National Health Insurance: Is it the answer to our healthcare problem?

The United States healthcare system is often criticized as being one of the most costly and ineffective systems in the developed world. Compared to countries with socialized healthcare, such as Canada and the United Kingdom, America spends a much higher percentage of their GDP on healthcare, yet there are still millions of people within its boundaries that have no health insurance and thus suffer from lack of proper care. The graph on the left shows us that as of 1999, 16% of our population was uninsured, and that number has not decreased. Because of all the criticism that our healthcare system has been receiving, healthcare reform has become one of the hot topics of this year. A type of national health insurance has been proposed by some as a possible answer to this healthcare crisis. This week, in response to this issue, I decided to search the blogosphere for post regarding national health insurance that would enlighten me on its pros and cons. I was successful in finding one post opposing socialized medicine and another that gave a more positive view of this plan. The first post, Top 10 Trends in Healthcare, was found in the blog entitled The Holistic Economy by Daryl Kulak. The author gives his readers of list of ten ways towards which America's healthcare is shifting. He includes trends such as: the continuous rise in cost of medicine, the tendency for companies to opt-out of providing health insurance for their employees, and the increase of consumer-driven healthcare, among many others. More important to this post is his view on the shift of the perception of socialized medicine of the American public. He believes that a "government-run system" would not work in the United States because we value our independence and our freedom of choice too much. While he does acknowledge the need for reform, he does not pose a better option for change. The second post, Most Doctors Want a National Health Plan, by Jane Sarasohn-Kahn, was found in the Healthcare Blog. She is more optimistic in her view of the possibility of implementation of a more socialized healthcare system in our country and supports her thoughts with a recent study claiming that more physicians desire universal coverage now than in 2002. Below you will find links to the comments I left on these authors' pages, as well as the actual comments themselves. I urge you to read their post and look at the comments they have accrued in order to better inform yourself on the realities of national health insurance.

Comment 1 - I have to admit that I found the ten points you provided in this post to be pretty accurate. In particular, I was intrigued by your comments on American's distrust of socialized medicine. Although you do admit that our healthcare system is in need of reform, you failed to mention a different alternative to national health care. I would have liked to see you go more in depth with this trend because it is an extremely important topic right now. I feel that if America thought that the answer to our healthcare crisis was in a socialized healthcare system, our fear of losing our independence would not overcome our desire to better this country. I am not implying that America should shift towards a national health insurance, but you seem to completely dismiss it as an alternative. While your experiences might have not been excellent with the socialized Canadian healthcare system, I am sure that you acknowledge that both the Canadian systems as well as the United Kingdom's system have some parts to it that work well and from which we could learn. It might not require a single payer system to repair our healthcare problem, but we must do something in order to help all those millions of people in our country who find themselves without insurance. While alternative medicine can help these people in the short run, there is going to come a point in time when they are going to need specialized care, and then it will be more costly on the country then if we are proactive now in changing our healthcare system into one that will be sustainable for a long time.

Comment 2 - In the case of a national health insurance, I would imagine that there would be fewer physicians that would be against it rather than for it. I can see why there would be an increase in physician supported in the group of ER doctors because you are right in saying that they do see most of the uninsured patients, but I have a hard time believing that other doctors would want this to happen. The reason for my previous statement is that if we were to function under a single payer system, much of the competition would die down and physicians would be paid a much lower salary than what they are currently earning. While I am neither for nor against a national health plan, I do have some concerns with the quality of care that would be provided by such a system. It is often the case that we focus on the good qualities of socialized healthcare networks in other surrounding areas, but very little do we notice all their flaws. Also, if we take a look at the current government run healthcare system, otherwise known as the VA, it is not the best of systems. In fact, there are constant stories in the news that remind us of the low quality of care that VA patients receive. I would hope that, if our country did move towards a more socialized healthcare, the appropriate measures and precautions be taken. I do think that there are parts of our healthcare system that do work, and that trying to fix what we already have would not be a bad idea either. In terms of the chart that you provided (pictured on the upper right), I would like more information about how the study was conducted. Were the doctors who were polled randomized? What types of questions were they asked? It just seems to me that six out of ten doctors is a bit extreme in terms on national health insurance support. If you could please direct me where I could view the study, I would greatly appreciate it.

Non Profit Hospitals: Are they becoming too focused on maximizing profits?

Within our healthcare system, there are
three types of hospitals which provide services for their surrounding communities. There are non-profit hospitals, for-profit hospitals, and government funded hospitals. The basic difference between these entities is that for profit hospitals strive to serve patients while still maximizing revenue for their shareholders, while non-profit hospitals are said to focus on providing charitable care to their community, and government funded hospitals also focus on serving the community through governmental funds. Through this network of facilities, most of the people within our country receive the proper care that they demand. While this system has worked well for many years, many non-profit hospitals are currently being scrutinized and accused of diverting from their main focus and instead making money more of a priority. If this were to be the case, this could potentially cause a plethora of problems because then these hospitals would be receiving tax breaks under the false pretense that their main focus is to serve the community rather than to make money.

There was a recent article posted in the Wall Street Journal that speaks about the recent trend in non profit hospitals in terms of revenues. As seen on the graph on the upper right, they show that hospitals have very drastically improved their net income, from $544 million dollars in 2001 to $4.27 billion dollars in 2006. They highlight the success of non profit hospitals such as Northwestern Memorial Hospital in Chicago, Cleveland Clinic, University of Pittsburg Medical Center, University of California at San Francisco Medical Center as well as a Catholic Healthcare West ( a system of hospitals in the San Francisco area). The authors point out that much of the income of these facilities has been dedicated to the renovation of their buildings, large payments to CEOs, and acquiring state of the art equipment, rather than on charitable care. While some of these expenses might seem somewhat deviated from the main purpose of serving those in need, I believe that we cannot be quick to judge all of these hospitals for spending the amount of money that they do in these areas without looking at the big picture. Non profit hospitals have always had to compete with for profit hospitals. As one of the writers for the Health Care Blog, Maggie Mahar (pictured left), stated in her blog post titled "Do non profit hospitals deserve their tax breaks?", non profit hospitals that are surrounded by a healthy mix of for profit hospitals are bound to act like for profit hospitals because they have to fight in the same market for the same patients. Although their main purpose is not to maximize income gains, money is necessary to run a hospital. It is no surprise that these hospitals mentioned above are paying money to renovate their facilities or to bring in state of the art equipment, because aesthetics and appearance of success is one of the ways in which hospitals can draw patients into their doors. While I am not condoning the focus of profit maximizing in non-profit hospitals, I am saying that perhaps a closer look at their total activity as a whole might be more beneficial and will give us a better understanding as to whether these hospitals are adhering to their primary mission of serving the community in need of care.

Because of all the fire that non profit hospitals have been receiving, the Internal Revenue Service has been very proactive in trying to investigate these cases and make sure all hospitals are complying with the community benefit standards that are required to qualify as a tax-exempt charity under section 501. Recently a study was done to show what the average activity was for most of the non profit hospitals in the United States. They were able to receive data from four hundred and eighty seven different non profit hospitals. I found it very interesting that the study found that these facilities were serving an average of 46 percent of people with insurance, 46 percent of people under government plans such as Medicaid and Medicare, and 7 percent with no insurance. I feel like these numbers really do show that on average, non profit hospitals really are helping a large part of the population who is in need. However, I do believe that Maggie does pose a good point when she say that perhaps the IRS should put a minimum requirement on charitable care in order for these non-profits to quality for tax exemptions, because at least we would then not doubt that they are providing at least a sufficient amount of help to the communities in need which they strive to serve. This would serve as a way to ensure that all of the money that our government spends on healthcare is being put to good use, and perhaps lead us into a future with a more efficient healthcare system.