Biggest Problems of Healthcare System in USA

by Jason Shaw
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  1. Briefly, From your Experience, What do you Perceive is the Biggest Problem in the Health System?

a. Nursing and the Doctor Shortage

I believe that this is one of the top problems in the health system because in most hospitals and other medical units in the world, there does not seem to be an adequate number of nurses and doctors to care for the needs of the growing population. Such problem is being reported in the news and this problem does not seem to have a clear end or solution. Many hospitals and health administrators point out that they foresee this problem unresolved in the next few years as long as there is no increase in nursing or medical school graduates. The nursing shortage has seemingly been brought on by the decrease in the number of enrollees in the nursing profession. It has also been brought on by the ageing of the current nursing population with a limited number of successors in their tail. This same trend is seen for doctors. 

This shortage of nurses and physicians is a concern because it leads to undesirable effects on the overall health care system. It causes the existing population of nurses and doctors to be overwhelmed with work and, subsequently, with the increased workload and longer working hours, to be burnt out and depressed. In health care, burnout and stress are a risky combination because they can compromise the standard of care given to patients. It also leads patients to an increased risk of errors in medicine. The problem of nurse and doctor shortages can also cause worker frustration, and it can also prompt these medical professionals to pursue other professions, one that would not be too stressful. I believe that this nursing and doctor shortage is a major problem in the health care system because it will continue to affect the quality of health care in the years to come. Enrollees for the nursing and medical degree have not increased significantly in the past few years and they do not appear to be increasing in the next few years as well. 

Biggest Problems of Healthcare System in USA

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b. Increasing Number of Uninsured

Another major problem in the health care system is the increasing number of uninsured individuals. In hospitals and health clinics, I have often encountered individuals who come for consults and medical care but who do not have health insurance. Many of them cannot afford medical insurance because of their low income. Since they do not have medical insurance, they seldom seek medical care and consult for their illnesses and diseases. I believe that this is a major problem in health care because the cost of health care is increasing with each year. Such costs are often shouldered by the uninsured and it can sometimes cause them major financial problems – driving them into indebtedness and even bankruptcy. 

This problem adversely affects out health care system because the uninsured patients often do not seek medical care as often or as early as possible. Since they know that they cannot afford to seek medical help or attention for their ailments, they would often postpone medical consults to the very last minute or sometimes when their symptoms have become worse. This negates the principles of early detection and prevention of diseases. More often than not, their disease may already have gotten worse and medical interventions can sometimes only do so much for them. This worsens patient outcomes and increases morbidity and mortality rates in general. With the increasing number of uninsured individuals, diseases and ailments would prove to be further away from being resolved. For those seeking medical help, their medical bills may cause them financial problems and eventually cause other problems in other aspects of their life. The growing number of uninsured individuals affects out health care system because it drives up the cost of medical care for the hospitals, for the government, and for the patients. 

c. Rising Cost of Health Care

Finally, another major problem in the current health care system is the rising cost of medical care. I believe that this is one of the major problems in medical care because it dictates the direction of health care and it leads to other problems in the system. I consider it a major issue because it seems to be a problem which is reported by many hospitals and even by the government. It is a problem which causes other problems. Even with health insurance, the rising cost of health care impacts on insurance premiums and patients often end up discarding the recommended care because they do not want to carry the burden of out-of-pocket costs of health care. Because of the rising cost of health care, employers are often forced to reduce or discard health benefits for their employees and this again causes many more people to be uninsured. State and federal governments cannot also adequately cover the cost of these rising cost, short of compromising other government expenditures.

The rising cost of healthcare is a which affects our health care system in the sense that there might come a point wherein the government would have to shell out more than it can actually afford towards health care spending. This would benefit the health care system well but it would also compromise other social services like education and national security. Higher costs in government spending may eventually mean and lead to higher taxes which are burdened by citizens who are already financially-weighed down by high insurance premiums and out-of-pocket health care payments. The higher cost of health care is a problem which affects the system because it overburdens those who cannot afford health care and those whose health are already compromised by decreased medical consults and exposure to health risks. 

  1. a. Have You or Your Family Members Ever Experienced Difficulty Paying Medical Bills? What do you Think Policy Makers Can do to Address this Problem?

Yes, my family and family members have sometimes experienced difficulties in paying medical bills. There were times when the treatment options given to us were beyond our insurance coverage and we had to make out-of-pocket payments for our medical bills.  Since these were really expensive bills, we had a hard time making the payments. I think policymakers can address this problem by enforcing policies on the issuance of state and federal grants. Legislators can set forth policies that would issue federal grants to citizens who qualify based on their socio-economic status. These federal and state grants are already actually available to the general population; however, if it is not availed of by the citizens then they cannot be issued such grants.  Making such grants part of the legislation would help ensure that these are available by law to qualified citizens. 

b. How Can Public Policy Promote Healthier Lifestyles?

Public policy can help promote healthy lifestyles by setting forth formal standards of healthy behavior and lifestyle.  Most companies in the food industry make free with what they incorporate into their products because there is no policy or standard which limits the elements they include in their products. Government policies can set these standards for companies to strictly follow in order to ensure that people are eating within healthy standards. These standards can include limits on salt, sugar, fat, and caloric contents of food products. These policies can also be implemented in fast food chains in order to limit the portions of their products and thereby promote healthy lifestyle. In the workplace, policies on exercise and increased physical activity can also be incorporated into the employee’s work day in order to ensure that workers are physically and mentally fit. 

c. How do you Choose a Doctor or Hospital? What are your Sources of Information? How Should Public Policy Promote Quality Health Care Providers?

I choose a doctor or hospital by considering the doctors or hospitals which are being recommended by my insurance company. From the roster of recommended hospitals and doctors, I choose who among the doctors is the best in his field and which hospital is most equipped or qualified to fulfill my needs. The sources of my information are mostly my insurance company and when I have made my choice as to a doctor or a hospital, I conduct an online search for reviews on said doctor or hospital. Bad reviews on the doctor or hospital would prompt me to make other choices. I believe that public policy should help promote quality health care providers by establishing review policies and standards for health care providers to comply with. As soon as they comply with these standards, they may be recommended to the general public and to private insurers.      

Patient Protection and Affordable Care Act and Health Care Education Reconciliation Act

            For the first problem discussed in this paper on nurse and doctor shortage, the provision of the Patient Protection and Affordable Care Act and Health Care Education Reconciliation Act on the improvement of workforce training and development is a means of resolving this issue. This provision specifically indicates that funds would be made available for training programs in order to increase the number of available primary care doctors, nurses, and public health professionals. This provision is set to be implemented this year 2010. By authorizing the release of funds meant for the training of medical personnel, more doctors and nurses would be fielded in future practice in order to fill in the gaps of the doctor and nurse shortage. The increased funding for trainings are meant to ensure that the number of health care professionals which are dwindling can be filled in when necessary and when the numbers would further decrease in the future. Funding for such training would also help ensure that there would be no shortage of funds for the training of health care professionals.  The importance of training is highlighted in this case and is meant to guarantee that the quality of the health care practice and delivery is maintained by the members of the health care team and the health care system in general. Funding which is ensured for the training of personnel would also help schools and training centers in teaching future nurses and doctors. More often than not, the cost of training nurses and doctors are borne by schools, but these costs are burdensome to most schools who have to prepare the training materials and equipment for the students and who have to pay the salaries of qualified instructors and trainers. The federal funding would help cover these costs and help guarantee that the cost of training would not be too burdensome for schools and training institutions.

The Patient Safety and Affordable Treatment Act and Education in Health Care

Reconciliation Act also set forth a program on improving workforce training and development which would run through 2015 to 2016. Such training is similar to the 2010 to 2014 program, only that it is more extensive and specific in coverage. The improvement in training specifies that there would be an increase in the number of Graduate Medical Education training positions by redistributing unused slots particularly noting those areas in relation to primary care and general surgery and in states which have low resident physician-patient ratios. Increased funding and improvements in training during this period also covers the establishment of teaching health centers which are roughly described as inclusive of community-based centers, ambulatory patient care centers, and federally-qualified health centers which are qualified to receive funding for training programs. 

            The program as established by the Patient Protection Act also calls on the granting of scholarship programs and loans for health professionals. Scholarship grants for areas which are underserved by medical professionals would be prioritized by this act. In order to address the shortage of nurses and the problem on the retention of nurses, the Act also includes provisions for an increase in the capacity for education, support for training programs, provisions for loan repayments, and retention grants for nursing enrollees. Moreover, the Act also makes provisions for up to three years in order to employ and train family nurse practitioners who administer care in federally funded health centers and nurse-managed health clinics. This program is set to run from 2011 to 2015. Such protective measures are meant to make final and close provisions in order to ensure that the shortage of medical personnel is resolved.

            I believe that the above solutions set forth by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act would be effective solutions for the nurse and doctor shortage problem because the act will help to cover the cost of training. More often than not, many nursing and medical schools find it costly to cover the cost of training for new and incoming enrollees. This is the reason why they cannot also afford to increase the number of enrollees in their programs because they have limited staff to train these enrollees. This is a cycle which leads to the nurse and doctor shortage. And when financing is increased for the training, then the number of training staff and the number of enrollees can be increased.     

            The increase in the number of uninsured, in general, is already being resolved as a whole by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. First and foremost its provisions on requiring most US citizens and legal residents to have health insurance already resolve the problem. More specifically, through the creation of the state-based American Health Benefit Exchanges where individuals can purchase coverage with premium and cost-sharing credits made available to individuals with income below 133 to 400 % of the federal poverty level. This option also allows separate exchanges through small businesses where they can purchase coverage; employers are also prompted to pay penalties for employees who have tax credits for health insurance. The new act also specifies expanded coverage for individuals under Medicaid.

This new act often assesses companies with 50 or more jobs who do not have coverage and who have at least one full-time employee who has earned a full-time employee tax credit fee of $2,000. Those with more than 50 workers would pay at least $ 3,000 for each tax deduction earned from each employee. Employers who supply employers with coverage have to offer workers with fewer than 400 percent FPL a free option voucher. Employers of more than 200 workers would enrol their employees automatically in health care policies. These provisions of the Patient Protection Act help ensure that all individuals in the United States are covered by health insurance – as purchasers and as employees covered under legally-mandated company insurance. Although their initial implementation starts in 2010, they are effective until the succeeding years in the United States, covering American citizens and legal residents. 

            From the years 2015 onwards, steps, in order to improve health insurance coverage, have been set forth by the Patient Protection Act. The act provides for finances to cover the newly eligible which means those who were not previously qualified for standard coverage.  The Act further specifies that from 2014 to 2016, states will be entitled to 100% discretionary funding; 95% in 2017; 94% in 2018; 93% in 2019; and 90% in 2020 and in the years that will proceed. States who have also extended their adult services of 100% FPL are required to be considered for a steady rise in federal care aid for non-pregnant childless adults.

            The law also provides for health insurance for eligible individuals through refundable and advanceable premium credits. Premium contributions are increased for those who receive subsidies yearly. This is meant to reflect the excess of the premium growth over the rate of income growth. This process makes the process of paying for insurance premiums equitable and affordable as it is based on the person’s capability of paying. The cost-sharing process is also set-up based on the brackets and percentages as designed by the act.

            The act also allows states to come up with a basic health plan for uninsured individuals with incomes in the 133-200% FPL.  In this case, the states which are considering this option will have to contract with the standard plans in order to make provisions for essential health benefits. This approach would help guarantee that anyone insured would not spend more in premiums than they are legally necessary and their cost-sharing would not go above that in the package already developed for enrollees with fewer than 150 percent FPL. States would later be entitled to 95% of the funds that have been paid to eligible persons as federal premium and cost-sharing grants. These provisions once again help ensure that insurance coverage would be improved and would reach as many of the uninsured as possible. 

            I also believe that the above policies set forth by the Protection and Affordable Care Act and the Health Care and Education Reconciliation Act would be effective in reducing the number of the uninsured because the program would impose coverage for individuals and employees as legal mandates. This will ensure that employers would actually set-up insurance for their employees and they would be assisted by the government in ensuring that they are indeed covered. There are no excuses for individuals not to have and be entitled to health insurance and coverage for their health costs. 

            As to the problem on the increasing cost of health care, the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act helps to resolve this issue by providing federal and state coverage for the cost of health care services. This program of the government is meant to run from 2010 up to 2020. The Congressional Budget Office (CBO) sets forth that the act would cover additional 32 million upon its full implementation in 2019 through the creation of the Exchanges and the Medicaid expansion. The CBO estimates that the components of the law would be about $938 spread out over ten years and these costs will be financed through savings from Medicare and Medicaid plus new taxes and fees. Through this increase in financing for health care, the cost of covering health care would be adequately financed despite the current difficulties in affordability. 

            The Act also implements cost containment measures through administrative simplification. The process would include the implementation of single set of rules on eligibility and claims status, including electronic funds transfers. The Act also implements the restructuring of payments to Medicare Advantage plans in areas with low FFS rates; provide bonuses to some plans who have 4 or more stars; modifying rebate systems based on plan’s quality rating; freeze and decrease the threshold for income-related Medicare Portion B premiums subsidy for those whose incomes are above $85,000 and $170,000. The Act also seeks to reduce disproportionate Medicare payments and instead to increase payments based on the percentage of the uninsured. In order to decrease cost of prescription drugs, the act also authorized the FDA to approve generic versions of biologic drugs; and also to grant biologics manufacturers 12 years of exclusive use before these generic drugs can be manufactured. The act also seeks to emphasize on reduction of waste, fraud and abuse in order to reduce the burden on the cost of health care and to ensure that health care is set at affordable prices.

            I believe that these cost-containment measures and increased funding for health care would help resolve this issue because increased funding would help cover the increased cost of health care. There are certain concessions which have to be made by the government when it comes to ensuring the quality of health care services. And these concessions are very much reliant on increased budgetary allocations for health care. The Medicare savings and increased taxes can help ensure that the long-term benefits of quality health care would be enjoyed by Americans. 

Implementation Phase

            As a lobbyist, I would help influence the policy-making process by first trying to find out everything I can about the system. In this case, I should try to understand all the provisions pertinent to the implementation of the policy. This would mean that I would have to read and research everything I can on the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, especially those provisions which are needed in order to help resolve the three top problems which I identified. I would have to research on the possible implementation process and the source of funding which these provisions are eyeing for. I would also have to consider how these provisions affect me and affect the health care system in general – most especially those who are financially vulnerable. I would also have to find out which agencies would be concerned with the implementation of the provisions pertinent to the identified problems. These agencies would have to be informed of the new provisions and how these provisions are to be implemented in order to resolve the major issues in this paper. These agencies have their own way of operating and I need to be familiar with how they operate in order to help ensure that the implementation of the solutions would benefit those affected. 

            It is also important for me to know who matters – to know the people who would be implementing these solutions. As a lobbyist, these are the people whom I should try to get to know better – how effective they are as leaders and managers and what type of leaders they are. By getting to know them better, I can learn to “speak” their language and to incorporate myself into their decision-making processes and eventually help lobby and rally for the implementation of the policies. I should also know how to explain and lobby for my cause and for the policies I want to be implemented by considering how to explain said policies in a way which would appeal to the leader’s qualities and decision-making style. In a strong and definitive way, this is about knowing my audience and how to appeal to the audience and eventually to help them decide favorably to the implementation of the policies I am lobbying for. 

            As a lobbyist, it is also important for me to know my goals. These goals will help direct my activities and my lobbying strategies. In this particular situation, my goal as a lobbyist is to seek for the implementation of the solutions on nurse and doctor shortage, on the increasing number of uninsured individuals, and on the increasing cost of health care. As a lobbyist, my goal is to assist in the implementation of policies concerning the patient Safety and Affordable Care Act and the Reconciliation Act on Health Care and Education. The policies which help resolve the issues are within this act.  And my role as a lobbyist would be to knock on the right doors and to ensure that these policies are implemented by the right people and for those affected by the issues. My goal as a lobbyist is to specify my goals and to define my activities in line with my goals. 

            As a lobbyist, my role is also to be involved in the policy-making process as early as possible in order to help ensure that the policies are shaped and are worded in ways that are favorable to the problem-solving process. It would be impractical for me to be involved in policy-making when the process has already been concluded. While there is a chance for me to suggest changes and to review the tentative policies, I should already be involved in the process. The longer time which lapses between my involvement and the actual approval of the policy, the less influence and impact I can have. As long as I stay vigilant before the finalization of decisions, I can still influence the decision-making process. Consequently, I can help ensure that the policies which would be implemented would be favorable to the resolution of the issues. 

            As a lobbyist, it is also important for me to build relationships with the individuals who would most likely have an impact on the decision-making process. Lobbying is most effective when a lobbyist already has relationships with the government officials and the pertinent leaders. This helps establish reputations in terms of how one positions himself in different issues. It also helps establish relationships of trust.  When decision-makers note that one is lobbying for a policy or cause then they know that the lobbying process has gone through adequate research and review – considering both the advantages and disadvantages of the issues at hand. These leaders somehow come to trust lobbyists who form relationships with them – knowing that one does not compromise when it is crucial for the people he is lobbying for. By establishing relationships, it would be easier for lobbyists to come to an agreement about issues – and not to argue, agree, or disagree without adequately reviewing all pertinent aspects of the issues. 

            It is also important for a lobbyist to be transparent. In order for me to be taken seriously as a lobbyist, I should be upfront with my intentions. There should be no subterfuge on my part. When I present my position on an issue or policy, I should be clear on what position I am taking on the issue. I should also be consistent on my position on said issue. All my efforts, activities, and statements should be directed towards the position I am taking.  Transparency should also be related to valid and legal transactions, especially in behalf of agencies, organizations, or interest groups that I am representing. This would help maintain a relationship of trust with those I may be representing. 

            As a lobbyist, it is also important for me to provide assistance to the government departments when they need information and assistance. I can make this process effective by fostering a healthy discussion with the government officials and to be available when they are at the threshold of considering policies for implementation. The government does not always have all the information they need in order to effectively implement policy. By providing them with the right and objective information, they can make the right decisions which would benefit all the parties. By offering assistance and information to the government, the latter would be able to ensure that decisions are not made within a vacuum or without considering all the people and factors involved in the policy or the issue to be resolved. 

            It is also important, as a lobbyist to assess one’s progress. Following the progress of the policy-making or lobbying process would help determine and review at which point the goals are being reached. For each goal, there are smaller tasks which have to be carried out and when each task is accomplished, then I can move on the next step and the next task – thereby, closer to my goal. Adjustments in the steps and the tasks may also have to be made in order to help accomplish the bigger goals. These adjustments have to be made in order to ensure that the ultimate goal is still met, even if the smaller tasks are not accomplished.  In the process of reviewing and assessing one’s goals, there may also be a point wherein, despite adjustments made, the problems and issues will remain unresolved.  In these cases, a clear assessment has to be done in order to ensure that each task and each activity is in line with the goals which seek to be resolved.

            There are various activities which have been done by other government officials which ultimately conflicted with their goals and the policies they wanted to be approved. For example, some officials have not included certain bans for products or services and later it would be discovered that they received donations or assistance from certain organizations which were favorably benefited by their actions. These officials and lobbyists sometimes accepted bribes which went against their ultimate goals. A lobbyist was even jailed after he was found to have engaged in fraud, tax evasion, and conspiracy to bribe officials.

The three websites that have significantly increased my understanding of the policymaking process are:

1- American League of Lobbyists

            This website helped me understand more about lobbying and the lobbying process involved in policy-making. I was able to find out more about the application of the First Amendment right in the petitioning of the government for redress of grievances. I also found out that lobbying also has its set of ethics and standards of behavior in actual practice. There is a need for lobbyists to undergo training and education in order to gain the skills and the correct techniques to be effective lobbyists. Despite the training required to be effective lobbyists, I found out through the website that all Americans should learn and should try to be advocates for different issues and policies which are being discussed in the government and in society. Lobbyists are also the best source of information on issues and they have to ensure that this information gets to the right people – those who decide on the issue and those who are affected by the issue. I also found out the American League of Lobbyists is an organization with a head office in the District of Columbia and in assessing the website, I found out that different lobbying efforts are already taking place and are scheduled to take place at some point in the future. Through the information they posted in the website, I was able to find out the important issues which are currently being battled out in the government and among different private and public organizations all over America.          

2- www.Medpac.gov

            This website, Medicare Payment Advisory Commission, was able to provide information on the different financial elements of health care services. I found out that the financial concerns in relation to health care are being discussed in detail by various lobbyists.  And these lobbyists provide the government with the necessary expertise in order to help establish sound decisions in relation to health care financing. I found out that the members of the commission come from varying backgrounds in relation to the different tasks in health care. They have transparency through their public meetings and this is important for lobbyists because it helps to maintain the trust and confidence of the public and the policy-makers in them. I found out that lobbying entails a lot of research and the MedPac has a research team that helps ensure that the decision-makers have the right information about the issues which have to be discussed or lobbied for. I also found out that Congress relies heavily on the MedPac for recommendations on policies. I found out that the government does not just rely on the information it gathers through its staff members, but it also uses agencies such as the MedPac, which is a credible institution, in order to come up with the best and well-informed decisions.

3- National Conference of State Legislature (NCSL)

I found out that this website releases data related to banking, immigration, health, transportation and similar points of discussion. The information gathered was able to help me understand and conceptualize the different issues and laws which were passed by the legislative body. Through the different discussions and research data presented by the website, I was able to glean deeper and more analytic information about the current issues in health care. I was also able to gain a more systematic understanding of how programs are conceptualized and how various committees are in charge of health care systems evaluation.  I found out that the ethical practices in the health care system are crucial to the lobbying and policy-making process. The website also increased my understanding of the issues through the different facts and statistical figures which they presented. It is a website which has helped me understand, as a whole, the most current data, news, reform measures in the health care system. It has helped me understand that facts and issues in the health care system help to ensure that the health care policies are thoroughly discussed and understood by policy-makers.

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