The US Health care system: Best or just the most expensive Essay
The US Health care system: Best or just the most expensive
The US is one of the developed countries that do not offer universal health care. It applies the ‘out of pocket’ approach in the funding of health care services. As Bernard in Making Sense of Political Ideology: The Power of Language in Democracy notes the government only provides health care to the elderly, disabled, children as well as the poor who only amount to approximately 27% of the total population. (Brock B, 2005). This health care system faces much criticism as although the US as a developed country ought to be an example to the wider world it has failed in meeting the health needs of its citizens.
According to the UN declaration of human rights article no 25, everyone has a right to a ‘standard of living adequate for well being of himself and his family’. This article stipulates that the provision of health care should be a government responsibility if equity in terms of accessibility is to be attained. This paper will focus on how effective the US health care is in terms of cost, accessibility as well as the quality provided.
It is possible to evaluate the performance of the US health care system by using the various research studies that have been carried out in other countries for comparison. In determining how effective any health care system is we consider three important aspects that is the cost, people’s response regarding the services provided as well as how accessible the system is to the people. According to the World Health Organization (WHO), a good health care system is one where good health is maintained. A country is said to have a good health system when the health status of people across the varying age groups is in the best possible condition. It should also meet the people’s needs as well as their expectations in terms of the quality of the care provided. (University of Maine, 2001).
The question addressed here is whether the care provided is satisfactory to the recipients. Another vital factor to consider when evaluating the efficiency of a health care system is fairness in its financing. WHO suggests that health care systems could be ranked as poor, good or fair depending on the characteristics they portray. A good health care system is one where there is good health characterized by low infant mortality rates as well as high disability adjusted life expectancy rates. There is a fair distribution of good health across the various ages and most importantly across the divergent races.
No age group or race ought to be considered as a ‘risk group’ if equity is enhanced. A fair health system ought to have a high responsive rate where a large proportion of the people are contented with the care given or rather have their expectations met by the health care system. (University of Maine, 2001). The responsive rate should also be equally distributed across ages and races such that some people are not discontented while others are satisfied.
It should be evenly spread despite discrepancies in people’s age, gender, social, economic or ethnicity. The cost of financing any health care should also be fairly distributed in accordance to people’s ability to pay. If the WHO standards can be applied to evaluate the US health care then it can be termed as ineffective or inefficient. It is costly, does not meet the people’s expectations and it fails to ensure equality in as far as accessibility is concerned. (University of Maine, 2001).
On comparing the total expenditure spent on health care at both an individual as well as a national level it is clear that the system is one of the most expensive in the world. In the year 1998 for instance the US spent $ 4178 on health care a figure more than twice what most OCED countries spent. The developed country that took the second position was Switzerland which $2794 a figure slightly above half what the US spent. (University of Maine, 2001).
Source: University of Maine. http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
Source: University of Maine. http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
Source: OCED health data. June 2008
A major reason for the high cost in the US health care is attributed to the high administrative costs. There are various bureaucratic procedures in the US government and the insurance companies aggravate the costs due to too much paper work like in approving as well as submitting claims. (Byrne M and Rathwell T, 2005) Advancement in technology has also accelerated the cost as new medical techniques come at a higher price. Health care providers are motivated by the profits they gain in this field making it difficult to ensure efficiency in the provision of health care. It has been observed that private health care centers or hospitals have registered a higher growth than the public hospitals courtesy of the intensive commercialization in the health care sector.
Failure to apply the preventive approach to curb diseases and thus enhance good health for the Americans has precipitated the high costs in the health care system. When people fail to seek early intervention, conditions that could have been easily treated or handled in their initial stages become overwhelming. Curative approach is more expensive than preventive approach to health care. Diseases are cheaper to treat before they advance or deteriorate necessitating the need for intensive care services. Another factor that can be blamed for the high costs in the US health care system is the increasing aging population that has a higher demand for health care services. (University of Maine, 2001).
According to the Institute of Medicine of National Academies lack of insurance in the US causes the death of approximately 18000 preventable deaths each year. The institute suggests that the health care system should therefore be made universal, sustainable, continuous and affordable to all if these deaths were to be prevented. This would be a positive move towards ensuring effectiveness, efficiency, timeliness, patient focused as well as equitable health care. (National Academy of Sciences, 2008).
There is poor accessibility in the US health care system. It is characterized by private insurances where coverage is on employment basis while a small proportion that is the poor, aged, military and the disabled have Medicaid or government insurance. Increased insurance rates due to the high cost of health care precipitates or rather sees the employers raise the amount of money they deduct from their employees leaving them with reduced disposable incomes. Some employees end up withdrawing the insurance benefits in totality worsening the health care accessibility. Policy makers are surrounded by much pressure to make the system universal.
Some critics view it as a big embarrassment for the US but the reality is that as the talks continue the poor continue to feel the pinch. Their life expectancy rate is lower than that of the other Americans and they generally lead unhealthy lives. The overall cost of the health care due to the inequality levels is transferred to other members of the society or the taxpayers as well as those in the private insurance. This cost shifting tendency has larger consequences to other people in the society apart from the poor.
The US health care can be termed as ineffective or poor if the well being of the people is to be used in evaluating its effectiveness. The infant mortality rates stood at 7.2 per every 1000 still births in 1996-8. Although this is a low rate it high when compared to the other developed countries. There is a large discrepancy between the infant mortality rates for the African Americans and the whites, a clear indication of the high inequality levels. The effects of one’s economic status and the accessibility to health care cannot be underscored. In the year 1998, the infant mortality rate for black children was 14.3/1000 live births while the white’s was 6/1000 live births. The mortality rates vary across varying states. (University of Maine, 2001).
When using the disability adjusted life expectancy or the number of healthy years that is expected on average in a given population, WHO ranks the US health care system the 24th position. Inequality in terms of how this rate is distributed is also registered as males tend to have a higher rate. This discrepancy is largely attributed to the high differences in accessing health care and most importantly the preventive care. (University of Maine, 2001).
Responsiveness of caregivers to the expectations of the patients in the US is largely affected or rather influenced by the differences in accessing health care. Without the health care insurance accessing healthcare becomes a big nightmare for the poor who are mostly from the minority groups. Responsiveness also addresses or rather deals with the manner in which the health care providers treat patients. Questions of essence here are whether the care providers treat their patients with dignity and respect. (University of Maine, 2001).
It is estimated that to a tune of 42.6 million people in the US do not have health insurance and others are uninsured. Without the health insurance, acquisition of health care services is very difficult and these people suffer drastically even from diseases that could have been prevented. (Commonwealth Fund International Health Policy Survey, 2004). Some opt for the ‘over the counter’ services for prescription and only seek medical attention when their conditions deteriorates. Seeking medical attention as a last resort can be explained by the increased number of cases in the emergency rooms.
The current health care system in the US makes the poor feel left out by the same society that they belong to or rather are part of. Sick or unhealthy poor people face the music given the fact that no one wants to make losses in the highly competitive health care system. To avoid or rather escape liability insurance companies are quite selective and opt for the healthier people who may rarely be in dire need of medical care while neglecting the sick who need medical attention with urgency. (Brown E, 2005). This is all attributed to the fact that these insurance companies are out to make profits and the revenues are to be maximized and expenses reduced.
A country’s health care system could have a direct negative effect on a country’s economy. Investors may opt to locate their industries in countries where universal health care is provided as then their costs in terms of medical cover for their employees would be reduced. Place in The healthcare crisis: as the number of uninsured grows the money disappears, backs this argument by suggesting that firms would prefer to locate their firms in Canada over US as their profit margins would be higher given the reduced costs. (Place, 2005).
The health care system in US is highly politicized with the liberals arguing that it ought to be made universal as it is in other developed countries. The argument that this would be a costly venture on the government side is dismissed on the basis that European countries using the National Health Service spend less than the US and their levels of accessibility are also higher. (Krugman P, 2007).
Liberals advocate for the application of progressive taxes as the most applicable in the financing of the proposed universal health care. This would be a fair way of ensuring that people contribute according to their ability to pay. Accessibility of the health care services would be attained and as the saying goes ‘a healthy nation is a wealthy nation’ the bridging of the inequalities would be a plus even to the economy as a whole.
The conservatives argue that the problems facing the US health care can only be resolved by making the current system effective. To them, there is no need for universal health care as the core problem is over consumption where people seek services they do not actually require due to the effect of the third parties. (Place D, 2005). Conservatives argue that universal health care would jeopardize with the quality of health care provided as there would be minimal motivation due to the lack of competition that precipitates innovation and excellence. They cite appropriate approaches of making the system effective such as the making it easier for people to access the medical health insurance as well as the adoption of modern electronic techniques in the administrative departments of health systems for instance in record keeping. (Bodenheimer T, 2005).
The US health care system ensures that inequality is enhanced among the various social groups. The minority groups tends to be the most affected as in most cases they are the low income earners. Most of the employers do not provide them with medical insurance and with their little income they are torn between spending it on medical care and other basic needs like food. It is voluntary for the employers to offer their employees’ medical insurance and even when offered it is not comprehensive.
Expensive health procedures for instance the heart transplants are not catered for. People who show signs of being susceptible to chronic or constant illnesses will in most cases be denied health insurance despite the fact that they are the ones in need of it. The Medicaid also seems an ineffective way of providing health care to the needy. Cook in his article Medicaid’s future foretold by Medicare Modernization Act notes that Medicaid only caters for a small proportion of the population in need. (Cook D, 2004).
A study carried out by researchers at Harvard Medical School established that the US government would benefit if the health care system was made universal. (Peterson B, 2008). Private health insurance is surrounded by much inefficiency due to the various bureaucratic procedures as well as administrative costs that would be effectively eliminated if it were to be made universal.
Preventive strategies to combat illnesses or diseases would ensure efficiency in realizing the goal of a healthy nation. When health care is made universal it is easily accessible and as the saying goes ‘a stitch in time saves nine’, the costs incurred are highly reduced. Critics of universal health care would be quick to argue that universal health care would lead to increased taxes and hence would be costly for the Americans. They also cite inefficiency as people would have a tendency of seeking medical attention even when is unnecessary due to the fact that it is free. (Mossialos O, 2005).
The US health care according to WHO is ranked position 15 in the world in terms of overall attainment and 37 in terms of performance. A high number of Americans are not contented or satisfied with their health care system. According to statistics collected between 1998 and 2000 only 40% considered it as satisfactory. Other shocking findings of how ineffective the US health care system is were established by a Commonwealth Fund 2001 survey on the quality of health care. It found out that there were great or rather major discrepancies in the accessibility as well as quality of care provided across the varying races. The minority groups were unlikely to acquire quality health care services as compared to the whites. (Karen Collins, Dora Hughes et al, 2002).
Minority races include the African Americans or the blacks, Asian Americans and Hispanics. The differences arose due to problems of inaccessibility, affordability, communication as well as cost which was due to their economic status. A significant proportion viewed the quality of health care provided to them as of a poor quality. Some felt disrespected and had the feeling that had they been from a different ethnic group then they would have been treated better. They feel that their doctors do not actually understand their plight given the differences in ethnic backgrounds. Others fail to contribute fully in the process of important decision making. (Karen Collins, Dora Hughes et al, 2002).
Accessibility to health care provision varied across the different minority groups with some recording higher levels than others. Approximately half the population of non elderly Hispanics lacked health insurance while African Americans and Asian Americans comprised a 1/3 and a 1/5 of the total population respectively. The study also established that a higher percentage of the people from the minority races do not consider themselves as of excellent or good health. 53% whites considered themselves of good or excellent health as opposed to 36% African Americans and 49% Asian Americans. (Karen Collins, Dora Hughes et al, 2002).
Language problems were also evident in the US health care and their impact on the quality of health care provided cannot be underscored. Language problems hindered effective communication between the physicians and their patients in this context the minority races especially the Hispanics. (Karen Collins, Dora Hughes et al, 2002). Some minority groups argued that the doctors handling them failed in effectively listening to them, others claimed that they did not quite understand what their doctors meant while others failed to ask questions they intended to ask. The survey also established that a significant proportion failed to adhere to the care recommended to them by their doctors due to the costs that such care involved.
Given their financial constraints some of the recommended care was unaffordable to them. 30% African Americans, 41% Hispanics could not afford the recommended care as opposed to 24% whites could not adhere to the recommended care due to cost constraints. This precipitated to the seeking of alternative medicine by some. More people from the minority groups had no confidence or trust in their doctors compared to the whites. 65% whites, 45% African Americans and 56% Asian Americans found the care provided satisfactory. (Karen Collins, Dora Hughes et al, 2002).
The US health care can also be termed as ineffective given the fact that considerable rates of medication errors were evident. Approximately 22% reported medication error incidences that led to aggravated problems. 13% African Americans and 14% Hispanics relied to emergency room care as opposed to 6% whites and 8% Asian Americans. 57% Hispanics reported having a regular doctor as opposed to 80% whites who had regular doctors. Without the health insurance low income earners will obviously not be satisfied with their health care system. They will only seek physician assisted care for curative services and this explains their high reliance on emergency rooms. (Karen Collins, Dora Hughes et al, 2002).
According to the Annie E foundation the minority groups register a higher prevalence or rates in diseases like TB, HIV, sexually transmitted diseases, depression, obesity, diabetes as well as low child immunization. They have poor housing and poor sanitation. They at times lack public transportation that would facilitate their easy accessibility to health care as well as their place of work. (The Annie E. Casey Foundation, 2007). Generally they are more likely to face worse health results when compared to the whites given the lack of health insurance, economic constraints as well as the lack of culturally competent care.
US can afford universal health care as it is already spending more on an ineffective health care system. The cost aggravates as it is done in various stages.
The Medicaid is also ineffective because it only caters for a very minimal percentage of the needy population. It ought to cater for those unemployed as well as those employed but without the health insurance. Effective universal health care would ensure that the high mortality rates among the minority groups are reduced and the life expectancy levels would be higher and at a uniform or rather equal rate. According to a research by PricewaterhouseCoopers (Pwc) for America’s Health insurance plans it was established that medical premiums have been rising over the years.
This trend was attributed to the fact that more people were opting for the broader access health plans, provider consolidation, rising cost of labor as well as the high prices attached to the new technologies. Cost shifting from the public providers to the private payers is also another factor for the rising premiums. There has been increased utilization which has led to the increased demand for health care services, people’s lifestyles have also changed and there is increased instances of obesity and physical inactiveness or sedentary lifestyles all of which increase the need for health services.
Smoking also increases the need for heath care attention given its harmful side effects. Pwc also suggests that new treatments which come with new technologies have also led to the increased premiums. Again, as defensive medicine or diagnostic testing is gaining popularity it also affects the price or cost of premiums. (PricewaterhouseCoopers, 2006).
The Kaiser Family Foundation is also in agreement that the premiums have been rising at a faster rate than the inflation as well as the wages. It is an unfortunate trend as it only works to make the accessibility of health insurance a difficult task and this translates to increased inaccessibility to health care. The levels of the uninsured are increasing with each passing year and special populations like children are not left out. (Kaiser Family Foundation, 2007). According to the 2006 campaign for children’s health care, the uninsured children were five more times more likely to have their health needs met as opposed to the insured children.
As Peterson notes, this has adverse effects on the children’s academic performance as some will only seek medical attention as a last resort and thus register a higher population in the emergency rooms. Their concentration in class is jeopardized by their poor health and they also record a higher rate of absenteeism as opposed to their counterparts the insured. (Peterson B, 2008).
To ensure that there is equitable satisfaction levels across all races the US health care must be made culturally competent in addition to the increased accessibility. Care must be culture sensitive as well as culturally appropriate to ensure that the system registers a higher level of satisfaction. Most health care providers tend to be white and this could be the reason behind the high levels of mistrust and lack of confidence from the minority races. Trust must be built between the health care providers and their patients as without it the minority groups might shy away from accessing early intervention. Positive interactions should also be embraced at all levels if trust is to be enhanced. (Abe-Kim and Goto, 2001).
Implementation of effective public policies would ensure that care given is not only effective and efficient but also meets the people’s expectations. The problem of language must be resolved through the use of translators as well as through the encouraging of the minority races to venture into the medical field so that their proportion in care giving is increased.
Medical professionals should also be trained on the advantages of offering culturally competent care so that they can meet the needs of their patients in an effective manner. (Abe-Kim and Goto, 2001). Preventive care must be encouraged for so that even the minority races have a chance to seek early intervention to their medical conditions. Quality health care would be ensured if comprehensive health insurance was offered to Americans.
The paper has by and large explained the state of the US health care system. It suffices to say that the system is very ineffective despite the fact that it is very expensive. When compared to other developed countries US spend the highest expenditure in dollars despite the fact that it has the highest infant mortality rates in the developed countries. There are great inequalities in terms of accessibility with the poor who are mostly from the minority groups being left out by the same society they claim to belong to. The lack of health insurance due to the cost factor hinders them from acquiring quality health care.
Although health care ought to be a government’s responsibility to ensure that it is everyone’s right this is not the case in the US. Poor people continue to succumb to diseases that could have been prevented as they simply cannot afford quality health care. The US health care also fails to meet the expectations of its citizens. This is attributed to the fact that it is highly commercialized and it divides people into two groups the rich who can afford it and the poor who cannot.
Those who cannot afford it will obviously depict high levels of dissatisfaction as opposed to the rich who have easy access to quality care. The well being or health of the poor also portrays high levels of inequality as can be confirmed by the differences in the infant mortality rates and adjusted life expectancy for the minority and the whites. Universal health care which has been applied in other developed countries seems a solution that can salvage the ineffective as well as inefficient health care system in the US. However the implementation of this policy is a highly debatable issue but the truth of the matter is as much talk continues, the poor continue to suffer.
Abe-Kim and Okazaki Goto. 2001. Unidimensional verus multidimensional approaches
to the assessment of acculturation of Asian American populations. Cultural
Diversity and Ethnic Minority Psychology.
Annie E. Casey Foundation. 2007. Health.Retrieved on 8th August 2008 from
Brown E. 2005. Job-based coverage drops for adults and children but public programs
boost children’s coverage. Policy Brief UCLA Cent Health Policy, Millwood.
Bob Peterson. 2008. Feeding Two Birds with One Hand. Why educators should demand a
national health care plan. Retrieved on 8th August 2008 from http://www.rethinkingschools.org/archive/22_03/feed223.shtml.
Byrne M and Rathwell T. 2005. Medical savings accounts and the Canada Health Act:
complimentary or contradictory. Health Policy Schoen C, Doty MM. Inequities in
access to medical care in five countries: findings from the 2001
C E. 2005. Access to care for people with special needs: role of alternative providers and
Cook D. 2004. Medicaid’s future foretold by Medicare Modernization Act. Journal of
Coon J. 2004. Health and health care in the United States: an insufficiently important
Oliver Mossialos. 2005. European health systems reforms: looking backward to see
Pijnenburg A and Gordijn B. 2005. Identity and moral responsibility of healthcare
Place D.2005. The health care crisis: as the number of uninsured grows, the money
disappears. America (NY).
Commonwealth Fund International Health Policy Survey. 2004. Health Policy. 2004
United Nation’s universal declaration of human rights. Chapter 25. Retrieved on 8th
August 2008 from http://www.unhchr.ch/udhr/lang/eng.htm
New National Scorecard: U.S. Health Care System Gets Poor Scores on Quality, Access,
Efficiency, and Equity. Retrieved on 8th August 2008 from
Karen Collins, Dora Hughes et al 2002.Diverse Communities, Common Concerns:
Assessing Health Care Quality for Minority Americans. Retrieved on 8th August
2008 from http://www.commonwealthfund.org/usr_doc/collins_diversecommun_523.pdf?section=4039
PricewaterhouseCoopers. 2006. The factors fueling rising health costs. Prepared for
America’s Health insurance plans. Retrieved on 8th August 2008 from http://www.pwc.com/extweb/pwcpublications.nsf/docid/BB82984D3A7DF2A485257267003C98BC.
National Academy of Sciences. 2008. Insuring America’s Health: Principles and
Recommendations. Retrieved on 8th August 2008 from
University of Maine. 2001. The US health care system: Best in the world or just the most
Expensive. Retrieved on 8th August 2008 from
Kaiser Family Foundation. 2007. Health insurance premiums rise 6.1 percent in 2007,
less rapidly than in recent years but still faster than wages and inflation. Retrieved
on 8th August 2008 from