Health care policy decision making in America is a ‘quasi corporatist’ process in which decisions and negotiations take place between insurance companies, health care stake holders and physician groups – the people who have the most to gain from private health care. Very little public participation has ever taken place concerning health care and perhaps this is where the problem lies. If the population continue to be ignorant when it comes to healthcare, they are less likely to want change. But people are suffering; if people can’t afford health cover and they are employed they have to ensure they are careful so as not to miss work otherwise they’ll lose money – making themselves worse off.
America is the only democratic nation of the West not to offer universal coverage; it’s also the nation which spends the most on health care but considering what it does spend (currently 16% GDP) it has the poorest record of equity, efficiency and general record of achievement. The costs involved are “incompatible with other economic demands on the U.S social system.”(Paton 1990)
Paton (1990) argues the biggest problem with the system is the level of access the poor have to health care, this is supported by Fording et al (2006): there is a huge gap in terms of health insurance coverage between the classes, of the 84 million American families living below the poverty line; there are 23 million people uninsured. There are 72 million families earning above the poverty line and only 5% (3.63 million people) of those are insured. Where people are insured, Paton (1990) argues that particular medical services are not always covered by insurance companies. Even under the Medicare and Medicaid programme, there are certain services which people are not entitled to or the funds are unavailable to cover every procedure or prescription drug.
In the forty years since Medicare and Medicaid were introduced in 1965, both programmes have continued to have had their funding cut, and limit and discriminate against a number of people who are potential receivers. In 1965 the public sector was spending 25% of its budget on healthcare, in 1992 it had risen to 40%, the blame has been aimed towards Medicaid and Medicare, the two programmes together are the second biggest consumer of state budgets. During the 1980s, the Medicare and Medicaid programmes were limited and funding was cut. The 1981 Omnibus Budget Reconciliation Act led to the tightening of eligibility to the welfare schemes, and many people were no longer covered by Medicare or Medicaid as a result. When Medicare as first introduced in 1965, 65% of poor people were covered by it, but by the 1980s only 40% remain covered. In Oregon in 1991, a family of three whose income surpassed $5,500 a year were considered ‘too rich’ to qualify for the Medicaid programme. Senator Kitzhaler appeared on the popular television show ‘The Today Show’ to discuss the issue of health care on 15th February 1988 and said: “We are not going to avoid rationing healthcare in this country. We can’t afford to pay for everything for everybody. Rationing has played a key part in the American health care system, insurance companies and health care providers refuse to treat certain people for certain procedures, even if people are on Medicare or pay for insurance cover themselves. Some drugs are also restricted under insurance companies and if people need them they have to pay for them, themselves. House Representative, Henry Waxman also stated in the 1980s: “Until recently, unequal access to healthcare was not tolerated.” Indicating that the recent level of care and access to that care has dropped and instead of questioning and raising the issue, people are choosing to cope with it.
B. Guy Peters (2007) argues that the American health system does have some positive attributes, he states how the level of involvement the government have when dealing with healthcare is highly significant, and that without public funding the health service would “certainly be different, probably not as good: healthcare would certainly not be accessible to the poor and the quality of health care received would not be as high.” Peters argues that although the healthcare system is good, he reflects how in the 1990s even middle class families were struggling to pay for their healthcare.
In 2009, House of Representatives Speaker, Nancy Pelosi stated how Congress is trying to undo Bush’s funding cuts to the Medicare programme in order to maintain Medicare’s pledge to insure the elderly. Congress, despite Bush’s veto passed the Medicare Improvements for Patients and Providers Act in July 2008 in order to prevent 10% pay reduction to physicians working for the Medicare programme. Nancy explains that the new legislation will increase the “Medicare preventive and mental health benefits and improve and extend programs for low income Medicare beneficiaries.” She describes the health insurance industry as “bloated and unnecessary.”
Health costs have increased from $41billion in 1965 ($206 per person, per year) 5.9% GDP to $666.2 billion in 1990, 12% GDP ($2,665 per person). The current GDP is 16% (2009) and in comparison to the United Kingdom’s 10% it’s clear that there is something wrong with the U.S health care system. The richest and best developed medical country in the Western world has one of the poorest health systems in terms of access and expense, the UK with its cheaper system performs better. Whenever reform has been high on the agenda, such as the Health Security Act during the Clinton administration, insurance companies and health care providers have always poured in a lot of money to ensure the proposals are always defeated. Opponents to the Health Security Act in 1994 were estimated to have spent over $100 – 300 million on defeating the bill. The American Medical Association and the Health Insurance Association both have very influential lobbying groups and their key argument is that if the government establish a national health insurance, medicine will be socialised and people won’t be able to choose the care they want.
It’s clear that America is in desperate need of a healthcare reform and the current administration believes so and is trying to rectify the problem. Paton (1990) argues that a national health service may become needed, which then addresses the best way of achieving it because “if the rich have to pay for the poor, neither they nor the government will be able to afford the old type of uncontrolled health care or huge tax allowances.”
California was close to reforming its healthcare; the state aimed to raise money for a health service by imposing an affordable income and business tax as well as placing a dollar tax on every packet of cigarettes. If this proposal, proposition 186 had passed and California had collected the additional taxes, the state’s budget would have doubled providing more than enough money for a decent health care system for all residents. The proposition failed because critics believed the taxes would burden citizens but the outcome would have benefited the residents significantly. (At that time 19% of California population uninsured)
Obama’s new enthusiastic administration plan to reform healthcare – illustrating that it is in dire need of change. Mckeever (2006) points out that in 2002 15% of the American population were without insurance. And if people are without insurance, they are leaving themselves in a very vulnerable position – what are they going to do if they fall ill? Medicaid and Medicare have had public funds cut so less people are offered cover under them – more people are working longer hours just to afford basic necessary items, if they fall ill how are they going to pay to live? President Obama hopes to bring a much needed efficient, affordable and fairer health care system to America,
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Bibliography
Books
- Fording, Schram & Soss, (eds) (2006) Race and the Politics of the Welfare Reform. University of Michigan Press, United States of America.
- Leichter, H.M. (1992) Health policy reform in America: innovations from the States. Armonk, NY : M.E. Sharpe
- Mckeever, R.J (2006) Politics USA. Longman, U.K
- Noble, C (1997), Welfare as we know it: Political History of American Welfare State. Oxford University Press, New York
- Paton, C.R. (1990) US Health Politics. Avebury, England
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B.Guy.Peters, (2007). American Public Policy: Promise and Performance. 7th edition. CQ Press, Washington.
Websites
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- Washington Post Survey – (Roper Center Online Poll, 2000. Accession no. 0374367. Question no.043)
Mckeever, R.J (2006) Politics USA. Longman, U.K
Guiden (1999) taken from Fording, Schram & Soss, (eds) (2006) Race and the Politics of the Welfare Reform. University of Michigan Press, United States of America. Pg 284-286
Washington Post Survey – (Roper Center Online Poll, 2000. Accession no. 0374367. Question no.043)
Fording, Schram & Soss, (eds) (2006) Race and the Politics of the Welfare Reform. University of Michigan Press, United States of America. Pg 284-286
Fording, Schram & Soss, (eds) (2006) Race and the Politics of the Welfare Reform. University of Michigan Press, United States of America. Pg 284-286
Paton, C.R. (1990) US Health Politics. Avebury, England. Pg.xi
Paton, C.R. (1990) US Health Politics. Avebury, England. Pg.xi
Leichter, H.M. (1992) Health policy reform in America: innovations from the States. Armonk, NY: M.E. Sharpe. Pg 117
Leichter, H.M. (1992) Health policy reform in America: innovations from the States. Armonk, NY: M.E. Sharpe. Pg 117
The Today Show, 15/02/1988 – Leichter, H.M (1992) Health policy reform in America: innovations from the States. Armonk, NY: M.E. Sharpe. Pg 117
Leichter, H.M. (1992) Health policy reform in America: innovations from the States. Armonk, NY: M.E. Sharpe. Pg 139
B.Guy.Peters, (2007). American Public Policy: Promise and Performance. 7th edition. CQ Press, Washington. Pg 241
Noble, C (1997), Welfare as we know it: Political History of American Welfare State. Oxford University Press, New York. Pg 133
Paton, C.R. (1990) US Health Politics. Avebury, England. Pg.143