Jacob Nieuwenhuis Contemporary Issues MSR 10 March 2010 Universal Health Care in the United States “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep. His cupidity may at some time point be satisfied; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. ” –C. S. Lewis (1898 – 1963)
The issue of universal health care taking over the present health care system has become a heated topic all over America. With President Obama’s promise to pass a bill that will give government coverage to all Americans, most people were happy that health care would become more affordable for them. But is this the case? There has been a stiff opposition to the passing of any bill of this kind throughout the entire process, but the longer a bill stays in circulation the more time people have to form an opinion on the issue.
With the law in effect now the issue now turns to if this will be better off for America in the long run, and if there is any good to such a system. History has a lot to say about socialized medicine. There have been many countries, not only socialistic countries which have used a public method of offering medicine. A few of these countries are Great Britain, Canada, France, Australia, and also the European system. These systems will be analyzed from their roots up in order to see whether they were successes or failures.
The National Health Service (NHS) of Great Britain, which was created on July 5, 1948, is the world’s largest publicly funded health service ever. As can be seen on the diagram, the NHS is divided into two sections: primary and secondary care. Primary care is the first point of contact for most people and is delivered by a wide range of independent service providers, including general practitioners, dentists, pharmacists and optometrists. Secondary care is known as acute healthcare and can be either elective care or emergency care.
Elective care means planned specialist medical care or surgery, usually following referral from a primary or community health professional such as a general practitioner. In this system there are a lot of different trusts (refer to diagram). These trusts are where the money is sent for certain types of care. The main trusts are the Primary care trusts. Primary care trusts (PCTs) are in charge of primary care and have a major role around commissioning secondary care, providing community care services. They are the main core to the NHS and control 80% of the NHS budget.
As they are local organizations, they understand what members of their community need, so they can make sure that the organizations providing health and social care services are working effectively for that community. Primary care is the care provided by people you normally see when you first have a health problem. It might be such a simple thing as a visit to a doctor or a dentist, an optician for an eye test or even a trip to a pharmacist to purchase medicine. The NHS was founded on a principle that all people, regardless of money, would be able to receive quality health insurance.
It still holds to this as its main principle today. With the exception of charges for some prescriptions and optical and dental services, the NHS remains free for the use of anyone who is resident in Great Britain, which is about 60 million people. It covers everything from preventive medicine and routine treatments for coughs and colds to open heart surgery, accident and emergency treatment and end-of-life care. All this is funded by taxation. When it first began in 1948 the projected budget was around $632 million dollars (roughly $13 billion today).
That number was undershot, and another $75 million was needed to balance that budget. Over time that number has risen tremendously to where it currently is at $144 billion dollars. This is over ten times the amount it was when it first started. This system has not proved to be cost effective and much preventive care is left wanting. A British man, David G. Green, did a report on the effects of preventive care in Great Britain for diseases such as circulatory disease and cancer. His main focus was on the circulatory system and the conclusion of his reports states that: “The main findings can be summarized as follows.
The UK has a poor record of preventing death from diseases of the circulatory system. After allowing for the different age structure of each country in the European Union, the UK death rate from circulatory diseases for persons aged less than 65 was ranked thirteenth out of the 15 countries studied. ” There are many negative aspects of the NHS. There are stunning reports of people who didn’t get care, or who waited for months in order to get prevented care. One example of a terrible thing that happened recently in Great Britain was a cancer patient who had to wait for 62 weeks before starting treatment. Patients were outraged by this.
They said that for some cancer patients with slow growing tumors could wait that long but that it is atrocious that someone would have to wait that long to receive any type of care at all. It was compared side by side with a case from 20 years earlier, when Heather Goodare was diagnosed with the same problem and received treatment within two weeks after first being diagnosed. The European system has run into a lot of obstacles over the years, mostly financial. There is currently a 5 percent to 8 percent increase in expenses per year in real terms, resulting in enormous deficits and even greater problems when the rate of unemployment rises.
When employment rates improve, the deficits are eased because more taxes come in to pay for care. But as soon as employment falls again (which is common everywhere right about now), deficits come back. A common method used for getting over this deficit is rationing care and restricting use of high cost preventive cares such as CAT scans. Sometimes this is only towards people who meet a certain criteria, e. g. the elderly. This can only be bad for the consumer. Michael Tanner sums this up nicely in his article condemning socialized medicine in the U. S. “The Europeans have run into a very simple economic rule. If something is perceived as free, people will consume more of it than they would if they had to pay for it. Think of it this way: if food were free, would you eat hamburger or steak? At the same time, health care is a finite good. There are only so many doctors, so many hospital beds and so much technology. If people over consume those resources, it drives up the cost of health care. ” All the countries in Europe have this health care system. There are, however, three countries in Europe that allow their citizens to opt out of he official system and to take with a tax credit for the money they paid to the official system, to purchase private insurance in the health market. These countries are Germany, the Netherlands, and Switzerland. In those countries, citizens do not have to pay twice in order to acquire private health insurance. The systems of these three countries are important in that they may point the way to a solution for the current financial problems Western health care systems are experiencing. This private plan is more expensive but reachable for at least a third of the population.
For the most part, people in Europe are happy with the health care they receive. In the Netherlands there is a basic plan that everyone can buy (it is not a government mandate). This covers things such as broken limbs, emergency room visits (just the visit), and seeing general practitioners. On top of this, a person may buy whatever “premium add-ons they want. An example of an add-on is dental and orthodontic care. With this add-on all the people in the household of the insurance buyer receive full dental care as well as braces for all the children of the family.
Trudy Rubin, who is a Philadelphia Inquirer opinion columnist, says that the United States is not learning valuable lessons from the European system of healthcare. She addresses the three myths that she thinks are thought to be believed as fact. She takes these myths from an excerpt from T. R. Reid. The three myths are as follows: “Myth No. 1, he says, is that foreign systems with universal coverage are all “socialized medicine. ” In countries such as France, Germany, Switzerland, and Japan, the coverage is universal while doctors and insurers are private.
Individuals get their insurance through their workplace, sharing the premium with their employer as we do – and the government picks up the premium if they lose their job. Myth No. 2, which is long waits and rationed care – is another whopper. “In many developed countries,” Reid writes, “people have quicker access to care and more choice than Americans do. ” In France, Germany, and Japan, you can pick any provider or hospital in the country. Care is speedy and high quality, and no one is turned down. Myth No. really grabs my attention: the delusion that countries with universal care “are wasteful systems run by bloated bureaucracies. ” In fact, the opposite is true. America’s for-profit health insurance companies have the highest administrative costs of any developed country. Twenty percent or more of every premium dollar goes to nonmedical costs: paperwork, marketing, profits, etc. “If a profit is to be made, you need an army of underwriters to deny claims and turn down sick people,” says Reid. ” Canada is another place where health care is run by the government.
This came into effect when the parliament unanimously passed the Canadian Health Act in 1984. This established all health care in Canada as a single-payer, publicly-financed system. Under this law, provinces must ensure that their health care systems respect five criteria: The first is public administration. This means that the health insurance plans must be administered by a public authority who is accountable to the government. The second is comprehensive benefit. The plan must cover all medically necessary services prescribed by physicians and provided by hospitals.
The third is universality. This means all legal residents of the province must be covered. The fourth criterion is portability. Under this, residents continue to be covered if they move or travel from one province to another. And the final criterion is accessibility. This means that services must be made available to all residents on equal terms, regardless of income, age, or ability to pay. The process which a patient goes through to receive health care is very simple. When a person goes to a doctor for any kind of medical treatment they have to present what is called a provincial health card.
This is a credit card-looking piece of plastic that lets your physician know you are a legal user of the system. Patients get to choose their physicians, although a general practitioner may refer them to a specialist. A resident can exercise the right to go to the emergency room for anything when they do not have an appointment. The ER works on a severity chart, where the most ill get treated before someone who has less of an ailment and is not based on ones ability to pay. On account of this there are waiting lists that are made for elective surgeries and in most cases are very long.
The greater part of Canadian doctors provide care in private practice and apply for admitting privileges at one or more nearby hospitals in their province. Most of these provide care on a fee-for-service basis. This means that the doctor is earning wages based on the services he provides to a patient and not on a salary or hourly wage. For doctors who choose to have a salary, usually at a local community health or social clinic, a cap is issued on how much they can make. This is regardless of how many people he sees. This is regarded as very socialistic. Health Care Expenditures in Canada
Although everything is so great and free there, there is a supplementary health care provider for the little things. Provincial health plans also do not cover some nonessential procedures, such as laser eye surgery, cosmetic surgery, procedures to reverse sterilization, and in most provinces in vitro fertilization (IVF). In addition, provinces do not pay for dental services and long-term or special care facilities, such as nursing homes and addiction-recovery centers. Also provinces generally do not cover prescription drugs for patients outside the hospital.
Canadians have two choices when it comes to paying for these additional services. First, they can either pay directly for whatever services they use, or secondly, they can join a private supplementary insurance plan, usually offered by their employer. These private insurers are not permitted to offer insurance coverage for any service that provincial insurance covers. That restriction is designed to prevent a two-tier system in which people who could afford more expensive private insurance would have greater access to necessary medical services and procedures.
Several provinces also have government plans that provide insurance coverage for drug costs and that are available to the entire population, but those plans require substantial contributions from the insured. Shifting over to our story, the earliest example of a prepaid healthcare arrangement in the United States was in 1910, when the Western Clinic in Tacoma, Washington provided a wide range of medical services to lumber mill owners and employees for a monthly premium of 50 cents. Before this there were mostly only doctors who worked independently. A few years later in 1929, a managed care pioneer by the name of Dr.
Michael Shadid began a cooperative health plan for rural farmers in Elk City, Oklahoma. The members who enrolled in his plan paid a predetermined fee and received medical care from Dr. Shadid. In the same year, the Ross-Loos Medical Group (now known as CIGNA) was established in Los Angeles, and it provided prepaid services to county employees and employees of the city’s department of Water and power. Its members paid a premium of $1. 50 a month. Also in 1929, the Baylor Hospital of Dallas, Texas started a prepaid system that provided medical care to about 1500 teachers.
This was the birth of the health care company known today as Blue Cross. Because Blue Cross only provided coverage for hospital services, the Blue Shield plans were created to cover doctor services, hence the name Blue Cross/Blue Shield. The premiums for this coverage were subsidized through government tax breaks, keeping them reasonably low. During the 1940’s when World War II was underway, labor was in short supply, and the government imposed wage controls. Wanting to deal with this situation, employers began to offer health insurance as a fringe benefit to attract more workers to work for them.
The government sought to encourage this new development, and started offering business’s income tax exemptions for health care related expenses. This was the beginning of the current trend of the employer as a health insurance supplier. All these early companies reimbursed health care providers on a fee-for-service basis. However, as improved medical technology and technical inefficiencies rose, more and more non-profit health maintenance organizations (HMOs) were founded. The goal of these companies was to achieve better management of services and to emphasize preventive care while controlling the cost of health care.
A similar pattern played out as the HMOs became more successful. Private insurers coveted their success and soon enough, profit HMOs stepped forward, and once again dominated the market. The enactment of the Medicare and Medicaid legislation by Lyndon B. Johnson in 1965 was a landmark in the history of managed health care, by extending coverage to millions of additional Americans who did not have it beforehand. In the 70’s there was a huge push for reforms in the healthcare system especially in terms of cost and accessibility for the poor.
The result of these pushes was the HMO Act of 1973 (not to be confused with the HOMO Act). Under this act there were three main provisions: First, grants and loans were provided for the planning and start-up of new HMO’s, and for the expansion of existing HMO’s. Second, state-forced restrictions on HMOs’ development were overridden if the HMO was federally certified. And third, the dual choice provision, which required that employers with 25 or more employees offer federally certified HMO’s in addition to the traditional insurance coverage. Not much has changed since then, but now some 47 million U.
S. residents have no health insurance, and the numbers keep growing. A good deal of this is due to deceptive malpractice law suites against the health care system based on greed. The United States spends about $2. 1 trillion on health care, roughly 16 percent of the gross domestic income. Also, government is responsible for approximately 50 cents out of every dollar spent on health care because of the huge and rapidly growing government health care programs such as Medicare, Medicaid, SCHIP, and state and publicly funded health care programs.
Currently, only nine percent of Americans directly purchase their own health insurance. The remaining ninety-one percent either get it through their current employer or do not have it at all. Obama’s plan to make all these problems disappear is his 1018 page monstrosity of a bill. This is to ensure that all American citizens will receive “free” health care no matter how much money they make. It makes insurance more affordable by “providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps 32 million Americans afford health care who do not get it today (this is over one tenth of the U. S. population) and makes coverage more affordable for many more. This will come about by government funding. This funding will come from taxation of the people. The projected price tag is about $940 billion dollars over the first 10 years, according to the Congressional Budget Office. This is a lot of money to raise. The administration intends to do this by a freeze of taxation on individuals making under $200,000 and families making under $250,000. This places a heavy burden set on the upper class.
These people in the upper class are seen as greedy by the administration and Obama seeks to redistribute that wealth to others who don’t make quite as much. First of all, if a person is making enough to be considered in the upper class, Medicare Part A (that’s hospital insurance) tax rate would be increased by 0. 9 percent, to 2. 35 percent. Second, the bill creates an entirely new tax of 3. 8 percent on unearned income (dividends, interest, etc. ) for people in those same income groups. This is the primary way the government plans to raise the money for this bill.
A second way where the government will take money is by taxing higher-end insurance policies. This was previously called the “Cadillac tax” but has now been cut back and should more properly be called the “Chevy with leather and A/C Tax. ” For policies that exceed $10,200 annually for individual coverage, or $27,500 annually for family coverage a tax good to 40 percent of the cost of the plan will be initiated. Obama and his administration also claim that this new government run program would reduce the national deficit by $100 million over the next ten years. How is this going happen?
It’s going to happen not only by taxation, but by cutbacks in care and health provider coverage. The biggest provider is Medicare, which is a government run program for seniors and certain people with disabilities. This is already taken out of the peoples pockets by taxation throughout their entire life, kind of like social security. Medicare Advantage, which is run by a private insurance company that is a more upscale alternative to traditional Medicare, will be hurt significantly. Currently, these Advantage plans cover offer 14 percent more coverage than traditional Medicare.
Over the next ten years, government payment to these plans will be cut by $132 billion. That is a lot of people who have paid a lot for extra care that will not be getting it. Traditional Medicare also will suffer some cutbacks under the new law. Government payments towards home health care via. Medicare will be reduced by $40 billion, and also cuts in certain hospital payments will save the government another $22 billion. With these cutbacks, doctors are going to be hesitant to receive people that have Medicare because they are not sure that they will be reimbursed for their labor.
So this is hurting them in more ways than one. This is not only going to be a burden on seniors but also the core of the people. This bill is a major burden on the middle class, even though ironically the whole bill was set up to relieve the burden. Jane Hamsher of the Firedoglake health team has put together a chart of myths and facts about common misconceptions on the Obama bill. In response to the myth that this bill would make insurance more affordable for middle class Americans, she states that: “A middle class family of four making $66,370 will be forced to pay $5,243 per year for insurance.
After basic necessities, this leaves them with $8,307 in discretionary income — out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible. Many families who are already struggling to get by would be better off saving the $5,243 in insurance costs and paying their medical expenses directly, rather than being forced to by coverage they can’t afford the co-pays on. ” This ne bill also affects different effects of people’s lives besides health care.
The new law requires employers who do not offer insurance that is satisfactory by the federal government to pay a fine of $2,000 for every employee, exempting the first 30 employees. Employers forced to pay this penalty will have to reduce wages, cut jobs, or rely more heavily on part-time workers. Any of these options will be bad for the economy because it will make businesses that are on the edge of 30 employers cut back in order to get exempt from paying. With this bill not taking full effect until sometime in the next 10 years the worst is still yet to be seen.
This is one of the greatest steps America has taken towards socialism since it began. America was founded on the principles that all men have equal freedoms to do with themselves and their money as they choose. This has put America ahead of all other nations in the past, but everything that goes up must come down. This bill forces the people to do something against their will and that is unconstitutional because it limits their freedoms. This bill was spoon-fed to the American people and will not benefit them in they way that they were told it would. Bibliography “Authorities and Trusts” ttp://www. nhs. uk/NHSEngland/thenhs/about/Pages/authoritiesandtrusts. aspx (accessed May 2010) “Canada” http://www. angelfire. com/pa/sergeman/issues/healthcare/socialized. html (accessed May 2010) David G. Green, Laura Casper. Delay, Denial and Dilution: The Impact of NHS Rationing on Heart Disease and Cancer IEA Health and Welfare Unit, Choice in Welfare No. 55. January 2000 (accessed May 2010) Dill, Monda “A Brief History of health Care in America” http://www. associatedcontent. com/article/339640/a_brief_history_of_health_care_in_america. html August 13, 2007. (accessed May 2010)
Encarta Encyclopedia “Health Care Expenditures in Canada” 2009. (accessed May 2010) “Great Britain” http://www. angelfire. com/pa/sergeman/issues/healthcare/socialized. html (accessed May 2010) Grier, Peter “Health Care Reform Bill 101: Who Will Pay for Reform? ” http://www. csmonitor. com/USA/Politics/2010/0321/Health-care-reform-bill-101-Who-will-pay-for-reform (accessed May 2010) Lindsay Moss “Cancer survivor confronts the health secretary on 62-day wait”, March 21, 2009 The Scotsman (accessed May 2010) Moffit Ph. D. , Robert “Perspectives on the European Health Care Systems: Some Lessons For America” http://www. eritage. org/Research/Lecture/Perspectives-on-the-European-Health-Care-Systems (accessed May 2010) “NHS Structure” http://www. nhs. uk/NHSEngland/thenhs/about/Pages/nhsstructure. aspx (accessed May 2010) Nix, Kathryn “Top 10 Disasters of Obamacare” http://www. heritage. org/research/reports/2010/03/top-10-disasters-of-obamacare (accessed May 2010) “Overview of NHS” http://www. nhs. uk/NHSEngland/thenhs/about/Pages/overview. aspx (accessed May 2010) Rubin, Trudy “European Socialized Medicine” Philadelphia Inquirer, February 28, 2010. (accessed May 2010) Tanner, Michael D. A Hard Lesson about Socialized Medicine” http://www. cato. org/pub_display. php? pub_id=6293 (accessed May 2010) ——————————————– [ 1 ]. “Overview of NHS” http://www. nhs. uk/NHSEngland/thenhs/about/Pages/overview. aspx [ 2 ]. “NHS Structure” http://www. nhs. uk/NHSEngland/thenhs/about/Pages/nhsstructure. aspx [ 3 ]. Ibid P. 1 [ 4 ]. “Authorities and Trusts” http://www. nhs. uk/NHSEngland/thenhs/about/Pages/authoritiesandtrusts. aspx [ 5 ]. “Overview of NHS” http://www. nhs. uk/NHSEngland/thenhs/about/Pages/overview. aspx [ 6 ]. Ibid P. 1 [ 7 ]. “Great Britain” http://www. ngelfire. com/pa/sergeman/issues/healthcare/socialized. html [ 8 ]. “Overview of NHS” http://www. nhs. uk/NHSEngland/thenhs/about/Pages/overview. aspx [ 9 ]. David G. Green, Laura Casper. Delay, Denial and Dilution: The Impact of NHS Rationing on Heart Disease and Cancer IEA Health and Welfare Unit, Choice in Welfare No. 55. January 2000 [ 10 ]. Lindsay Moss “Cancer survivor confronts the health secretary on 62-day wait”, March 21, 2009 The Scotsman [ 11 ]. Robert Moffit Ph. D. “Perspectives on the European Health Care Systems: Some Lessons For America” http://www. heritage. rg/Research/Lecture/Perspectives-on-the-European-Health-Care-Systems [ 12 ]. Robert Moffit Ph. D. “Perspectives on the European Health Care Systems: Some Lessons For America” http://www. heritage. org/Research/Lecture/Perspectives-on-the-European-Health-Care-Systems [ 13 ]. Michael D. Tanner “A Hard Lesson about Socialized Medicine” http://www. cato. org/pub_display. php? pub_id=6293 September 23, 1996 [ 14 ]. Ibid P. 13 [ 15 ]. Trudy Rubin “European Socialized Medicine” Philadelphia Inquirer, February 28, 2010 [ 16 ]. “Canada” http://www. angelfire. com/pa/sergeman/issues/healthcare/socialized. tml [ 17 ]. Encarta Encyclopedia “Health Care Expenditures in Canada” 2009 [ 18 ]. Ibid P. 2 [ 19 ]. Encarta Encyclopedia “Health Care Expenditures in Canada” 2009 [ 20 ]. Ibid P. 3 [ 21 ]. Monda Dill “A Brief History of health Care in America” http://www. associatedcontent. com/article/339640/a_brief_history_of_health_care_in_america. html. August 13, 2007 [ 22 ]. Ibid P. 2 [ 23 ]. Monda Dill “A Brief History of health Care in America” http://www. associatedcontent. com/article/339640/a_brief_history_of_health_care_in_america. html August 13, 2007 [ 24 ]. Ibid P. 2 [ 25 ]. Health Care in America” http://www. heritage. org/Initiatives/Health-Care [ 26 ]. http://www. whitehouse. gov/issues/health-care [ 27 ]. Peter Grier “Health Care Reform Bill 101: Who Will Pay for Reform? ” http://www. csmonitor. com/USA/Politics/2010/0321/Health-care-reform-bill-101-Who-will-pay-for-reform [ 28 ]. Peter Grier “Health Care Reform Bill 101: Who Will Pay for Reform? ” http://www. csmonitor. com/USA/Politics/2010/0321/Health-care-reform-bill-101-Who-will-pay-for-reform [ 29 ]. Ibid P. 2 [ 30 ]. Peter Grier “Health Care Reform Bill 101: Who Will Pay for Reform? ”