Did you know that the United States is the country that spends the most on health in the world?
But in spite of the great expense in health this country has results very below the standards of the developed countries. For example, the United States is ranked 170 in the world ranking (223 countries) which measures infant mortality, well below all developed countries including Canada, Spain, France. So, if it is one of the health systems worldwide that receive the most money, why do not you see this reflected in your figures? Anyone could say then that in a certain way this country spends inefficiently.
It is because of all this that the health system in the United States is one of the most controversial issues in politics today. The debate is intense on issues of quality and future improvement policies. Beyond a political debate, it is a social debate. At one extreme there are people who think that the American health system is one of the best in the world.
Qualifying the quality of service, technology, and medical facilities, along with the freedom to choose how much and which service to receive as the reasons why the country is a pioneer in medicine. At the other extreme, however, we are the ones who consider this system a fragmented and inefficient system.
The organization of the health system in this country and in the world is mixed, that is, there are both public and private insurers. What is unique about this system is the dominance of the private sector over the public. In 2017, 49% of the US population receives private health insurance through their employer, 5% have independent health insurance, 8.8% do not have health insurance, 17.2% are covered under Medicare and 19.3% have Medicaid or some other type of public health insurance.
Medicaid is a program designed for low-income families. They are protected under federal law, pregnant women, children, seniors, people with disabilities and parents who qualify under the poverty standards of the country. This program is administered by different states, so there are 51 different Medicaid programs. S-CHIP is a public program that offers financial assistance for those families who earn more than the limit to qualify for Medicare assistance but not enough to obtain private health insurance. Veteran's Administration is a program administered by the federal government that offers medical benefits to army veterans.
Despite the benefits of these public safety programs (and the low administrative cost thereof), there are many aspects that are still problematic. For example, Medicare does not cover preventive medicine, or services such as dentists or ophthalmology. Medicaid is exposed to rejection by providers of health services since their reimbursement rate is very low. In the same way the S-CHIP program.
Obamacare: This health system, proposed during the Obama administration, based on the Patient Protection and Affordable Care Act, also called as Obamacare, was one of the most controversial measures during the presidency of President Barack Obama was enacted during 2010 and start-up in 2014.
Some of the key points of this health program and that marked the difference in the time when it was proposed as law, were:
Children of insured persons can enjoy medical insurance up to 26 years of age.
The health insurance service cannot be denied if there is a pre-existing basic disease.
The cost of health insurance should be equal for women and men, women will not pay more than men for the service.
What are the advantages of the Obamacare program?
American citizens can really access an affordable health insurance service with better quality.
The population that did not have access to pay for medical insurance or probabilities of being selected for one of these services, had a greater guarantee of being able to opt for a low-cost insurance program, some being helped by the "Health Insurance Marketplace"
The possibility of insurers of cutting coverage to people when they are sick or have a pre-existing disease is eliminated. It can only be canceled in case of fraud of the terms and conditions of the insurance company by the patient.
What are the disadvantages of Obamacare?
If someone does not enroll in health insurance will be penalized with the payment of a tax. The amount will go up every two years.
All people have to get insurance. It does not matter if they are sick or not, they need insurance because it is the law.
Insurance companies are withdrawing from Obamacare because fewer Americans than expected are registering; which raises insurance costs and lowers participation even more.
For some middle-income Americans, the subsidies available for buying Obamacare policies are not generous enough and the fines for not having coverage are too small to encourage them to sign up for plans.
Premium prices will rise to an average of 25 percent in 2017. This increase was predicted at the start of the law, and the government subsidy to help pay for insurance will also increase, but not all Americans are not eligible for said subsidies.
There are still 30 million people without health coverage, in addition to undocumented immigrants, who are tacitly outside the statistics.
The United States is a developed country with the worst results in health at the national level. The country spends 12.6% of its GDP on health, the highest percentage among the member countries of the Organization for Economic Cooperation and Development (OECD), such as Canada, Chile, Mexico and most countries in Europe. The country is the only one in the OECD where the public sector is a minority in the financing of health services.
Addressing health policies implies a multidisciplinary approach because we want to accept it or not, money is involved and society too, so it will always be exposed to criticism and demands from users of the health system.
As a health professional, the need to help patients always prevails and although many may proclaim: "In the American health care system, no one is left unattended" to a certain extent it is true but we must not leave all those patients who avoid going to a medical center for fear of billing costs this only generates an increase in preventable and treatable diseases, reaching patients hospitals clearly complicated, which ironically generates more expenses
It seems a little distant to think that at some point free health is a reality however these models in other developed countries have proven to be effective as long as they are under well-supported policies.
I believe that humanity and good service can coexist in a free health system as well as private health for anyone who wants and can make use of it, this may take some time, for now, it is vital to reform the most problematic points of the system to keep dragging errors and somehow optimize health.
---Dr. Charlotte Piper
St. Louis, MO, USA.