The Health Care System of the United States
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Chapter 14: The Health Care System of the United States
Chapter Summary
The focus of this chapter is to sociologically examine the health care system in United States. In terms of access and outcomes, the U.S. health care system is less than effective. America spends more than any other country, yet has more than 47 million people without health insurance.
The cost of health care has been provided by a variety of sources such as employers, individuals and families, and the government. The greatest amount of these payments has come from third-party payers over time. Because of Medicaid and Medicare, the federal government is the largest payer of U.S. health care services.
Health care costs have been escalating for decades. Several factors have created this rise, including new medical technologies, people living longer and needing more care for chronic and acute illnesses, medical wastes, enormous corporate profits, exorbitant salaries and compensation packages for management, high administrative costs, and medical fraud.
Managed care programs have attempted to cut costs while securing lower provider reimbursements and regulating patient care. There are several types of managed care organizations: health maintenance organizations (HMOs), preferred provider organizations (PPOs), and a combination of health insurance and health care delivery in a single package.
The United States Congress passed The Affordable Care Act (ACA) in 2010. Despite heavy political resistance from Republicans in Congress, this legislation should bring health insurance to millions more people over the next several years.
Chapter Outline
- Introduction
- Rating the S. Health Care System
- Based on Systematic Analysis
- Based on Consumer Attitudes
- The S. Health Care System
- The Foundation of the Health Care System
- The Development of Private Health Insurance
- The Development of a Nonprofit Health Insurance Alternative
- The Entry of Public (Government-Sponsored) Health Insurance
- Medicare
- Medicaid
- Children’s Health Insurance Program (CHIP)
- Incentives to Overuse Services
- Provision of Unnecessary Services
- Cost Containment
- The Development of Managed Care
- Managed Care
- Types of Managed Care Organizations
- Health maintenance organizations (HMOs)
- Preferred provider organizations (PPOs)
- Point-of-service (POS)
- The Financing of Health Care in the United States
- How Much Money Does the United States Spend on Health Care?
- National health expenditures (NHE)
- Personal health expenditures (PHE)
- Who Receives the Dollars Spent on Personal Health?
- Hospital care
- Physician services
- Drugs and other medical nondurables
- Nursing home care and home health care
- Dental care
- Who Spends the Dollars for Personal Health Care?
- Private Sources
- Employers
- Individuals and Families
- Public Sources (Government)
- Explanations for the High Cost of American Medicine
- The Aging of the Population
- The High Cost of New Medical Technologies
- Defensive Medicine
- Physician Self-Referral
- Medical Entrepreneurialism
- The Medical-Industrial Complex
- Corporate Profit
- High Administrative Costs
- Exorbitant CEO Salaries and Compensation Packages
- Medical Fraud
- America’s Uninsured Population
- Who are the Uninsured?
- The Role of the Employment-Based Health Insurance System
- Individuals who are unemployed
- Individuals after retirement but before Medicare
- Individuals during any transition period from one job to another
- Individuals working part-time
- Individuals who work for small businesses
- Individuals who cannot afford the employee share of employer-provided health insurance
- Individuals who are in this country illegally
- The Consequences of Being Uninsured
- Historical Efforts to Reform the Health Care System
- The 1990s and the Clinton Health Initiative
- Health Care Reform at the State Level
VIII. Health Care Reform of 2010
- Positions on Health Care Reform
- Advocates for a Private Market Approach
- Advocates for an Incremental Social Justice Approach
- Advocates for a Social Justice Approach
- The Political Process of Reform
- Summer, 2009: Opponents of Large-Scale Reform Go on the Attack
- September and October, 2009: Supporters of Large-Scale Reform Strike Back
- November, 2009: House Passes Reform Bill, But It Stalls in the Senate
- December, 2009: Senate Passes Reform Bill
- January, 2010: The Importance of a Single Vote
- February, 2010: A Democrat-Republican Summit But No Change
- March 2010: Congressional Passage of Large-Scale Reform—But Not an End to Partisan Politics
- Basic Benefits of Health Care Reform
- Who Will Pay for Health Care Reform?
- Who Benefits the Most from Reform?
- What are the Key Criticisms of the Plan?
- What Was the Successful Strategy in Getting Health Care Reform Legislation Passed?
- Physicians
- Hospitals
- Health insurers
- Pharmaceutical companies
- Business groups
- How Much Did Public Opinion Influence the Process?
- Constitutional Challenge
- Key Issues to Watch
- Summary
Chapter Objectives
After reading this chapter students should be able to:
- Describe and discuss evaluative ratings of the pre-Affordable Act, U.S. health care system.
- Describe the foundation and origin of the private nature of the U.S. health care system and the entry of public programs such as Medicare and Medicaid.
- Describe and evaluate the managed care approach that was developed to control rapidly increasing health care costs.
- Identify and explain five key reasons for the high cost of health care in the United States.
- Describe the pre-Affordable Care Act “uninsured” problem in the United States. Discuss the problems associated with not having health insurance.
- Thoroughly analyze the Affordable Care Act. Describe how it changes the U.S. health care system, who most benefits from it, and political perspectives about the law.
Links
Affordable Care Act:
Affordable Care Act (White House):
http://www.whitehouse.gov/issues/health-care
Free Clinics:
Health Care Rights:
http://www.hhs.gov/healthcare/rights/
Single Payer Health Care:
http://www.healthcare-now.org/
U.S. Health Care System Wastes Up to $800 Billion a Year:
http://www.reuters.com/article/2009/10/26/us-usa-healthcare-waste-idUSTRE59P0L320091026
Key Words and Terms
Children’s Health Insurance Program (CHIP)
Consumer-driven health plans (CDHPs)
Cost containment
Health maintenance organizations (HMOs)
Managed care
Managed care organizations (MCOs)
Managed competition
Medicaid
Medical entrepreneurialism
Medical fraud
Medical-industrial complex
Medicare
National health expenditures (NHE)
Personal health expenditures (PHE)
Physician self-referral
Point of service (POS)
Preferred provider organizations (PPOs)
Private (commercial) health insurance companies
Private market approach
Social justice approach
Suggested Readings
Abramson, J. (2008). Overdosed America: The broken promise of American medicine. New York, NY: Harper Perennial.
Bradley, E.H., Taylor, L.A. (2013). The American health care paradox: Why spending more is getting us less. New York, NY: Public Affairs.
Emanuel, E. (2014). Reinventing American health care: How the affordable care act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system. New York, NY: Public Affairs.
Foreman, L (2009). Health care reform. Edina, MN: ABDO Publishing Company.
Goldhill, D. (2013). Catastrophic care: Why everything we think we know about health care is wrong. New York, NY: Vintage.
Himmelstein, D.U., Thorne, D., Warren, E., & Woolhandler, S. (2009). Medical Bankruptcy in the United States, 2007: Results of a National Study. American Journal of Medicine, 122(8), 741-746.
Jacobs, L. (2009). Health care reform and American politics: What everyone needs to
know. Oxford University Press.
Kennedy, B.R., Mathis, C.C. & Woods, A.K. (2007). African Americans and their distrust of the health care system: health care for diverse populations. Journal of Cultural Diversity: 14(2):56-60.
Mechanic, D. (2010). Truth about health care: Why reform is not working in
America. Critical issues in health and medicine. New Jersey: Rutgers University.
Potter, W. (2010). Deadly spin: An insurance company insider speaks out on how corporate PR is killing health care and deceiving Americans. London: Bloomsbury Press.
Saputo, L. (2009). A return to healing: Radical health care reform and the future of
medicine. Origin Press.
Sommers, B.D., Long, S.K., & Baicker, K. (2014). Changes in Mortality After Massachusetts Health Care Reform: A Quasi-experimental Study. Annals of Internal Medicine, 160(9), 585-594.
Thomas, B. (2014). Health and Health Care Disparities: The Effect of Social and Environmental Factors on Individual and Population Health. Int J Environ Res Public Health, 11(7):7492-507.
Videos/Films
Bill Moyers Journal: Profits or Patients?: America’s Healthcare System (2009). An interview with Wendell Potter, a health insurance whistleblower. Available at http://www.pbs.org/moyers/journal/07102009/watch2.html
The Business of Being Born (2007). Documentary showing the value of midwifery and how mainstream medicine has worked to delegitimize it as a medical practice. Available at https://www.youtube.com/watch?v=KvljyvU_ZGE
Escape Fire: Fight to Rescue American Healthcare (2013). Documentary shows the corrupt business takes all U.S. health care market and the leaders trying to radically reform the system.
Forgotten Ellis Island: The Extraordinary Story of America’s Immigrant Hospital (2008). Documentary about the massive, modern hospital that served as a gateway for some (mostly European) working-class immigrants and a last U.S. destination to those who died or were returned to their home countries.
Hospital (1969). Shows the daily activity and social interactions of the emergency room and outpatient clinics of Metropolitan Hospital Center, New York City. Part of this is available at https://www.youtube.com/watch?v=2_jZRlh5QTc
Money-Driven Medicine (2009). A documentary highlighting the wasteful profit-at-all-costs mentality that drives the U.S. health care industry.
Single Payer Health Care (2014).
http://www.healthcare-now.org/whats-single-payer
Unnatural Causes: Is Inequality Making Us Sick? (2008). Four-hour documentary examining racial and socioeconomic inequalities in U.S. health. Video clips avaliable at http://www.unnaturalcauses.org/video_clips.php
The Waiting Room (2013). Documents a U.S. public hospital struggling to care for a community of mostly uninsured people. “The film offers a raw, intimate and even uplifting look at how patients, staff and caregivers each cope with disease, bureaucracy and hard choices.”
Review Questions
- What role is there for private (commercial) health insurance companies?
- Why did the government opt to sponsor health insurance?
- What is Medicare?
- What is Medicaid?
- What is the Children’s Health Insurance Program?
- What is managed care?
- Name the types of managed care organizations.
- What contributes to the high cost of medical care?
- Who suffers from the public/private, employment-based system in the United States?
- Trace the historical efforts of heath care reform in the United States.
- What are the benefits of health care reform?
- Who benefits most from health care reform?
- What are the criticisms of the plan?
- What groups helped to get the health care reform legislation passed?
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