Has to have all of this! 1. Clearly state topic with brief explanation as to why it is important to focus on this area of study 2. Documentation and incorporation of findings from the literature (what the literature says and what other people think). Use 9 or more references- sources have to be credible. 3. Sensitivity to the multiple dimensions of a topic: governmental, ethical, professional, institutional (breadth). 4. Capacity to look beyond the surface of a topic (depth). 5. Ability to articulate your personal opinion, draw conclusions, and identify where further research or investigation is necessary. (Please see uploaded file for example of paper)
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Universal Health Care System, Case For and Against
One of the issues that were strongly discussed during the recent national health care
debate were the pros and cons of universal health care and whether it can be delivered in the
United States without a fundamental change to the prevailing system. Conceptually, universal
health care can be viewed as the delivery of basic health care coverage to all individuals who
meet the minimum legal residency requirement. Its delivery can be totally governmental at
one end of the spectrum or entirely private at the other end of the spectrum, or more
commonly, a hybrid of government and private insurance companies.
Historically, through the health insurance bill of 1883, Germany became the first
nation to have some form of universal health coverage for its citizens, and currently covers
99.8% of its legal residents. Funding is mostly public and it provides universal basic health
care coverage, but allows individuals to purchase supplemental plans which could deliver
additional coverage. Premiums are capped and government provides subsidies for low
income workers (Shafrin, 2008). In United Kingdom, the government is heavily involved in
health care delivery through the National Health Services (NHS) enacted in 1948. Funding is
entirely public and coverage is extended to all legal residents (Godber, 1988). The Canadian
system is a form of single payer universal health care whereby the government is the
administrator and the payee while private companies deliver the care. Unlike the British
system, funding is public and private, with the public part of funding being shared by the
federal government and the individual provinces. Hospitals and providers are private entities
and they bill the government, the single payer, for their services (Steinbrook, 2006).
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Switzerland and Netherlands are other countries with universal health care system
which covers about 99% of their legal residents. Private insurance companies deliver
coverage to individuals, either through a national exchange as in Netherlands or through
decentralized private companies as in Switzerland. Coverage is without regards to age or
pre-existing medical conditions, and in turn all citizens are mandated to purchase health care.
Even though individuals are entirely responsible for their premiums, government provides
subsidies for low income workers and poor people (Leu, Rutten, Brouwer, Matter, &
Rütschi, 2009).
The Patent Protection and Affordable Care Act (PPACA), signed into law by
president Barrack Obama in 2010 have the goal of providing health coverage for legal
residents in the United State. Insurance companies will be forced to compete for the hitherto
uninsured pool through state-based exchanges (HealthReform.gov., 2010). The PPACA
mandates individuals to purchase health coverage, with the provision that government will
provide subsidies for low income individuals. Insurance companies are also mandated to
cover everyone without pre-existing medical condition exclusionary criteria. Contrary to this
goal of PPACA to cover almost all residents, it has been projected that by 2019, about 23
million (8%) Americans will remain uninsured (Brown, 2011). Is universal health care the
utopia proponents portray or is it as flawed as the opponents describe? The next part of the
paper will attempt a balanced analysis of the merits and demerits of universal healthcare.
The Case for Universal Health Care
About 60% of health care coverage in the United States is employer based (Fronstin,
2007). As a result, loss of job results in loss of coverage with possible catastrophic
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consequences. With universal care, there will be some form of coverage for that individual
and people will not have to declare bankruptcy to cover the cost of care. Furthermore,
employees would be able to change jobs if they wish without feeling tied to an unsatisfactory
job due to health insurance considerations. Prior to the enactment of the PPACA, over 45
million residents do not have health care due to the exorbitant cost of health care coverage.
Proponents of universal health care believe that the system would reduce the number of this
uninsured population by providing affordable access to basic care packages. In Switzerland
and Netherlands, subsidies are provided if the premium exceed 10% of the person’s income.
Up to 40% of legal residents receive such subsidies in Switzerland (Shafrin, 2008). In the
United States, according to the Congressional Budget Office (2011), PPACA “will produce a
net reduction in federal deficits of $143 billion over the 2010-2019 periods”.
Under the current system, the high premium businesses are paying on their
employees’ health care is rendering the price of their products un-competitive in the global
market. Universal health care may thus free businesses from health care expenses thereby
leading to higher profitability. The Emergency Medical Treatment and Active Labor Act
(EMTALA) requires all patients who present with an emergency at any hospital to be treated
regardless of residency status or affordability. The cost of treating these uninsured
individuals consequently contribute to a higher running costs for the hospitals, which means
they either absorb the costs or pass it to individuals who have coverages. Some people see
this as inherently unfair and believe that universal coverage, which would be funded by
health care taxes from everybody, would minimize the likelihood of such costs to others
(American College of Emergency Physicians, 2011). Another advantage reported by
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proponents is the significant reduction in administrative costs through prevention of
wasteful duplications by streamlining record keeping. Woolhandler, Campbell, &
Himmelstein, (2003) found that through pluralistic administrative bureaucracies, United
States spends more on health care as a percentage of its gross domestic product than any
other industrialized country in the world. They concluded that United States will achieve
significant savings if the single payer type of health system like in Canada was implemented.
The Case against Universal Health Care
In order for care to be truly universal, legal residents must be mandated to buy
insurance coverages. In a country like United States which was founded on the principle of
freedom and liberty, is it really judicious to take away people’s freedom under the
paternalistic guise of health coverage? Taxes are more likely to go up in order to maintain
universal coverage. Higher taxes serve as disincentives to businesses. This could lead to
fewer new businesses, closure of existing businesses, more unemployed people and more
people depending on the government.
The ingenuity of market forces have been shown by a truly capitalist economy like
the United States. Universal coverage delivered through a single payer entity or a
governmental take over like in England are more likely to stunt innovations. Over-regulation
will stifle the growth of many insurance companies leading to them folding up with resultant
loss of jobs for many people who work in the health care industries. Responsibility for
health care may slowly fall to the government with possible invasion of peoples’ privacy or
curtailment of peoples’ liberties.
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When everybody is covered regardless of affordability, it may naturally create huge
waiting lists, for example the waiting list to have an MRI in Saskatchewan province of
Canada is reportedly 22 months (Messerli, 2011). Apart from this, there would be more
rationing of care, as some new but expensive drugs may be deemed ‘experimental’. The
recently enacted PPACA has a governmental advisory body with responsibilities to give
treatment guidelines. While this may not be as dramatic as the ‘death panels’ as described by
some politicians (Rutenberg & Calmes, 2009), there is the possibility that arriving at such
guidelines could be heavily influenced by the preference of politicians and government
bureaucrats. Finally given the current debt situation, commitment to provide subsidies will
create a new set of entitlements, thus placing the overall funding for traditional programs like
Medicare and Medicaid at risk.
Conclusion
In conclusion, universal care may not be the only way to achieve the altruistic goal of
providing coverage for all residents in the United States. Given the size of the country,
enacting a universal form of coverage irrespective of the unique needs of member states is akin
to the European Union having a single health care system. Given the cultural differences
between the Germans, the British and smaller countries like Belgium, this would simply not
work. The financial crisis in Europe is currently being perpetuated by adopting a single
monetary policy for member countries with different financial structure. Just like individual
member countries in Europe are adopting health care system which suits their needs, United
States should also allow member states to adopt systems which suit their needs. For example
Massachusetts modeled its health care system after Switzerland; New Jersey has its own unique
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and effective way of covering low income families while Vermont is seeking a waiver from the
federal government to start a single-payer plan in 2014 (Goodman D, 2011). Given the
current debt situation, it may not be financially judicious to start a new set of entitlement
program with future unforeseen financial implications for the country.
Finally, United States was founded on the principle of rugged individuality, liberty and
freedom. To be mandated to buy health care coverage, no matter how altruistic the intention,
runs antithetical to this principle. The constitutionality of this mandate is slated to be heard by
the United States Supreme Court (Cigna, 2011). If the law is deemed unconstitutional, it may
pave way for alternative measures like tort reforms and giving more freedoms to individual
states to enact their own policies based on their unique cultures and needs.
References
American College of Emergency Physicians (2011). EMTALA. Retrieved from
http://www.acep.org/content.aspx?id=25936
Brown, A. (2011).What is universal healthcare? Physicians for a National Health
Program. Retrieved from http://www.pnhp.org/news/2011/march/what-isuniversal-healthcare.
Chitty, K. & Black, B. (2011). Professional Nursing: Concepts & Challenges, 6th ed.
Maryland Heights, Missouri: Saunders.
Cigna (2011). Supreme Court will hear PPACA challenges. Retrieved from
http://www.cigna.com/aboutcigna/informed-on-reform/news/supreme-court-willhear-ppaca-challenges.html
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Congressional Budget Office (2011). Estimates for March 2010 health care legislation.
Retrieved from
http://www.cbo.gov/publications/collections/health.cfm
Fronstin, Paul (2007). “The future of employment-based health benefits: Have employers
reached a tipping point?” Employee Benefit Research Institute. Retrieved from
www.ebri.org/pdf/briefspdf/EBRI_IB_12-20073.pdf
Godber, G. (1988). Forty years of the NHS. Origins and early development.. BMJ. 1988 July
2; 297(6640): 37–43.
HealthReform.gov. (2010): Fact Sheet – The Affordable Care Act’s New patient’s bill of
rights. Retrieved from
http://www.healthreform.gov/newsroom/new_patients_bill_of_rights.html
Leu, R.E., Rutten, F.F.H., Brouwer, W., Matter, P. and Rütschi, C. (2009). The Swiss and
Dutch health insurance systems: Universal coverage and regulated competitive
insurance markets. The Commonwealth Fund. January 16, 2009. Volume 104.
Retrieved from
http://www.commonwealthfund.org/Publications/Fund-Reports/2009/Jan/The-S
wiss-and-Dutch-Health-Insurance-Systems–Universal-Coverage-and-Regulated-Com
petitive-Insurance.aspx
Messerli, J. (2011). Should the government provide free universal health care for all
Americans? Retrieved from
http://www.balancedpolitics.org/universal_health_care.htm
Rutenberg, J. & Calmes, J. (2009). False ‘Death Panel’ rumor has some familiar roots
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Retrieved from http://www.nytimes.com/2009/08/14/health/policy/14panel.html
Shafrin, J. (2008). Healthcare Economist. Health care around the world: Germany.
Retrieved from
http://healthcare-economist.com/2008/04/24/health-care-around-the-worldGermany/
Shafrin, J. (2008). Healthcare Economist. Health care around the world: Switzerland.
Retrieved from http://healthcare-economist.com/2008/04/23/health-care-aroundthe-world-Switzerland/
Steinbrook, R. (2006). Private health care in Canada. N Engl J Med 2006; 354:1661- 1664.
Woolhandler, S., Campbell, T. & Himmelstein, D.U. (2003). Costs of health care
administration in the United States and Canada. N Engl J Med 2003; 349:768-775
Grading weights for paper:
20% Clearly state topic with brief explanation why it is important to focus on this
area of study. Wellstates and justified….A
20% Documentation and incorporation of findings from the literature. About 10
references should be used in the paper. (What the literature says and perhaps what other
people think) Use the APA format rigorously. One sources of reference:
http://owl.english.purdue.edu/owl/resource/560/01/
Excellent documentation….A
20% Sensitivity to the multiple dimensions of a topic (breadth)….Well tuned in to
all the points of argument, and neutrally presented…A
20% Capacity to look beyond the surface of the topic (depth)…..Good…A
20% Ability to articulate your personal opinion, draw conclusions, and identify
where further research or investigation is necessary. Personal opinion clear although
there is much more data to collect and investigation to do….A
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