Question

Assume you represent the interests of one of the following groups: physicians, low-income public, upper- and middle-income public, large insurance companies and HMOs, small employers, or large employers. Now, develop your legislative lobbying position with respect to each of the following reform ideas:

1. A British type system

2. A Canadian type system

3. Filling the cracks in our present fragmented system by expanding Medicaid to cover all of the poor, requiring all employers to provide coverage for their workers, and requiring all self-employed individuals to buy their own private insurance

4. An entirely privatized system that gives each person a voucher, funded by the government, sufficient to pay for 60 to 100 percent (depending on income) of the cost of the lowest-priced insurance policy in the market, and then leaving it entirely to individual choice whether and what to buy

Meet with representatives from the other interest groups and attempt to negotiate comprehensive health care reform. In other words, do not just present the case for the group you represent. Present your case for your group, but also address what you would identify as the concerns of all the other groups, in defense of your group's stand. Be sure to include analysis and material from the text. You may do other research as well, such as on the Internet. Be sure to reference any other source you use.

For each idea, post your thought in either the physicians, low-income public, upper and middle-income public, large insurance companies and HMO, small employers or large employer point of view.

Answer 1

Poverty is a universal issue, yet the poor seem to be the last on everyone’s agenda. They are easy targets for political, social and economic exploitation. One politician may champion their cause to win votes, displaying deep concern, but will quickly abandon them when the responsibilities of office set in. To garner support, others may attack them outright, accusing them of being a plague on the world due to laziness and their supposed mismanagement of resources. The world seems to love these narratives: the poor as leeches, willing to benefit from the labor of others, and the poor as merely charity cases for show, to prove how “good” of a people we are as individuals and collectively as a nation. It is for this reason that the poor always stand to lose in this system. Healthcare is no exception. However, by incorporating aspects of multiple systems and developing a plan specifically designed for those lower on the socioeconomic ladder, the delivery of care can be improved and the cost lowered.

            Britain’s healthcare system is a centralized single-payer system in which the government pays for all health care through tax revenues. The National Health Service guarantees care for everything from ambulance rides and emergency room visits to long hospital stays, complex surgery, radiation and chemotherapy — are all free. In addition, any medication you get during a hospital visit is free, and the cost of most prescription drugs at a pharmacy are cheap — a few dollars (Hall, Orentlicher, & Bobinski, 2018). I believe that adapting such a system will benefit both low income citizens as well and middle and upper income citizens. This will also benefit employers who will not have to provide insurance to workers. Everyone will be guaranteed care. However, the quality of care will be in question as this system is known for extreme rationing which results in long wait times.

            Canada’s system is similar to Britain’s, universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay. The responsibility for public health is shared between the three orders of government: federal, provincial/territorial and local or municipal. However, these services are generally delivered at the provincial/territorial and local levels. They are responsible for administration of their health insurance plans; planning and funding of care in hospitals and other health facilities; services provided by doctors and other health professionals; planning and implementation of health promotion and public health initiatives; and negotiation of fee schedules with health professionals. Most provincial and territorial governments offer and fund supplementary benefits for certain groups, including low income residents, such as drugs prescribed outside hospitals, ambulance costs, and hearing, vision and dental care, that are not covered under the Canada Health Act (Canada, 2019). These conditions are immensely favorable to the poor, but Canada’s system is also favorable to physicians. In Britain, doctors and nurses are government employees and paid accordingly (Hall, Orentlicher, & Bobinski, 2018). In Canada, doctors in private practice are generally paid through fee-for-service schedules that itemize each service and pay a fee to the doctor for each service rendered. These are negotiated between each provincial and territorial government and the medical professions in their respective jurisdictions. Those in public settings, such as clinics, community health centers and group practices, are more likely to be paid through an alternative payment scheme, such as salaries or a blended payment (e.g., fee-for-service payments plus incentives for providing certain services such as the enhanced management of chronic diseases). Nurses and other health professionals are generally paid salaries that are negotiated between their unions and their employers (Canada, 2019). This sort of system brings the equal opportunity for healthcare from Britain and combines it with supplemental care for the poor. It provides incentives and pay for medical staff is not fixed and can be satisfactory to them.

            Expanding Medicaid to cover all the poor would have tremendous effects. For millions of low-income adults, Medicaid expansion has fully or largely eliminated the cost barrier. Substantial research evidence has not only shown how expansion has improved insurance coverage and access to care, but it has also quantified its effect on multiple specific health outcomes, such as lives saved, reduced infant mortality, earlier and increased cancer diagnosis, enhanced public safety, improved financial security, etc. (West, 2018).

The voucher system would benefit people of all incomes, giving them control over their coverage, so that they can receive the level of care that their means affords. It works as follows. The voucher could be used only for health care plans that meet minimum federal standards, which would ensure some standard of care. Second, insurers would not be able to discriminate against persons with pre-existing medical conditions by charging higher premiums. Health plans would have to accept vouchers from all comers, and payments to plans would be adjusted according to the health status of their customers. Third, the voucher would be worth the full cost of the lowest-priced plan, with individuals paying out of pocket for the extra cost of a higher-priced plan. Because most people would not want to pay extra for their health care, insurers would have a strong incentive to offer the lowest-cost plan, year in and year out. This would give insurers a continual incentive to contain health care costs (Orentlicher, 2012). In this system, the poor can be alleviated of the burden of health care costs, and insurers benefit by having many people insured on low-cost plans.

References:-

Canada, H. (2019). Government of Canada.

Hall, M. A., Orentlicher, D. undefined, & Bobinski, M. undefined. (2018). The Law of Health Care Finance and Regulation (3rd ed.)

Neville, S. (2018, December 30). England's poor have worse access to GP services than the rich.

Orentlicher, D. (2012). An Alternative Approach to Health Reform: Vouchers for All.