Abstract
The prevailing healthcare system in the United States has drawn many criticisms – from healthcare professionals and citizens alike. The American system fares badly compared to nationalized public health systems of Western Europe. Even in terms of overall costs, the American model is more expensive, which is significantly inflated by bureaucracy costs. All comparative evidence points in one direction – that the country would benefit through an overhaul of the healthcare system. Single payer and universal insurance coverage are the cornerstones of the optimal system. Posing hurdles for this noble objective are vested private interests in the form of private insurance companies, ideologically entrenched politicians and to a lesser extent, healthcare providers.
Why is the article relevant to our course discussions on the U.S. Healthcare system?
The issue of healthcare is a pressing social problem in the United States. All healthcare practitioners, hospitals, policymakers and the citizens all have a stake in the healthcare system. Of all these stakeholders it is the citizens who end up getting a raw deal. In fact, despite being the richest country in the world, the United States has close to 50 million of its citizens uninsured. That is nearly one out of six people in the country cannot even get access to basic healthcare if they fall ill. If any member of this group is unfortunate enough to get a grave malady, his/her chances of survival itself are very low. This situation bespeaks of various vested interests acting upon the healthcare system. There are so many profit-oriented parties at various stages of healthcare delivery that only the well-to-do can never worry about healthcare costs. Considering that documented American population is now nearly 300 million and there are millions who are illegal immigrants, there is much at stake for the continued cohesion of American society. This makes the research paper by Marleise Rashford very relevant for all stakeholders, especially students of health sciences.
The article is relevant to course discussions for other reasons as well. For example, the wide coverage given within the article – which is organized under various subheadings – makes it an overview of the current healthcare situation in America. Students can refer it to get a concise yet precise picture of core problems and factors bearing upon the healthcare system.
What are the major themes of the article and how were the conclusions and findings derived? Do you agree with the conclusions or findings, why or why not?
One of the major themes of the article is finding supporting evidence for universal health coverage in America. As it stands, 50 million Americans have no insurance coverage whatsoever. Even among those who have coverage, depending on the premiums they can afford, they get varied coverage. This means even many insured Americans may not have insurance support for grave or chronic illnesses. This brings into question the moral basis of social policymaking in the country. This lacuna is made more conspicuous by America’s rich history of legislature. A proponent of democracy and plurality for more than two centuries, the current inequities in its healthcare system stands in contradiction to the spirit of its liberal history. Author Rashford evaluates the American health system by contrasting it to nationalized health coverage offered in several European democracies. The strongest argument Rashford makes is this: Why can’t America replicate the successful systems of Britain, Canada and Germany when it has more resources and a bigger population to take care of? It is a persuasive argument and something I quite agree with.
As part of her literature review, Rashford also peruses a comprehensive survey of registered physicians in America. The results of that study show that a majority of the participants favor a nationalized health care arrangement. Although the surveyed were less favorable toward a single payer system, they are mostly in agreement with the European public health care models.
Those who defend the existing healthcare model often cite the heavy burden on the tax-payer that a public system will impose. But this is not such a big burden as is made out to be. For example in advanced industrial societies such as Britain, France and Germany the total expenditure on healthcare as a percentage of the GDP is still smaller than what it is in the USA. The crucial difference though is the number of private business that are involved at various stages of healthcare delivery. In the United States this is markedly higher. Another reason why the nationalized health care models of European democracies are cost-effective is due to the simplified bureaucracy (a benign by-product of a single-payer arrangement).
In what way does this article tie into the content that we have studied and discussed in our textbooks, other sources, and on the discussion boards?
The article offers a synopsis of all the core and related issues facing American healthcare today. The article is a suitable accompaniment to the textbooks because it adds new perspectives to the considerable knowledge that is already contained in the textbooks. Marleise Rashford’s article is an apt addition to the course mainly because of its literature review section. Therein, the reader is brought up to date with the state of the healthcare industry from the perspective of key stakeholders.
A healthcare professional needs a strong theoretical foundation to a successful practice. This article, along with core texts studied in the course, endeavors toward offering the same. In this sense there is continuity and unity between the article by Rashford and the other course content.
What influence does this article have or has the potential to have on health care administration, public health, and health care reform, if any?
The article is little short by conventional research paper measures. But it serves as a good starting point for those interested on the subject. The message conveyed by the article is quite strong i.e. there are no fundamental reasons why the United States cannot have universal insurance coverage or lesser overall costs. What is obstructing progress in this direction are entrenched private interests – in particular private insurance companies, privately run hospitals and the huge pharmaceuticals industry. These power centers lobby in Congress and Senate very persistently and persuasively. They eventually get the desired legislative outcomes for their corporations and industry interests. Such has been the case for many decades now, which has resulted in the poor state of health access in the country. The message delivered by this article is sound enough. But the real question is whether or not people in power – policy makers and business leaders – put public interest ahead of private benefits. If policy makers are looking for inspiration, they need look no further than the decade spanning 1990-2000, when several states took early steps toward universal coverage. The establishment of “the Oregon Health Plan, the Washington Basic Health Plan, Wisconsin Badger Care, and Mass Health as the most prominent progress towards some semblance of universal coverage for people of those states. The researchers found four specific factors that made this era successful, and they were political leadership, funding, the flexibility of federal waivers, and public–private partnership.” (Rashford, p.8) So, even in the much criticized American model there have been success stories which can be replicated or taken to new heights. What is required is the political will to carry out this project. The article can serve as a manifesto for healthcare professionals and the general public alike in pressuring policymakers to begin meaningful reforms. What was proclaimed and enacted by the Obama administration as healthcare reform during its first tenure is not substantial. All it accomplished were some cosmetic changes to a long ailing system. On the back of the facts revealed in Rashford’s article what is needed is radical reform.
What did you learn that either surprised you or caused you to reflect? Elaborate on your reflections and learning.
One of the surprising findings I encountered is how much the United States lags behind the rest of the developed world in offering a critical social service to its citizens. The most important finding for me is the proven effectiveness of universal healthcare. Wherever in the globe such a system has been implemented, access to healthcare for those in lower socioeconomic strata had considerably improved. This has had an impact on their overall quality of life. If the very notion of nationhood is based upon solidarity with compatriots, then the beginning point for this bond lies in socialized healthcare. If we as members of society do not even care about the wellbeing of our neighbours then it betrays a moral and cultural vacuum. I am alarmed to realize that such is the state of American society today, with its healthcare system proving to be a source of national disgrace.
I find it unacceptable that healthcare ranks so low in priority compared to military or homeland security expenditures. The Congress and the Executive branch do not fret over allocating huge amounts of funds for futile and counterproductive wars in far corners of the world. But when it comes to taking care of the basic needs of its citizens the government is indifferent. I find this state of affairs as very troubling. It is my wish and hope that in my own lifetime I would see a change – a radical change – in the State’s social contract. And I would do whatever I can in my own career to realize this change. I understand that every one’s participation counts. Being a healthcare professional puts me in a position of privilege and responsibility in this regard. I will strive to make good of my status, opportunities and contacts to improve the situation. Finally, as author Rashford notes in her conclusion, further research on the subject is warranted. Perhaps due to commercial disincentives of taking a contrarian position to the status quo that research on the suitability of universal healthcare in America remains underdone. I would contribute my two cents in rectifying this situation.
References:
Marleise Rashford, A Universal Healthcare System: Is It Right for the United States? Nursing Forum, Volume 42, pp. No 1, January-March, 2007.
Delivering Healthcare in America – A System Approach by Shi and Singh 2012.