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This is a paper I wrote in 2001 about healthcare in the United States. :

ENC 1101-101
June 9, 2001

The largest single industry in the United States, say Patel and Rushefsky, is health care (1). Since business is a profit-oriented enterprise, it is little wonder that our country does not rank highest on health care when compared to the other industrialized nations. Jonas states that the United States spends more on health care than any country in the world, but does not have the best health levels in the world (100). In other industrialized countries government and private sector health care are intertwined in varying degrees. While every industrialized country has a ministry of health, the United States does not. The United States' armed forces have their own health care systems, while the civilian population relies on private sector health care. We have a so many different systems of private sector health care, that it challenges anyone to find the slightest organization at all. The waste of money, time, and resources is shameful for a country as great as ours is supposed to be. The political system is partly to blame, but the early political power struggle between the AMA (American Medical Association) and the government is the major cause of our current predicament. In the United States the armed services manage their own health care system, giving us a working model of efficiency and effectiveness. Since we can maintain the armed services by taxation, it would follow to tax further for a medical branch of service. This would not eliminate all private health care, but it would promote the general health of the citizenry, and do away with the financial chaos created by the present private sector health care systems.

In the Constitution our forefathers declared their intent to "promote the general welfare" of the new country. McGinnis tells us that Thomas Jefferson called for the government to give highest priority to the health of the citizenry. At that time our health and safety was a concern for the new government. (81). One must understand that scientific approaches to medicine, also known as the biosciences, were not around at the time of the founding of the country. Patel and Rushefsky explain that until the civil war, neither health care nor the biosciences were popular in the United States (27). The Union armies found scientific medical practices to be useful during the Civil War, and the armed forces integrated these practices into the army hospitals. In the civilian population many colleges were training doctors, but the training had no set of standards; anyone could get a degree in medicine if they could merely pay for it. The civilian doctors had already created the AMA in 1847. This organization was concerned about the doctors these "diploma mill" colleges were producing. The state governments turned to the AMA to accredit colleges, making the organization an extremely powerful force nationwide. Had the national government stepped in and taken control at this time, our health care system today would be much less chaotic. But since this was a new science, and there was no public calling for the unimagined benefits, the government did not intervene.

Patel and Rushefsky tell us that during the latter part of the nineteenth century doctors and pharmacists were the sole dispensers of health care. Doctors got very little compensation from the government; doctors instead got fees from patients, establishing the private practice of fee for service in the United States (27). At this time the government was limited to enforcement of sanitary regulations and the spread of communicable diseases. Government proposals designed to regulate health care were attacked by the AMA. The AMA now started to openly exert political influence. This was clearly shown when, in 1899, the AMA created the Committee on National Legislation to represent the Association's interests in Washington (American Medical Association). By 1920, great advances in scientific medicine had been made, and the cost of health care was rising. European countries were reforming their health care systems, giving their governments more control in regulating health care. In the United States, reformers met strong opposition. Physicians, insurance organizations, and pharmaceutical companies lobbied against reform proposals. Health care had grown into big business; labor unions and businesses, fearing competition from government welfare, failed to support the reformers. The health care industry had now proven itself to be a self-sustaining economic force.

Steven Jonas tells us that third party payers, health insurance companies or managed care organizations, retain a certain percentage of money transferred from patient to service provider (84). Third party insurance came about in the 1930s as a direct result of the great depression. Patel and Rushefsky tell us that prior to the depression medical insurance programs were nonexistent; people were too poor to pay hospitals and physicians, and third party payment replaced the one on one transactions between patient and physicians. Third party payers kept consumers from the realities of health care cost (29). The government, at this time, was being directed to address such problems as unemployment insurance, workmen's compensation, and pensions. Patel and Rushefsky infer that these were problems financially stricken state governments could not handle alone, and perceived by the country as federal government issues (31). In essence, the government was to design programs to help people pay for health care, instead of applying the money toward programs providing health care.

Little change has been made to this day because of the political influence of the AMA. Patel and Rushefsky tell us the AMA is the voice of American medicine, and much of the AMA's efforts are directed toward protecting the economic interests of it's members (21). AMA history shows that in 1935 the social security act is approved, but it does not include compulsory health insurance due to AMA influence. In 1948 the AMA launches a campaign against Truman's plan for national health insurance (American Medical Association). Patel and Rushevsky further observe that in the 1991-92 election, that the AMA's Political Action Committee donated $2.3 million to congressional candidates (21). To this day the AMA fights the government on health care issues threatening the profitability of the private sector health care, but recommends steps the government should take in areas that are not profitable for the private sector health care industry. Jonas tells us that the strength of the private health care sectors oppose government control and interference except in the areas that are not profitable or are technically difficult to deal with. These areas include care of the sick poor, care of the mentally ill, care of the elderly, and infectious disease control (103).

Insurance plans, whether government or private, cover a risk pool. A risk pool is the group of people purchasing insurance for health care. Feacham tells us that a national health service, such as the United Kingdom, is a risk pool of all citizens and financed by taxation. In many parts of the world, such as China, the risk pool consists of the extended family. Not only is this too small a pool to buffer the expense of medical care, but it is also a risk pool that shares common health problems due to genetics, environment, and income level (391). The cost for each individual goes down with a larger health pool. Feacham also points out that if a person is not a member of a risk pool, they may face a major illness that they cannot afford. They will either forego treatment or, borrow money or sell assets to pay for treatment. The first option could lead to death; the other two options could lead to financial ruin (391). In 1998, according to the census bureau, 16.3% of the United States had no health insurance (U.S. Census).

The private health care market has had over a century to prove that no government interference is necessary for the United States to have a comprehensive and effective health care system; they have failed. According to Hinds, private spending on health care in 1998 was $1.1 trillion, an estimated 16.2% of the country's gross national product (Public Agenda). According to the census, the civilian population of the country in 1998 was 269 million (U.S. Census). Feachem verifies that in the United States about $4,000 was spent that year, on health care, for every man, woman, and child in the country (390). In contrast, the armed services spent $2,500 for each service person in 1998 (Defense Health Program). Theoretically $672.5 billion would have been saved had the government managed the civilian health care with a system patterned after the military health care system. This figure does not take into consideration that the risk pool would have been enormously larger, thus further lowering the rates per person. The armed services maintain their own health care service, providing, according to the census, health care to 2.3% of the nation (U.S. Census). I suggest that as a nation, we create a service branch dedicated to the health services of this country, and bypass the self-serving interests of the politically powerful private health care organizations.

While in theory a medical branch of service maintained by the government is simply idyllic, in practice it would solve many problems. Consider a United States Health Care Corps. The organizational structure for this service branch already exists in the armed services health care systems; the structure needs only to be duplicated on a larger scale. Hospitals could be managed by this Health Care Corps and could follow all the guidelines currently practiced by the armed services health care system. Private sector medical care would exist, but only allowed private sector medical resources. If citizens choose to maintain private health care, that is their right, but strict guidelines would prohibit their personal physicians from abusing government resources. Such abuse would take the forms of government-paid prescription drugs, authorized by private sector physicians, and using government-paid hospital care for cosmetic surgery.

This Health Care Corps would necessarily be financed by higher taxation, but with no private health care expenses, citizens would actually spend less money. People would not be bound to jobs just because of insurance benefits, and people would also have the freedom to live where they chose, since health care would be provided equally in any location. Citizens in general would not have to worry about losing the things they struggled all their lives for, and the populace would be healthier if only for annual physical check-ups. One should not forget that health care includes dental and psychiatric services also. Above all, people would have the freedom to live their lives without the burdens imposed on them by an industry that seeks to profit from human suffering.

The government is not at fault for the current state of our health care problems; the private health care industry is to be blamed for manipulating our political system for their personal gain. Health care is unlike all industry since it deals with life directly. Health care can not be boycotted, nor can it be ignored. Health care organizations sing themselves praises, as if they do a noble thing, while holding us ransom until we have no more to pay. The federal government needs the backing of the whole of the nation in order to force the legislation needed to take control of this tragedy. Until the government does take control, reform is impossible; something that has not been formed can not be reformed. If patterned after the military, and run by the government, an efficient health care system is possible. As human beings, we should be outraged; as a nation, we should come together and take care of the work to be done on our health care system.

Works Cited:

  • American Medical Association. "Illustrious History." 7 Jun. 2001. 9 Jun. 2001 .
  • Defense Health Program. "FY 1999 President's Budget." 3 Feb. 1999. 4 Jun. 2001 .
  • Feachem, Richard J. A. "The Role of Governments." Critical Issues in Global Health. Eds. C. Everett Koop, Clarence E. Pearson, and M. Roy Schwarz. San Francisco: Jossey, 2001. 384-398.
  • Hinds, Michael deCourcy. "Public Agenda: Voter 2000: Healthy Debates [2]." American Demographics 22.7 (2000): 20-21. First Search/Wilson Select Plus. OCLC. Edison Community Coll. Lib., Fort Myers, FL. 5 Jun. 2001 .
  • Jonas, Steven. An Introduction to the U.S> Health Care System. 4th ed. NewYork: Springer, 1998.
  • McGinnis, J. Michael. "United States." Critical Issues in Global Health. Eds. C. Everett Koop, Clarence E. Pearson, and M. Roy Schwarz. San Francisco: Jossey, 2001. 80-90.
  • National Coalition on Health Care. "How Much Do We Spend?" Health Care Facts. 6 Jun. 2001 .
  • Patel, Kant, and Mark E. Rushefsky. Health Care Politics and Policy in America. 2nd ed. New York: Sharpe, 1999.
  • U.S. Census Bureau. "Current Population Survey." Sep. 2000. 5 Jun. 2001 .

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