Problem Statement 2
Stakeholder Analysis 4
Benefit group 4
American Government 5
Insurance companies 6
Medical providers 6
Evaluation Criteria 7
Policy Alternatives 7
Reference list 11
With the development of The Times and the changes of the social population structure, the American medical insurance system shows the malpractice of imbalance, which is mainly reflected in the medical security of low-income people. Because of the rising cost of health care, low-income people can't afford to pay for medical care, nor can they afford the higher premiums due to advances in medical technology.
America is one of the most successful countries in modern society.The free development thought brought by capitalism has made all walks of life flourish.However, the quality of life in one group is not satisfactory, the vulnerable group. Foner(1995) did a study of the vulnerable groups in the United States and found that their plight, including poverty, homelessness and inequality could cause serious and continuing social problems.
The government has the responsibility to set up sound policies to solve these problems. Among all policies, social security system could be important for political sustainability according to Galasso’s(1999) opinion. Nevertheless, Cespedes, Jaramillo and Castano (2002) also believe that social security system could do great impact on health services equity.
Social security system is a great innovation in the modernization of developed countries. It is not only the product of economic modernization, but also the regulator of government maintaining social stability and consolidating the rule of capitalism. As an important part of social security measures, the medical security system has been developing. Gao(2007) studied America's unique health insurance and government reforms.
Before the 20th century, the medical care in America followed the nature of the cottage industry, where people were receiving treatment at home, or relying on religious organizations and charities to ward off disease. In the early 20th century, the emergence of Blue Cross Blue Shield opened the door to private medical insurance. In 1935, when the economic crisis broke out, the American government and people began to reflect on the capitalist system. President Roosevelt had the foresight to draft and discuss the social security act. The 1965 Medicare and Medicaid programs marked the U.S. government's formal involvement and the intervention in the territory of health care. In the 1990s, the malpractice of the medical system appeared, and President Clinton began the most comprehensive medical reform since he took office, trying to improve medical coverage and reduce medical costs. In 2010, President Obama learned the lesson of his predecessor and finally introduced a universal health care bill.
After President trump took office, Mcdonough(2016) expressed concern about the future health care system in the United States in his book. The medical insurance system in the United States has been developed for a hundred years, forming a medical insurance mode with private insurance as the priority and national public insurance as the supplement. Today, about 150 million of the 300 million Americans are covered by employer-provided private insurance. However, considering that about 160 million people are working in the United States and insurance companies can put the spouses and children of the working population in the insurance range at a relatively low cost, there are a lot of people in the United States who are with an income, but without health insurance, not to mention the disabled and children who do not have the ability to work.
Meng et al.(2011) believe that health insurance plans generally do not include vulnerable groups. A strategy to expand coverage of these groups would help to address inequality. They searched 45 databases, summarized options for expanding coverage, and evaluated national health policies. In their report, the disadvantaged are defined as children, the elderly, women, low-income, rural population, ethnic or ethnic minorities, immigrants and people with disabilities or chronic diseases.
The coverage of U.S. medical assistance is determined by federal and state governments. The federal government sets minimum standards, and states can raise standards, but require federal recognition. In general, medical treatment is the main object Categorically needy, Medically needy and Special groups. The common denominator of this group is poverty, where they cannot afford to pay for themselves to the hospital, nor can they afford the rising cost of health care insurance expenses. For them, the welfare of the government is the only source of their health care and one of the basic guarantees for their survival. If their survival is not guaranteed, many social problems will be magnified. They are an absolute champion of the government's universal health care plan.
Although the United States is nation with free competition, the federal government cannot ignore the needs of vulnerable people. In the case of Medicaid, which began in 1965, it provides health care services to low-income individuals and families recognized by federal and state law through public transfer payments. The CMS statistics show that medical assistance system helped 40% of America's poor, 25% of American children, 20% of severely disabled, 44% of patients with HIV/AIDS, 15% of the elderly and 60% of the people living in nursing homes. Medical assistance is one of the most important health care programs in the United States. It plays an irreplaceable role in achieving health equity and improving the accessibility of medical services for vulnerable group. The government's commitment to health care can improve and maintain its influence, but the huge cost of health care is a burden that the government has to consider.The government must analyse the problem in a sustainable way.
The implementation of medical policy may reduce the unit price of individual insurance. At the same time, the coverage of uninsured people will increase the number of insurance coverage. Because of the re-distributive nature of policy, the cost of rescuing vulnerable people may fall on the insurance companies. In that case, the insurance company needs to measure the premiums it collects from the policyholder to cover its expenses, which will determine how friendly the insurance company is to the policy.
Part of the cost of medical benefits is paid by medical institutions. Medicaid, for example, some large medical institutions have withdrawn from the market or lost some of their systems. So there are few opportunities for trivia to access mainstream health care facilities. Most of the remaining hospitals who still operating the Medicaid are smaller and less-competitive managed medical organizations, they also consider Medicaid as a dispensable program.
According to statistics, the average medical fee for physician is only $ 18.1, even with federal subsidies. Norton’s(2000) study shows that between 1993 and 1998, the cost of medicaid fell by 14.3% for doctors, while the cost for medicare increased by 4.6%. Similar research has also studied by Zuckerman et al.(2009), whose results show that from 2003 to 2008, the cost of medicaid increased by 15.1%, below the total rate of inflation. In addition, U.S. government subsidies to doctors will stop, causing doctors to lose 60 percent of their income. So fewer doctors are willing to offer medicaid.
The policies can be evaluated from the following criteria for the health of vulnerable groups in the United States, whether the policy can effectively, quickly and profoundly solve the problem, how well the government and other stakeholders afford the financial cost to solve the problem, to what extent the policy changing the distribution of social resources can be socially acceptable, how possible the potential threat of policy have serious consequences.
Referring to the existing medical systems in Sweden, Germany and the United States, this paper presents three alternative policies as following. According to the summary of social welfare from Esping Andersen(1990), the Social welfare in developed countries can be summarized three theoretical models: Social Democratic, Corporatist-statist and Liberal, respectively correspond Sweden, Germany and the United States.
Liberal countries advocate free competition, emphasize market self-regulation and avoid government intervention. This idea also permeates the social welfare system.Liberalism sees work as a market, and employment and unemployment are the adjustment and reflection of demand and supply. Under such thinking, the government's first priority is to provide a policy framework that ensures that the job market works well, rather than intervening. Health insurance is also seen as a market in which the government supports market self-regulation but does not interfere. Therefore, the social welfare system is relatively weak, and he government's medical benefits are mostly aimed at the bottom of society. United States does not have a wide range of medical benefits, so the United States will spend less on this. But America's tax revenues have been low, a test of the government's fiscal pressure. Moreover, the implementation of the policy will have an impact on the operation of insurance companies and medical institutions. If mishandled, it is likely to cause opposition from these groups.
The primary purpose of the welfare of the Corporatist-statist countries is to maintain social order and maintain the current standard of living.In the face of a group of people who need help, the government first adheres to the principle of subsidiarity, which means that the government can only help when individuals or close relatives cannot solve the problem. But when it comes to health problems, the country will interfere in the market, providing a unified health insurance, namely policy holders pay insurance premium amount depends on income, but there is no difference among policy holders in terms of the medical service they can get. Such a system enables healthy people to help the sick, the high income group to help the low income group, and fully reflects the fairness of social medical insurance. However, such a system has two drawbacks. First, governments need to bear the high cost of capital. Germany's endowment insurance and unemployment insurance are all linked to the total amount paid. Moreover, German companies and individuals need to pay high income taxes, which is not in line with the national conditions of low tax incentives for consumption and production. Second, the impact of the system is on the whole class, not just the disadvantaged, so it is likely to cause dissatisfaction among high-income earners.
The welfare policies of the Social Democratic countries even more emphasize the average distribution of society. Their medical concept is to apply the limited medical resources in the society to the most needy people and not to waste any medical resources without regarding social contribution as a standard. In Sweden, it takes about a week to make a doctor's appointment, except for a life-threatening situation. In the case of a cold, the patient can make an appointment to the doctor without a fever for three days and no improvement in the body. Swedish existing medical mechanism to ensure the interests of most people, but also gives ordinary people caused the medical trouble, which became the main reason why some people attack the existing health care system.
Among the three options, Social Democratic policies are better suited to high-tax countries, such as the Nordic countries. The idea of Corporatist-Statist is more like the union of two other ideas, which could be the future of American medical system. In the current situation, Medicaid is undoubtedly more in line with the choice of the United States.
However, Medicaid has some blind spot that still needs to be covered, such as the government's financial pressure, the screening approach of vulnerable groups, etc. Dubard & Massing’s (2007) research showed that from 2001 to 2004, a total of 48, 391 individuals of undocumented immigrants received the Medicaid assistance of North Carolina. However, allowing undocumented immigrants to gain Medicaid benefits is an abuse of the taxpayers’ contribution, since they are the main sources of the medical care funding. The ratio between the contribution number and the withdrawal number keeps decreasing, the current ratio is 3.9:1, it is predicted that the ratio will drop further to 2.4:1 by 2030. It is obvious that the pressure of contributors is becoming larger. Rector (2007) believes that illegal immigrants are now available for emergency medical services but they should not be allowed to obtain benefits from Medicaid or SCHIP. Only by addressing these issues can Medicaid achieve a lasting positive impact.