plan generated hundreds of books and articles seeking to explain the outcome.  Some . . . blamed more enduring features of American politics—the institutional structure of the state, antistatist values, or racist sentiments.” (Quadagno, 200)  Therefore, the research here helps us to conclude that it is a very important for us to change the direction of our healthcare industry immediately by taking rational steps that might move us incrementally toward a more universal standard.  The problems described here could have long-lasting effects on our public health and on our economy and should thus be addressed with some urgency.

            The solutions recommended, which might move the U.S. more gradually toward a comprehensive national coverage system here are justified by the clear dangers of allowing so many Americans to continue without any medical assistance.  Also, while there is an explanation given here for it, there may be no excuse for America’s decline when it is compared to other nations.  The United States has a responsibility to its citizens to bring better control over big businesses involved in the industry, to reduce the rate of rising costs for the average American and to change the healthcare worker shortages effecting the quality of care.  By shifting its strategy to a more progressive and less commercial approach, the government may be able to change the industry’s direction before these problems get any worse.


Clinton, H.R. & Obama, B. (2006).  Making patient safety the centerpiece of Medical    Liability Reform.  New England Journal of Medicine, (354)21, p. 2205-2208.

Cummings, Jennifer.  (Oct. 27, 2006).  About Half of U.S. Adults Lack Confidence in   both Democrats and Republicans to Do a Better Job of Addressing Healthcare  System Concerns.  The Wall Street Journal.  Ret. 4/14/08 <        http://www.harrisinteractive.com/news/newsletters/wsjhealthnews/WSJOnline_H            _Health-CarePoll2006vol5_iss19.pdf>.

Kessler, Daniel P.  (2004).  Health, Wealthy, and Wise.  The Washington Journal.

Levit, K.; Smith, C.; Cowan, C.; Lazenby, H.; Sensenig, A. & Catlin, A.  (2001).  Trends           in U.S. Health Care Spending.  Health Affairs, 22(1), p. 154-164.

McLaughlin, C.G.  (2004).  Health Policy and the Uninsured.  Urban Institute Press.

NCHC.  (2004).  Healthcare Insurance Cost.  The National Coalition on Health Care.     Ret. 11/14/06 < http://www.nchc.org/facts/cost.shtml>.

NCHS. (2005). Access to Health Care Part 3: Older Adults. Centers for Disease Control.          Ret. 4/14/08 < http://www.cdc.gov/nchs/products/pubs/pubd/series/sr10/199-       190/sr10_198.htm>

Quadagno, J.  (2005).  One Nation, Uninsured: Why the U.S. Has No National Health   Insurance.  Oxford University Press.

Rahkonen, Dennis.   (May 2006).  Dying For Wall Street:  America’s Worsening Healthcare Travesty.  Online Journal.  Ret. 4/14/08 <         http://www.onlinejournal.com/artman/publish/article_799.shtml>.

Simmons, Dr. Henry E.  (2006).  Health Insurance Costs.  National Coalition on  Healthcare.

Tanner, M.D.  (2007).  Obama’s Health-care plan:  Wrong RX.  The CATO Institute.

UPI.  (Dec. 2005).  Nurses group:  Healthcare Profits a Scandal.  United Press Institute.

Vasuda, Dr. L.  (2008).  Interview.  Naperville, IL: Radiation Oncology Department,      Edward Cancer Center.

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