The plight of the American woman Karen Dove, an uninsured lady depicted in the PBS video Critical Care, is unfortunately a common example of the horrendous status of the healthcare system policies and planning in the United States. After physicians had denied her consultation, treatment, and access she finally took it upon herself to initiate seeking medical help by contacting an organization dedicated to cancer. Should seeking and receiving adequate medical care in a modern industrial society be this difficult? Many think not. However, the business of health care, whether a public or privatized affair, must begin with effective policy and planning. The research paper logically, and hopefully cogently, explores the four theoretical models of health care as a precursor to a comparative evaluation of healthcare in the United States versus Canada, with the inclusion of the fundamental bill passed by Congress in 2010 HR 3590.
Tragically, Karen Dove’s medical condition had advanced to a third-stage ovarian cancer condition due to the fact that physicians would not treat her to the specialists required for attacking her ailment. According to the film clip, while Mrs. Dove was in between health insurance she finally was shortly after able to get it, but following surgery the post-surgical medicines costed $2,500 per month (“Critical Care”). Dove admitted to traveling to Mexico to buy them. Even after her insurance kicked in, Mexico’s $4.00 versus the $50.00 monthly bill in the United States applied a welcome financial relief. The potential for disputatious patients automatically being deemed as troublemakers, only highlights the problem of inadequacies and inefficiencies in the American health care system. A brief review of the four different models is in order.
Beyond the heart-wrenching human factor of the situation, as felt when Karen tried on the wigs after having her hair shaved due to the upcoming prescribed chemotherapy sessions, there are four models in health care planning. They include the Beveridge Model, Bismarck Model, National Health Insurance Model, and the Out-of-Pocket Model. According to one source, the Beveridge Model is named after Britain’s “daring social reformer,” William Beveridge, and is a system providing financial supports from government via tax payments (“Health Care – Four Basic Models”). The model is akin to how the public library or police force function. The UK and Scandinavia use this model, and Britain’s citizens never get a doctor bill, as the amounts charged are controlled. The Bismarck model holds the protocol of an insurance-based through a person’s employer, which is familiar to Americans. The National Health Insurance model is a kind of combination of the two, and closest to the Canadian system of healthcare. It calls for no claim denials based upon financial reasons, using private-sector low-payment providers that derive from government controlled insurance programs. For example, in its Canadian application, low prices are negotiated from pharmaceutical companies, and the plan also controls costs by “limiting the medical services” the plans will pay for, or “by making patients wait to be treated,” according to the PNHP physicians organization (“Health Care – Four Basic Models”). Mostly representative in developing and less industrialized nations, the Out-of-Pocket model simply means scratching enough money together to pay whatever medical care costs. Things are changing in the United States, however.
The bill passed by Congress in 2010 known as H.R. 3590 has appended to the Supreme Court ruling in 2013 as being integrated into the all-encompassing legislation of the Affordable Care Act (ACA).According to a U.S. government website from the Committee on Energy & Commerce, H.R. 3590 was the precursor to the “historic health reform legislation, commonly referred to as the Affordable Care Act” and as such is “the consolidation of H.R. 3590”). (“H.R. 3590 Patient Protection and Affordable Care Act”). The goal and plan is to reduce the number of American citizens who do not have medical insurance coverage. By doing so, the Congressional Budget has issued an estimation that the improvement of health care coverage for Americans will help boost non-elderly protection by slightly over ten percent – from 83% to 94%. So, under the auspices of H.R. 3590 as woven into the fabric of the Affordable Care Act provides more affordability for medical insurance plans by implementing a reduction in premiums and outright out-of-pocket expenses. The overall legislative plan aims to do several things, including the following: a) lower prescription costs, b) stall denials in healthcare coverage, c) invalidate automatic barring with pre-existing health condition, and d) give people more options and choices in the new health-insurance market that remains competitive. Although the American healthcare system is just transitioning into the new ‘Obamacare’ model, as many refer to the ACA, there are still concerns.
Many American citizens have complained that Canada has a well-planned medical care policy that is quite adequately implemented for its population. The idea lies behind the question: Why not duplicate the Canadian system? Perhaps, an equally compelling inquiry might ask, why not copy Britain’s Beveridge Model of healthcare? The answer to the latter question may be because the United States has drastically fallen behind economically, that it is no feasible to emulate UK’s Beveridge Model. For one thing, the global recession has shifted and destroyed too many American businesses, relocating production and work forces outside the U.S. For this reason alone, the present trillion-plus deficit the American government is experiencing, it could no longer afford to duplicate or apply the Beveridge Model. Perhaps the reason why Britain can afford to generously extend such a medical plan of service provided care to its citizens is because its monarchy sits on quite a bit of royal money, in terms of literal billions and trillions of British pound sterling. Obviously then, this tactic would be akin to comparing apples to oranges.
The basics of the Canadian health care system can be described as a kind of socialized health insurance coverage, which is publicly funded, yet distributed throughout a territorial basis. The exceptions are few, in terms of everyone getting medical treatment when needed, so when considering controversy over treatment delivery in a “timely fashion,” overall Canada boasts one of the “highest life expectancies” in the world of eighty years-old (“Introduction”). According to the Canadian government’s official website on Health Canada (2014), its system seems to be a constant “work in progress,” which perhaps explains it success, because their plan responds “to changes within medicine and throughout society” which makes perfect sense (“Health Canada”). Their plan operates as an interlocking regional that works in concert with each province.
Two decades ago, in early addressing how the United States might follow the Canadian model of health care, one scholar noted several aspects. Naylor (1992) said the basics of medical and hospital coverage by Canada “costs per capita that are about US$700 lower” while hospitals are “run as non-profit private corporations” (p. 19). Contrasting and comparatively, the new United States ACA legislates to never deny benefits to children under age 19, ensuring those under age 26 to stay on their parents’ plan, bans lifetime coverage limits, removes co-payment requirements for preventive care, and allows patient choice of primary physicians (“About the Law”). A contemporary report by scholars Crooks et al. (2012) examine Canada’s system of addressing basic care, wellness, and diagnostic/illnesses by looking at the state of primary health care (PHC) access, concluding that further studies will help policy-makers and administrators to better evaluate the quality of healthcare (p. 1). In contrast, the United States medical health care plan leans towards a kind of hodge-podge transitional model reflecting the Bismarck, National Health Insurance, and Out-of-Pocket model.
For example, it is no secret that the idea and implementation of so-called Concierge Medicine seems to cater to those who can afford to pay extra for personal and timely care from physicians. The important part of the Crooks team research points to the factor that the assurance of access to quality primary health care actually helps to impact better health outcomes. Reviewing the case of Karen Dove, this aspect seems to have been a large part of the culprit in her not being able to adequately access quality primary healthcare in the first place. Had she been able to participate in a health insurance program in the United States, perhaps her condition of cancer would not have progressed to a most serious level of debilitation. If you really think about it, better efficiency and help for impoverished people will work towards imperative cost savings, thus providing an economic patch to wasteful gaps. The PNHP (2010) organization seems to agree, stating “The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody” (“Health Care – Four Basic Models”). This reality brings a fundamentally flawed system of health care in the United States to light. In other words, the U.S. system is built upon a confusing cacophony of inharmonious sub-systems, which is exceedingly difficult for citizens to comprehend in the first place. The physicians’ organization wisely note that the Canadian system is fairer and cheaper.
In conclusion, there are no simplistic answers to fixing or rearranging a nightmarish healthcare system in America that leaves the poor without medical provisions, despite the incremental improvements that the H.R. 3590 bill (under ACA contract) proposes. It has been noted in this report that the Canadian system model of healthcare is effectively a combination of the Beveridge and Bismarck models, so obviously an integration of method/styles can work. Controlling costs will be a huge challenge for American healthcare medicine, as citizens openly are scrambling both above and below their borders to be able to afford pharmaceuticals. Policy cannot be relegated to simply deciding once how healthcare provisional needs should be met. As learned from the Canadian side of the matter, it is important to make the project a constant work-in-progress. Hopefully, policy, implementation, legislation, and best practices will come together and do the right thing for the American people.
References
Canadian Health Care. (2007). Introduction [Data file]. Retrieved from
http://www.canadian-healthcare.org/
Committee on Energy & Commerce. (2010). H.R. 3590, the “Patient Protection and Affordable Care Act.” [Data file]. Retrieved from http://democrats.energycommerce.house.gov/?q=bill/hr-3590-the-patient-protection-and-affordable-care-act
Crooks, V.A., & Schuurman, N. (2012). Interpreting the results of a modified gravity model: Examining access to primary health care physicians in five Canadian provinces and territories. BMC Health Services Research, 12230. doi:10.1186/1472-6963-12-230
Health Canada. (2015). Health Canada – Health care system [Data file]. Retrieved from http://www.hc-sc.gc.ca/hcs-sss/index-eng.php
Naylor, C.D. (1992). The Canadian health care system: a model for American to emulate? [Abstract]. Health Economics, 1(1), 19-37.
PBS.org (2008, September 30). Critical condition – POV documentaries with a point of view [Data file]. Retrieved from http://www.pbs.org/pov/criticalcondition/
PNHP – Physicians for a National Health Program. (2010). Health care systems – Four basic models [Data file]. Retrieved from http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php
U.S. Department of Health & Human Services. (2015). About the Law [Data file]. Retrieved from http://www.hhs.gov/healthcare/rights/index.html
