Health care in the United States is a paradoxical system in which physicians from all over the world come to train and practice the best standard of care coupled with cutting-edge diagnostic and treatment modalities. However, the manner in which these methods are delivered is inefficient from both the patient and physician perspective.
The U.S. leads the world in health care as percentage of GDP (17 percent in 2009 with 25 percent estimated by 2025). Such expense does not even buy universal care, as 15 percent of the population is without medical coverage. According to the 2009 U.S. Census Bureau, nearly 40 percent of the uninsured have a household income hovering at the national average. These numbers demonstrate an unbalanced medical cost burden on middle class households, along with the extent to which employers are cutting health benefits to lower income workers as insurance companies raise premiums. Generally, federal and state government programs take care of the impoverished, whereas employers and personal expenditures garner private insurance for the remaining middle class and wealthy. Given the inequalities in care delivery, there are several factors accounting for the United States having the world's third highest health expenditure per capita.
The U.S. medical-legal system encourages litigation and is directly responsible for driving up health care costs. The current administration neglected this central contributor in the legislative process. The vast majority of DC politicians are attorneys, accepting large contributions from the American Trial Lawyers Association. Medical litigation is an incentive-based big business. Though 70 percent of claims are eventually dropped and physician non-negligence is ruled in 95 percent of cases reaching court, the possibility of large cash settlements drives legal action. Constant physician concern of lawsuits encourages defensive medicine and results in often unnecessary diagnostic testing on patients, adding 10-15 percent to national health care spending according to a 2009 AMA study.
The fundamental ethical principle in medical practice is "first do no harm." Physicians must be held accountable in cases of negligence and maligned patients must be compensated. However, the current system is failing both physicians and patients. According to the Common Good, up to 80 percent of verdicts against defendants are unjustified by scientific evidence. Medical justice is a random process dictated by the capriciousness of juries with no guarantee of rightful judgment. Physician errors are widespread, with thousands of patients dying annually due to mistakes. However, unreliable justice has not decreased errors and practitioners have taken a bunker mentality regarding the subject. Distrust of the medical-legal system undermines the health care profession, physicians abandon high-risk professions (such as OB-GYN and neurosurgery), and exorbitant malpractice premiums have forced experienced, good physicians out of business. A specialized system of medical courts would establish reliable, fair justice, with adjudication directed by magistrates trained to evaluate scientific evidence and standards of care.
The obesity epidemic is placing increased strain on U.S. health in terms of expenditure and capacity. The rising frequency of obesity related diseases pervades into every field of medicine, as 30 percent of population qualifies as obese. Diabetes, hypertension, peripheral vascular disease, obstructive sleep apnea, etc. are treated with a combination of pharmacotherapy, injections and surgery. These modalities decrease the morbidity of obesity diseases without addressing responsible lifestyle choices and societal inertia. Given the vested interest large pharmaceutical companies have in selling their products, would they advocate diet and exercise as causal treatment for obesity related pathology?
Engendering a conscientious population is the non-interventionist, cost-effective cure for the obesity epidemic. Preventive care supplies the ammunition to live healthy, productive lives by rewarding habit-based behaviors such as eating less and exercising more. The creation of federal, state and local government sponsored programs will permeate into community events, education and social institutions. While awareness of the obesity epidemic in the United States seems to be present, the results of a thinner society are lagging. Implications of the current obesity trend are unsustainable health care costs and management ability.
The social welfare state will expand under new legislation planning to increase Medicaid coverage and Medicare/Medicaid provider remuneration. The health bill also promises employers incentives for wider private health care coverage. Government is necessarily taking the lead in the mixed health care economy due to private sector failure over the last 35 years, beginning with the flawed managed care concept. The current framework is being established for consistent health care, outside of the transient emergency room, to all U.S. citizens.
The U.S. social welfare state has roots in the 1930's Great Depression and has steadily grown to produce minimal provisions for all citizens as a hallmark of modernity. Health care providers rely on the social welfare state to treat patients. Over-aggressive expansion of the welfare state by the health bill may threaten the system's balance, force cuts to non-medical agencies, and pave the way for too much government power.
Obama care failed to formally incorporate undocumented populations into the national health system, which may eventually further stress the social welfare state. Illegal immigrants represent one-third of the uninsured population. Their difficult to calculate medical costs comprise 20-35 percent of uncompensated care depending on the state. Allowing this population to buy into the national health care system may preserve the well being of social welfare in this tenuous time.
Given the legal, social, and economic complexities of U.S. health care, legislation took a quick fix approach for reform, targeting payment as its primary instrument. An uninsured population ultimately creates higher medical costs. Inconsistent access to care permits pathologies to progress, manifesting as increased deferred costs of advanced disease. Delayed care also increases morbidity and opportunity costs of lost wages and productivity. A point of contention with insurance revision is that the mandate to obtain medical coverage limits civil liberty and individual right. In actuality, a nation with consistent health care access paves the way for increased personal decision making, accountability, education, and productivity, all promoting civil liberty.
Some people have argued that President Obama and his political colleagues proceeded with health care reform in a nontransparent fashion, passing legislation for legislation's sake. An aura of surreptitious deal-making carried out in a Capitol Hill business-as-usual manner surrounds the bill. In reality, compromise is inherent to politics and the bill paves the way for crucial enhanced distribution. The national economic and social ramifications of health care's current sky-rocketing costs and problematic delivery beckoned the guiding hand of government. With substantial federal effort and resultant legislation in place, it is time for health care workers in the trenches to incite, direct and achieve meaningful pro-patient change.