P.O. Box 44027
Atlanta, GA 30336
For many individuals in the U.S., good health is elusive and access to health promotion and prevention programs and appropriate healthcare are often related to economic status, race or ethnicity, gender, education, disability, geographic location or sexual orientation (CDC, 2005). The current literature overwhelmingly supports the fact that disparities continue in U.S. healthcare. The uninsured still do not receive the same level of care as the insured. With increasing numbers of Americans losing work due to the current economy, the number of uninsured Americans continues to rise. Nearly two-thirds of these uninsured adults do not have access to consistent medical care and make less than 200% of the federal poverty line (Oberlander, 2002). The United States can no longer afford to sacrifice a major portion of its population to inadequate, substandard access to health care. A general consensus is forming that the system is broken, is not getting better, and is actually hurting the rising number of people who cannot gain consistent access to its services for lack of money. This lack of access is increasing health and health care disparities, as well as health care costs. Instead of a cohesive national policy to ensure access to long term care, our citizens face a patchwork of programs that is inefficient, inequitable and often ineffective. Services vary from state-to-state and community-to-community. Each program has its own standards of eligibility, and each provides different services. People most often receive care in the setting in which it can be reimbursed, rather than according to their own needs and preferences (Rosenthal, 2003). Significant improvement is needed to remove the problem of access to care, or it will continue to be an uphill battle to remedy the disparities of health care. The most important prerequisite for access is health insurance. To significantly jump-start the process of facilitating access to care, we must remove the burden of obtaining health insurance, which for the most people is currently tied to employment, and offer universal health care coverage.
According to the Kaiser Commission on Medicaid and the Uninsured, longer periods without coverage are more common and occur when the person’s employer does not offer coverage, when the person cannot afford premiums, when health conditions make the person uninsurable in the private market, when a spouse’s benefits are lost because of divorce or death, or when the person does not qualify for public health coverage. The report also states that persons with low incomes and those in fair or poor health are significantly more likely to be uninsured for longer periods, and that young adults (19 to 34 years of age) are at greater risk of being uninsured for longer than 12 months compared with those in other age groups. The long-term uninsured are much more likely to lack a usual source of care than those who are uninsured for five months or less (Neff, 2004).
Inequitable financing of health care contributes to the current level of preventable mortality and morbidity among children and pregnant women in the United States. Children without a usual source of care may be at increased risk of adverse outcomes, including not receiving needed immunizations. Previous research indicates that children without health insurance are more likely to lack a usual source of care, a regular clinician, and access to after-hours medical care than are those with coverage (Weinick & Krauss, 2000). There is growing evidence that access to comprehensive and continuous care, including preventive care and behavioral and mental health services, leads to positive health outcomes and decreased health expenditures. Poor and near-poor children who were up-to-date on their well-child visits in the first 2 years of life had fewer avoidable hospitalizations. Expansion of ambulatory care coordination and other supportive services led to decreased lengths of hospital stays and total inpatient expenditures among children with chronic conditions. Comprehensive follow-up care decreased the risk of life-threatening illness in the first year of life among high-risk inner-city infants without increasing costs. Although the establishment of the State Children’s Health Insurance Program (SCHIP) has not created universal coverage for children, it has been an important opportunity to expand insurance coverage to a large portion of uninsured children (American Academy of Pediatrics, 2003).
The debate for health care reform throughout the later part of the 20th century has currently shifted into two basic arguments: (a) continued but focused incremental reform to universal health care coverage, and (b) change to a single-payer national health insurance system. The incremental approach, over as long as 7 years, is based on the assumption that a single-payer system would never get through the U.S. Congress (Tooker, 2003). The idea of focused incremental reform is to improve those areas of health care coverage that can be enacted into current legislation, such as expanding existing public insurance programs or providing tax credits to the uninsured for the purchase of private health insurance (Oberlander, 2002). However, extending health care coverage incrementally will continue to increase costs and spending while creating a multi-tiered, unequal system of care delivery, unless additional resources within the existing system are found and re-allocated (Himmelstein & Woolhandler, 2003). The tax credit proposal is flawed, because the amount of proposed tax credits will not cover the cost of the insurance premiums.
The proposed single-payer national health insurance plan bases its argument on the premise that the current HMO/PPO bureaucracy consumes almost 30% of all the monies designated for health care, a layer of administrative bureaucracy that is uniquely American (Himmelstein & Woolhandler, 2003). By reducing this bulging bureaucracy, an estimated $140 billion could be saved annually, leaving more than enough funding for the uninsured and the underinsured. A recent study evaluating the California Health Service Plan (CHSP) has shown that a single government payer linked to public authority and accountability can effectively finance health care and significantly save on health care spending, while improving the health of the population (Shaffer, 2003). Both politically and fiscally, a national health insurance could not only improve medical care for the poor but also for the majority of insured Americans.
Universal access to quality health care is a basic human right of every member of our society, and that the inability to guarantee that right is evidence of a failure of our society that must be addressed. Even those with good insurance are scared about gaps in coverage, higher premiums, and all the deductibles. Or we fear losing our job and, with it, the health insurance (Massachusetts Nurse, 2005). The advantage of National Health proposals is that they are actually better for most people: benefits are more comprehensive, out-of-pocket costs are lower, and there are fewer restrictions on access. But convincing people of these advantages is not easy. It’s hard enough for organizers, let alone the average citizen, to follow the distinctions between one plan and another. The federal government should be accountable to us and not insurance companies and drug companies. The basic goals of federal reform should be to: (1) provide coverage for everyone, because that is just and it is the foundation for controlling costs; and (2) achieve universal coverage in such a way that allows the system to continue to evolve towards greater equity and more effective cost controls. Everyone in the country should have the option, and the means of paying for, coverage through Medicare or through private insurance. Such a proposal is built around familiar systems, and allows institutional forces to protect and even expand what they have now.
American Academy of Pediatrics. (2003). Principles of child health care financing. Pediatrics, 112(4), 997-1000.
Beck, E. (2005). Health Biz: Advancing national healthcare. UPI Perspectives.
Bush-Cheney. (2005). Making health care more accessible and affordable. Retrieved July 27, 2005, from http://www.geogewbush.com/HealthCare/Brief.aspx
Centers for Disease Control. (2005). Racial/Ethnic Health Disparities. Retrieved July 1, 2005, from http://www.cdc.gov/od/oc/media/pressrel/fs040402.htm
Gorin, S. (2004). Will the United States ever have universal health care? Health and Social Work, 29(4), 340-344.
Hadley, J. & Holahan, J. (2003). Covering the uninsured: How much would it cost? Health Affairs, 22(3), 250-265.
Himmelstein, D. & Woolhandler, S. (2003). National health insurance or incremental reform: Aim high, or at our feet? American Journal of Public Health, 93(1), 102-105.
John Kerry’s Plan to Make Health Care Affordable to Every American. (2005). Retrieved July 27, 2005, from http://www.johnkerry.com/issues/health_care/health_care.html
Kaiser Family Foundation. (2005). Coverage and cost impacts of the president’s health insurance tax credit and tax deduction proposals. Retrieved July 29, 2005, from http://www.kff.org/insurance/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=32681
Neff, M. (2004). Fact sheet examines effects of being uninsured on access to healthcare. American Family Physician, 69(5), 1032.
Oberlander, J. (2002). The US health care system: On a road to nowhere? Canadian Medical Association Journal, 167(2), 163-168.
Physicians For A National Health Program. (1989). A National Health Program for the United States: A Physicians’ Proposal. New England Journal of Medicine, 320, 102-108.
Reinhardt, U. (2003). Is there hope for the uninsured? Health Affairs, 22(3), 391-404.
Rosenthal, B. (2003). Broken and unstable: the aging of Baby Boomers means a cost crisis in long term care. Contemporary Long Term Care, 26 (10), 22-25.
Shaffer, E. (2003). Universal coverage and public health: New state studies. American Journal of Public Health, 93(1), 109-111.
Thorpe, K. (2004). Federal costs and savings associated with Senator Kerry’s health care plan. Retrieved July 10, 2005, from http://www.sph.emory.edu/hpm/thorpe/kerry4-4-04final1.htm
Tooker, J. (2003). Affordable health insurance for all is possible by means of a pragmatic approach. American Journal of Public Health, 93(1), 106-109.
Unknown Author. (2005). Nurses’ guide to single payer reform. Massachusetts Nurse, 76(1), 2.
Universal Health Care Action Network. (2005). Health Care Access Campaign. Retrieved July 27, 2005, from http://www.uhcan.org/HCAR
Weinick, R. & Krauss, N. (2000). Racial/Ethnic Differences in Children’s Access To Care. American Journal of Public Health, 90(11), 1771-1775.
August 8, 2005
Although the principle goal of such a national health insurance plan is to arrange health care financing for all U.S citizens, specific proposals must address not only the mechanism of financing but also potentially controversial strategies for issues such as service coverage, delivery of care, and cost containment (Ackermann, 2003). Congress is not going to move on the uninsured until the costs of doing nothing hit the middle class or the upper middle-class squarely in the wallet and there is a resulting public outcry or mandate for change.