National Health Insurance a possible solution to US healthcare crisis

Health care spending continues to rise at the fastest rate in our history. In 2007, total national health expenditures were expected to rise 6.9 percent which is two times the rate of inflation. The total spending was $2.3 trillion in 2007, or $7600 per person. Total health care spending represented 16 percent of the GDP.U.S. Health care spending is expected to increase at similar levels for the next decade reaching $4.2 trillion in 2016, or 20 percent of GDP. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400.

Despite this expenditure, the current U.S. system fails to provide universal health coverage. Nearly 47 million Americans or about 16 percent of the population lacked health insurance in 2006.The lack of universal coverage contributes to another flaw in the current U.S. health care. In dimensions of performance, it under performs relative to other industrialized countries. In a 2007 comparison by the Commonwealth Fund of health care in the U.S. with that of Germany, Britain, Australia, New Zealand, and Canada, the U.S. ranked last on measures of quality, access, efficiency, equity, and outcomes.

Policy experts agree that our health care system is puzzled with inefficiencies, excessive administrative expenses, inflated prices, poor management, inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect families.

To overcome such high costs some policy makers and political representatives have proposed National Health Insurance as a possible solution. National Health Insurance is a government operated or publicly funded system of insurance that provides financial benefits and medical services to persons in need of a treatment or disabled by sickness or accident. Typically, most health care costs are met by the population via compulsory health insurance or taxation, or a combination of both. National health insurance systems are found in many countries, particularly in Europe. In the United States health insurance has been provided by private enterprise on a voluntary basis.

National Health Insurance at political level:
In Congress, Rep. John Conyers has introduced The United States National Health Insurance Act (HR 676). As of January 2008, HR 676 has 88 co sponsors. It was first introduced, with 25 cosponsors in 2003 and since been reintroduced each session. The act calls for the creation of a universal single payer health care system in the United States, in which the government would provide every resident health insurance free of charge. In order to eliminate unequal treatment between richer and poorer Americans the Act would also prohibit private insurers from covering any treatment or procedure already covered by the Act. The bill is currently in the House Energy and Commerce's Subcommittee on Health. The bill has drawn significant attention beginning in July 2007 because of the release of the Michael Moore documentary Sicko which focuses on the status of health care in the United States.

National health insurance is a priority issue among the presidential candidates for the elections in 2008. Hilary Clinton whose first attempt at a health care overhaul failed 13 years ago, suggests that that she would mandate coverage for 47 million uninsured Americans, provides tax credits for Americans who cannot afford insurance, offer more choices for coverage, end discrimination based on pre-existing conditions and expands Medicaid and the State Children's Health Insurance Program. Obama on the other hand suggests that all children will have health insurance and it will be paid for by rolling back President Bush's tax cuts for households earning over $250,000. Republican candidate John McCain is for free-market, consumer-based system he has pledged affordable health care for every American he says universal health care is possible without a tax increase. Whatever, their plan is the current system needs a fix before the projected health share of GDP crosses 20 percent by 2017.

National Health Insurance at State Level:
Inspired by the increasing number of uninsured Americans, the declining number of employ¬ers offering insurance to their employees and the lack of federal action, states are leading the way in health care reform. States are using market based initiatives, Medicaid and SCHIP expansions, and public-private partnership to increase access and affordability of insurance. Massachusetts is implementing a universal health care system by mandating that residents purchase health insurance .The City of San Francisco is also undertaking a universal health care system for uninsured residents. California, Maine, Vermont and Hawaii are also considering or seeking to implement universal or close to universal systems. Recently, a California State Senate committee voted on a bipartisan basis against a plan to help establish a $14 billion fund to subsidize medical insurance for 5 million uninsured Californians.

Possible Funding Models:
U.S could adopt a mixed model of funding. General taxation revenue is the primary source of funding, but in many countries it is supplemented by charge to the individual and/or an employer or with the option of private payments (either direct or via optional insurance) for services beyond that covered by the public system.
Another solution is a mix of public and private contributions. The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal). Some nations, such as France and Japan employ a multi payer system in which health care is funded by private and public contributions.

A distinction possibly can be made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, specialty healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency.

Compulsory insurance could be enforced to cover up costs. This is usually enforced via legislation. Sometimes there may be a choice of several funds providing a basic service or sometimes just a single fund.

A risk compensation pool to equalize the risks between funds can be used. A fund with a predominantly healthy, younger population has to pay into a compensation pool and a fund with an older and predominantly less healthy population would receive funds from the pool. In this way, sickness funds compete on price and there is no advantage to eliminate people with higher risks because they are compensated for by means of risk-adjusted capitation payments. Funds are not allowed to pick and choose their policyholders or deny coverage, but then mainly compete on price and service. In some countries the basic coverage level is set by the government and cannot be modified.

Opponents of government mandates or programs for universal health care argue that people should be free to opt out of health insurance and that government programs would require higher taxes, increase utilization, and reduce health care quality. Opponents also claim that the absence of a market mechanism may slow innovation in treatment and research.

Possible Solutions:
National health care costs would be lower than the current US system due to lower administrative costs. By lowering these administrative costs the United States would have the ability to provide universal health care, without managed care, increase benefits and still save money.

The US denies access to health care based on the ability to pay. Under a universal health care system all would access care. There would be no lines as in other industrialized countries due to the oversupply in our providers and infrastructure, and the willingness/ability of the United States to spend more on health care than other industrialized nations.

National health care administered by a state public health system would be much more democratic and much less intrusive than our current system. Consumers and providers would have a voice in determining benefits, rates and taxes. Problems with free choice, confidentiality and medical decision making would be resolved.

For profit, managed care cannot solve the US health care problems because health care is not a commodity that people shop for, and quality of care must always be compromised when the motivating factor for corporations is to save money through denial of care and decreasing provider costs. In addition managed care has introduced problems of patient confidentiality and disrupted the continuity of care through having limited provider networks.

Insurance industry with some change in government mandates has the expertise to make universal health insurance possible by simply redesigning some insurance products and better utilizing the dollars we already have available. For example, every employer in this country is required by law to purchase workers' compensation. Most employers offer health insurance to some degree. However, job-related sickness or injury must be covered by workers' compensation. Off-the-job sickness or injury must be covered by health insurance. This has the employer paying out of two different pockets for one common end health insurance. By mandating universal health insurance and shifting the part of the workers' compensation premium that covers health issues to universal health insurance, these premium dollars will be better utilized.

Federal government along with state and local government in partnership and on a mandatory basis provide National health insurance by adopting as single type or a mix and match of multiple types of healthcare funding models and provide health coverage for all including the uninsured.

Another possible solution instead of providing NHI is enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets that could truly expand coverage, improve quality and make care more affordable

In establishing universal health care the best remedy for countries health care crises is not increasing government power, but increasing patient power instead. Affordable, high quality health cares a right of all Americans irrespective of age, race, income and residency differences in our society Any National payer system should have these two characteristics:
1) A defined set of benefits guaranteed to all citizens; and,
2) A global budget to pay for the health services provided (the fixed total amount of money that will be spent for one year on a given set of benefits offered to the entire population).