U.S. Health Policy: Should It Be Government Or Market Based?
Health policy in the U.S has been a major concern over the last decade, with as much as 16 % of the population un-insured in 2010. Further, the U.S. is lagging other members of the G5 in life expectancy and having the most costly healthcare system in the world in 2008. Government health initiatives through Medicare, Medicaid, military and other specialized healthcare programs cover about 27.8% of the population with the rest of the population either self insured, employer covered or uninsured. Other than through licensing and safety related regulations, the government has little control over the health sector, which is essentially dominated by private practice (DeNavas-Walt, Proctor & Smith, 2011). A debate has in the recent past been ongoing as to whether health care should be put under government control or market systems. This paper argues in favor of a market system.
The market system of healthcare as it is in the U.S. is a flawed market since it lacks standardization, proper regulation, and is open to political manipulation. However, the alternative, government control, is an even worse option (Hopper and Hopper, 2007). The critical reasons for this position are outline below. The government controlled healthcare system is very controversial and inefficient. The current U.S public health system is a combination of all four healthcare models. The Beveridge model is one in which health care is paid for by the government, whether doctors are public or private, and citizens fund the system through taxes. U.S adopts this model for veterans. The Bismarck model is where the government covers everybody as well as insurance is non-profit making. The national health insurance model uses private sector facilities but government pays the bills, while the out of pocket model features self payment for health care by citizens (Fisher, Wennberg , Stukel , Gottlieb , Lucas , Pinder 2003). The American system is a fusion of all four models, with veterans in the Beveridge model, citizens older than 65 years use on Medicare use the Bismarck model, and employed citizens receive national health insurance, while uninsured persons must pay from their pockets (Fisher et.al 2003). The problem with government centric models is that, firstly, none of them is flexible on payments. The premiums are either employer met or nonexistent in for veterans. Self contributors, however, lack easy payment structures and premiums are fixed (Harrington and Estes, 2009). Secondly, government systems are costly to run and cost more bills payable by the government. Another factor is the quality of care. It is expectable that government care initiatives lack a personalized touch and follow up services that may exist with a market structure because of their non-profit nature. Access to government supported care maybe restricted by poor program implementation, high ratios of doctor to patient as well as mismanagement. The division of patients into categories may lead to scenarios like the present American culture of fully insured and also un-insured populations. Government health care models will also be open to political manipulation and self interest, while a market system would be purely operational on a profit perspective (Lorber, 2009).
A markets system, on the other hand, would be based on a needs scenario where every medical practitioner is free to compete in the market (Wangsness, J2009). Such a system would use many creative approaches to enhance affordability of medical care for all. One such system is the Healthcare Happily Ever After arrangement proposed by Robert Hopper where each citizen may operate a health savings account from which healthcare providers may cover. Market based systems would still provide options for government or employer support while effectively reducing rates of un-insured people. In addition, level of care and quality of service would go up due to the competitive nature of markets, as well as access and sustainability of services owing to the widespread nature of private practice. In addition, private healthcare would be less prone to political interference and stake holder manipulation. Reforming the U.S. healthcare must therefore focus on more emphasis on a market based care system with only fundamental control from state and federal governments. This way, affordable health care for all with be realized, government health bill reduced, better access and quality of care realized, and progress achieved.