Most experts agree that the United States has set the standard for health care innovation. Thousands of people from around the world travel to the U.S. each year for medical treatment not found anywhere else. But many analysts say America's health care policy needs drastic reform.
The U.S. government offers free health insurance coverage to some 27 percent of the population. For the elderly and many disabled Americans, the federal Medicare program covers about 80 percent of medical costs. Medicaid programs help insure the nations poor. And the State Children's Health Insurance Program covers about six million low income children whose families are ineligible for Medicaid but cannot afford private health insurance. The rest of the population must find health care coverage on their own, typically through employers.
But many Americans have to bear the full cost of health insurance. For an average family, that ranges from 11 thousand to 12 thousand dollars a year. And even that does not cover the full cost of medical care. Millions of Americans often have trouble paying for prescription drugs and other treatments.
"Here is a country with a very expensive and very vast health care system that leaves many out of being able to participate fully in the abundance of the American health care system," says Diane Rowland, the Executive Vice President of the Kaiser Family Foundation, a non-profit organization that focuses on health policy in the United States. "We need an America to reinvest in our people and reinvest in providing primary and preventive health care services equitably to all Americans."
Why Many are Uninsured
According to the U.S. Census Bureau, about 47 million Americans do not have health insurance. Joel Cohen is Director of Social and Economic Research for the U.S. government's Agency for Healthcare Research and Quality. "There are a lot of different reasons why people are uninsured -- some of which have to do with what they perceive to be the affordability, some of which have to do with their access to different kinds of health plans, and some of it has to do with their individual preferences as to how they view health insurance and medical care."
Cohen says many people between the ages of 19 and 29 believe they are healthy and do not need costly medical insurance. Overall, he says, insurance coverage varies with the fluctuating economy. "Most people get their insurance through their employment. So as unemployment increases, then people would have more difficulty getting insurance. On the other hand, if the economy improves and more people are employed, then it would go down. So there is a little bit of an economic cycle to that."
Radical Reform
About 60 percent of Americans receive health insurance through their workplace. Employers typically offer workers insurance plans that cover a portion of health care costs, leaving employees responsible for the difference. With nearly 16 percent of Americans uninsured, some analysts say federally-funded health care coverage for all Americans is the answer.
"We are the only industrialized country without universal health insurance coverage," says Sara Collins, Assistant Vice President for the Commonwealth Fund, a private foundation that provides support for health care research. "You notice when you look at our rate of cost growth compared to France, compared to Germany, compared to Canada, we have a much higher rate of cost growth. We spend a much larger percentage of our G.D.P. [i.e., gross domestic product] on health care costs than do other countries where everybody is in the same system. And we actually have much poorer health outcomes; we rank among the very bottom in infant mortality compared to our neighbors overseas [in developed countries]. I think that the health system would improve dramatically by including everybody in the system as other industrialized countries are doing now."
Many people equate universal health insurance with socialized medicine. But analysts say socialized medicine is government control over all aspects of health care, while the government would administer only insurance programs under a universal health insurance system. Critics of universal coverage point out that patients in Canada and Britain, for example, often encounter long waits for medical care and have little choice in selecting doctors.
Fixing the Current System
Scott Serota is President and CEO of the BlueCross BlueShield Association, the largest group of private health insurance franchises in the U.S. He admits the current system needs reform, but he says he is wary of a system that might not sustain America's standard of health care.
"My biggest comment to the critics of the current financing system is it has created a health care system second to none in the world. And we need to ensure we continue to support that system while modifying the incentives in such a fashion that we can continue to afford that system," says Serota. "I think we need to move away from a finger pointing exercise and toward a solution-oriented exercise, which says these are the problems and this is how we need to fix them."
According to Serota, the insurance industry supports reforms that focus on disease prevention, chronic illness management and health information technology. But, he says, the industry does not support reforms that would increase government bureaucracy in order to manage the nation's health care industry. Several public opinion polls show that rising health care costs are the number one domestic concern among U.S. voters ahead of next year's national elections.
Political Positions
Diane Rowland of the Kaiser Family Foundation says the two major political parties already are beginning to map out their positions. "Among the Democratic candidates, there's been a lot of discussion of how to improve health care services, how to improve the quality of care for everyone, how to try to bring down the inefficiencies in the system, so that we can have more affordable health care services, and clearly providing for some way to help assist those who are lower income and need coverage. On the Republican side, we've seen much more of a commitment to some of the market-based strategies, increasing the availability of tax credits for the purchase of health insurance and greater reliance actually on the individual market, on the private market, for health care coverage where there's more consumer choice."
Presidential candidates from both major parties agree that reform is needed. Meanwhile, most analysts predict that under the current system, the number of uninsured people in the U.S. will continue to grow.
This story was first broadcast on the English news program,VOA News Now. For other Focus reports click here.
