THE FUTURE OF AMERICAN HEALTH CARE (Excerpt) / Jiezel Nara

On September 13, 2017, Senator Bernie Sanders of Vermont unveiled his “Medicare For All” health care legislation[1]. This proposal, if approved, would improve the current US Medicare system, expanding it to universal health care. Universal health care coverage is the idea of every being having equal access to quality health services and not put them under financial risks for accessing such services as defined by the World Health Organization (WHO)[2]. It is based on WHO’s 1948 constitution declaring health as a fundamental human right[3]. Expectedly, some Americans are against this bill and it currently has an unlikely chance of passing the Republican-controlled Senate. The question is why Senator Sanders would introduce this “radical” bill despite almost no-chance of advancing? I can only surmise the answers from the context, but most likely, Sen. Sander’s goal is not to immediately have universal health care, but for his proposal to be the center of discussion and debate in the Senate and in the media, which will help promote the idea of universal health care. This may seem futile with the current opposition, but the US population is facing a rapid shift from the Baby Boomer’s generation to the Millennials. Baby Boomers are those who were born after World War II, between 1946 and 1964[4]. Meanwhile, Millennials often pertain to those born between 1980 and 2000[5].iven that the youngest of Baby Boomers are already in their fifties, their population is expected to decline with Millennials taking the reign. The latter tend to be more progressive in all areas, ranging from cultural, societal, domestic and international policies among others. The majority of them perceive universal health care as a necessity or the next step forward for the US as evidenced from the results of several surveys conducted. In one recent Gallup Poll of 2016 showed 58%f Americans support the idea of universal health care as an improvement of the current Obamacare while 37% opposes it[6]. Will Americans go with this idea and implement universal health care, or will this policy end in vain like the gun control bill? The US has reached one of the most crucial turning points in its history, whether or not to implement universal health care that most advanced economies share.

 

  1. How US health care fare compared to other advanced economies

To fully understand how dire the US health care system or the lack thereof, comparison is inevitable. Due to geographical proximity, historical and cultural similarities, and Sen. Sander’s ideal universal health care system, Canada is used for comparative purposes. The author compared three criterions; infant mortality, life expectancy at birth, and annual cost per capita. It was found out that despite allocating more than 17% of its GDP and the highest per capita spent on health care, America’s results were inferior to Canada and other countries used as reference in all three measures.

Health care costs in the US have risen faster than American’s income. In fact, between 1999 and 2007, the health insurance premiums or the amount individual pays monthly, dramatically increased by 114% while workers’ incomes only by 27%[7]. This makes it unsurprising that people cannot afford health care and why many Americans have been filing for bankruptcy because of health care-related incidents. Even the American median household income in 2015 of 55,775 US dollars or 6.3 million yen[8] seems to be not enough. Meanwhile, Canadian families’ average income for 2015 was 80,940 Canadian dollars or 7.2 million yen[9], almost 1 million more than the US. Canadians earn more than Americans and could afford better medical care on average, but they don’t need to do that because the country administers a national health insurance system. Of course, some Canadians still apply for private health insurance to cover other areas that are not considered as basic medical needs. According to the US Census Bureau, about 45.7 million or 16% of the total American population was uninsured in 2007 and while this number seemed a lot, this was 1.3 million less than the year before. In 2015, one year after Obamacare’s implementation, the uninsured dramatically decreased to 28.6 million or 9.1% of the entire US population[10]. This marked the first time in US history when the percentage of uninsured reached less than 10%. While this was a momentous occasion and a cause of celebration for American health care policy, the fact remains that the US still has the smallest number of insured people in the group of industrialized nations. In Canada’s case, all Canadians and permanent residents can apply for government health insurance. As a result, Canada ranks among the top countries in the number of insured along with other advanced economies because these countries have their constituents insured in some form of health system. Consequently, Americans visit their doctors about 4 times in a year compared to 8 in Canada on average for 2014, according to the health data produced by the Organization for Economic Cooperation and Development or OECD, an organization composed of 35 nations that was founded in 1960 and focuses on the development and building of a sustainable world economy. Moreover, the infant mortality rate, or number of infants who die before they reach their first birthday in every 1000 live births is more potent in the US with 5.8 deaths per 1000 infants before reaching the age of one. This rating is particularly important to gauge the general health level of society. Just for 2015 in the US, more than 23,000 infants lost their lives[11]. Understandably, a child born in a flourishing and nourishing environment would have a better chance of living up to the life expectancy of that specific country, but the US clearly doesn’t provide such. Aside from other factors, it can be said that inaccessible health care is one of the main causes. The average length a new-born in the US is expected to live in 2014 was 78.9 and while there is no data provided on Canada, we can expect that children live longer there as reflected in the previous years. Meanwhile, Japan has the longest life expectancy at 83.5 years[12]. Some live longer than expected and several elements including better living standards, lifestyle, and access to quality health services are contributors. Unfortunately, the US is infamous for its poor eating habits and expensive health care that living longer is not often the case.

The US health care system, frankly, is infamous for producing some of the worsts data out of all advanced economies on infant mortality, life expectancy and others despite spending the most. The US allocated 17.1% of its GDP to health care in 2014, compared to its northern neighbour Canada who only used 10.4%. The US spent 9036 US dollars per capita on health care while Canadians used 4502 US dollars in 2014. From this, Americans “voluntary payment” or the amount they pay through private health insurance and out-of-pocket payments, was about 4457 US dollars while their Canadian counterparts were only burdened with 1332 US dollars[13]. Nevertheless, the US produced one of the worst numbers for infant mortality and life expectancy at birth as mentioned before.

One of the issues often raised by those who reject emulating health care systems (hereafter “sceptics”) like the ones in Canada and Western Europe, is the cost. Needless to say, health care implementation is expensive. Some Americans believe that instead of using such money to improve health care or “entitlements”, the money should be allocated to education, military, infrastructure, and others. While such points are valid, it can also be argued that enough budget is appropriated in these sectors and proper implementation of policies and use of funds are what’s necessary. Emerging economies like Brazil, Mexico, and war-torn Rwanda has undertaken successful health care reforms despite exceedingly fewer resources than the United States[14]. This clearly suggests that the US, with its budget, should be capable to do the same, if not better.

 

  1. Arguments against universal health care

 

  1. Sceptics: Private businesses

The two main priorities of for-profit health care industries are to require every American to afford health insurance and to eliminate other sources of health care that would give Americans the choice to avail themselves of the alternative. Universal health care would be the antithesis to their primary goals. Firstly, because universal health care will provide a basic care for each Americans through the government, paid by taxes, which can satisfy the needs of common Americans making it unnecessary for them to pay extra for the care they will not need nor require. Second, because universal health care will be the alternative to for-profit insurance, private insurance business will be void. Logically, why should one payxtra for a care that will be provided from the taxes the government already take from oneself? Of course, there are many countries where both the government and private companies provide health care. Though, whether the same can happen in the US remains to be a question.

Universal health care would mean that every American will be able to go to hospital without worry of possible bankruptcies that initially came with it. As a result, a surge of people seeking care and rushing to hospitals even when unnecessary is very likely to happen. In the case of the Democrat’s Obamacare, it expanded Medicare and Medicaid so that more Americans can have access to health care, but the system of providers weren’trepared. As a result, the waiting times would most likely be longer according to the estimate of Steven Pizer, health care economist at Northeastern University[15].herefore, if government-based health care system is approved, longer waiting times can be expected because the US government failed to expand structure of providers, in addition to longer waiting time being the case in most of the advanced economies who have government-administered health care. One of the many instances where the health care system is abused can be observed in the UK where partygoers indulged themselves with much alcohol on New Year’s Eve, then “selfishly” call for ambulances and occupy beds that could have been allocated to those in dire need, understandably frustrating medical practitioners. It was estimated that more than 40% of emergency calls for ambulances during the first few hours of New Year’s will be alcohol-related incidents[16]. This example of entitlement is one understandable case why hospitals and Americans fear and are reluctant to implement universal health care.

Moreover, an introduction of universal health care and reduction of for-profit insurance corporations and hospitals would lead to less funding for the development of new medicines and machines to improve the lives of people suffering from several illnesses. As pharmaceutical companies lose the incentive of developing and researching new medicines and cures, a setback in medical advancement can be expected. For 2015, the medical and health industry which includes pharmaceutical, biotechnology, and health IT companies invested about $102.7 billion in research and development that encapsulate 64.7% of the entire research and development funding. Within this, pharmaceutical companies contributed $72 billion[17]. Meanwhile, the federal government contributed about $35.9 billion in research and development or 22.62% of the total investment. Which apparently means that private businesses invested almost thrice the amount the government infused to medical research and development. While we detest how many of these industries prioritize profits, we all reap the benefits from the results of their research and development. We benefit through the dramatic success in treatment of diseases, more affordable drugs, and through dissemination of medicines in areas where they used to be impossible because drugs have become cheaper. Furthermore, despite the overall cost on health care, their big investment for research and development made the US possess what can be classified as the most advanced treatments and hospitals like those provided at the El Camino Hospital in California, John Hopkins Hospital in Maryland, Mayo Clinic Cancer Centre in Arizona, Florida, and Minnesota. These world-class hospitals are visited by the richest and those who want the best medical care money can buy from around the world. Truly, signifying the gap between US and the rest of the world.

 

  1. Sceptics: Politicians

It may be infuriating to know that some Americans are against universal health care and this is embodied by their government representatives. What makes them vote against their well-being? Or do they even view their actions as acting against their benefit? This part gives probable reasons why some US politicians and common Americans are vehemently against universal health care.

One of the key players for the US health care system to adopt changes are politicians. The US administers a mostly two-party system where the Democrats and Republicans control large parts of the government, particularly the Congress. After the 2016 Presidential election, the Republicans, with Donald Trump’s victory over Secretary Hillary Clinton ended up with total government domination. This led to a Republican House of Representative (246 out of 435), Senate (52 out of 100), and President. This control of government is important to gauge the possible proceeding decisions this government will undertake, especially in regard to health care. For instance, in 2009, one year before ACA became law, a record-breaking 550 million US dollars was utilized by the health industry (including pharmaceutical and health products, hospitals and nursing homes, health professionals and others) for lobbying activities according to the Centre for Responsive Politics or CRP, a non-profit, non-partisan organization that tracks campaign contributions and lobbying[18]. The years prior to 2009 saw a gradual increase in health care lobbying. Just from the vast sum of money, it is clear the health care industry is trying to control the eventual form of the ACA and will be and used by lobbyists to argue for their position. In 2017, a moment when the entire US debated the pros and cons of the ACA and whether to repeal and replace it, the health industry already used more than $413 million, unsurprisingly more than half or $208 million of these came from big pharmaceutical industries that we are well acquainted with such as Pfizer and Johnson & Johnson, a few Japanese companies like Takeda Pharmaceutical and Eisai Corporation, among many others.

Republicans have been major dependents of the health care industries’ generous contributions and they have consistently been depending on health care industry contributions for re-election. Since 1994 until 2016, Republicans have received more than Democrats from healthcare industries donors. It can be remembered that these years are significant in health care reforms beginning with President Obama’s running on a platform to provide health care coverage for all Americans which was in 2008. Many medical care invested businesses supports the part of coverage for all Americans in ACA as it means more to provide insurance, cure or sell medicines for them. 2010 was the critical year when the ACA passed Congress and was signed by President Obama. 2016 is the Presidential election year which brought the US Donald Trump. Health care coverage was heavily debated during this period suchlike the decision on whether to “repeal and replace Obamacare”, negotiating drugs prices, and the talks on universal health care.

Moreover, the Republican Party’s main political mantra is small government and less taxations. Though contemporary Republican objectives are questionable because of for instance, an over-funded US military whose expansion they have continuously supported instead of cutting. Their record of legislations shows several attempts to decrease tax for the common Americans, the rich, and megacompanies. By decreasing taxes on everyone, the US will not reach the big government or welfare state, that some Americans, in principle, hate. Small government means less funding for welfare or “entitlement” programs that include the Medicare and Medicaid that poorer Americans rely on. Additionally, Americans want less taxes in general. The Republican Party hopes that by decreasing taxes, people would spend more stimulating the economy. Ideally, that lower taxes would encourage companies to invest and build more in the US rather than outsourcing abroad, decreasing the unemployed in the US. Of course, there are Democrats who support decreasing taxes, but in general, this policy leans more to Republicans.

In short, because the government is currently dominated by Republicans who are opposed to higher taxation that can result in “socialized” health care and the fact that they receive generous contributions from health industries who are opposed to non-competitive health industry market, voting in favour of universal health care may not happen with the current Trump administration.

 

America’s Next Step

  1. The Future of American Health care

As of 2015, Millennials population of 83.1 million have outnumbered Baby Boomer’s 75.4 million[19]. This population is more racially and ethnically diverse according to the census results. This information is crucial to predict the potentiality of America years from now. For example, the state of Texas which has consistently been a Red state since the 1980 Presidential election may become Blue again because the Hispanic population has been dramatically on the rise. A few decades from today, this state’s voting pattern can change. One evidence is New Mexico which used to vote Red but has now voted Blue six times in the last seven Presidential elections[20]. This trend is a result of Latinos recently aligning to the Democratic Party, which coincidentally, New Mexico has the highest percentage of Hispanics at 47.7%[21]. From this, the author’s assumption of Texas, turning Blue again in the future sounds more feasible. This example of change in voting pattern because of demographic change may also lead to differing vote on health care. Hispanics, in general earn less than other races (e.g. Asian and Caucasian) so having a socialized health care can benefit them more which may incentivise them to vote for politicians who promise to support universal health care. In the case of Millennials, the November 2008 poll conducted by the American Centre for Progress showed an overwhelming support at 88% for Millennials when they were asked whether they agree/ support providing quality affordable health coverage for every American[22].

Like the rest of advanced economies, the US is experiencing a declining birth-rate and even its immigrants suffer from this. Compared to American citizens total fertility rate (TFR) or the number a woman of children women is expected to give birth in her life-time, of 1.75 for 2015, immigrants TFR stands at 2.16[23]. What is important here is that children of migrants are born into the US and as the country practices Jus Soli or right to citizenship in the country one is born into; the children of immigrants will be one of the key demographics for the future of the United States. The children of immigrants and Millennials will be the foundation of a new America. They will be deciding not just the issue of ACA or universal health care, but as well as other matters.

While a majority of these groups believe that everyone should have access to quality affordable health care, the idea of universal health care or a socialized health care system seems to be not known as originally assumed. The gap in their belief (quality health care should be accessible and affordable) and knowledge (socialized health care system makes it possible) seems huge, particularly in the Millennial population. This gap needs to be addressed for the US to successfully transform into a socialized health care model like the rest of advanced economies.

 

Epilogue

 

Senator Sanders of Vermont introduced the “Medicare for All” on the 17th of September 2017. 3 years from now, on 2020, the next Presidential election is scheduled. This will be the first presidential election where all Millennials will have reached voting age and this generation will be 103 million strong[24]. This group of better educated Americans will be deciding the future of US health care. There is great expectation that these Millennials will vote for a “better” health care system suitable for a rich economy like the United States. Or in Sen. Sanders’s vision, a universal health care system like Canada’s. However, before anything else, the next candidate who will run his/ her platform on health coverage for all Americans should try addressing the issues with socialized systems that makes it unpopular for some Americans.

Sen. Sanders was popular and his messages of free college education, taxing corporations and the top 1% in addition to accessible quality medical care strongly resonated with the younger generation. Therefore, the group of people who will vote and be the main decision-makers in the next Presidential election are positively expected to vote for the candidate who embodies their aspiration of how the United States should be. The candidate who will successfully undertake all these tasks will be the next President and will decide the future of America’s health care system.

 

 

Bibliography

Bradley, Elizabeth. H., Taylor, Lauren. A. The American Healthcare Paradox: Why Spending More is Getting Us Less. New York: Perseus Books Group, 2013. 81.

Brady, Enda. Britons use NHS as ‘national hangover service’, says health boss. Skynews. December 31, 2016. Accessed August 2017. http://news.sky.com/story/britons-use-nhs-as-national-hangover-service-says-health-boss-10712755.

Center for Immigration Studies, “Immigrants Birthrate Declining Rapidly”, October 2, 2017, https://cis.org/Press-Release/Immigrants-Birthrate-Declining-Rapidly

Centers for Disease Control and Prevention, “Reproductive Health”, August 29, 2017. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

Cohen, Robin A., and Martinez Michael E. “Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2008” PsychEXTRA Dataset. Doi:10.1073/e565212009-001.

Department of Numbers, “US Household Income”, http://www.deptofnumbers.com/income/us/.

Government of Canada Statistics, “Median total income, by family type, by province and territory (All census families)”, Statistics Canada, July 12, 2017. http://www.statcan.gc.ca/tables-tabelux/sum-som/101/cst01/fami1108a-eng.htm

Health Lobbying 2017, Open Secrets. http://www.opensecrets.org/industries/lobbying.php?cycle=2017&ind=H

Kounang, Nadia. “Big Pharma’s big donations to 2016 presidential candidates”, CNN, February 11, 2016. http://edition.cnn.com/2016/02/11/health/big-pharma-presidential-politics/index.html.

Madland David and Texeira Ruy, “Millennials support for health care reform, New Progressive America’ The Millennial Generation”, Center for American Progress, May 2009, 19.

Martin, Gary. “Baby Boomer’ – the meaning and origin of this phrase.” Phrasefinder Accessed October 2017. https://www.phrases.org.uk/meanings/baby-boomer.html.

New Mexico, 270 to Win, https://www.270towin.com/states/New_Mexico.

Research America, “US Investments in Medical and Health Research Development 2013 – 2015”, Fall 2016, 2. http://www.researchamerica.org/sites/default/files/2016US_Invest_R%26D_report.pdf.

Rosenthal, Elizabeth. “The Healthcare Waiting Game”. The New York Times, July 5, 2014. http://www.nytimes.com/2014/07/06/sunday-review/long-waits-for-doctors-appointments-have-become-the-norm.html.

Savronsky, Rebecca. “Poll: Majority of Americans support universal healthcare”, The Hill, May 16, 2016. http://thehill.com/blogs/blog-briefring-room/news/279991-poll-majority-of-americans-support0federally-funded-health-care.

Sharf, Samatha. “What Is A ‘Millennial’ Anyway? Meet The Man Who Coined The Phrase.” Forbes. September 06, 2016. Accessed November 2017. https://www.forbes.com/sites/samathasharf/2015/08/24/what-is-a-millennial-anyway-meet-the-man-who-coined-the-phrase/#753c6cf14a05.

Sherrow, Victoria. Universal Healthcare. New York: Infobase publishing, 12. United States Census Bureau, “Millennials Outnumber Baby Boomer and Are Far More Diverse, Census Bureau Reports”, June 25, 2015. https://www.census.gov/newsroom/press-releases/2015/cb15-113.html.

Weigel, David. “Bernie Sanders introduces universal health care, backed by 15 Democrats.” Chicago Tribune. September 13, 2017. http://www.chicagotribune.com/news/nationworld/politics/ct-bernie-sanders-health-plan-20170912-story.html.

What is universal coverage? World Health Organization. Accessed October 2017. http://www.who.int/health_financing/universal_coverage_definition/en/.

World Health Statistics 2014. WHO. Accessed November 2017. http://www.who.int/mediacentre/news/releases/2014/world-health-statistics-2014/en/

[1] David Weigel, Bernie Sanders introduces universal health care, backed by 15 Democrats, Chicago Tribune, September 13, 2017. http://www.chicagotribune.com/news/nationworld/politics/ct-bernie-sanders-health-plan-20170912-story.html.

[2] World Health Organization, “What is universal coverage?”. http://www.who.int/health_financing/universal_coverage_definition/en/.

[3] Ibid.

[4] Gary Martin, Baby boomer’ – the meaning and origin of this phrase, Phrasefinder. https://www.phrases.org.uk/meanings/baby-boomer.html.

[5] Samantha Sharf, “What Is A ‘Millennial’ Anyway? Meet The Man Who Coined The Phrase, Forbes, August 24, 2015. https://www.forbes.com/sites/samanthasharf/2015/08/24/what-is-a-millennial-anyway-meet-the-man-who-coined-the-phrase/#753c6cf14a05.

[6] Savronsky. Poll: Majority of Americans support.

[7] Victoria Sherrow, Universal Healthcare, New York: Infobase Publishing, 2009, 12.

[8] Department of Numbers, US Household Income, http://www.deptofnumbers.com/income/us/.

[9] Government of Canada Statistics, Median total income, by family type, by province and territory (All census families), Government of Canada, Statistics Canada. July 12, 2017. http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/famil108a-eng.htm.

[10] Robin Cohen, Michael Martinez, and Emily Zammitti, Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2015.

[11] Centers for Disease Control and Prevention, Reproductive Health, August 29, 2017. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm.

[12] WHO, World Health Statistics 2014, 2014. http://www.who.int/mediacentre/news/releases/2014/world-health-statistics-2014/en/

[13] WHO, 2014.

[14] Elizabeth H. Bradley and Lauren A. Taylor. The American health care paradox: why spending more is getting us less. New York: Perseus Books Group, 2013, 81

[15] Elisabeth Rosenthal, The Health Care Waiting Game, The New York Times, July 5, 2014. https://www.nytimes.com/2014/07/06/sunday-review/long-waits-for-doctors-appointments-have-become-the-norm.html

[16] Enda Brady, Britons use NHS as ‘national hangover service’, says health boss, Sky News, December 31, 2016.

[17] Research America, U.S. Investments in Medical and Health Research and Development 2013 – 2015, Fall, 2. 2016.  https://www.researchamerica.org/sites/default/files/2016US_Invest_R%26D_report.pdf

[18] Open Secret, Health Lobbying 2017, http://www.opensecrets.org/industries/lobbying.php?cycle=2017&ind=H

[19] United States Census Bureau, Millennials Outnumber Baby Boomers and Are Far More Diverse, Census Bureau Reports, June 25, 2015, https://www.census.gov/newsroom/press-releases/2015/cb15-113.html

[20] New Mexico, 270 to Win, https://www.270towin.com/states/New_Mexico

[21] Ibid.

[22] American Progress.

[23] Center for Immigration Studies, Immigrants Birthrate Declining Rapidly, October 2, 2017, https://cis.org/Press-Release/Immigrant-Birthrate-Declining-Rapidly

[24] Madland and Texeira, Millennials support for health care.

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