US health care: profit over people
Health care is a very important part of any country. According to the World Health Organisation, a healthy population contributes to a higher rate of human happiness, contributes to economic progress and results in a more productive society. US healthcare is argued by many experts to be a broken system. There is no universal healthcare and the available healthcare is very expensive. One US citizens’ biggest consumer spending is health insurance. Healthcare and health insurance being expensive is not the only problem. Healthcare being expensive does not equal good healthcare. The US spends a lot more on healthcare without achieving better health situations. The majority of US citizens do have health insurance and they are paying a lot of money for it. People with lower incomes cannot always bear the prizes for insurance and could end up in heavy debts when they have to make use of healthcare. The development of healthcare has been halted since Trump became the president of the United States. The comparison of US healthcare with, for instance Canada is ridiculous. No universal healthcare results in a system where companies put profit above the people. Now during COVID-19, a good health system is more important than ever. This blog will focus on how the US healthcare system looks like and how it can be improved.
How does the US health system work?
Many developed countries have a universal healthcare system. Universal healthcare means that every citizen of a country is assured of access to healthcare without having to take huge financial risks. US healthcare is not universal. US healthcare without having insurance implies that when someone becomes ill, they have to pay for the treatment themself and the bill of this treatment could become very expensive. Some companies provide insurance, but the annual cost for a family of four would be approximately above 20.000 US dollars. It is a fact that the most abundant cause of bankruptcy in the US is due to medical bills.
The US does have government-sponsored programs to help specific groups cover the healthcare costs:
- the State Children’s Health Insurance Program
- the Department of Defense TRICARE and TRICARE for Life programs
- the Veterans Health Administration program
- the Indian Health Service program
These government-sponsored programs have been introduced to protect vulnerable groups such as the elderly, children, disabled persons, low-income citizens and veterans. But these programs support active military personnel and Native Americans as well.
These programs are funded partly by the states and partly by the government. Healthcare is sometimes provided by US employers. Not every employer provides healthcare for their employees. Some people get health insurance on their own. No universal healthcare has the consequence that a lot of people do not get insurance. Above twenty-seven million people do not have any insurance in the US.
US healthcare facilities are divided by non-profit facilities, governmental facilities and privately-owned facilities.
Why healthcare is so important
A good healthcare system is incredibly important for a country. A good healthcare system contributes to the mental and physical well-being of a countries’ population. Mental and physical well-being results in a great contribution to a countries’ economy. A good healthcare system can prevent illness, diseases, injuries and lifts the life expectancy. A healthy population often results in economic growth since fewer people will be ill or injured and the higher life expectancy results in more years of work. It is strange that a developed country, who’s citizens often claim that it is the best country in the world, has such a bad healthcare system. People who get injured that do not want an ambulance since it is too expensive for them. Or all the people who opt out of receiving healthcare because of the high costs.
Issues of the US healthcare system
The US has not a great healthcare system and the people are suffering because of this fact. Not only the medical bills are overwhelming for US citizens. Even though healthcare is very expensive in the US, it has nothing special to offer compared to other developed countries’ healthcare with much lower costs. The US had a life expectancy of 78.6 in 2017, while the average life expectancy of developed countries is 82.3. The US is also running behind on the average of growth in life expectancy over the years compared with the average of developed countries. The US has a very high rate of infant mortality as well. In the US there are around 5.9 infant deaths in their first year of life per 1000 births.
It seems that doctors are paid for providing lots of healthcare and not for good healthcare. And the salaries of doctors are ridiculously high.
Half of all healthcare spending was spent on only 5% of the US population in 2016. This ridiculous 5% is mainly built out of two groups. The first group consists of people that are hospitalized for several days. The second group consists of people that suffer from chronic diseases, people who need regular physician care or people who are hospitalized for longer times.
The US lacks fair healthcare equality. Research concluded that the higher someone’s income is, the better their health is. The reason there is this much healthcare inequality in the US is because the US relies on private health insurance. People with lower incomes lack the access to good healthcare. They cannot keep up with the increasing rate of the price of healthcare and sometimes they cannot afford healthcare at all. As mentioned before, above twenty-seven million have no health insurance at all. You could argue that the US healthcare system is broken since so many people are uninsured. When an uninsured person has an accident or gets ill, the financial consequences could be dire.
Non-profit hospitals do not have to pay taxes. This entails no property taxes, no sales taxes and no federal taxes. The purpose of tax-free hospitals was to give those tax numbers back to the community and lower the costs of healthcare. Some non-profit hospitals, unfortunately, abuse the no tax rules abundantly for self-gain.
Expensive US healthcare
There are multiple reasons for the fact that US healthcare is so expensive. First of all, the US spends twice as much money on health care than the 10 highest-income countries. The percentage of the money that is spent on administrative costs in healthcare in the US is about 8%, which is way higher than in other high-income countries, where it differs from 1 to 3%. US citizens also pay almost 4 times more for medicines than other high-income countries. Medicines are the biggest costs where the US has the largest overspending in comparison to European countries. On average, the US spends $1,443 per person on medicines per year, while costs for medicines are $749 in other prosperous countries.
Doctors in the US get paid a considerably higher amount of income than in other countries. An average doctor has a salary of around $218,173 a year and specialists have a salary of around $316,000. The cost of surgery is way higher than in other countries as well and can vary wildly. An urgent visit for Covid-19, for example, can vary from $241 to $4,510.
Another reason for the expensive health care is that hospitals are afraid of getting sued. Because of this fact, hospitals sometimes do extra or unnecessary tests to make sure they made the right decision.
There are a lot of privately-owned hospitals in the US. These privately-owned hospitals, that are profit-oriented, need to earn money and that is not beneficial for the citizens who use those hospitals. You hear a lot of stories about medical bills that have been frauded, for example putting supplies or treatments on the bill that have not been used or provided. Luckily, this only happens in a small number of fraudulent hospitals.
To lower the cost, the government needs to get involved. The government often can negotiate lower prices for medicines and medical equipment.
According to many people, healthcare in America was going in the right direction under Obama. During his term, he introduced Obamacare or the Patient Protection and Affordable Care Act. However, when Trump became president, he promised he would abolish this new system. Trump is not a fan of Obama Care because of the high costs and the government interference. Trump did not abolish it, but he was able to make some changes.
What does Obamacare exactly entail and what did Trump repeal? Obamacare helped financial unstable and vulnerable people to get free or very cheap health insurance via Medicaid. People with average incomes could also get this insurance against a lower price. Richer people are not eligible for Obamacare and had to get insurance via the private sector. Often, employers pay completely or partially for insurance for their employees.
Until the age of 26, you can get insurance under your parent’s health insurance policy. Every health insurance plan has to have certain basic coverage, such as prescription drug coverage. Also, insurance companies cannot decline you because of your medical past and therefore people do not have to answer complicated questions about their history and they do not have to wait long anymore for their application. In most states, there is a certain period in which your application for a health insurance plan is guaranteed approved. Approval outside this period is very hard unless you have a qualifying event, such as a loss of a job, pregnancy or marriage. If you are insured for more than three months, you receive a tax penalty.
So, the act originally obligated all citizens to get a health insurance plan and or to pay a fine. However, the Republicans changed the costs of this fine to $0. The deductibles for a healthcare treatment under Obamacare can amount to more than 20 per cent, but the rest is covered by the insurance company. This gives people a piece of social security.
Trump stated that he does not want to repeal everything from Obamacare. For example, he wants to keep the opportunity for young people to be insured under their parent’s insurance. Also, he wants to keep the rule that insurance companies cannot refuse you because of an existing medical problem. Obamacare provided payments to insurance companies to keep their deductibles low. Trump cut those payments, but the insurance companies still need to keep their deductibles low. At first, health insurance plans that did not cover the essentials could be provided for no longer than three months. Trump changed this period of three months to a whole year.
Since the start of the Covid-19 pandemic, the unemployment has increased a lot in the US. Like previously mentioned, many Americans have insurance through their employer. Although many will continuously get this or get eligible for Medicaid, also a lot of people will become uninsured. The number of 31 million people that were already uninsured will increase a lot because of this development.
Of course, the government needs to react to this development, but they have not done anything to help the newly uninsured. They do not educate these people, for example on how to apply for insurance outside of the enrolment period. Fourteen states have already chosen not to expand Medicaid during these difficult times. Also, a lot of hospitals in rural areas have to close, because of the high numbers of positive cases. Hospitals in busy places do not get extra funding from the government to get them through the financial hard times.
Many people are likely to end up in the hospital during this pandemic without choice. With the high costs of hospitals and the large number of uninsured people, many are going to end up with high bills they cannot afford.
While the US only has a population that entails 4% of the world, they are responsible for 20% of all the positive cases in the world. They did make testing widely available during the early stage of the pandemic, but they do not have strict regulations to stop the spread of the virus. The US lacks legislation on contact tracing, testing and isolation of affected people.
Joe Biden vs Donald Trump
Health care is a hot topic of discussion during the elections between Joe Biden and Donald Trump. The republicans and democrats have a distinctive vision of how the US healthcare system should reform. Biden wants to build further on the foundation that Barack Obama built. Trump craves to take it in another direction and wanted to repeal Obama Care from day one Trump has already made severe changes to Obama Care, like previously mentioned. The outcome of the elections will determine in which direction the health care in the US will go.
Trump promotes the use of private insurance through the Medicare system. Biden wants to lower the age of Medicare to 60 and wants to include more areas in Medicare, such as vision and hearing. Trump also supported states that wanted to make changes to Medicaid, such as work requirements and block grants. Biden on the other hand wants more federal support for Medicaid during the economic crisis.
They also have different views on how to tackle the coronavirus pandemic. Trump has put responsibility at the state level. Biden wants to manage the pandemic at a federal level. If Biden were elected, he would inject money in efforts against the spread of the virus.
How can the US improve healthcare?
The US simply does not have good healthcare. The COVID-19 numbers, the costs of healthcare, the grade of healthcare and the statistics of US healthcare all scream that the healthcare system is broken. The best way to improve the US healthcare system is to simply introduce universal healthcare. Unfortunately, this is very unlikely since many American do not believe in universal healthcare and political and interest groups are indifferent as well. Since universal healthcare is not likely, Obamacare should develop considerably in the next years. And to achieve developments in Obamacare, Biden needs to be elected. Biden is aiming to develop Obamacare, make it cheaper and reform the healthcare system to a more simplistic system. Biden has the opinion to make healthcare an equal and affordable right for every American citizen.
Non-profit hospitals need to receive more support from the government under strict transparency to avoid any abuse of this policy. Non-profit hospitals struggle to provide the best medical equipment even with tax benefits. While non-profit hospitals dedicate themselves for the community, profit-hospitals give less to the community, are only profit-oriented, are more expensive and give a lot of bad debts. Out of these results you could conclude that profit-oriented hospitals are not a good contributor to the healthcare system. Hospitals therefore should only be owned by the government or by non-profit organisations. The prices for medicine need to be reduced since it is an enormous cost for US citizens, especially for chronical ill people. Doctors should be paid for providing good healthcare and not by the amount of healthcare they provide. And this entails lower doctors’ wages and bigger support for medical equipment. The government need to provided government sponsored programs to encourage their citizens to get healthcare and avoid being uninsured.
The inequality needs to disappear in the US. A developed affordable care act could lead to major changes in the unequal health system. Since the health inequality is focused on lower income citizens, a lower cost of healthcare could be sufficient to solve health inequality. Since universal healthcare is not an option for the coming years, Obamacare is the only hope for all lower-income citizens.