Why are Americans so worked up about health care reform? Statements such as “don’t touch my Medicare” or “everyone should have access to state of the art health care irrespective of cost” are in my opinion inexperienced and visceral replies that indicate an unhealthy understanding of our health and wellness care anatomy’s history, its current and future resources and the funding challenges that America faces going forward. While we all wonder Sildenax Preço how the health care system has reached what some refer to as a crisis stage. Let’s try to take some of the feelings out of the debate by in brief examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let’s look at the pros and cons of the National government health care reform proposals and let’s look at the concepts supply by the Republicans?
Access to state of the art health care services is something we can all agree would be a a valuable thing for this country. Experiencing a serious illness is one of life’s major challenges and to face it without the means to pay for it is positively frightening. But as we should see, if we know what exactly is it, we will find that achieving this goal will not be easy without our individual contribution.
These are the themes I will touch on to attempt to make some sense out of what is happening to American health care and the steps we can personally take to make things better.
A recently available history of American health care : what has driven the costs so high?
Key elements of the Obama health care plan
The Republican view of health care : free market competition
Wide-spread access to state of the art health care : a worthy goal but not easy to achieve
exactly what do we do?
First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What owned costs higher and higher?
To begin, let’s turn to the American city war. In that war, old tactics and the carnage inflicted by modern pistols of the era combined to cause awful results. Not generally known is that most of the demise on both sides of the particular war are not the result of actual combat but from what happened after having a battlefield injure was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to injure care, related surgical practices and/or amputations of the affected hands or legs and this often resulted in the oncoming of massive infection. That serves to survive a battle injure in order to die at the hands of chunks of money providers who although well-intentioned, their interventions were often quite poisonous. High death tolls can also be attributed to everyday illnesses and diseases in a time when no antibiotics existed. In total a product like 600, 000 demise occurred from all causes, over 2% of the U. S. population at the time!
Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to newer times. After the city war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new operative techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone bone injuries and increasingly attempt risky surgical practices (now largely performed in sterile operative environments) but medicines are not yet available to handle serious illnesses. The majority of demise stayed at the result of untreatable conditions such as tuberculosis, pneumonia, scarlet feeling sick and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.
This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor whenever were relegated to emergencies so usual scenario costs are curtailed. The straightforward in order to that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of somebody’s personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Excepting the very destitute who were lucky to find their way into a charity hospital, health care costs were the obligation of the individual.
What does medical insurance must do with health care costs? Its have an effect on health care costs has been, and remains to this day, absolutely enormous. When health insurance if you are and families emerged as a method for enterprises to escape income freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the option of billions of dollars from health insurance private pools, encouraged a progressive America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast selection of treatments we have available today.
I not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives which were saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and gain access to the latest available health care technology in the form of prescription drugs, medical devices, diagnostic tools and surgery. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only accelerating.
At this point, let’s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current velocity of U. S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% individuals gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add governmental policies and an political election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly provided we can more wisely determine whether certain health care proposals might solve or intensify some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?
The Obama health care plan is complex for sure : I have never seen a health care plan it’s not. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs usual manner that quality and our access to health care is not detrimentally affected. Republicans seek to achieve these same basic and broad goals, but their approach is offered as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.
Through insurance deals and an expansion of Medicaid, the Obama plan dramatically increases the number of Americans which is to be covered by health insurance.
To cover the cost of this expansion the plan requires everyone to have health insurance with a punishment to be paid if we don’t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.
To cover the added costs there were a number of new taxes introduced, one being a 2. 5% tax on new medical technologies and another increases taxes on interest and dividend income for richer Americans.
The Obama plan also uses concepts such as evidence-based medicine, answerable care organizations, comparative effectiveness research and reduced repayment to health care providers (doctors and hospitals) to overpower costs.
The insurance requirement covered by points 1 and 2 above is a worthy goal and most industrialized countries not in the U. S. provide “free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of rules which is why many Americans would be culturally unprepared. Here is the primary debatable part of the Obama plan, the insurance requirement. The U. S. Great Court recently decided to hear arguments from what constitutionality of the health insurance requirement as a result of a case by 26 states attorney’s general that congress surpass its authority under the commerce clause of the U. S. composition by passing this element of the plan. The problem is that if the Great Court should rule up against the requirement, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance for all would be severely limited if not terminated altogether by such a decision.
As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and users who have to pay them. Medical device companies, pharmaceutic companies, nursing homes, doctors and insurance companies all had to “give up” something that would either create new revenue or would keep your charges down on their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1, 000 employee cut of part to cover these new fees. This is being experienced by other medical device companies and pharmaceutic companies as well. The cut of good paying jobs in these sectors and in the hospital sector may rise as former cost structures should be dealt with in order to accommodate the reduced rate of repayment to nursing homes. Over the next several years some estimates put the cost deals to nursing homes and health professionals at half a trillion dollars and this will flow on to and affect the companies that supply nursing homes and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does make a splash both positive and negative.
Finally, the Obama plan searches for to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like ordinary people and their training and day-to-day experiences influence to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to health professionals from what outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps still another of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary ensure that you procedures that do not compare beneficially with health care interventions that are better documented as effective. Now the Republicans among others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.
A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their capacity pay. But the main difference is that these folks see market forces and competition as the way to creating the cost deals and efficiencies we’d like. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would learn to drive cost down by the choices we make. This works in many sectors individuals economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The reccommended population, however, is not so informed and besides just about everyone has been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the impression that health care is something that is just there and there really isn’t a reason not to access it for no matter what reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to include those with serious problems.