position-paper-sy by nuhman10



                                                                            Shaleena Young
                                                                             March 24,2008
                                                                                ENGL 2010

                 Prescription for American Healthcare

       The patient was on the operating table. He would soon die without a mechanical

pump to support his failing heart. His insurance company would pay for a heart

transplant but not for the mechanical pump needed to keep him alive while awaiting a

heart donor. The surgeon chose to save the man’s life. The insurance company sued the

hospital for prolonging the man’s life and thus incurring additional expenses (Oz, 2007).

       Unfortunately, every day in the United States, physicians have to choose between

patient’s health and insurance company profits. This position paper will examine the

current American health care system and compare it with other countries’ systems.

                    The United States spends more on health care than any other country

             in the world, whether expressed per capita or as a fraction of the total

            economy. But by most measures of national health, the U.S. ranks well

below many other advanced countries that spend less and still manage to cover almost all

of their citizens (Relman, 2007). Why is American health care so expensive?

       Most of the U.S. citizens are covered by private, profit-based health insurance

companies. Such companies often have a controlling interest in the hospital and

physician offices they require their subscribers to go to. In 2006, private health insurers

attributed 15% of their costs ($120 billion) to overhead. $40 billion of that was pure

profit (Quinn, 2007). Compare that to less than 2% for Medicare’s overhead and it

becomes apparent why U.S. private health insurance is so expensive. The loss of these

huge incomes is what drives insurance companies to vehemently oppose any kind of

socialized universal health insurance.

        Another factor that drives up the cost of care is malpractice insurance and

defensive medicine practices. Circumventing lawsuits has added an estimated $50-100

billion a year to the system (Oz, 2007). Fear of lawsuits inhibits doctors’ actions. For

example, it may be better to let a patient die than get sued over an error made trying to

save his life.

        So what of those who cannot afford such costly avenues for their health

insurance? According to the 2007 U.S. Census, 84% of Americans are insured, 27% of

them by government funding (U.S. Census, 2006). The current system leaves 16% or 47

million Americans uninsured. It is unconscionable for such a wealthy and compassionate

nation to have so many citizens in such a precarious state.

        The United States Federal Government provides two main programs for health

insurance coverage: Medicare and Medicaid. Medicare applies to full-time students

under 21, the disabled, and retired elderly citizens who qualify; Medicaid applies to low-

income families. Even though such programs exist, a poll in 2006 revealed that only

39% of males and females ages 65 and over had excellent or very good health, suggesting

more elderly will need to be covered by Medicare (National Health Interview Survey

[NHIS], 2006). Additionally, only 25% of the 44.6 million uninsured American citizens

are even eligible for Medicaid (Holahan, Cook, Dubay, 2007).

        60% of Americans are covered by private health

insurance. 23% are covered by a government insurance

program. 16% or 47 million Americans are uninsured

(Relman, 2007). Many employers pay a part of the monthly premium to private health

insurers as a main component of their benefits package. The employee must pay the

other part of the premium. The private health insurers contract with doctors, hospitals

and specialists to provide services at set prices. The services provided and the limits set

usually match the limits set by the Medicare program. Up to 25% of the premiums paid

to private insurance go to pay administration salaries and cover profit margins. Private

for-profit hospitals are another area where administrative salaries and profit margins

contribute to the high cost of healthcare. Also for-profit hospitals have a higher mortality

rate than non-profit hospitals (Relman, 2007).

       In most industrialized countries, medical assistance is accessible to everyone. For

those who go on through life                     Annual spending as % of GDP
without medical assistance, it is

often by personal choice; and         15.0%

for the people who do not have        10.0%

personal means of payment, the         5.0%

medical professionals receive          0.0%
                                                 U.S.       France      Canada     England
payment from some other

source. In Germany, only 0.2% of the total population is without health insurance. They

make this possible by having a universal health care network (NCHC, 2007).

          Canada is another country where health care is available to everyone. The

government is the entity that supplies financial resources to the health care providers.

The doctors and other health care providers do not have to deal with insurance personnel

or wait for payment from a patient. The doctor will simply bill the government and then

be reimbursed (Klein, 2007).

          The French government allows any person to see a physician at any time (Public

Health News, 2004). This allows for a great deal of preventative care. On average,

people in France see a physician six times a year, whereas Americans only see a doctor

2.8 times a year (Klein, 2007). Later in life, preventative care such as this can cut costs

associated with high blood pressure- and diabetes-caused complications.

          The World Health Organization (WHO) analyzed the world’s health systems.

Using five performance indicators to measure health systems in 191 member states, it

finds that France provides the best overall healthcare. The United States health system

spends a higher portion of its gross domestic product than any other country but ranks 37

out of 191 countries according to its performance. The United Kingdom, ranks 18 while

spending only 6% of its gross domestic product (WHO, 2004).

World Health Organization’s ranking of Health Systems among member states:

1 France                          9 Austria                        17 Netherlands
2 Italy                           10 Japan                         18 United Kingdom
3 San Marino                      11 Norway                        19 Ireland
4 Andorra                         12 Portugal                      20 Switzerland
5 Malta                           13 Monaco                        21 Belgium
6 Singapore                       14 Greece                        22 Colombia
7 Spain                           15 Iceland                       23 Sweden
8 Oman                            16 Luxembourg                    24 Cyprus

25 Germany                        30 Canada                       36 Costa Rica
26 Saudi Arabia                   31 Finland                      37 U.S.A.
27 U. Arab Emirates               32 Australia                    38 Slovenia
28 Israel                         33 Chile
29 Morocco                        34 Denmark
                                  35 Dominica

       The 2008 United States Presidential Candidates of both the Democratic and

Republican parties are extending their own views on the “correct” direction for the

nation’s health care system, promising reform and hoping to insure most, if not all of the

47 million American citizens without insurance. Arguing over who has the better plan,

the Democrats are focusing on controlling the costs of insurance and proposing universal

coverage. The Republicans, on the other hand, plan to expand coverage and reduce the

costs through tax incentives, without increasing the federal government’s role.

       The Democrats that will be considered here are: Hillary Rodham Clinton, and

Barack Obama. The Republicans that will be considered here are: Mitt Romney.

       Clinton will require all citizens to obtain insurance, either subsidized by

employers and/or the Government. “I call my plan, the American Health Choices plan. If

you have private insurance you like, nothing changes, you can keep that insurance. If,

however, you don't have health insurance or you don't like the insurance you have, you

can choose from the same wide variety of private plans that members of Congress choose

from. You will have access to a public plan that will provide a stable, competitive

alternative to private insurance if that is your choice.”

       Obama is prospectively looking at making health coverage universal, but will in

the least require that all children have insurance. “The main disagreement with John

[Edwards] and I is John believes that we have to have mandatory insurance for everyone

in order to have universal health care. My belief is that most families want health care

but they can't afford it. And so my emphasis is on driving down the costs, taking on the

insurance companies, making sure that they are limited in the ability to extract profits and

deny coverage -- that we make sure the drug companies have to do what's right by their

patients instead of simply hoarding their profits. If we do those things then I believe that

we can drive down the costs for families. In fact, we've got very conservative, credible

estimates that say we can save families that do have health insurance about a thousand

dollars a year, and we can also make sure that we provide coverage for everybody else.

And we do provide mandatory health care for children.”

       Romney encourages states to develop market-based health care programs. He is

also opposed to a national version of the plan he supported for Massachusetts as

Governor of the State, requiring everyone to get insurance. “The way we improve

something is not by putting more government into it. Instead, the right

way for us to go is to bring in place the kind of market dynamics that

make the rest of the economy so successful” (Hossain, 2007).

                                    Work Cited

Fuchs, Dale. “In Europe, care for the elderly is being transformed.” International Herald

        Tribune 13 April 2007. 29 October 2007. www.iht.com.

Gray, Claire. “Healthcare in Latin America – It’s Better than You Think.” 16 July 2001.


Holahan, John, Allison Cook and Lisa Dubay. The Henry J. Kaiser Family Foundation.

The Kaiser Commission. The Kaiser Commission on Medicaid and the Uninsured.

February 2007.

Klein, Ezra. “The Health of Nations.” May 2007. 5 November 2007. <www.sirs.com>

National Coalition on Health Care. “Health Care in Germany.” 2007. 29 October 2007.

<www.nchc.org/facts/Germany.pdf >

National Health Interview Survey. Health Statistics. June 2007.

       Oz, Mehmet. “America’s Current System of Healthcare Endangers Patients and

       Providers.” Current Controversies: Healthcare. Ed. Jan Grover. Detroit:

       Greenhaven Press, 2007. Opposing Viewpoints Resource Center. Thomson Gale.

       Retrieved 21 Oct. 2007 from http://libweb.slcc.edu:TGDN

Public Health News. “The French Health Care System.” 27 June 2004. 29 October 2007


Quinn, Jane B. Yes, We Can All Be Insured. Newsweek July 30, 2007

       Retrieved Oct 20, 2007 from SIRS Database <www.sirs.com>

Relman, Arnold M.D. A Second Opinion: rescuing America’s healthcare. New York:

       The Century Foundation, 2007

United States. Department of Commerce. Census Bureau. Income, Poverty, and Health

       Insurance Coverage in the United States: 2006. August 2007.

United States. Department of Health and Human Services. Centers for Medicare &

       Medicaid Services. Medicare & You 2008.

(WHO)World Health Organization. “Core Health Indicators.” 2006. 14 November 2007.


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