The Need for Healthcare Reform in America

The healthcare model in the United States is deeply flawed with spiraling costs, rising numbers of uninsured citizens, limitations on the plans of those with insurance coverage, and deficiencies of the government sponsored health plans. According to a Commonwealth Fund survey in 2004, the American people have a more negative view of their healthcare system than their counterparts in the other industrialized nations with a third of Americans insisting on a restructuring of the system. Looking at the numerous issues that plague the current system, the best option to meet the immense need and widespread desire for accessible quality is a single payer, or socialized, healthcare model. While every other industrial nation, such as Denmark, Japan, Germany, Australia, and Norway, have a national system of universal coverage, the United States allows many to go uninsured and divides the right to healthcare from everyone to those who can afford it. The statistical data demonstrates the discrepancy in healthcare among those of different social-economic classes, proving an ever widening gap between the wealthy and the poor, and exposing just how flawed the American healthcare system is.

America's healthcare history is punctuated with milestones in an effort to either expand or modify the system. Beginning in the first part of the 20th century, there was discussions about bringing health care to the average American. It wasn't until the Roosevelt Administration that there was a serious push towards health insurance with President Roosevelt requesting an "economic bill of rights" from the Congress that included a right to adequate medical care. In the 1950's, hospital care doubles and President Truman suggested a single system national health program that would have included everyone in American society. This was the first serious attempt at universal care, and like successive attempts, was defeated and denounced by the American Medical Association (AMA) and labeled by a House of Representatives subcommittee as a Communist plot. In 1965, Congress's amendment of the Social Security Act and the formation of Medicare and Medicaid was signed into law by President Johnson and thus the current system of federal healthcare was established.

Medicare is a national health insurance program that provides a basic program of hospital insurance and aids in paying healthcare bills with a supplementary assistance program for persons over the age of 65 and those disabled for more than two years. Medicaid, while also a national health insurance program, is administered by the individual states, and while specific coverage and benefits vary from state to state, it is meant to provide services for the "categorically needy", such as the blind, aged, or disabled. Medicaid is intended to bridge the gap for those with huge medical costs and that are not old enough to qualify for Medicare. However there are several restrictions on who qualifies and is not offered to everyone who is poor and unable to afford medical care. Medicaid completely excludes poor men and women without children and only covers a woman while pregnant, not before conception or after delivery. In 1994, less than half of all non-elderly people living under the federal poverty standard qualify in their states for the program.

Medicaid, which is state funded, does provide for medication while Medicare, which is federally funded, leaves a gap of three thousand dollars that many elderly and the disabled are able to afford. Medicare covers 75% of the first $2,250 in drug costs and then drops to zero only to resume at an expenditure amount of $5,100, where is pays 95%. Compounded by the problem of increasing drug costs that are several times faster than inflation at nearly 10% and that the elderly population on average is taking seven medications per individual and it becomes clear how nearly seven million seniors can fall in the crack of uncovered prescription drugs.

Age, economic, and gender exclusions of the established government healthcare programs require the remainder of the citizens in America to look to private organizations to provide their healthcare. After World War II, in an effort to attract employees, funded health insurance plans become a part of the employee's benefit package. However, not all those employed are covered. Over a third of workers earning less than $30,000 a year are covered under employer provided health insurance plans, while over 60% of those earning more than $30,000 are covered. Today, because of increased health costs, those plans rarely amount to full coverage, and have restrictions on coverage which has lead to the advent of managed care programs. In an effort to maintain profits for their shareholders, private insurance companies have to deny care for medical services they find unnecessary. This has lead to litigation with lawsuits awarded to plaintiffs in the hundreds of millions of dollars. For example, Aetna Inc. paid out $120 million in 2003, Blue Cross/ Blue Shield paid out a total of $117 million in 1995, and Cigna Corporation in 2004 paid $85 million.

Health Maintenance Organization (HMO), a term coined by Nixon advisor Paul Ellwood, was the cornerstone of President Nixon's "new national health strategy" in 1971. This "strategy" was one in which an external influence on the doctor/patient relationship was meant to ensure an outcome relating to quality, cost, or both that might not otherwise occurred. While HMO's provide direct medical services, most allow individuals to visit contracted primary care physicians and designated specialists, like dermatologists and obstetricians/gynecologists. This restriction of access, in a freedom of choice driven society, is the biggest complaint of HMO's. Other critical issues surrounding HMO's include the increase in costs to employers and their ability to continue their contribution underscores a dilemma surrounding the effect of outside influence on the management of medical care. If an insurance plan is paid by an employer, a sick employee can be seen as an unproductive employee and may need to seek employment elsewhere as a means for the employer to afford to provide coverage to the other employees.

If an individual doesn't qualify for federal healthcare programs, isn't covered by a private insurance plan, then they join the multitudes of the uninsured in America. In 2006, the Centers for Disease Control and Prevention reported that nearly 55 million people were uninsured for part of that year and the Center on Budget and Policy Priorities reports that the five years prior to that the number of uninsured rose by nearly six million. In spite of the fact America spends more on health care than the rest of the world, it is the only developed industrialized nation that does not ensure health coverage for everyone