A Rough Draft of an Ideal Healthcare System

Universal healthcare is increasingly popular in the U.S., but it is difficult to formulate a plan that is amenable to all and is in harmony with our values. There are several key ideas that are routinely offered as desirable to a universal health system. The purpose of this blog is to outline a rough, foundational overview of what an ideal healthcare system should look like in the United States. Mapping out our latest sources revealed that money remains a formidable foe, but there is another, more basic obstacle on the path to Universal Healthcare.

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The first key point on US healthcare is fundamentally an issue of perspective. The above graphic shows a clear fact; your health is not solely your making. There is a significant environmental and societal influence on your health decisions. Therefore, healthcare mustn’t be viewed as a privilege or personal responsibility. It must be viewed collectively, as a right. According to this article, despite the fact that the United States adopted the Universal Declaration of Human Rights, including Article 25 which includes health as a basic human right, we have consistently failed to uphold any such standard and have even gone so far as to not even refer to health as a right. This is unacceptable. As long as healthcare is not viewed properly, both by the government and the populace at large, then the healthcare we need will remain elusive.

The second key is that at the least, the insurance aspect of the healthcare system should be single-payer. According to an opinion piece by Kate de Klerk, OMS IV, and Mayra Salazar, OMS III, much of physicians’ time is spent on administration, on the order of 10+ hours for about 70% of physicians. This robs them of time with patients. To boot, switching to single-payer can potentially save a combined 200 billion in overhead, billing, and paperwork costs.

The third, and for this blog, the final key is that the ideal healthcare system covers everyone. Switzerland, which currently holds the top-rated healthcare system, covers its entire citizenry, rich to poor, for all health needs. Uninsured, notably the lower-income citizens, pay more out of pocket. Ultimately, they burden the whole populace as they must receive aid, yet cannot afford it, so the cost is handed off to the insured. These costs go on to cause more issues everywhere for everyone.

At base, healthcare must be treated as the basic right that it is. Indeed, the first inalienable right spoke of in the Declaration of Independence is the right to life. From that basic understanding, every other aspect of universal healthcare takes root. You cannot have health for some, and not for others. You cannot have many people bartering and interfering with your healthcare. All this, because it’s a right. You cannot have rights for some, but not for others, or have companies bartering over how you are to enjoy your rights and what rights they are willing to pay for.

The Role of Congress in the Healthcare Debate

Universal Healthcare is not a new idea. It has been brought up multiple times throughout the years and continues to be a talking point among both citizens and their representatives. Despite ample support and the will to enact such legislation, universal healthcare bills don’t tend to get very far. Healthcare bills have a tough time in Congress, and the purpose of this blog is to show how the legislative process, both classic and modern, can make enacting a universal healthcare system a grueling task for legislatures.

A chart that shows the steps a bill takes to become law. Each step is depicted in a separate box in a linear fashion. From left to right, the boxes read “Bill”, “Introducing legislation”, “Committee work”, “Debate and Amend”, “Budget and Engrossment”, “Committee Work”, “Debate and Amend”, “Enrollment”, “Conference Committee (optional)”, “Final approval”, “Publication”, and “Law”.

The above graphic is a depiction of the classic legislative process. You may remember it from School House Rock and it is how Congress is designed to function. Anyone can propose a bill to be submitted for the legislature. It will go through committees and debates the purpose of which is to refine the bill to be amenable to all parties. Unfortunately, a bill can “die” in the committee process. H.R. 1300 of the 102nd Congress went through 5 committees. The bill was introduced on March 6, 1991, was shuffled through committees until it was referred to the Subcommittee on Health and the Environment on March 25, 1991, where it languished.

The bill could also be beset by stiff opposition and its own complexity. The Clinton Healthcare Plan could not be enacted despite a Democrat-controlled Congress. Right-leaning groups opposed the bill on the grounds that it introduced an excessive amount of government interference into private matters. The bill was also complex, totaling over 1000 pages. In the end, it could not survive the opposition and went through many committees before being declared dead by then-Senate Majority Leader George J. Mitchell.

At least, I wish I could say those bills went through the classic legislative process. Since 1974, many bills have been passed as omnibus bills. Instead of being process by the legislature as intended, representatives attach policies and reforms to the budget, which must be voted upon yea or nay. According to the American Government textbook, the popularity of omnibus bills stems from their utility; omnibus bills “allow Congress to quickly accomplish policy changes that would have taken many votes and the expending of great political capital over a long period of time.” If want Healthcare now, attach it to the budget. On top of that, Congress is greatly divided with party leaders holding vast influence. Modern legislation often features bills dying off just as the two healthcare bills above did. A party leader often sends unwanted bills through an endless gauntlet of committees until the bill simply fades away.

The takeaway here is that if you want healthcare reform soon, your best bet is to attach it to the House budget as an omnibus bill. However, if you want this done right, then some things in congress have to go back to the way things were. Without a change, the partisanship of modern politics will force any reform into committee hell. The classic legislative process is designed to get bills enacted in a form that all parties can agree to.

Who Pays for Healthcare in the United States

Among the first questions asked when the subject of the countries healthcare is how much is spent to provide the service. The second question is who is paying. In the US healthcare system, that answer is somewhat complicated. The system is something of a hodgepodge of private and public funding chock full of subsystems and rules most people don’t really understand. The purpose of this blog is to elucidate, if only a little, who is paying for your doctor visits.

During an overview of my group’s concept map, it became apparent that a great deal of focus is spent on healthcare resources, namely in the form of money. So, who is the payer? Where does the money come from and go? In a sense, there is only one payer for healthcare; you. However, this is not a direct connection. Simply put, both here in the US and abroad, citizens pay someone to pay the clinic, hospital or physician. According to this site, most health providers are paid through Medicaid, Medicare, and/or private insurance. This means that the government is, in fact, the largest payer of healthcare since Medicaid and Medicare are both government-funded. The next highest payer is according to the same site is private insurance.

Looking a little closer at government-funded healthcare, Both Medicare and Medicaid are overseen by the CMS or the Centers for Medicare and Medicaid Services. This organization is a branch of the Department of Health and Human Services and is also tasked with overseeing the Medicaid programs of each state. According to the same source, these programs are funded by two trust funds; the Hospital Insurance Trust Fund(HI) and the Supplementary Medical Insurance Trust Fund(SMI). The HI is funded by payroll taxes, trust fund taxes, and income taxes. SMI is funded by Congress and Medicare Part B premiums.

The above graphic depicts a breakdown of insurance coverage for the US population. The first thing to note is that both Medicare and Medicaid are in fact insurance plans. This would imply that US healthcare is heavily insurance-based when taking both government and private funding into account. After all, a good 84% of the population is insured. The second thing to notice is the extent of private insurance. According to the above graphic and a study on insurance coverage for Americans, private insurance is much more prevalent, with employer-based insurance covering ~50% of all insured citizens.

It must be said that in the quest to improve the healthcare system, it is often overlooked that healthcare and health insurance are two different things. However, they are tightly bound in the United States, as nearly the entirety of the system is funded through some insurance provider or another. As stated before, the US government does pay the most in the healthcare system. Yet, most citizens aren’t insured by the government but by their employer. As such, any effort to address healthcare must also address health insurance and its role in the system.