Healthcare Policy

Healthcare Policy

Healthcare is among the top priorities of the socio-political agenda in the United States, and citizens consider it significant when voting for a candidate. According to Zieff et al. (2020), the U.S. has used private and public approaches to healthcare for decades before. In the private and public approach, businesses or citizens are able to get health insurance from private insurance such as Kaiser Permanente and Blue Cross Blue Shield, whereas individuals can get health insurance from public insurance that is subsidized by the government such as Veteran’s Affairs, Medicare and Medicaid (Zieff et al, 2020). On the contrary, countries from the West have utilized other strategies to provide widely or entirely subsidized nationalized healthcare to every citizen irrespective of ability to pay, employment status, or socioeconomic status. Nationalized healthcare, in this case, refers to ensuring that every person accesses health services inclusive of palliation, rehabilitation, treatment, promotion, and prevention, of adequate quality in order to be effective as well as ensuring that the services do not expose the individual to financial hardship (WHO, 2020). The passage of the Affordable Care Act is one of Obama’s period passages that came close to moving the U.S. close to nationalized healthcare through expansion of the health coverage for myriads of American citizens.

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Giving specific reference to our reading material for the week and drawing upon your own resources (journal articles no more than five years old), explain the pro and con debate surrounding nationalized healthcare policy in the United States. Use real-life examples. Be sure to cite specific current statistics in your discussion.

Cons of Nationalized Healthcare Policy

Although many advanced nation-states have utilized nationalized healthcare policy, very few or none of these nation-states are as geographically populous, large, or racially/ethnically diverse as the U.S. is. Various regions in the United States are identified by distinct people, cultural identities, and citizens with unique political and religious ideologies as well as socioeconomic statuses. In addition, population densities and heterogeneous climates speak of different health challenges and need across the country (Zieff et al, 2020). Therefore, given these differences, many critics of nationalized healthcare policy perceive the execution of this policy as not feasible both financially and organizationally (Fuchs, 2013). It is widely agreed that implementing nationalized healthcare policy would necessitate substantial costs such as those related to technological and physical infrastructural healthcare system changes at local, state, and federal levels and provider’s levels such as pharmacy, clinic, outpatient, and hospital (Zieff et al, 2020). Moreover, there would be costs arising from treating and providing insurance coverage to previously uninsured and widely unhealthy populations, as well as costs from extended services such as hearing, vision, and dental services.

Therefore, the cost of a nationalized healthcare system depends on the extent of coverage, levels of benefits, and its structure. According to Zieff et al. (2020), one proposal for addressing the cost of the healthcare system was a 7.5% payroll tax and a 4% income tax imposed on all citizens of the U.S., with higher income earners being imposed higher taxes.

Aside from the federal and individual costs, some critics have argued that nationalized healthcare policy would pose the problem of system inefficiencies, such as obstructing innovation and medical entrepreneurship as well as increased patient wait time (Katuu, 2018). For instance, the Health Security of the Clinton Administration was under critique as people viewed it as the government intruding into medical care that would lead to a larger government inefficiency (Zieff et al., 2020). Another example was when Canadian citizens were reported to be on the waiting list for about 1,040,791 procedures and the median waiting time for surgery such as arthroplasty was between 20 to 52 weeks (Barua, 2017). This may even be worse for the U.S. because of its big geographic area and wide population, as well as the challenges brought about by bureaucracy like red tape, disorganization, wastefulness, and inefficiency.

Pros of Nationalized Healthcare Policy

The most conspicuous advantage of the nationalized healthcare policy lies in its ability to solve the epidemic level of chronic illnesses that are non-communicable such as obesity, diabetes type II, and cardiovascular illnesses, which more often strain the local economy. Individuals of low socioeconomic status face numerous health challenges, yet they are the neediest population when it comes to accessibility and quality health insurance. For instance, when diabetes is diagnosed for a low socioeconomic status individual, their mortality rate is higher compared to when a higher socioeconomic person has diabetes (Saydah, 2013). In addition, Saydah (2013) finds that uninsured diabetic people result in 55% more visits to emergency rooms every year compared to insured diabetic patients. Besides, it is also reported that the prevalence of obesity is higher in low socioeconomic status populations than in their counterparts. Therefore, having a more affordable and more accessible healthcare system that would allow preliminary intervention to prevent or reduce the risks linked to non-communicable chronic illnesses, increase the general public health, and limit the economic strain that the unhealthy low socioeconomic populations face, is the most appropriate and effective approach.

In addition, it was noted that about 45,000 people in the U.S. die every year because of the challenges related to lack of health insurance (Gale, 2019). When healthcare is nationalized, these deaths could be avoided. For instance, after the implementation of the Affordable Care Act in 2010 during the Obama administration, the rate of U.S. citizens who lacked health insurance reduced from 16% to 8.6% in the last months of the Obama presidency (Gale, 2019). However, some critics argued that individual premiums increased because of the ACA system and that the benefits of the system were experienced disproportionately.

Based upon your own independent research (journal articles no more than five years old), compare and contrast the healthcare models of the United States and at least one other developed nation. Where are these models similar? Where are they different?

When it comes to healthcare insurance, both Canada and the U.S. use healthcare insurance as the fundamental way in which citizens pay for healthcare. However, the two advanced countries differ on how health insurance is funded. On the one hand, the U.S. government expects its citizens to fund their own insurance unless the citizens qualify for the government-funded programs of health insurance offered in specific brackets of disability, age, and income (Crowley et al., 2020). Such programs include the Veteran Health Administration, Medicaid, ACA, and Medicare. More often than not, health insurance is linked to employment, with the citizens’ employers giving coverage of insurance in the benefits package. On the other hand, the Canadian federal government is responsible for the provision of funding support when it comes to healthcare insurance. They provide this support to provincial governments expecting the provincial governments to adhere to the Canada Health Act regulations of 1984 (Martin et al., 2018). This kind of fund is utilized to provide all citizens of Canada with health insurance in the system of nationalized healthcare.

Private industry is also a key aspect that distinguishes the healthcare models in Canada and the U.S. In the U.S., private businesses are the basic providers of healthcare services and insurance as insurers compete for customers to sell insurance policies to employers to be incorporated in the employee benefits package (Crowley et al., 2020). However, some private enterprises sell their insurance policies directly to individual customers. Cost, quality, and medical specialty are key aspects used by healthcare insurers to compete for consumers. Although consumers are powerful in this kind of market, they are limited by the types of services that their insurance providers cover or by the medical professionals available to serve them. In Canada, many of the healthcare services are offered by private providers as opposed to provincial or federal providers (Hajizadeh & Edmonds, 2020). The physicians and doctors work autonomously in private practice or they may be employed by private health service companies or private hospitals. They mostly get their revenue through billing the health insurance that is government-based as opposed to claims created through private insurers.

Additionally, despite how the healthcare insurance is funded in both countries, consumers in both Canada and the U.S. express their concerns regarding which services are covered under respective healthcare systems. Since the systems are different in terms of how they are funded, each nation-state has different access to kinds of services. In the U.S., the coverage of healthcare via private insurers varies on the kinds of benefits negotiated by employers or the kinds of policies the individual customers can afford or choose. Nonetheless, the Affordable Care Act and Patient Protection require individual consumers to secure a minimum of important coverage through a private insurer or an employer. It is also mandatory for the insurers to cover important health benefits, including ambulatory services, newborn care, maternity, pediatric services, preventative services, laboratory services, rehabilitation services, substance use services, mental health services, emergency services, and hospitalization services (Crowley et al., 2020). On the other hand, the Canadian universal healthcare system has limited its insurance coverage to surgical, and dental services, medical practitioners, and hospitals. Aside from this, the provinces are permitted, although not required to provide insurance for more services like dental care, vision care, mental health care, long-term care, home care, and prescriptions (Martin et al., 2018). Services like dental care are covered either via private insurance or out of pocket because dentists often work outside the hospital environment.

After examining these healthcare models, explain which of these you would favor more than the other. For example, what are the benefits of a marketplace healthcare model? How could some of these marketplace problems be addressed through a nationalized approach to healthcare? Explain in detail.

One of the key advantages of the marketplace healthcare model is the fact that all the plans of health insurance cover the same important benefits, including pre-existing conditions. In this case, the Canadian healthcare system is preferable to the U.S. healthcare model because the Canadian system provides all its citizens with essential services of medical practitioners, hospitalization services, and surgical, and dental services in the hospital. Although not all essential services are covered universally in Canada, the model is better than the U.S. However, if the U.S. were to employ a similar model to Canada, the country could move steps higher than its counterparts because, for instance, the Affordable Care Act and the Patient Protection have made it mandatory for insurers to cover essential health benefits, including ambulatory services, newborn care, maternity, pediatric services, preventative services, laboratory services, rehabilitation services, substance use services, mental health services, emergency services, and hospitalization services. These essential services are not wholly covered in Canada; rather, they are allowed to be covered at the provincial level. Regardless, Canada is much better because some of the basic essential services are covered universally. More advantageously, all the healthcare plans cover the same essential services making it convenient for patients. Moreover, it has been reported that most American citizens perceive that Canada has thrived in the successful implementation of a universal national healthcare system that has become popular and cost-effective (Ridic, Gleason & Ridic, 2012). According to Martin et al. (2018), the Canadian healthcare system has more services, lower costs, as well as universal access to health services without barriers of socioeconomic status, and this is why their life expectancy is longer, and infant mortality is lower (Ridic, Gleason & Ridic, 2012).

Finally, analyze a socialized medicine program that used in the United States. In your analysis, explain the cost of this program, its long-term viability, and most importantly, ways that this program might be improved. You may think about Medicare and Medicaid in this analysis, but there are many other regional socialized medicine programs that are worth examining.

The Veteran Health Administration (VHA) is one of the socialized medicine programs in the United States. It provides care at 1,293 healthcare facilities, inclusive of 1,112 outpatient clinics, 171 VA Medical Centers, and to more than 9 million Veterans that are enrolled in the VA healthcare program (The U.S. Department of Veteran Affairs, 2021). All of the VHA medical centers currently provide fundamental healthcare services, including traditional hospital services like physical therapy, radiology, pharmacy, orthopedics, mental health, critical care, and surgery (The U.S. Department of Veteran Affairs, 2021).

Since the 1970s, the VHA services were considered of poor quality by nearly all stakeholders. However, in recent years, academic research and the press have reported a positive transition in the performance of the VHA. For instance, research by Petersen and colleagues conducted in 2001 revealed that VHA hospitalized patients were more likely to get angiotensin-converting enzyme inhibitors as well as thrombolysis following myocardial infarction than patients in Medicare (Oliver, 2007).

The recent improvement of the VHA program has come at a cost. For instance, in monetary terms, although the annual proportion of the program was fairly stable between 1995 and 1999 at about $20 billion, it increased to about $30 billion by 2005 (Oliver, 2007). Even though the budget for the VHA program has increased dramatically over the years to improve the services, the number of patients that visit VHA has also increased. For instance, this number increased from 1995 to 2005 from 2.5 million patients to 5.3 million patients (Oliver, 2007).

In conclusion, the VHA program has mainly grown to be a popular healthcare program in the U.S. because of various reasons. These include good local and national leadership, good vision, planned integrated care networks, performance management, the development and implementation of the complex electronic healthcare record, technical and research development, incentives for competition, and transition from a hospital system to a wider healthcare system (Oliver, 2007). However, the program poses a future risk by focusing so much on primary care and losing focus on acute care. To address the issue of accessing specialty care, and to enhance or maintain the quality of specialty care, the VHA can increase its appropriation to more than inpatient care. Nonetheless, the VHA investment in research on healthcare services as well as the use of nonfinancial competitive incentives should be lessons learned from other healthcare programs in the U.S.

References

Barua, B. (2017). Waiting Your Turn: Wait Times for Health Care in Canada, 2017 Report. Vancouver: Fraser Institute.

Crowley, R., Daniel, H., Cooney, T. G., & Engel, L. S. (2020). Envisioning a better US health care system for all: coverage and cost of care. Annals of internal medicine, 172(2_Supplement), S7-S32.

Fuchs, V. R. (2013). How and why US health care differs from that in other OECD countries. Jama, 309(1), 33-34.

Gale (2019). Universal Health Care. Gale.

Hajizadeh, M., & Edmonds, S. (2020). Universal pharmacare in Canada: a prescription for equity in healthcare. International journal of health policy and management, 9(3), 91.

Katuu, S. (2018). Healthcare systems: typologies, framework models, and South Africa’s health sector. International Journal of Health Governance.

Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal healthcare system: achieving its potential. The Lancet, 391(10131), 1718-1735.

Oliver, A. (2007). The veterans health administration: an American success story?. The Milbank Quarterly, 85(1), 5-35.

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia socio-medica, 24(2), 112.

Saydah, S. H., Imperatore, G., & Beckles, G. L. (2013). Socioeconomic status and mortality: contribution of health care access and psychological distress among US adults with diagnosed diabetes. Diabetes care, 36(1), 49-55.

The U.S. Department of Veteran Affairs (2021). Veterans Health Administration. Retrieved 5/6/2021 from https://www.va.gov/health/aboutvha.asp

Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of America: A Healthy Debate. Medicina, 56(11), 580.

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Week Seven Assignment: Healthcare Policy

Purpose

Sociology provides a unique and important perspective toward healthcare policy in the United States and abroad. In the below assignment, you will define aspects of the core debate surrounding nationalized healthcare United States, and then engage in your own independent, comparative research.

Healthcare Policy

Instructions

Write an 8-10 page paper (not including the title and reference pages) that addresses these four areas:

• Giving specific reference to our reading material for the week and drawing upon your own resources (journal articles no more than five years old), explain the pro and con debate surrounding nationalized healthcare policy in the United States. Use real-life examples. Be sure to cite specific current statistics in your discussion.
• Based upon your own independent research (journal articles no more than five years old), compare and contrast the healthcare models of the United States and at least one other developed nation. Where are these models similar? Where are they different?
• After examining these healthcare models, explain which of these you would favor more than the other. For example, what are the benefits of a marketplace healthcare model? How could some of these marketplace problems be addressed through a nationalized approach to healthcare? Explain in detail.
• Finally, analyze a socialized medicine program that used in the United States. In your analysis, explain the cost of this program, its long-term viability, and most importantly, ways that this program might be improved. You may think about Medicare and Medicaid in this analysis, but there are many other regional socialized medicine programs that are worth examining.

General requirements:

• Submissions should be typed, double-spaced, 1″ margins, times new roman 12 pt font, and saved as .doc, .docx, .pdf.
• Use APA format for citations and references according to the 7th edition.
• View the grading rubric so you understand how you will be assessed on this Assignment.
• Disclaimer- Originality of attachments will be verified by Turnitin. Both you and your instructor will receive the results.
• This course has “Resubmission” status enabled to help you if you realized you submitted an incorrect or blank file, or if you need to submit multiple documents as part of your Assignment. Resubmission of an Assignment after it is grades, to attempt a better grade, is not permitted.