Universal Health Care For Canada example essay topic

HMOs Take The 'Care' Out Of Health Care. In the early 1990's insurance companies, in attempt to control spiraling medical costs, created what would be termed "health maintenance organizations", also known as HMOs. What HMOs do is create a team of physicians and medical personnel that the patients agrees to use. Within the contracts both the patient and the doctor sign, limits and restrictions are put on what the hospital will reimburse and what they will or will not provide in order to keep the costs down. At the beginning, these organizations were successful in bringing medical costs down and has made health insurance more affordable than ever. However, the contracts that the HMOs have you sign basically limits the doctor on how he or she can treat their patients, thus putting their job as the physician in the hands of the HMO.

As profits began to go up and down these organizations have put more effort into keeping their costs down and have lost sight of actually caring fir the patients they are insuring. To prove my thesis in this paper I will discuss how our senior citizens and the chronically ill have been hurt by recent cuts their HMOs have made. I will discuss the many reports of HMO negligence and the issues concerning the patient doctor relationship. I will also go into what actions, or lack thereof, our government has taken in response to HMO woes. All of these points will show that HMOs have lost the concept for caring for their patients including our elders who are one genre that are being hit hard by the actions these HMOs have taken. In January of 2001, nearly one million senior citizens were kicked out of their Medicare health plan ("What's Behind" 1).

Why have so many HMOs dropped these health plans? The reason why is because these Medicare programs are for the elderly only and simply were not profiting, and in response, the insurance companies shut them down. The HMOs claim that federal reimbursement levels were not keeping up with the medical cost inflation forcing them to cut these programs. For instance, in 2001, the government's reimbursement to the HMOs went up only 2 percent while the insurance company's costs went up between 11 and 13 percent (par. 3). Though the reimbursement level issues may have contributed to the HMOs decision to cut these programs they are just the surface to the problem.

Back in the mid-1990's HMOs began purposely enrolling more senior citizens in their mid-60's who did not require as much medical attention as do people in their mid-80's. This made it so that the younger senior citizens were covering the costs of the older ones while the HMOs cashed in. This worked out well for the HMOs until there was a sudden increase in the average age of their patients and costs began to skyrocket, thus leaving one million of our elders with out health insurance. Senior citizens are not the only ones struggling with their HMOs. Many people of all ages, races, and gender are struggling with the health insurance. These problems can be summed up to the simple fact that the HMOs simply do not care about the patient anymore.

For instance, few HMOs have special disease management programs, though they have proven to be very cost effective. These programs are targeted directly to the disease of the patient and are more then just a visit to the doctor every so often it involves every aspect of treatment such as the nurses, pharmacist, rehabilitation and so on. To the HMO this makes chronic conditions, such as cancer, non-profitable because they require a lot more medical treatment than the average. Therefore many doctors' HMO dissuade their patients from seeing specialists. In order to see a specialist, the patient needs a written referral from their "primary physician". Ron Henderson, who had been getting pains in his chest and through out his arms.

When visiting his doctor, his file showed an irregular e.g. and a previous heart attack. The doctor ignored this and diagnosed Henderson with a hiatal hernia and failed to send him to a heart specialist. Ron would die of a heart attack later that year. Kaiser Permanente insured Henderson; one of Americas longest withstanding HMO. Kaiser is present in 17 states including Texas where in 1993, nine heart attacks, including Mr. Henderson's, were misdiagnosed under care given by Kaiser (Tuleya 2). Kaiser would settle out of court with the Henderson family for $5.3 million contributing to the approximately $270 million Kaiser lost in 1997 (3).

Kaiser Permanente is not the only HMO that has had issues with medical negligence among their patients. A report in May of 2001 revealed that HMOs and hospitals have basically ignored a federal program that requires them to report medical incompetence. The purpose of this program is to keep information on doctors in a computer system known as the National Practitioner Data Bank so that patients can know of their physician's history of incompetence and / or bad health care. Some examples of incompetence include performing surgery on the wrong side of the body, sexual relations with patients, and doctors prescribing narcotics to ones self (HHS: HMO par. 10). The HMOs failure to follow these guidelines and let the patient know if the care they are receiving is of good quality further shows the HMOs true lack of care for the patient.

The report shows that in the 1990's eighty-four percent of HMOs and sixty percent of hospitals did not report one case of medical incompetence. A survey in July 2000 showed that between 235,000 and 284,000 deaths were doctor-caused. This places medical incompetence third to cancer and heart disease as our nations leading cause of death ("HHS: HMO" par. 5). At first glance those just seem like more numbers.

However, deeper into it, that is nearly 300,000 people whose family and friends mourning over a loved one that could have lived if HMO limits would not have prevented the health care provider form giving proper diagnosis and / or treatment. I believe this issue should most definitely be higher on our list of priorities and be very closely recorded. In A.J. Tuleya's article "The HMO Dilema" she discusses Saving the of Medicine by Margaret A. Mahony, where Mahony writes about the many stories of HMO struggles and strongly believes that HMOs are nothing but a scandal. One of her stories involves a woman who had been seeing seven different medical personnel in attempt to find out what was causing her chronic disabling pain. After two years of no success the woman was forced to go outside of her HMO so that she could see a specialist her insurance wouldn't cover (Alleger par.

5). Explaining the purpose for writing this book Mahony stated", One purpose of this book is to highlight the contemptible consequences of managed health care. This intimate view may arouse some unpleasant and negative visceral feelings. It is very important not to direct any of these feelings at any particular physician, hospital... rather, direct these feelings at the real culprit-that intangible, seemingly omnipotent force known as managed care".

(Alleger 1). Here are a few more undeniably ignorant and unfair issues dealing with HMOs. If for some reason you don't agree with your primary doctor or feel uncomfortable around him or her and would like to change, you need to get a written referral from that doctor. Even after the uncomfortable task of telling your doctor you don't get along with him, the entire process can take up to 5 months. Though proven effective in cutting costs, very few HMOs provide disease management programs. These are programs targeted directly to the disease of the patient and are more then just a visit to the doctor every month.

It involves the nurses, pharmacists, rehabilitation and so on. Insurance companies hire large commercial laboratories to do all of their testing. These labs are picked based on the lowest price to meet the HMO's bottom line, not giving their patients the quality care they are paying for. Though large in part, HMOs are not the only culprit we should be pointing the finger at. In our last two national elections HMOs have been one of the top issues. Though many have made promises to save Medicare and bring an end to our HMO woes, none have taken the action.

When elected, Bill Clinton appointed a panel to come up with a set of rules that would insure that HMOs followed guidelines to be fair to their members. The panel came up with some recommendations they were introduced as bills that have yet to be passed; it has been six years since. Just last year a bill was finally passes to provide Medicare members with prescription drug benefit. However, the government chose to allow private HMOs to run program meaning if they do not happen to make a profit then they can bail out which is something they are known for. While laws have been passed to help HMOs grow, none have been made that require HMOs to stay in business or keep certain programs for a certain amount of years.

No laws were created to ensure senior citizens their old Medicare plan if they decided to leave their HMO or if they get the boot. The time has come for something to be done. More and more seems to go wrong and yet no action is taken. Our government needs to step up to these HMOs and create some guidelines before things really get out of hand. With the jobs of doctors being put into the hands of a business, things are only bound to continually get worse. Health care needs to remain just that, not another profit that heartless businessmen embark on.

Our government is, and continues to be very negligent to the facts. HMOs maybe at the most blame. However some kind of government guidelines is pretty much the only way these HMOs can be handled and if it is not getting done now then the next finger needs to be pointed at ourselves. We need to make clear to our elected officials that if they promise something they need to keep that promise when we vote them into office. If something isn't done soon health care will be nothing more than another product on the shelf. One step that this nation needs to take is making out a plan for a universal health care system.

As of now the United States is one of the only industrialized societies in this world that doesn't have such a benefit. Those who do oppose a universal health care system in America oppose it on many false beliefs. One myth is that universal health care would cost to much for the United states when the truth is that it would cost no more than the government is already spending on our nations health care according to studies done by Congressional Budget, the General Accounting Office (GAO), the Lewin Group, and the Boston University School of Public Health. The GAO estimates that the U.S. would save nearly $34 billion in overhead and $33 billion in hospital and physician administrative costs (AMSA par.

1). For those who think that this would make it harder to see their physician need to look at Canada and how their universal health care has made so that Canadians see their physician more often than Americans and the patient to doctor ratio, 1 doctor to every 1000 patients, is much more efficient (AMSA par. 10). Thus Canadians have a lower infant mortality rate and a longer average life expectancy, nearly 80 years (Canadian Health Care).

Physicians would see little or no change in their salaries. In a survey nearly two-thirds of the physicians were "satisfied" or very "satisfied" with the current universal health system. 57.1 percent of U.S. physicians support converting the U.S. to a single-payer system with universal coverage according to a 1999 New England Journal of Medicine (AMSA). Another concern that comes to debate is the rationing of medicine.

This concern can be shot down by the fact that HMOs already ration medicine. However, they ration medicine based on profits while universal health would ration based on medical necessity. To understand one way universal health care would benefit this country, as it has in other countries, lets take a look at how the Canadian health care system, one of the most successful universal health care systems in the world, works. In 'recent years Canadian legislation put into effect the Canada Health Act in which each province in Canada receives funding to provide health care for its citizens. The five main principals of this act are as follows. First, all health insurance is to be administered by a public authority on a non-profit basis.

Second, all necessary health services must be covered by the insurance. Third, all citizens are entitled to the same level of health care regardless of social status, financial status race etc. Fourth, those who move from one province to another are entitled to their previous provinces health plan for a certain amount of time. And lastly, all who are insured must have good access ability to health care facilities (Canadian Health Care).

This does not mean there are no privately owned health insurance companies in Canada. Though the government funded health insurance covers all of the necessary practices, i.e. hospitals, family physicians, and needed referred specialists, they do not cover such practices as dental services, optometrists, and prescription medication. This is where privately owned insurance companies come in. Employers often include this kind of coverage for their employees. Not only has the universal health care for Canada improved the quality of the health care they receive and the over all health of the citizens, it has also had a very positive effect on the countries economy. Annually Canada spends approximately 9.5% of its gross domestic product (GDP) on health care compared to the 14% the U.S. spends of it's GDP on health care.

Also about three quarters of all of Canada's funding for health care comes from public sources. Thus private businesses and private insurers don't pay as much in taxes, (Canadian Health Care) something conservative republicans like to hear. Studies in 2000 showed that nearly 42.6 million (15.5%) Americans were not insured (Universal Health Care). Young adults, ages 18-24, are the least likely of any age group to have insurance in America. Nearly 72% of this age group are uninsured (Universal Health Care Coverage).

Now lets take a look at the absence of universal health in the U.S. from this angle: because those who are uninsured often have no access to preventative care go with out care until easily treatable conditions become emergencies thus the uninsured individual must receive expensive care from hospital emergency rooms, increasing the cost of health care for everyone. Another angle to look at is the multiple insurance providers cause healthcare providers to waste money of administration and have expensive billing departments. The percentage of people covered by medicaid rose from 10.6% to 11.2% (29.5 million to 31.6 million) between 2000 and 2001 (Universal Health Care Coverage). In 1945 President Harry Truman urged legislation to establish a universal health care system in the united states.

By the end of his administration, Truman had given up on his plan for universal coverage however he sparked the idea of providing health coverage for Social Security beneficiaries and on July 30, 1945 Medicare and Medicaid (which insures indigent recipients) were signed into law by President Lyndon Johnson. The government needs to take more action to handle all of our healthcare issues in this country. Legislation is lethargic in any action they take to create and pass bills that concern our health care. For instance drug prescription discount card for medicare patients was introduced as bill during the Clinton administration and is still in the process of being passed or denied well into Bush's second term. Come election time health care is on the top of every campaigns priorities.

However, once these people get into office they do nothing about it. In a study done on families with children who have complex chronic medical conditions and their relationship with their HMO families reported high levels of stress associated with dealing the multiple agencies and healthcare providers. Since managed care's beginning, the way medical care has been provided and delivered as drastically changed, and this trend is more than likely to continue. No one is going to be hit harder by these changes than the families who have children with complex chronic medical conditions.

Work Cited Alleger, Irene. "HMO's- Business Masquerading as Medical Care". Tows ned Letter for Doctors and Patients 215 (2002): 135. par. 9. Almanac of Policy Issues. "Universal Health Care Coverage".

March 29, 2005. American Medical Student Association. "Myths & Facts About Single-Payer Universal Coverage". Marc. h 29, 2005 Canadian Health Care.

"Canadian Health Care". March 29, 2005". HHS: HMO's Ignore Medical Incompetence". International Council for Health & Human Services 5.21 (2001): 1-2 par. 17.

Tuleya, R.J. "The HMO Dilema". Nutrition Health Review: The Consumer's Medical Journal 79 (1999): 3. par. 22". What's Behind the Medicare Woes?" People's Medical Society Newsletter 19.6 (2001): 1-2 par.

7. Universal Health Care. "Summary of recommendations Poor Health and Homeless. March 29, 2005.