Medicare & Medicaid

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It should also be noted that despite being the highest spender on healthcare, the US life expectancy is not the highest world wide (see Appendix B for tables). In fact it ranks 27th in the world with a life expectancy of 77 years, just slightly above Cuba’s 76. 9 years who – as a country – only spends $186 per capita on healthcare. Leading the list is Japan (life expectancy 81. 5 years, healthcare spending about $2000 per capita) while Switzerland, second highest at per capita spending (around $3000) enjoys a life expectancy of 80.

4 years – all values significantly higher (in terms of life expectancy) and lower (in terms of per capita spending) compared to US numbers (UC Atlas, 2007). In terms of access, the US is the only country “that does not provide healthcare for all its citizens” (cited in Bureau of Labor Education, 2001, p. 3). This is in part due to the hodge-podge coverage provided by employer-based private insurance and public (Medicare, Medicaid) insurance for the military, poor and veterans. As of 1999, an estimated 42. 6 million Americans were uninsured and this number has grown in recent years.

This is embarrassing and dangerous since “it is a matter of life and death” for most cases. In fact “people without health insurance tend to live sicker and die younger than people with health insurance” (Bureau of Labor Education, 2001, p. 4). A far-reaching consequence of health insurance inaccessibility is that hospitals and care providers are forced into cost-shifting strategies which come at the expense of tax payers and private insurance holders who suffer increased premium rates (Bureau of Labor Education, 2001, p. 4).

Overall health status indicators on the other hand (which uses Infant Mortality Rates [IMR] and life expectancy – particularly that of disability-adjusted life expectancy [DALE]) in 1998 showed that the US, in comparison to other OECD’s had the highest IMR and ranks 26th among industrialized countries. Though somewhat misleading, the reality behind the data is much more disconcerting. According to the OECD 1998 report, the high IMR is actually the lowest in American history at the time but the IMR accounts for a wide disparity persisting among racial groups.

Data from the Department of Health and Human Services show that the IMR is representative of the following data: an IMR of 14. 3 for black children and 6. 0 for white children and that these data are higher at certain areas of the country. As the OECD report worded, it is “a shocking indictment of living conditions for segments of the population in the richest country on earth” (Bureau of Labor Education, 2001, p. 5). Additionally, the US also ranked very low (24th) on DALE as compared to other OECD member countries in 1998.

The US DALE also suffered from unequal distribution, particularly with males who some of which enjoy longer DALE than others – a phenomenon naturally attributed to lack of access, particularly, to preventive care (Bureau of Labor Education, 2001, p. 5). In the category of financing fairness – a measure of the degree by which financial contributions to the system are distributed (fairly) across the population – the US once again failed and is ranked lowest among all OECD countries.

Fairness in financing has grave consequences for the population especially for those who are uninsured, underinsured and the poor. These susceptible populations suffer the impact of being pushed deeper into poverty by the lack of fiscal protection from illness (Bureau of Labor Education, 2001, p. 6). On a positive note, the US ranked number one in terms of responsiveness (extent by which caregivers/providers respond to client/patient expectations in non-health areas such as dignified and respectful treatments etc. ).

However, this does not fairly represent the situation as extreme disparities exist among different populations in the US. For example, those who have no insurance or can only avail limited access via Medicaid experience greater problems finding responsive caregivers in comparison to those with access to private health insurance (Bureau of Labor Education, 2001, p. 6). At this point it has become obvious that the US healthcare system has performed generally poorly in comparison to other developed and OECD countries.

Data from the 1998 study reveal that in terms of Overall Attainment Ratings (based on the five criterions mentioned in the above paragraphs – Cost, Access, Overall Health Status, Responsiveness and Financing Fairness) the US is ranked 15th in the world. On the other hand, in terms of Performance (how well a country’s healthcare system performs given the resource level it has in its disposal), the US is ranked 37th worldwide.

This by itself already reflects the wide disparity in the US healthcare system and coupled with the low level of satisfaction (rated at 40%) it seems that even as early as 1998 the US healthcare industry has been showing signs of instability, inefficiency and ineffectiveness (Bureau of Labor Education, 2001, p. 7). Universal Healthcare – Definition and Overview A universal healthcare system is a form of coverage that is government provided so that all its citizens have access to healthcare services.

It is “a tax-payer funded, government administered healthcare delivery system” (Insurance Specialists, 2008) that runs along similar veins as the US’s government run Medicare and Medicaid system. Countries such as Canada, Russia, Western Europe and parts of South America are some of those known to have a running program described as universal healthcare (Insurance Specialists, 2008).

Historically, universal healthcare traces its roots back in Germany where Otto Von Bismarck instituted a widespread system of reforms that included how healthcare was delivered. Under the early system, both employee and employer pay into the healthcare system that was administered by local health bureaus. Among modern existing universal healthcare systems, the most socialized system is that of United Kingdom’s National Health Service (NHS) which was established in 1948 during World War II.

As a system, it was initially criticized “for offering a fairly low quality of health care, and for extended wait times for service” (McGuigan, 2009) but since then the UK government has increased funding for the NHS and since successfully modernized the NHS, bringing it at par with the rest of Europe. The NHS system is characterized by the medical care that is funded entirely from tax revenues and patients are not required to pay for services. However, universal healthcare also takes on several forms.

Some systems employ mandatory insurance – a system where all are required to buy into the system while at the same time being provided subsidies to keep insurance rates at a minimum. Also, the government provides assistance to those who cannot afford the insurance payment. In some systems, on the other hand, employers are required to carry the bulk of the burden in paying insurance costs (McGuigan, 2009). Lastly, as McGuigan (2009) writes in his article: “In the modern world, every wealthy industrialized nation, aside from the United States, offers some form of universal health care to its citizens. ”

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