“Our health care system is broken. If we go on without change, the consequences will be devastating for millions of Americans and disastrous for the nation in human and economic terms.” Hillary Rodham Clinton, 1994.
Today millions of Americans cannot afford the sufficient healthcare they need. Politicians, experts, and health care providers have warned for more than four decades that the American health care system was “poised on the verge of a … meltdown” (Flood 200). Constant concerns about the state of the health care system produced many promises from presidents and congressional officials to change this situation, but brought few positive results. Today, it is clear that state governments should be the principal source of policy innovation in health care that will provide the public with sufficient healthcare. Government should ensure that every citizen, naturalized citizen, and alien resident is entitled to basic level or “core” health care benefits (Daniels 1). It should also be a basic premise of that system that every citizen who is able to pay toward those health care services should do so. A major argument of this paper is that government alone has the ultimate responsibility for the health care of its community and not business or industry.
Government Regulation and the Health Care System
Government should provide health care to all citizens regardless of their ability to pay for that care. There are different ways of expressing the basic moral demand for sufficient health care as due. First, people have a right to health care that they can claim against the government. Second, the governments have responsibility to provide health care that will generate commitment to social solidarity. As one of the leading proponents of a just, easily accessible, and universal care system, Norman Daniels, has claimed, “by keeping people close to normal functioning, health care preserves for people the ability to participate in the political, social, and economic life of their society” (Daniels 1). To this one can add the right to participate in the family and private life of communities. The idea in Daniels’s vision of health care is that of a “fair equality of opportunity” (Daniels 3).
The concept of state health care to all citizens is strong in Canada and Western Europe. The governments focus on the need of the citizens living together to support and help one another. The governments provide health and social resources necessary for people to function as a community (McDonough 160). The main focus is on the needs of the people living in one country. Guaranteed access to health care is meant to locate the citizens within a community and produce a communal and not just a private good.
The fundamental principle of the state health care is simply stated. It is that affordable, high-quality health care should be available to all citizens without financial barriers to access. There are a variety of regulation forms through which the principle may be implemented. For example, a tax-based public service as in the UK or the Nordic countries, tax-financed insurance as in Canada, or legally required obligatory social insurance as in Germany. In their different ways all three forms of state organization can be considered as compatible with the principle of comprehensive, high-quality healthcare available to all who need medical help.
Responsibility for managing the organization and delivery of health care should rest wholly on the shoulders of state governments. Constantly increasing competition in the modern health care industry has changed the role of the governments. It rearranged health care advocacy coalitions and interests, and made existing government policy tools obsolete or less meaningful. The public remains anxious about efforts to reduce subscriber utilization of inpatient hospital care and specialist services as a means of controlling costs (Chapman 14). The growing use of restrictive managed care arrangements by insurers has generated new concerns about the quality of care provided to the elderly, the poor, and patients who require costly treatments (McDonough 180). Under these circumstances, enacting comprehensive health care reform at the government level is necessary for coping with the dramatic changes in the organization and financing of health care.
Insurance and the Government
Within all societies, the governments should assume responsibility for assuring medical care for all citizens. On the one hand, some members of society may not have sufficient means to insure themselves. On the other hand, if they have sufficient resources, they may suffer a form of myopia that means they allocate not adequate resources to cover their health care needs. One solution here can be to blanket in these difficult cases by socializing insurance either through the tax system, as in Canada, or through a system of non-profit sickness funds based on compulsory membership, as in Germany (McDonough 342).
Insurance services would be produced more efficiently if they were produced by the governments. It is indicated that the government provides some insurance benefits at a lower unit administrative cost than the private markets would be able to provide them. For example, Flood (2000, p.1154) makes that point in the consideration of the Polish social insurance system. It is true that the government can nationalize medical care, make it universal, impose the same benefit scales on every citizen and then administer the system more cheaply than the private markets would do. Government may develop sufficient range of insurance products that may appear to add value because they can be adapted to suit individual needs.
Assurances from the government to the members of the medical profession and the leaders of the voluntary hospital sector can improve access to the health care system for two seriously disadvantaged groups, the elderly and the poor. All conditions of medical care delivery would remain under professional control and guidance.
Responsibility for providing health care services to the uninsured and underinsured should rest evidently with state government. For example, in the case of the poor, Congress created Medicaid: the government became the principal payer. This initiative designed a system of universal coverage for their residents. Both Medicare and Medicaid have had success making easier for the states to cover incremental expenditures incurred in treating increasing numbers of the poor and the uninsured. Medicare has also made it easier for rural hospitals and physicians that are in difficulties to increase their revenues and earnings, thereby helping them continue to provide sufficient health care to the rural population.
Funding the Government Health Care
The government actively promotes competition as a means of controlling costs and increasing access to health care. Medicaid managed care waivers, for instance, can be used to considerably expand access to health care for individuals without health insurance by plowing cost savings from capitation for program enrollees into state-subsidized insurance programs for the working poor (Bauman 219). Government can also impose a mandatory budget cap on health care expenditures. In both examples, government officials are not just passive observers of market competition. Instead, they are channel and direct market forces in pursuit of public goals (for example, controlling Medicaid costs).
The primary funding for the health care can be accomplished through a Government Health Care Fund. The funds for this heath care program is derived and provided to the Fund in the following manner (Bauman 251):
- Employer contribution equal to 3 percent of the gross earnings of each wage or salaried employee.
- Employee contribution of 7 percent of gross earnings, with no upper limit.
- A 1 percent Value Added Tax (VAT) on all consumer durables produced in the home country or imported from foreign nations.
- For each dollar of foreign aid granted to any foreign government or nation 0.001 percent of such amounts will be provided to the Health Care Fund for national health care.
If any kind of universal coverage is adopted, the costs are large in size and require all citizens to both contribute to the government health care system and contribute to the reduction of the national debt. If health care is absolutely “de-linked” from the workplace and the government makes a social contract with individuals for their own health care, business and industry can go about doing what they should do-making a high quality product at the lowest possible price, while providing a reasonable rate of return to investors (Crichton and Robertson 142). In this case, a government health care plan will stand or fall on the willingness of individuals to pay their fair share of the costs for the received health care.
The Role of Government in Health Care
The following aspects of health care need to be put into focus:
- Patients’ incentives should probably be reweighed by subjecting every lab test, visit to a medical office or clinic, or other item of medical service to a “deductible” (Chapman 36).
- Governments need to bar “punitive” damage claims for malpractice. Careful estimations must be required for “substantive” damage claims (Crichton and Robertson 57).
- Governments need to control litigiousness. For example, in the United States it is far worse than in other countries (Havighurst and Richman 10).
- Governments urgently need legislative reform to control the authority of such interest groups as health insurers and health providers (Havighurst and Richman 10).
The unsuccessful attempts to enact national health care since early in the century were the result of constant constraints on reorganizing the financing and delivery of health care. Health care has historically been fixed in fee-for-service physician care and the prevalence of voluntary hospitals. Further, the health care system was extremely transformed in the post-war period by the rapid growth of private health insurance. However, except for tax subvention, the government played no direct role in public health care until the passage of Medicare and Medicaid.
Today, the governments should take a lead role in the reform of the current health care system. The governments have residual responsibility for the provision of essential health care to all of their citizens. Government, not companies, should provide health care. The goal of transferring full responsibility to government might prove effective. A completely government-controlled health care system could provide basic health care services to the entire population. Government provision of adequate health care for the whole population produces commitment to social justice and a sense of solidarity and mutual dependence among the population.
Bauman, Robert E. (1995). “Can Government Run a Health Care System?” USA Today. Vol. 123, no. 2596.
Chapman, Audrey R. (1994). Health Care Reform: A Human Rights Approach. Georgetown University Press: Washington, DC.
Crichton, Anne and Robertson, Ann. (1997). Health Care: A Community Concern? University of Calgary Press: Calgary, Alta.
Daniels, Norman. (2001) “Justice, Health, and Healthcare,” American Journal of Bioethics 1.
Flood, Colleen M. (2000). International Health Care Reform: A Legal, Economic, and Political Analysis. Routledge: London.
Havighurst, Clark C. and Richman, Barak D. (2006). “Distributive Injustice(s) in American Health Care.” Law and Contemporary Problems. Vol. 69, no. 4.
McDonough, John E. (2000). Experiencing Politics: A Legislator’s Stories of Government and Health Care. University of California Press: Berkeley, CA.