Health Care Reform

The debate over health reform in the United States around the central question the right to health, access, equity, sustainability, and high quality that the sums spent. With mixed public-private health system in the United States is the most expensive in the world, with health costs per person over the other in Indonesia. A greater than the gross domestic product (GDP) spent on health in the U.S. than in other UN member countries except for the Marshall Islands. An international study on the level of health spending in 2000, published in the health policy journal Health Affairs, found that although the United States spends more on health of other countries in the Organization for Economic Co-operation and Development (OECD), the use of health services in U.S. under the OECD average by most measures. The author of the study concluded that the price to pay for health services is higher in the U.S.

According to the Institute of Medicine of the National Academy of Sciences, the United States is the "only wealthy, industrialized nation that does not guarantee that all citizens have coverage." Whether federal government should mandate universal health care system is applied in the United States will remain a hotly debated political topic, divided along the party line in the United States views of the health system in the U.S., and what should be done to improve it. They favor a government guarantee of universal health care that many uninsured Americans to create direct and hidden costs shared by all, and expand coverage to all akan reduce costs and improve quality. opposite government program or mandate for universal health states that people should be free to exit the health insurance. [5] Both sides of the political spectrum there are also more philosophical arguments, debating whether people have the right to basic health care provided to them by their government.

Although the amount spent on health in the U.S., a 2008 report by the Commonwealth Fund ranked last in the United States compared to the quality of health among 19 countries. [8] Other comparisons concluded that the United States do better on the system some action, such as the response and the high price of drugs for serious diseases such as cancer.

Cost

Current estimates that spending on health in the U.S. reached about 16% of GDP. In 2007, about $ 2.26 trillion was spent on health in the United States, or $ 7439 per person. [15] health care costs rise faster than wages or inflation, and the health of the GDP is expected to continue up to the historical trend, reaching 19.5 percent of GDP by 2017. [13] As a proportion of GDP, government health care spending in the United States is larger than that of most other countries in the west. [16] In addition, there are many expenses are paid from private insurance. A study found that the cause of medical expenditures for 60% of all personal bankruptcy in the United States. According to Dr. David Himmelstein of Harvard University who helped author the study, "Unless you are Warren Buffett, you only have one family from the severe failure ... to middle-class America, a health insurance offer little protection ..."

United States spends more on health per capita than any other UN member countries. [1] He also spends a larger fraction of the national budget on the health of Canada, Germany, France, or Japan. In 2004 the U.S. spent $ 6,102 on health per USD, 92.7% more than any other G7 country, and 19.9% more than Luxembourg, which, after the United States, have the highest expenditure in the Organization for Economic Co-operation and Development (OECD). [18] Although the U.S. Medicare prescription drug coverage begins in 2006, most prescription drug patents are significantly more expensive in the U.S. than in most other countries. Factors involved in the absence of government price controls, enforcement of intellectual property rights restrict the availability of generic drugs until after patent expiration, and buying power monopoly seen on a national payer system [need quote]. Some U.S. citizens get their drugs, directly or indirectly, from foreign sources, to take advantage of lower prices.

United States has a large component of the system. Every dollar spent for health care in the U.S., 45 cents comes from some level of government. [19] The federal Medicare program includes parents and people with disabilities, the state-federal Medicaid program to provide insurance to the poor, children, the State Health Insurance Program (SCHIP) to expand the scope of low-income families with children, traders and seaman covered by the Public Health System, train workers and retirees and military veterans who are also protected by the government. [20] The government will also affect the private sector, through drug licensing and regulation barriers to entry into the health professions.

Health expenditure in the U.S. is also very concentrated. In 1996, 5% of the population accounts for more than half of all costs.

Uninsured

People in the U.S. without health insurance at some time during 2007 total 15.3% of the population, or 45.7 million people. This number has decreased slightly from 47 million in 2006 due to increased public-sponsored coverage and about 300,000 more people have been discussed in Massachusetts, which operates a Massachusetts health reform law in 2007. [25] It is estimated that the current economic downturn and rising unemployment rate is likely to cause the number of uninsured to grow by at least 2 million in 2008.

Comparison with the health care system

Cost and quality of care in the United States are often two main issues for discussion. Meanwhile, the price comparison is relatively easy, with the reason the cost is higher in the U.S. and the quality of action is often subject to debate.

World Health Organization (WHO), in 2000, ranked the U.S. health care 37. Overall system performance, and 72. By the overall level of health (among 191 member nations included in the study). Although the expenditure is greater, then the United States is only slightly better level of infant mortality and life expectancy of the European Union. However, David Hogberg, a political scientist, has written that the baby's death and life expectancy is not accurate to compare the U.S. health care system to other people.

For example, the U.S. CDC show that the higher number of infant deaths in the United States is "because in most to continue the existing disparities between different racial and ethnic groups in the country, particularly African American." Some research claims that the data collected on infant mortality and life expectancy does not lend itself to the comparison fair.

Access to medical care and sophisticated technology is greater than in most other developing countries, and wait a short period of time may be substantial for treatment by specialists.

Insurance companies that provided health-uncapped receive tax benefits. According to the OECD, it "encourages the purchase of insurance plan is cheaper, especially with the cost sharing plan a little, so exacerbating moral hazard." Many of the health market analysts assert that the failure has occurred in the health care market, but have some suggestions that result from too much government involvement rather than too little. Consumers want unfettered access to medical services, they also choose to pay through taxes or insurance rather than from the pocket. Both need to create cost-efficiency challenges to health. Some studies have found no consistent and systematic relationship between the type of health care financing and cost containment.

Health care consumers often lack basic information than medical professionals buy from them, and information selection (especially in an emergency) are often implausible. Meanwhile, insurance companies and health care are also suffering from the service provider of information asymmetry, as patients almost always know more about their family history and risk behavior compared with the company. Price theory dictates that the cost of risk associated with the lack of this information will be delivered to consumers. Demand is likely to be rigid. Medical profession which has the potential to set prices in the top of the market value, and they are controlled by licensing requirements, with some degree of monopoly or oligopoly control over prices. Monopoly which is made with a greater variety of specialists and the importance of geographical proximity. Insurers have been stabilizing the private sector may be the only power, because they still pay the contract for a procedure. With no more than one or two specialist heart or brain Surgeons to choose, for the competition between the patient as expert is limited, so pre-arranged contracts to help reduce the supply price is limited.

Increased use of preventative treatment is often recommended as one way to reduce health expenditure. Research shows, that in many cases, prevention does not produce significant long-term costs. Preventive treatment is usually given to the many people who will never become sick, and for those who have become ill, this is partly offset the additional health care costs for the year of life.

Reform or restructuring of private health insurance market is often suggested as a means to achieve health care reform in the U.S.. Reform insurance market has the potential to increase the number of United States with insurance, but will not significantly reduce the rate of growth in health expenditure. Carefully consider the basic principles of insurance is important when considering the insurance market reforms, in order to avoid the consequences and do not guarantee long-term viability of the system reformed. According to a study done by the Urban Institute, if not implemented on a systematic basis in accordance with the security, market reform has the potential to cause more problems than solves.

Because most of the United States with private coverage receive it through employer-sponsored plans, many employers suggested that "pay or play" requirements as a way to increase coverage levels. However, research indicates that at this time to pay or play proposals are limited in their ability to increase the scope of work among the poor. These proposals generally exclude small companies, does not distinguish between individuals who have access to other forms of coverage and those who do not, and increase the overall cost of compensation to employers.

Premium subsidies to help people buy their own health insurance has also been recommended as a way to increase coverage rates. Research confirms that consumers in the individual health insurance market is sensitive to the price. Estimated demand elasticity in this market vary, but generally fall in the range -0.3 to -0.1. It appears that price sensitivity varies among population subgroups and are generally higher for young people and low income individuals. However, research also shows that the subsidy itself is not possible to solve the uninsured problem in the United States.

A report issued by the Commonwealth Fund at 15 December 2007 to review federal policy options and concluded that, taken together, they have the potential to reduce the future increase in health spending by $ 1.5 trillion over 10 years. Options include increasing the use of health information technology, research, and incentives to improve medical decision making, reduce tobacco use and obesity, provider payment reforms to encourage efficiency, so the federal tax exemption for health insurance premiums, and some market reforms such as changes in price as the benchmark back to the Medicare Advantage plan and allows the Department of Health and Human Services to negotiate drug prices. The author is based on the modeling they combine the effects of these changes with the implementation of universal coverage. The author concludes that there are no magic bullets to control health care costs, and that the terms of the approach will be needed to achieve meaningful progress. The congressional Budget Office has concluded that the increase in health information technology will not only significantly reduce overall health expenditure unless combined with measures that more broadly to reduce cost.

History of reform efforts

U.S. efforts to achieve universal coverage began with Theodore Roosevelt, who had the support of progressive health care in the peace election in 1912, but was defeated. During the Great Depression in 1933, Franklin D. Roosevelt, asked Isidore S. Falk and Edgar Sydenstricter to help draft regulations to Roosevelt's Social Security legislation pending to fund programs including public health. This reform has been attacked by the American Medical Association and state and local affiliate of the AMA as "compulsory health insurance." Roosevelt's health finally issued draft regulations in 1935. Fearing opposition from organized medicine universal health care to become the standard for decades after the 1930s.

Medicare program established by the signed legislation into law on July 30, 1965, by President Lyndon B. Johnson. Medicare is a social insurance program administrative government by the United States, providing health insurance for people who are both aged 65 years and over, or who meet other special criteria. Omnibus Budget Reconciliation of Consolidated Act of 1985 (Cobra) amended the Employee Retirement Income Security Act of 1974 (ERISA) provides some employees the ability to continue health insurance after leaving a job.

Reforming health care is a major Bill Clinton's administration led by First Lady Hillary Clinton, but in 1993 Clinton health plan was not set to become law. Health Insurance Portability and Accountability Act of 1996 (HIPAA) made it easier for workers to keep health insurance when they change jobs or lose their jobs, and also provides national standards to protect personal health information.

In 2001, a Patients' Bill of Rights was debated in Congress, which will be given a list of patients with explicit about the rights of their health. This initiative was basically taking some ideas found in the Consumers' Bill of Rights and applies to the health sector. It is done in an effort to ensure the quality of patient care by preserving the integrity of all processes that occur in the health industry. Standardizing the nature of health care institutions in this manner is quite provocative. In fact, many groups, including the American Medical Association (AMA) and the pharmaceutical industry out vehemently against the congressional bill. Basically, to provide emergency medical care to anyone, regardless of insurance status, patient rights and to hold their health plan is responsible for any and all damage done to become the biggest stumbling block is money. As a result of this intense opposition, the Patients' Bill of Rights initiative ultimately failed to pass Congress in 2002.

Expansion of health services is one of the focus of John Kerry's presidential campaign in 2004.

More recently, President George W. Bush signed the legislation into the Medicare Prescription Drug, Improvement, and Modernization Act that includes prescription drugs for older people and disabled American plan. health care reform has also been developed as part of the 2008 presidential campaign platform both Hillary Clinton and Barack Obama.

In January 2007 Rep. John Conyers, Jr. (D-MI) have been introduced in the United States Law National Health Insurance (HR 676) in the House of Representatives. In October 2008, HR 676 has 93 co-sponsors. Also in January 2007, Senator Ron Wyden introduced the Healthy America Act (S. 334) in the Senate. In October 2008, S. 334 has 17 cosponsors.

In December 2008, Institute for the Future of the United States with the way the head of the Health and Hearing Sub-committee Pete Stark launched a proposal from Jacob Hacker is co-director of the UC Berkeley School of Law at the Health Center that basically says that the government must offer health insurance plan to compete on level playing field with private insurance plans. This said, the foundation of Obama / Biden plan. The argument is based on three basic arguments. First public on the success of cost control management plan (Medicare medical expenses increased 4.6% pa compared to 7.3% for private health insurance as in-for-like basis in the 10 years 1997-2006). Both general insurance have a better quality and payment-refinement method based on large databases, new payment approaches, and care-coordination strategies. Thirdly it can set standards for private plans should compete who will help unite the community around the principle of sharing risk with a larger building, and trust the government through the long term.

Also in December 2008, American Health Insurance Plans (AHIP) announced a proposal that could reduce the projected growth in health spending 30% more than 5 years (although does not give detailed costings).

In March 2009 AHIP further acknowledge that the delivery and payment in the United States from health care market structure "and not extravagant." System, he said, "overpays and encourage the overuse of expensive special treatment, but underpays primary care that fosters the coordination and management of chronic care." He also said that "the traditional cost of service is often made to pay for services or if they are not appropriate or effective." There are several proposed reforms include

* The physician fee schedule (part of Medicare); the setting of standards and expectations for safety and quality of diagnosis

* Improve coordination of care and patient-care center by designating a "medical home" (the same as the UK general practitioners), which will replace the care with a coordinated approach to care. Doctors will receive periodic payments for a set of defined, such as coordination of care that integrates all of the treatment received by all patients with acute illness or event. This will continue to improve the management of comprehensive care, optimize patient health status and help patients navigate the health care system

Connecting the payment for quality, adherence to guidelines, clinical results for the better, provide better patient experience and reduce total cost of treatment.

* Bundled payments (bills, not individuals) for the management of chronic conditions in which service providers will share responsibility and accountability of the management of chronic conditions such as coronary artery disease, diabetes, chronic obstructive pulmonary disease and asthma, and therefore

* Fixed rate all-inclusive average payment for the treatment of acute episodes tend to follow the pattern (although some acute care episode in May cost more or less than this).