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Running Head: IS UNIVERSAL HEALTH CARE THE ONLY OPTION FOR THE UNITED STATES? (2013)

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(I, Hanof Abozendah, give Administrative

Studies the permission to publish my

Professional Contribution).


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IS UNIVERSAL HEALTH CARE THE ONLY OPTION FOR THE UNITED STATES?

By

HANOF ABOZENADAH

(Professional Contribution)

Submit to the faculty of the Administrative studies program with

in department Social workers at Marywood University in partial

fulfillment of the requirements for the Master Degree in Health

Service Administration

Approved

Mentor

Nov, 2013


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DEDICATION

I dedicate this Professional Contribution to my parents Amal Halwani and Atif

Abozenadah who have always been my source of inspiration. This paper will finally

complete their dream that they have nurtured for all these years. After all, I am finally

able to complete my education from one of the best universities in the United States of

America, which is no small achievement by any means.

Thanks to my hubby Naif Saaty for being there with me throughout the master’s program.

It would not have been possible without his love and support.

I cannot forget my Son Hassan Saaty who have made every single day of my life a

pleasurable experience.

Finally, this work is dedicated to my professor Dr. Alice Elaine McDonnell who has

guided me throughout the process of writing this paper. I have no qualms in saying that

this work could never have been completed without her support and guidance.


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Table of Contents

List of Figures

Figure 1: Sources of Insurance Coverage, 2011………………………………14

Abstract …………………………………………………………………………………..6

Chapter One: Introduction…………………………………………………………....7-8

Problem Statement

Purpose of the Study

Research Question

Chapter Two: Literature Review

Recent History of the United States Health Care System…………………………9-10

Problems Associated with Health Care in the United States…………11-16

Government Actions to Deal with the Problems………………………….16

Patient Protection and Affordable Care Act (Obamacare) ………….17-21

Universal Health Care System…………………………………………..21

Pros…………………………………………………………………….22-25

Cons……………………………………………………………………25-26

Reflection……………………………………………………………...26-27

Chapter Three: Methodology……………………………………………………..28-34

i. Research Design

ii. Population

iii. Instrumentation

iv. Timeline


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v. Procedure

vi. Garbage Can Theory

vii. Conceptual Model

Chapter Four: Data Collection……………………………………………………..35-58

Chapter Five: Analysis……………………………………………………………..59-66

Chapter Six: Recommendations …………………………………………………...67-69

References……………………………………………………………………………70-76

Appendix:

(Appendix A)……………………………………………………………………77


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Abstract

The United States’ patchwork healthcare coverage has become an embarrassment

at the global level. The goal of bringing all citizens under healthcare coverage has eluded

many presidents. After decades of inaction, the proponents of the universal healthcare

system led by President Obama are increasing their efforts to reform the system. President

Obama thinks that it is time to give every American quality healthcare at an affordable

cost. However, the task is not easy.

The political firefight that is engulfing the United States is over the 45 million

people who currently have no health insurance. The issue is highly debated in terms of its

costs, benefits and overall effectiveness. While the main concerns of the opponents are

that the healthcare system is not ready to absorb millions of uninsured Americans,

proponents feel that there is no other option except to correct the system and provide every

American the right of access to healthcare.

This research project aims to determine if universal coverage is really the only option

for the United States, a country which has always advocated capitalistic principles. This

study investigates the problems that the health care system is facing so that appropriate

strategies can be recommended.

Detailed data was gathered through open-ended questions posed to twelve participants

who are three doctors, two college instructors, two health field workers, two students, one

nurse, and two community workers. There is a general consensus among the participants in

this study that a universal health care system is the only option to address issues with

accessibility and affordability in the United States’ healthcare market. Any new universal


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health care system must consider three key issues—price controls, reduction of waste and

ways to lower administrative costs.


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Chapter One

Introduction

“A national health care consumer advocacy group estimates that three Americans die

every hour as a result of not having health insurance.” (Young, 2012) Uninsured people often

need to forgo or postpone treatment. The White House and the Congress are concerned about

how to provide coverage to millions of Americans who are currently without health insurance.

The number of uninsured is increasing every year. For the most powerful nation in the world,

it is shocking that providing insurance to every citizen remains a challenge. As such, many

health care experts argue that universal health care system is the only option for the United

States.

“The Harvard study found that people without health insurance had a 40 percent higher

risk of death than those with private health insurance.” (Abelson, 2009) The risk of death for

uninsured people has been increasing over the years. Uninsured people face difficulty in

finding care because public hospitals have closed or cut back on services. There are fewer

places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling

back across the country in cities like New Orleans, Detroit and others (Heavey, 2009). At the

same time, uninsured people lack access to quality health care which insured people can

easily avail. With the health care getting better for the insured, the gap in health status

between the insured and uninsured has been increasing. Therefore, a strong case definitely

exists for the universal health care system in the United States.

Problem Statement

The health care system in the United States has been facing many challenges

throughout the decades. Especially in areas of cost, accessibility, coverage of pre-existing


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conditions, shortage of medical professionals, waiting time, medical errors, and heavy reliance

on ER by the uninsured and illegal immigrants.

This paper examines the Affordable care Act (Obamacare) and how it addresses these

challenges. It also looks at the universal health care system as an option to address the issues

that remain unresolved by the new health care reform law.

Purpose of the Study

In the midst of major political upheaval with regard to Obamacare, this study explores

whether the universal health care system has the potential to solve health care issues in the

United States. This research paper conducts an exploratory study to learn about the exact

problems the health care system is facing so that appropriate strategies can be recommended to

deal with them.

The health care field is currently under huge pressure. It is the job of the administrator

to ensure that the problems with the health care system are dealt with effectively.

Research Questions:

What are the core issues or problems in the American health care system?

In what ways can the universal system solve issues relating to the United States’ health care

system?

How effective has been Obamacare in dealing with the current health care issues?

What has been the experience of other developed nations with regard to universal health care?


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Chapter Two

Literature Review

Recent History of U.S. Health Care System

In the early 1900s, health care was considered too costly and the majority of American

households lacked access to it. Health care was largely limited to preventing disease by keeping

clean, recommending good diets, providing good nursing, performing basic surgery, and

praying for a rapid recovery. Most people paid for medical care out of their own pockets.

At the end of the 1920s, a broader form of prepaid employer-provided hospital care began to

come into existence. A group of Dallas teachers arranged for Baylor hospital to provide 21 days

of hospitalization to its members in return for a $6.00 annual payment (Gorman, 2006). The

Baylor plans attached sickness insurance to the workplace. This ensured that healthier people

were selected for insurance.

The Great Depression hit hospitals hard. The expenditure of individuals on health care

needs fell drastically. As a result, hospitals rushed to embrace plans for prepaid health care.

Hospitals knew that they could benefit from prepaid plans as they provided a steady flow of

income. The American Hospital Association (AHA) began to market prepaid hospitalization

plans to the people as a tool that can save them from disaster in the emergency of sickness

(Gorman, 2006).

Community hospitals slowly began to organize with each other to offer networked

hospital coverage reducing inter-hospital competition. Eventually in 1939, these plans adopted

the Blue Cross name and logo as the national symbol for plans that met its requirements. The

American Medical Association encouraged state and local medical societies around the country

to form similar plans, and they soon affiliated and became known as Blue Shield (Gorman,

2006).


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Under the pay-as-you-go system created by the Blues, insured members receive

services as they are needed, but the company reimbursed those providing the service, rather

than those who either pay for the policy or receive the health care (Gorman, 2006). One major

drawback of the system was that people who used little medical care paid the same amount as

those who used a lot. As a result, it encouraged overconsumption of health care services.

After Blue Cross showed the way, commercial insurers quickly realized that insuring

employees through their employer was a good business and an effective way to lower risk

(Gorman, 2006). As a result, employers started offering health insurance to employees as a pre-

tax fringe benefit. It slowly became popular in the United States.

“The Blue Cross Blue Shield approach to health insurance was cast into regulatory

concrete when the Democrats won a majority in Congress in 1964 and immediately passed the

Medicare and Medicaid programs in 1965.” (Gorman, 2006) Medicare copied the Blue Cross

Blue Shield pay-as-you-go approach to health insurance and applied it to almost all Americans

over 65. Medicare is a federal health-insurance program that covers residents of the United

States over the age of sixty-five. The costs are met by a tax on wages and salaries. When

created in 1965, Medicare did not cover prescription drugs. Medicare is the second-most

expensive federal program after Social Security. On the other hand, Medicaid is a joint state-

federal taxpayer-funded program that provides medical care to the poor and has been the

biggest expansion of government entitlements in the past 50 years.

Medicaid and Medicare revolutionized the way in which citizens of the United States

thought about health care, changing it from something that people had to save for to an

entitlement (Gorman, 2006).

Despite these two programs running for decades now, millions of American still

remain uninsured and lack access to quality health care services.


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Problems Associated with Health Care in the United States

Just a few statistics are enough to understand that the health care system is in deep

trouble today. The spending on healthcare is not only increasing in absolute terms but also as a

percentage of Gross Domestic Product (GDP). Despite the higher level of spending on

healthcare, which is much more than any other country, it is lagging behind in health outcomes.

There is an urgent need to overhaul the whole healthcare system. In spite of a number of steps

taken by the government, healthcare costs continue their flight upward, making quality health

care unaffordable to millions of families in the United States. In many of the indicators,

including life expectancy at birth (average age that a newborn baby is expected to live up to

given the current mortality rates), infant mortality (death of infants below 1 year of age per

1,000 live births), life expectancy at age 65, injury related mortality, chronic disease

prevalence, etc., the United States is lagging behind several other countries (Piper, 2008). “In

2001, overall US life expectancy at birth was 77.2 years.

Life expectancy was higher in women than men by 5.4 years and higher in whites than

in blacks by 5.5 years.”(Mensah, MD, 2005) The average life expectancy has grown slowly in

the United States, depicting how the health care system in the country is inefficient. Therefore,

having the highest health care expenditure in the world is doing the United States no good.

Health care costs have been rising for several years now. Health care expenditures

surpassed $2.3 trillion in 2008, which is about three times the expenditure in 1990 and over

eight times of the expenditure in 1980 (Kimbuende, 2010). According to the Centers for

Medicare and Medicaid Services (CMS), the United States is projected to spend over $2.5

trillion on health care in 2009, or $8,160 per resident health spending in 2009 is projected to

account for 17.6% of GDP (Henry J. Kaiser Family Foundation, 2009). Also, the CMS projects

that the private share of national health spending will fall to 49% by 2018, with public spending


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growing to 51% as the oldest baby boomers become eligible for Medicare (Henry J. Kaiser

Family Foundation, 2009). On an aggregate basis, the spending on health care accounted for

17.6 percent of the nation’s GDP. The United States spends more on healthcare compared to

any other country. A number of factors are driving the growth in health care spending. These

factors include increased spending on new medical technology and prescription drugs, greater

prevalence of chronic diseases, and aging of the population and rising administrative costs.

“For several years, spending on new medical technology and prescription drugs has

been cited as a leading contributor to the increase in overall health spending.” (Kimbuende,

2010) The costs of more expensive sophisticated technological services and new drugs are

recouped from the patients, insurance companies and the government, which play a large role in

driving up the health care costs. The longer lifespan and greater prevalence of chronic diseases

and illnesses have increased the demand for health care system. Long term care services and

chronic disease treatment have accounted for a major chunk of national health expenditures.

Aging is another problem as health expenses rise with age. The mixed public and private health

care system prevalent in the United States creates overhead costs and large profits fueling

health care spending (Johnson, 2010).

One major problem is the high drug prices charged by the pharmaceutical companies

in the United States. There is a continuous battle between huge pharmaceutical companies and

the consumers. There is also the growing tension between the increasing costs of scientific

innovation and the consumers’ demand to keep the prices of drugs low and affordable.

Consumers are frustrated by the skyrocketing costs of prescription drugs. One interesting

phenomenon is that people in other developed nations pay lower prices for drugs made in the

United States. The drug companies agree that while price controls keep drug prices lower in

most other countries, it is America’s free-market system that makes drug innovation possible


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(pbs.org, 2003). These companies claim that developing new drugs is not an easy task and

requires years. Research leads to nothing most of the time. As such, when a successful drug is

finally innovated, the company must not only obtain the cost of manufacturing that drug but

also recuperate the costs for all the failed drugs that never came to the market (pbs.org, 2003).

In other words, prices are kept high to fund the expensive research and development phase.

The current system is not efficient, which leads to rising cost pressures. Costs are increasing

because of the transaction costs, the rising cost of administering and coordinating a system.

According to the American medical association, “Out-of-pocket spending accounted for

10% of health expenditures for physician and clinical services in 2006.” (Georgia A. Tuttle,

MD, Chair. 2008)

Insurance companies try to sell insurance to those unlikely to need care so that they do

not have to pay much in claims. These companies spend a great amount of time and resources

screening subscribers and identifying those likely to submit claims. The collection of insurance-

related information has become a major source of waste in the American economy. The

insurance companies tend to drive away needy subscribers and their health care providers.

Health insurers' administrative costs are among the fastest-growing in the health-care sector in

the United States.

For-profit health insurance also creates an issue. It creates waste by discouraging

people from receiving preventive care and by driving the sick into more expensive care settings.

Lagging health outcomes have resulted from the inequitable provision of health care

through our private, for-profit health-insurance system (Friedman, 2011). Patients, who are

more insulated from the true costs of their care, are likely to use more care.

The number of uninsured people in the United States has been rising at a strong pace

driven largely by unchecked and escalating health care costs. The United States Census Bureau


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has found that the share of Americans without health insurance declined by 0.3 % point, from

15.7 percent in 2011 to 15.4 percent in 2012 (White House Blog, 2013). Also (See Figure 1), it

describes the income poverty and health insurance coverage in the United States: 2011 (U.S.

Census Bureau, 2011). The percentage of people covered by employer-sponsored insurance for

2011 was 55.1%, statistically unchanged from the 55.3% in 2010. Previously, the percentage of

people covered by employer-sponsored insurance had experienced a steady decline over the

past decade (Susan R. Todd and Benjamin D. Sommers, 2012)

Figure 1: Sources of Insurance Coverage, 2011

Source: U.S. Census Bureau, Income Poverty and Health Insurance Coverage in the

United States: 2011

The majority of such people without health insurance coverage, the costs to

individuals, families and communities have been enormous. “The rate of young adults and

minorities without coverage is relatively high 44% of 19- to 29-year-olds, 51% of


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Hispanics and 37% of blacks.” (Charles Fiegl, 2011). Ill health, decreased workforce

productivity, developmental and educational losses among children and shorter life spans are

some of the problems associated with the uninsured.

The worsening economy has further added to the number of Americans going without

health insurance. Besides the employees working with high-wage employers, others are having

a tough time finding available, affordable and adequate insurance. Matters are worse for

individuals who are outside of employer-based health care plans. Getting a good insurance

coverage in the individual market is quite a difficult task, even more so for a black individual

with a pre-existing condition.

For low-income people, it is nothing short of a quest to find and keep health insurance.

In contrast to the United States, other developed nations offer universal health care, which

requires insurance companies to cover everyone. However, policies to implement universal care

in America have largely failed.

Low income families are feeling the impact of rising health care costs. The rising price

of health insurance forces many to go uninsured and risk their health and in some cases, even

their lives. Even if an individual is covered by insurance, the out-of-pocket expenses become a

headache. The companies are facing the heat of rising cost of employment-based health

insurance and forcing them to delay wage increases. Quality of life and security for families are

being threatened. Many families are facing difficulties in meeting their medical bills. In general,

Americans are becoming increasingly worried about healthcare.

Current demographic and economic trends are putting a growing strain on health care

systems. Many states are experiencing severe deficits in health care financing and are therefore

cutting health care funding. Health care providers are facing increasing acuity levels due to the

aging population with worsening health. The increases in health care cost are far exceeding


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inflation. Health care providers are facing an increase in labor costs. Malpractice liability, high

insurance premiums, etc. are also resulting in putting stress on health care providers. More and

more health care providers are facing the challenge of limited access to capital. Limited access

to capital severely restricts many providers’ ability to update aging facilities, and upgrade

information technology and medical equipment.

Government Actions to Deal with the Problems

There have been a number of proposals to contain health care costs over the decades.

However, most have failed to produce any long-term impact on health care costs. Some of these

proposals in today’s scenario include investment in information technology such as electronic

medical records (EMR), which can efficiently share information and reduce overhead costs.

The health system needs to be streamlined and needless spending on health care needs should

be eliminated. Another important proposal is to revamp provider payments to ensure that fees

paid to physician’s reward value and health outcomes, rather than volume of care (pbs.org, The

Other Drug War, 2003). Costs have emerged as a central element of any national health reform

effort. Comprehensive health care reform is being planned. Costs will surely remain at the

forefront.

Some people argue that restricting access to health care by raising insurance

deductibles, co-payments, and cost sharing and by reducing access to insurance can solve the

problem of rising costs. However, reducing access does not reduce health-care expenditures

when it makes people sicker and pushes them into hospitals and emergency rooms, which are

the most expensive settings for health care (Friedman, 2011).


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Patient Protection and Affordable Care Act (Obamacare)

In light of the above economic and social consequences, the government passes the

Affordable Care Act. This major policy that has been established to address the problem of

lack of insurance coverage is the Patient Protection and Affordable Care Act (PPACA),

which was signed into law by President Obama on March 23, 2010. The health care law

seeks to extend insurance to more than 30 million people, primarily by expanding Medicaid

and providing federal subsidies to help lower- and middle-income Americans buy private

coverage. It will create insurance exchanges for those buying individual policies and

prohibit insurers from denying coverage on the basis of pre-existing conditions

(nytimes.com, 2012).

After Medicare and Medicaid, it is marked as the biggest attempt to expand access to

healthcare. Insurers will be banned from denying access even to those with pre-existing

illnesses. Medicaid is expected to be expanded to cover all poor people and subsidies will be

provided for such people to buy insurance (cqresearcher.com, 2010). However, these are the

goals that are only aimed at, the attainment of which remains extremely dubious.

Several provisions have been incorporated in the new healthcare reform bill that

addresses the problem of uninsured in the United States. It is claimed that insurance

coverage will now expand to near-universal levels. According to an estimate in 2007, more

than 45 million people were uninsured at that point – which is more than one-seventh of the

population. Due to lack of insurance, people generally find it difficult to obtain the needed

care and face problems in paying for the problems they receive (Congressional Digest,

2009). The annual increases in healthcare costs, which make quality healthcare unaffordable

to common people, will be limited. “Costs are a particular source of anxiety for families that


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are planning for retirement or where someone is seriously ill.” (Congressional Digest, 2009)

Medicare’s economic clout will be used to cut healthcare costs. Insurance will greatly be

subsidized for low-income people and insurance markets will be strictly regulated by the

government (CQ Press, 2009). People without employer-sponsored insurance can buy

subsidized coverage in this regulated market.

“A new pre-existing condition insurance plan will provide new coverage options

to individuals who have been uninsured for at least six months because of a pre-existing

condition.” (healthcare.gov, 2010) The coverage has been extended for young adults. Under

the new law, young adults will be allowed to stay on their parents’ plan until they turn 26.

One of the major objectives of the bill has been to increase access to affordable care.

Coverage has been expanded for early retirees. Americans who retire without employer-

sponsored insurance, before they are eligible for Medicare, become uninsured. The new law

has the provision of a $5 billion program for providing required financial assistance for

employment-based plans, so that valuable coverage can be continued to be provided to early

retirees (healthcare.gov, 2010). Insurance companies are now held accountable for

unreasonable rate hikes and premium increases will have to be justified. The new bill allows

states to cover more people (low-income individuals and families) on Medicaid. All of the

above provisions are likely to reduce the number of uninsured considerably.

PPACA encourages new methods of health care delivery (Suguness, 2011).

Delivery system reforms are being led by the bill through the provisions of Accountable

Care Organizations (ACOs). “An ACO is a group of providers, which may include primary

care physicians, specialists, ancillary services providers and hospitals, who agree to be held

accountable for the cost and quality of healthcare delivered to a defined population of


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Medicare beneficiaries.” (Troutman, 2011) The present system of health care delivery is

based on fee-for-service model of care. Under this system, the providers get paid for each

procedure performed. Therefore, they lack incentives to control costs; instead, they

intentionally engage in wasteful procedures. PPACA tackles this issue through the

encouragement it provides to the creation of ACOs, organizations that would integrate

insurers and providers into one entity (Suguness, 2011). These organizations are paid based

on the savings they generate. PPACA encourages them to control costs and reward them

when they save on enough costs. Through this mechanism, PPACA attacks the perverse

incentives that existed before and contributed greatly to the rising health care costs.

Capitation through ACOs would greatly help in improving the healthcare delivery

system. “Under capitation, providers are paid a set dollar amount for assuming the financial

risk for the provision of a predetermined set of healthcare services to a defined population.”

(Troutman, 2011) An ACO is in a better position to manage capitation risk because of its

size and available resources by which it can more accurately predict costs. Merger and

acquisition activities are likely to increase to take advantage of economies of scale which

are so very vital for global capitation and bundled payment opportunities in health care

reform. However, the integration of providers does not necessarily make them more

efficient. It is yet to be seen whether the health care reform is truly paying dividends. Health

care reform, through the PPACA, has increased the probability that the quality of health care

will improve because of linking of payments to outcomes.

By regulating the insurance market, PPACA is attempting to make health care

services affordable and accessible for all.


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Better care coordination, shared accountability, and judicious use of health resources should

be undertaken to improve the quality of care (Filson, 2011). The PPACA incorporates a

wide range of provisions for improving health care quality. Metrics method has been

developed, improved, and refined for measuring the quality of care (Williams, 2010).

Efforts have been made for improving coordination of care among various participants

involved in health care delivery.

Despite offering several advantages, the problem with PPACA is that it leaves

intact most of the existing infrastructure through which health care is delivered and paid.

Although the PPACA did not bring in an immediate transformation in the American health

care system, it has taken a step forward toward potentially fundamental changes to the

existing health care delivery infrastructure (ahcancal.org, 2010). One example is

empowering a new Independent Payment Advisory Board to recommend changes to the

Medicare program to limit its spending growth. There are still doubts whether the health

care reform will be able to bring down health care costs and increase the scope of insurance

coverage in the long run.

The new reform is astonishingly expensive and comes at a price tag of about one

trillion dollars over the next ten years. New fees and taxes that will be implemented for

meeting such expenditure will place a huge burden on the taxpayers in the United States. A

number of state attorneys generals are even challenging the constitutionality of the law’s

requirement that everyone buy health insurance (cqresearcher.com, 2010). They argue that

the federal government has no right to force individuals to buy insurance or states to

participate in coverage expansion plans (cqresearcher.com, 2010). “Federal powers to

undercut prices and regulate the industry could, in a heartbeat, knock out private insurance


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choices.” (Healy, 2009) There is not enough money to pay for what is being promised and

there can be rationing or delays, where people are waiting to avail the benefits of healthcare

services (Leland, 2009). The program can be crippled by lack of funding even before it gets

off the ground (Barry, 2010). “A concern critics have of the health care reform law is

whether there will be enough doctors to take care of all the newly insured patients.” (Hood,

2010) It is yet unclear how the quality health care services can be delivered to these added

enrollees with the existing facilities, medical professionals, and systems being inadequate

for the existing level of patients (Davis, 2010).

Certain aspects of the new health-care reform needs to be modified so as to answer

the issues and concerns raised by experts and the people. The states that have introduced

their own legislation are providing an effective means to limit, alter and oppose such

aspects. One such legislation implemented by a few of the states aims at keeping the health

insurance optional and allows people to purchase any type of coverage they choose

(cqresearcher.com, 2010). Similar measures can be adopted by the central government and

modifications can be made to the existing law.

Universal Health Care System

The universal health care system that is being proposed would be federally mandated

and ultimately funded by the federal government, but administered largely at the state and local

level. Everyone would be included in a single public plan covering all medically necessary

services. These will include acute, rehabilitative, long-term, and home care. Mental health

services, dental services, occupational health care, prescription drugs and medical supplies

would also be covered. Preventive and public health measures are also included nhp.org, A

National Health Program for the United States: A Physicians' Proposal, 2013).


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Pros of Universal Health Care System:

In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32

percent, prefer a universal health insurance program over the current employer-based system.

Support for change is based largely on unease with the current system's costs. Seventy-eight

percent are dissatisfied with the cost of the nation's health care system; including 54 percent

"very" dissatisfied (Langer, 2003).

According to Thorpe’s study, universal health care tied with cost controls, can save

money while expanding health care access to everyone. If universal health care simply

expanded access, the disposable expenditure would be large. The only way to pay for this

expanded access to happen is to institute cost controls such as administrative simplification.

(Thorpe, K. 2005)

Universal coverage would solve the gravest problem in health care by eliminating

financial barriers to care. A single comprehensive program is necessary both to ensure equal

access to care and to minimize the complexity and expense of billing and administration

(pnhp.org, A National Health Program for the United States: A Physicians' Proposal,2013).

Despite having the most costly health system in the world, the United States

consistently underperforms on most dimensions of performance, relative to other countries

(Davis K. , 2010). In a study presented in the article, the United States ranks last overall in the

health outcomes among the seven nations studied - Australia, Canada, Germany, the

Netherlands, New Zealand, the United Kingdom, and the United States. The United States

ranks last among the seven nations on dimensions of access, patient safety, coordination,

efficiency, and equity (Davis K. , 2010).

In the absence of universal coverage, access to healthcare is also limited for American

citizens, compared to the people of other countries. An uninsured person in the United States


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with health problems is likely to face access issues related to cost. Insured people, however,

have rapid access to specialized health care services. In contrast to the United States, countries

like the United Kingdom and Canada provide increased access to health care services and the

patients in these countries face little to no financial burden (Davis K. , 2010). It is believed that

quick access to health care services with short waiting times and smaller size of out-of-pocket

costs cannot be achieved simultaneously. However, patients in the Netherlands and Germany

have quick access to specialty services and face little out-of-pocket costs (Davis K. , 2010).

“Americans with below-average incomes were much more likely than their

counterparts in other countries to report not visiting a physician when sick, not getting a

recommended test, treatment, or follow-up care, not filling a prescription, or not seeing a dentist

when needed because of costs.” (Davis K. , 2010)

In planning and implementing its comprehensive health care reform, the United States

can learn from other capitalist democracies in the ways that they address universal healthcare

and price controls. “There are about 200 countries on our planet, and each country devises its

own set of arrangements for meeting the three basic goals of a health care system: keeping

people healthy, treating the sick, and protecting families against financial ruin from medical

bills.” (pbs.org, Sick Around America, 2009)

In the United Kingdom, about 8.3 percent of Gross Domestic Product (GDP) is spent

on healthcare and healthcare is funded by taxation. The government both provides and pays for

healthcare. As it is funded through taxes, administrative costs are low—there are no bills to

collect or claims to review. The co-payments are none for most services. Hospital doctors are

paid salaries. General practitioners (GPs), who run private practices, are paid based on the

number of patients they see. The socialized medicine system does result in long waits and

limited choice (pbs.org, Sick Around America, 2009).


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“The current patchwork system of for-profit payers and private insurers necessarily

waste health dollars on things that have nothing to do with care: overhead, underwriting,

billing, sales and marketing departments as well as huge profits and exorbitant executive pay.”

(pnhp.org, 2011) Such wasteful expenditures on administration can be reduced quite a bit and

once a concrete system is in place, high administrative costs can be done away with. Single-

payer financing provides an opportunity to recapture this wasted money. The potential savings

can then be used to bring every citizen of the United States under the umbrella of insurance

coverage.

As a citizen’s right, everyone must be covered for all medically necessary services

including doctor and hospital visits, preventive, long-term care, mental health, dental, vision,

etc. Eliminating private insurers and recapturing their administrative waste could finance a

single-payer system. Some new taxes may have to be levied to replace premium and out-of-

pocket payments currently paid by individuals and businesses. Costs could be brought under

control through negotiated fees, global budgeting and bulk purchasing.

In a report prepared for the state of Vermont, William Hsiao of the Harvard School of

Public Health and MIT economist Jonathan Gruber estimated that shifting to a single-payer

system could lead to savings of around 25% through reduced administrative cost and improved

delivery of care. According to the Physician for a National Health Program a single-payer

system, all hospitals, doctors, and other health care providers would bill one entity for their

services. This alone reduces administrative waste greatly and saves money, which can be used

to provide care and insurance to those who currently do not have it (PNHP, 2013).

Health care should be treated as a citizen’s right and not as a commodity that can be

bought and sold in the marketplace. The United States spends more on health care compared to

any other country in the world, yet the quality of care delivered remains lagging behind other


26

industrialized countries on major health indicators such as life expectancy, infant mortality and

immunization rates. The other advanced nations provide comprehensive coverage to their entire

populations, while the United States leaves millions of its citizens uninsured and millions

inadequately covered. The solution lies in single-payer financing, which offers an opportunity

to provide comprehensive coverage to everyone.

Making health care as a right will help in resolving the crisis of escalating health costs

and the increasing racial disparities and generally falling accessibility of health care. All other

attempts have historically failed to bring every American citizen under the umbrella of

insurance coverage or making health care accessible. As such, it is important health care is

fixed as a right and steps are taken to enforce this right strictly. This is high time to understand

and implement a strategy where no one in the richest nation on earth should go without health

care. The overall benefits include reduced medical bankruptcies, improved public health and

reduced overall health care spending.

The United States’ constitution promotes the general welfare of the people and health

care is one essential component in this. Americans have the right to education—it is just as

important to provide all Americans with the right to health care.

The only way to control health-care costs and avoid fiscal and economic catastrophe

is to establish a single payer system with universal coverage. The question is not whether a

single-payer health-insurance system would provide adequate health care for all Americans can

be afforded. The real question is: Is there any other alternative?

Cons of Universal Health Care System

It is said that the universal health care system is against the market economy. Profit

motives, competition, and individual ingenuity prevalent in the market economy have always


27

led to greater cost control and effectiveness (Messerli, 2013). However, this has failed to hold

true in the field of health care. Costs have been running out of control whereas access and

quality of health care have failed to keep pace. Various solutions at the market level have

largely failed to deal with the health care problems in the United States.

Universal health care is not free as taxpayers will need to pay for it. Expenses would

have to be paid for with higher taxes or spending cuts in other areas such as defence, education,

and others (Messerli, 2013). It is also said that government-controlled health care would lead to

a decrease in patient flexibility. Some controls will be put in place to keep costs from

exploding. The government will need to decide first if a particular service that is being availed

is necessary. At the same time, the waiting time before the surgery or other service can be

availed is expected to be large.

The health care industry may become plagued with corruption, back room dealing to

keep costs from exploding. At the same time, patients will not have the motive to curb their

drug costs and doctor visits if health care is free. Health care costs will rise.

Reflection

Despite having a few disadvantages, the universal health care system appears to be the

only solution for the health care problems in the United States. Millions of Americans will be

brought under insurance coverage. Costs can be curtailed in the long run. There are few

concerns that will need to be taken care of. It needs to be properly implemented so that it does

not become plagued with corruption. Stringent controls will need to be put in place so that the

system is not misused. At the same time, it is important that these controls do not make the

system inefficient. The United States will need to churn out an increased supply of physicians


28

and workers in the health care industry to satisfy the demand of an increased number of patients

as all people come under the insurance coverage.


29

Chapter Three

Methodology

Research Design

A qualitative approach was adopted to conduct the research study. The aim is to create

understanding from data as the analysis proceeds. The qualitative design helps to gain insight

and explore the depth, richness, and complexity inherent in the collected data. Qualitative

researchers are concerned with making inference based on perspective, so it is extremely

important to get as much data as possible for later analysis.

Qualitative research studies are particularly helpful in contributing to a holistic picture of

the phenomenon under investigation, often by incorporating the perspectives of particular

stakeholders, such as service users. In this study, the stakeholders are none other than the

citizens of America who are entitled to health care services.

Detailed data is gathered through open ended questions that provide direct quotations.

The interviewer is an integral part of the investigation. This differs from quantitative research

which attempts to gather data by objective methods to provide information about relations,

comparisons, and predictions and attempts to remove the investigator from the investigation.

Populations

Population refers to the aggregate or totality of all the objects, subjects or members

that conform to a set of specifications. The population for the research study consists of doctors,

nurse, health field worker, student, college instructors, and community workers irrespective of

whether they are insured. This population consists of people from all walks of life, all races, age


30

groups, educational status, socio-economic status, and residential areas. For this study, efforts

have been made to make the sample selected from this population as representative as possible.

Instruments

A great deal of qualitative material comes from talking with people and knowing their

opinions. This study used the Garbage Can Theory and conceptual model structure to make the

reader understanding the research study. Interviews have been conducted to tap into the depths

of the reality of the situation. It has been ensured that interviews are carried out unobtrusively in

order not to impose one's own influence on the interviewee. The researcher has engaged in

active listening so that close attention is being paid to what is being said.

The aim of the structured interview is to confirm that each interview is offered with

exactly the same questions in the same order. This guarantees that answers can be reliably

collected and that comparisons can be made among the participants. With structured interviews,

the level of understanding of the participants with regard to the topic can be examined. These

interviews provide information about whether the views of a specific participant need to be

explored in detail. The quality and convenience of the information is vastly dependent on the

quality of the questions asked. Interviews are designed to generate participant perspectives

about ideas, opinions, and experiences.

Timeline

Data has been over a period of 40 days, from August 30, 2013 to October 9, 2013.

This amount of time was required because interviews with each of the 12 participants were

conducted on different days. At the same time, fixing appointments with each of them,

depending on when they had sufficient time, involved a bit of time.


31

Procedures

Care has been exercised to ensure that the rights of those individuals are protected. A

sufficient amount of time was given to the respondents to give answers to the questions asked.

Utmost care has been taken to ensure that the respondents are not influenced in any manner

possible by the interviewer. They have been encouraged to freely express their views and

opinions with regard to the questions asked. At the end, they have been given the power of

providing their overall opinions and their responses were not restricted to any question.

The interviews included participants from different walks of life to ensure that

different views were obtained with regard to the American health care system.

Respect for human dignity has been maintained with regard to the individuals who

participated in the study. The right to self-determination was observed by providing the

participants with the right to refuse to participate in the study, the right to discontinue the study

if they felt uncomfortable, the right not to answer specific questions if they did not want to

disclose that information and the right to ask for clarification if they were not sure about any

question.

The right to privacy was respected because the researcher offered each participant

confidentiality. Participants were interviewed individually in a private area and the data were

collected with confidence. Anonymity was adhered to by ensuring that no one who completed

structured interview schedule could be linked to any specific participant. The completed

interview schedules were only accessible to the researcher. Data collected was used for the

purpose of this study only.

Each participant was fully informed about the nature of the research and requested to

participate. No remuneration was paid.


32

Garbage Can Theory as a framework for the Study:

This research used Garbage Can Model (GCM) of policy making (Cohen, March,

& Olsen, 1972) as a framework to better understand the data collected from this

qualitative and administrative study about their decision making systems. The GCM

model challenges the hypothesis that administrations make decisions by first detecting

problems, then finding all possible solutions, and then rationally choosing which solutions

best address the problems.

The health care system in the United States has been facing many challenges

throughout the decades. Especially in areas of cost, accessibility, coverage of pre-existing

condition, shortages of medical professionals, waiting time, medical errors, and heavy

reliance on ER by the uninsured. The four aspect of the GCM model – problems,

solutions, participants and opportunity choices – were used to help identify reliable

subjects or influences on the decisions made within the group that was interviewed.

Problems are identified as all of the concerns facing the participants in the decision

making, including three key issues—price controls, reduction of waste and ways to lower

administrative costs.

The second stream, solutions, refers to the writer of this study coming up with

recommendations for the future researcher and the Secretary of United States Department of

Health and Human Services to make the American health care system more efficient.

The third stream, participants, refers to the twelve interviewees who participated in

the study--doctors, nurses, health field workers, professors, students, and community

workers. These participants gave their opinions regarding solutions to the health care

issues in the United States.


33

The fourth stream, opportunity choices, are those times when an administrator

elects to create a response or a recommendations in response to the opportunity, such as

creating recommendation to find an option to solve the uninsured issue in the United

States by learning from other capitalist countries which used universal health care system

for their citizen. The GCM was used to help better understand the problem action, or the

problem expectancy, within the administrative decisions about universal health care

options. The Garbage Can Model was used to frame and describe the results of this study.

Conceptual Model:

Researchers use conceptual models or theoretical frameworks to provide policy making

structure for their studies, and to place research finding within the context of literature. A

triangular observation of health care issues in the United States can help in assessing the American

health care system. These three dimensions that can help in the examining the challenges of

Obamacare and the recommendations for the universal health care system.

History of U.S.

Health Care System

Recommended

universal health care

system to solve U.S.

healthcare system

issues Universal Health

Care System

OBAMACARE (PPACA)


34

After the research questions have been defined, it is important to determine the data that

will be needed to answer the research questions. However, resource constraints can be a significant

factor in determining the amount of data that will be collected. In other words, the most is done

with the time and with the resources available. Researchers should look at the results of previous

studies to see if there is a way to justify a narrow focus.

Data collected needs to be valid and reliable. For validity, data must reflect what

the study needs to measure. Keeping this in mind, all questions have been framed to assess

the current health care system and the proposed universal health care system. Participants

have knowledge of the health care system as they work in the system or participate in the

system as it currently exists.

Sampling:

The process of selecting a portion of the population to represent the entire population is

known as sampling. A non-probability sampling method was adopted which is less vigorous

and tends to produce less accurate and less representative samples than probability or random

samples. However, given that the participants needed to provide detailed answers to a number

of questions related to the American health care system, it was important that selected

participants have some knowledge and perspective regarding the system. Non-probability

sampling implies that not every element of the population has an opportunity for being

included in the sample. Participants have been selected based on convenience and networking,

most of which have been in Scranton, Pennsylvania and the state of Oregon.

The non-probability sampling procedure might have limited the application of the

findings to the entire population. A convenience sample is the sample selected from the use of


35

readily accessible persons in a study. The researcher finds it easy to obtain participants, but

the risk of bias is greater than in a random sample, because each member of the population

does not have an equal chance of being included in the sample.

The sample size for this study consists of 12 participants who are three doctors, two

college instructors, two health field workers, two students, one nurse, and two community

workers. Since this is a qualitative study, the sample size is adequate. Efforts have been made

to ensure that the sample is representative of the population. The sample includes persons

from different walks of life. Participants include doctors, nurses, students, health field

workers, instructors, and community workers. This helps in attaining different perspectives

with regard to the current state of the American health care system.


36

Chapter Four

Data Collection

Data for this study was collected using the structured interview included in (See

Appendix A). A structured interview schedule was used in order to capture data relevant to the

study’s objectives and research questions.

Qualitative researchers are concerned with making inference based on perspective, so it

is extremely important to get as much data as possible for the analysis. Interviews with the 12

participants have been conducted over telephone, face to face, and through email as well. The

12 participants are three doctors, two college instructors, two health field workers, two students,

one nurse, and two community workers. Questions are primarily related to the current state of

the American health care system and their opinions on how the problems associated with the

system can be solved.

Data collection about a controversial research topic was not going to be easy. It was

expected that many of the respondents would be hesitant in expressing their true opinions about

the universal health care system. Moreover, it was important to get to the respondents such as

doctors who had good idea about the health care system. At the same time, a balance needed to

be achieved with regard to having people from different walks of life such as doctors, college

instructors, health field workers, students, nurse, and community workers. Responses to my

interview questions:

1. What is your opinion of the health care system in the U.S.?

A. The major issue today is about providing a service to the lawful residents

of the United States who deserve it. It may not be our right to demand


37

provision of affordable health care for all but it's the moral responsibility of

our government to make it available. Even if one takes away the "touchy-

feely aspect" of its humane value, the fiscal benefits for our future are

staggering.

B. The US healthcare system needs a great deal of change. We need to

simplify our reimbursement system. We also need to focus more on patient

education, preventative care, and disease management.

C. There currently is no system per se, but a mix of independent actors with

their own interests in mind.

D. It is the only healthcare system in the OECD world that runs as a business

rather than a service for the people. There is no system to really describe; it

is a fragmented disorganized phenomenon for financing and delivery of

healthcare services. If you have good insurance coverage you may get good

service, if you do not…then “every man for himself”.

E. It is flawed we are running on fumes attempting to care for the uninsured

without the ability to pay out of pocket.

F. US do not have a national health care system. It only have program to run

nationally such as Medicaid and Medicare. Insurance company involved

too much in the delivery of health care. Sometimes patients have to give up

the treatment because the medication or exam is not covered by insurance

(pay out-of-pocket is too expansive).


38

G. I believe the current health care system in the United States is

dysfunctional. Although it is in the process of being overhauled, and many

improvements are being put in place, the health care system still needs a lot

of improvement to make the U.S. have a high quality system that cares for

all people.

H. The health care system in the U.S. has potential but it lacks effectiveness

because it isn’t allocated fairly. I don’t believe anyone should be without

insurance however, I find it very unfair that people who are dependent on

society carry better insurance than those working to keep the society

functioning.

I. That too many insurance companies are for-profit focused instead for-the-

people focused.

J. I believe it needs heavy reform, focusing on destroying the monopolies

held by big “health care” corporations.

K. The United States is a great country. It has the number one world economy

with an important health sector; both in terms of quality of care and the

economic revenues generated. The level of care is very high. It is

unfortunate that so many Americans cannot access this great care because

they cannot afford it.

L. I believe that our health care system is not perfect, but is far superior to the

health care system in some countries around the world.

2. How would you evaluate the current health care system in the U.S.?


39

A. A lukewarm effort to tackle one of the most critical domestic challenges

that is being outside of the economy. Despite the mandate promising health

care coverage, there is still no clear evidence that the private sector will

oblige and lower the rates so small businesses and patients are able to

afford the premiums

B. We have a lot technology and advancements but lack in access and cost.

C. Excellent in terms of quality, poor in terms of accessibility

D. We have the best trained medical personel, the best drugs, the best medical

technology…you just need the money to have access to it all. About

700,000 people declare bankruptcy every year because of medical bills.

E. Classic capitalistic healthcare the rich get better and the poor remain in

awful circumstances and condition.

F. For middle class, the cost and expense on the healthcare is hardly to

afford.

G. The current system is more about profit, than actual health care. It is driven

by private companies, whose goals are not improved care, but are about

their bottom line. This has caused many people to question whether or not

some diseases have had cures discovered, but that the treatment/cures are

being hidden by pharmaceutical companies, health care providers, and

insurance companies. Hiding treatments that could potentially cure one’s

illness would result in a loss of money for those companies The bottom line

is that the current system is a “sick care” system, not a health care system,

and sick care is a money making business.


40

H. Again it’s fair, in that there are programs to help the low income and the

disabled, but I do think that there should be some form of assistance to the

working class.

I. Healthy for the insurance company’s wallet, not for the people they serve.

J. It leaves so many gaps in society for people not to be treated, or paying

extraordinary amounts for otherwise simple procedures.

K. The care rendered is excellent. But the costs are so very high. One of the

reasons for this is uncompensated care provided in emergency rooms to

persons who cannot afford it. Again because they cannot afford to see a

doctor regularly. One other reason might be excessive testing.

L. In the United States unfortunately the Health care costs in the US rise due

to the lack of reimbursement from private and government insurance

companies.

3. How would you compare the American health care system with that of the system

prevalent in other developed countries for example UK, Canada, and Russia?

A. Disastrous as the number of uninsured and underinsured will skyrocket,

raising health care costs even higher than what would be required to fix it

now. According to the National Coalition on Health Care, a study found

that 62 percent of all bankruptcies filed in 2007 were linked to medical

expenses. Of those who filed for bankruptcy, nearly 80 percent had health

insurance. About 1.5 million families lose their homes to foreclosure every

year due to unaffordable medical costs.


41

B. I believe we are advanced in technology but have a much higher spending

rate and debt.

C. In my experience, health care in the US is more expensive, less effective

and less accessible than in other developed countries.

D. We are #1 in spending; we spend more than any other OECD country per

capita and %GDP. Yet we do not produce the best health results as

indicated by life expectancy, infant/child mortality and chronic disease

rates.

E. We have lower health care delivery capacity, imparked access to

emergency depts., weakened local economy, and adverse effects on public

health, lack of preventive care.

F. United Kindom has national health plan called NHS. It ensure that every

citizen can get healthcare once they sick.

G. While I am not familiar with Russia’s health care system, I am familiar

with the UK and Canada. I am most familiar with the system in the UK,

because I have family that lives in the UK, and my own father grew up in

Scotland. The way their system works is everyone pays into the system in

the form of taxes, and as a result everyone is covered completely, by the

government, from the day they are born. I know this is a good system, as I

had a young cousin who had major heart failure while traveling through

Scotland. She was actually from Australia (who also has the same type of

universal health care system, which is also known as single payer), and was

traveling through Scotland visiting family. When she got sick she was


42

hospitalized and given the best care immediately. She was kept in the

hospital, and her parents and siblings were given a nice place to stay next to

the hospital. She was not “cut loose,” as is typical here in the U.S. Had she

been treated here in the U.S., she would have been in the hospital just long

enough to stabilize her then she would have been sent home. My cousin

spent several months in the hospital, and experts were flown in from all

over the world to help her. At no time did my cousin’s parents have to

worry about how they would pay for her treatment, or wonder if her

treatment would bankrupt them. Here in the U.S., that would have been the

case. The time of her being in the hospital, surgeries, nursing staff, and

equipment would have cost hundreds of thousands of dollars.

H. I am very embarrassed to say that I don’t think we can compete with the

countries that do provide health care to all their citizens. I think it’s

commendable that these countries have found a way to accommodate all its

people’s health care needs. And as a super power country I do feel that we

should have been at the example for the health care system but instead our

system is in dire need of reform.

I. You cannot compare those health care systems because they are vastly

different populations, governments, and tax systems. We simply don’t

have the people or correct mind set to follow those systems.

J. Unfortunately, I don’t feel I know enough about their health care systems

to fully develop a hypothesis.

K. There is definitely more access because the costs are not as high and

because there is some type of national insurance. As for the level of quality


43

of care and the level of medical research, I would say they are rather at the

same level.

L. Hospitals end up always charging more for services knowing that they will

only receive a very small percentage back. Since the hospitals end up

charging more this ends up creating a cycle of rising premiums, debt and

costs!

4. What are the likely benefits of universal health care system?

A. The payment system would be simplified and all citizens would have health

care coverage.

B. I hope that more people will be covered and that a greater percentage of the

population will have access to high-quality primary and preventative care.

C. No more families going bankrupt because someone got sick. No more

suffering from chronic conditions such as asthma, diabetes, arthritis etc,

because of lack of access to care. Less community crime and destruction if

there are more mental health and drug treatment services.

D. As of late, we are the only industrialized country without universal

healthcare. It is simply a moral dilemma and obsoletely the biggest an

argument for U.S. is that every citizen would be entitled to healthcare.

E. Universal Healthcare system may provide each people the equal chance to

get health care services when people need it.

F. There are many benefits to a universal health care system! First off, the

system is about actual health care, not profits! The costs of health care are


44

reined in by the government, and can’t be artificially manipulated for the

purpose of profiting on people’s illnesses. Secondly, everyone is covered.

Nobody has to worry about lapses in coverage. This allows people to focus

on preventative care, and when they actually are sick, are more likely to

seek prompt treatment before the illness worsens. This actually will save

employers money, as their employees will lose less time to illness. Thirdly,

people will not have to worry about going bankrupt if they become sick.

They can focus on getting better, instead of spending time worrying about

how they will pay the bills. There is another benefit that people don’t often

think of about the universal health care system: it creates a demand for

more jobs! Since everyone would be covered, more people would seek

medical care when needed, which in turn creates a demand for more health

care professionals! Fourth, with people seeking care without worrying

about cost, our health care quality won’t be rated thirty-something in

quality compared to the rest of the world. Sadly we don’t have the best

rates when it comes to things like infant mortality. That is not something of

the U.S. to be proud of. Fifth, universal health care covers pretty much

everything. Right now insurance coverage varies from place to place,

company to company. Lastly, but not least the lowered cost of the health

care system is good for the overall U.S. economy, and will help bring down

costs of the debt, as the health care costs are known to be tied directly to

the country’s economic health.

G. A) No one will be without healthcare, even those with pre-existing

conditions. B) Doctor would be able to concentrate on healing rather on


45

the bureaucratic of healthcare. C) Medical coverage might encourage

people to live a healthier lifestyle and practice preventive medicine, and get

diagnosed earlier when feeling ill. D) With all doctor connected there will

be a centralized database that can help with diagnosing and treating

illnesses quicker.

H. Easy access to health needs.

I. More individuals getting the treatment for their ailment they need. We

would be a better nation if everyone was able to get treatment and become

healthier.

J. More people getting the insurance they need/deserve. Everyone should

have access to a doctor.

K. More coverage for more people. And the possibility for more people to see

a doctor regularly; therefore more preventive measures. In the long run this

will be advantageous for the whole country in terms of public health. More

people will be healthier and will be more productive.

L. Love’s the concept of Universal health care but rationally it is not feasible.

Who would want to turn away an old lady or a child in pain? It is human

nature to feel compassionate towards another in pain and in need.

5. What are the problems associated with the universal health care system?

A. “Private, for-profit companies are threatened by the prospect of a public

option believing they may lose revenue. But they will survive, albeit with more

regulations, just as FedEx and UPS survive along with USPS and Harvard and

Notre Dame thrive in the presence of much cheaper, public institutions. It is all


46

about choices, lowering costs of products, and competing to improve without

compromising on service.”

B. Patients having to wait for treatment or not receiving treatment that is

deemed unnecessary.

C. It is a hot-button political issue. It is very hard to implement a new system

while Republicans continue to play games with the funding mere months

before it is supposed to go into effect.

D. Universal means having access to healthcare, it does not address who is

going to pay for the healthcare. In countries that have universal health care the

people do not go broke, but the doctors and hospitals to not make much money

or are “in the red”; or the government must go into debt to cover their

population.

E. Because businesses are realized to provide measurement .They are cutting

hours and therefore poverty may increase. U.H.C does not address why costs

are so high in the rarest place.

F. Problems may be lacking staff(nurse, doctors) to meet the demand of

patients. Financial problems may also rise.

G. A very common argument against the universal health care system is that it

would cost a lot of money; however, I have read in many research articles that

explain we actually pay more right now for our current health care system than

a universal, single payer system would cost. Having a universal health care

system would actually lower the cost. In my opinion there is no problem in

having a single payer system. Setting it up, would in all likelihood, be the


47

hardest part; this would be because transitioning millions of people over would

take time, and of course insurance companies would probably fight it, as it

would result in their own demise.

H. A second argument people have against having a universal health care

system is that it would create a longer wait time to see a Dr. This argument

would dissipate because the focus would shift to prevention rather than sick

care, and any increased demand would result in an increase in health care

professionals.

I. The last common argument against universal health care is that it is

“socialism,” really isn’t an argument, but is more a political opinion. To me

this also has no merit, as we have many programs in the U.S. which are

“socialism,” yet these same people aren’t demanding these other programs be

dismantled. Other “socialism” programs include roads, food safety, air safety,

schools, police, fire, and more. I personally do not think that this argument has

any merit.

J. A) The government has to find a way to foot the bill for this health care

system and the answer might be higher taxation. B) Government control of

healthcare might minimize the Doctors flexibility to treat. C) Healthy people

will be subjected to paying for the healthcare of people who chose to live an

unhealthy lifestyle. D) Patient may have to wait longer to receive care and

treatment.

K. Abuse and overuse of the system. Doctors may not get paid what they feel and

become more lax on the job. Becoming a doctor or nurse may become less

glamorous/popular career field for the younger generations to go into. Our elderly


48

population in our country is rapidly increasing with this the rate of chronic diseases

and lifestyles are also increasing and we need to adapt universal system.

L. Apart the fact that it was about time that the US had one, there is just too much

confusion and misinformation. More information sharing is necessary in order for

people to understand what it is about.

6. Why do you think health care costs are rising at such a rapid pace in the U.S.?

A. Insurance premiums are rising by an average of 12 percent annually over

the last decade. Compare that to the GDP growth, which averages around 4

percent. More employers are reassessing their benefits packages, asking

employees to share more of the cost. As costs rise, more people will be

unable to afford their end of the bargain. Possibly they will opt out of the

health benefits.

B. I believe that health care costs are rising due to providers raising their

charges to compensate for lack of payment from insurance companies or

uninsured patients.

C. Because of the high cost of technology and because of the greed of

insurance companies.

D. The population is getting older and more services are needed and used.

Since healthcare is run as a business, profit is an important factor of every

aspect of healthcare: pharmaceuticals, medical technology, provider

services, and insurance coverage. Also because the financing of healthcare

is so disorganized, there is a lot of wasteful administrative costs (and the


49

Electronic Medical Records mandate is making this even more expensive,

and making great profit for the software development companies.) The US

also spends little money on prevention, which would cut down costs in the

future.

E. Because we are trying to compensate for the amount of uninsured people

recreating treatment and our primary doctors are over saturated creating

high tend competition on living prices higher and higher.

F. For benefit of the health insurance company

G. No answer.

H. Because health isn’t about the patient, it’s a profitable

business. Healthcare is a necessity and so people have to pay what is asked

if they want coverage.

I. Maybe because the idea of the universal health care is a wonderful idea but

it would threaten to put many major insurance/health

providers/pharmaceutical companies out of business. I think many of these

corporations would take a huge loss in profit to become a larger

conglomerate company.

J. I think to make more money. The insurance costs for doctors to run their

own business is astronomical, the administration fees are huge for them

too, so the cost gets filtered down to us, the patients.

K. Because there is no health managerial plan.

L. Because of reimbursement.


50

7. Are taxpayers ready to bear the burden of financing such a reform?

A. The road to economic recovery cannot be navigated without addressing the

future of our health care. Either the government needs to look at the bill more

seriously, or start bringing equally comprehensive options to the table rather

than focusing on negative campaigns that confuse people even more.

B. I do not believe so. There are already working citizens paying high

percentages of taxes to pay for government insurance programs.

C. I believe that the burden would be less if everyone were a part of the same

system and if much of the management of the system was taken out of the

hands of for-profit entities such as insurance companies.

D. In America the people always complain about taxes and are suspicious of

any tax rate hikes. Pay the premiums to the insurance companies (at an

average of $200 per month) or pay “health” tax to the government

(probably less than $200 per month)!

E. No, I do not think they are either ready or willing.

F. I do not think so.

G. Yes. The system would actually be cheaper. Once people started reaping

the benefits, there would be no-one complaining.

H. Unfortunately as necessary as it is we are not in the position to foot such a

bill. There are other issues that require the attention of our finances, ei:

education, social services, and tending to the elderly.


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I. Simply, no. Taxpayers won’t want to put in so much effort and money.

Opposing media sites/TV stations/etc will put “spins” on the reform and

persuade the population to feel strongly one way or the other. I do not

foresee a quick resolve, financially or politically.

J. Maybe. It would take a lot of positive thinking, openness and honesty, and

a few good leaders/faces to really rally people together to support it. Right

now, with so many people being unemployed, financially it would be very

difficult. Maybe 5 more years or so?

K. Maybe, but i guess this is very subjective. But another question that could

be asked is: are they ready to pay the exorbitant bills of medical care if they

become ill?

L. They can if they get together and think about the citizen before the country

benefit.

8. Besides universal health care system, do you think any other alternative can solve

the problems associated with millions of uninsured citizens as financial prevalent

in obamacare?

A. I believe that offering some type of coverage plan could help such as a

Primary Care Access programs. These could provide prescription benefits

and a few primary care visits and preventative tests a year for a lesser cost.

Catastrophic insurance plans can also offer coverage in the event a patient

needs a major procedure.


52

B. Greater access to primary/preventative care for everyone could make a big

difference. Education about nutrition, exercise and how to maintain health

long-term could also be useful.

C. Switzerland and Germany have private insurance companies to cover the

population. But there the insurance companies are not allowed to be “for

profit”…that is they cannot have shareholders and be on the stock

exchange. The insurance companies in these 2 countries are doing very

well, competing and keeping costs down. The US could do this, the

insurance companies could still exist and compete. If there was any profit

at the end of their year, they can re-invest it in to the company and lower

the premiums for the people for the next year. That would be very popular

with the people.

D. A state mandated health care system with gate keepers to a void

oversaturation.

E. Maybe universal health care system will be the best choice.

F. No. Without universal coverage, not everyone will be covered. To me this

is unacceptable. Everyone is guaranteed by our government the right to life.

How can that be a right, if not all can afford health care to ensure they can

live? That is contradictory!

G. Funding for universal health care is provided by the population, whether

through compulsory health insurance, taxation, or a combination of both.

H. The only idea I could come up with is more pro bono work by doctors.

Maybe 5% of their entire client populous should be low income, at risk, or


53

uninsured. This way, no doctor is being excluded from doing this work,

they are still getting paychecks, and they can feel good about helping their

local people with reduced cost care.

I. No, I cannot think of anything new. We already have free clinics, mobile

clinics, primary doctors, etc, but they aren’t working as well as they would

like. Many people are doing good things for their community, but they

don’t have the resources to help everyone that needs it, nor help the people

as deeply as they would like to, in some cases.

J. Communicate with each other and look for the citizen need not for the

benefit.

K. They should learn from other capitalist who has universal health if they

plan to benefit there citizens.

L. The universal system is not hard to implement, however that effective

implementation of the system can be very beneficial to the country and its

people. Universal healthcare guarantees the treatment of all citizens. No

one would ever have to be left alone in pain simply because they could not

afford the care!

9. What do you think are the positive aspects of Obamacare?

A. “A concerted bipartisan effort is the key to success. Health-care reform is

vital, and we need it now, before it's too late and the bottom falls out.”

B. Insuring uninsured citizens and focusing more on quality of care.


54

C. Availability of coverage for all citizens is a huge positive aspect. The ACA

provides a variety of choices for individuals looking for health care. Many

people who have not been covered in the past will now have that option.

D. No answer

E. Medicaid is expanded to the 138% poverty level. Required preventative

care.

F. To provide health care to the unisured citizens.

G. Obama-care (ACA) does have some positive aspects. The ACA reins in

some health care costs by limiting how much insurance can profit. An

insurance company cannot profit more than 20%, and any extra money they

make above that must be refunded to the customer. I also like that

preventative care is fully covered, and insurance companies can’t refuse to

insure or drop people based on pre-existing conditions or people getting

sick. I like that there are no more lifetime caps on paying for people’s

illnesses. I also like the fact that women are entitled to receive birth control

under it. Just as Viagra has more than one purpose for men, birth control

has more than one purpose for women, and should be treated (covered),

just as Viagra is for men.

H. A) Free preventative care for woman. B) Children under 19 years of age

cannot be denied coverage for pre-existing conditions C) children can stay

on their parents insurance until age 26. D) Free Medicare preventive

services. E) equality in premiums

I. I don’t feel I know as much about Obamacare as I would like to give an

educated answer.


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J. Those who need the insurance will have access to it.

K. More coverage for more people; especially because preexisting conditions

cannot be taken into account.

L. I do not know for sure, but I think it is good start.

10. What do you think the negative aspects of obamacare?

A. With regard to the Affordable Care Act, Dr. I think that the act has many

flaws. Unfortunately, these flaws are a direct result of partisan pressures from

both sides of the aisle, influenced by strong lobbies.

B. Penalizing providers based on patient survey questions that are unrealistic.

C. The implementation seems to be problematic and complicated. The whole

situation is politically charged and is deepening the divide between

political parties.

D. No answer

E. Reimbursement for cost is too low and therefore providers may sacrifice

the actuality of sources. Without competition, it is difficult to determine the

lowest cost of providing care. Prices set without competition may impact

innovation.

F. Quality of care may be decreased if the number of health professionals

does not increase correspondingly.

G. There are several negative aspects to the ACA. Not everyone is covered.

People can basically refuse coverage by paying a fine. I also don’t like that

there is no set plan that covers everything, unlike universal health care. It


56

still comes down to this: if you have money you can afford better coverage

than a poorer person can. Coverage can be transported by a person between

jobs, but there is still the issue that if a person suddenly becomes ill, or

loses a job, they won’t be able to afford their insurance. They may not be

able to be covered by their respective state’s Medicaid insurance if they

have too many assets, such as owning a house that is above the limit.

Should a person have to give up things they have worked hard for their

whole life so they can be covered for basic insurance? NO!

H. A) Explosive deficits. B)Government strong hold and control C)mediocre

care because care is not privatized

I. High cost is not something I can pay. If the insurance available to me is

only high risk and expensive then I would rather go without so I can feed

my family.

J. The exurbanite fees of insurance for those with previous ailments. Myself,

I’ve had three major surgeries in my life, so I will be able to get insurance

but it will cost me more than I would like, or maybe even be able to, pay.

K. I do not know.

L. Not sure.

11. Do you think that the government should adopt the universal health care system in

the U.S.?

A. No, I feel that our country could adjust well and I believe that the state we

are in is too far gone.


57

B. It already has to a degree—the ACA (“Obamacare”) goes into effect on

January 1, 2014. Starting on October 1, 2013, individual and small

businesses can be to select their new plans. That mean yes they can do

that.

C. That will be contentiously debated. Just as Obamacare is hotly debated

now.

D. Not at the federal level, but at the state level, yes and sure they can if they

have time.

E. Yes.(But it is hard to achieve because each state have their own health care

system)

F. Absolutely, yes!

G. Yes, to solve these big uninsured issues.

H. If applied correctly, yes!

I. Politically, it will take tons of work, and the health care system might get

turned on its head, but it could work.

J. Yes they can if they plan it right.

K. Yes they must do that to save the U.S citizen health.

L. Definitely, they can.

12. Is there anything you would like to add?

A. It is an important topic that needs to be addressed and improved upon.

B. I think greater access to primary/preventative care for everyone could make

a big difference to the American nation and the economy. Also, eliminating


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private insurers and recapturing their administrative waste can finance a single-

payer system.

C. Sure, I need to clear to things “Public” means “government” pays for the

services instead of private people or companies. The theory behind insurance is

to have many people (the healthy and the sick, the rich and poor, the young and

old) put their money in to one “pool”. Then the company pays out to cover the

people who need it (sick, poor, old). The idea is that everyone pays in whether

they need it or not, but eventually they will need healthcare and can feel

assured they will get it. If the government wants to collect the money and have

the “pool” how is that different from an insurance company? Well, the

government does not look for a profit not does it pay dividends to shareholders

in the stock market.

D. Universal health care can solve part of this big issue in the system.

E. No

F. In my opinion the U.S. should transition to universal health care. I will

support any political candidate who fights for this!

G. Let me know what other option you will find.

H. I have hope but doubt. And I feel everyone needs to be more educated, in

black and white, no frills, no political commentary, on the health care reform.

I. I’m so glad that this movement has started. I just hope it turns out as well

as the people advocating are saying it will.


59

J. The immigration bill as it is currently written (and if passed) would not

allow for newly legalized immigrants to apply for Obamacare for a period of

10 years. This does not make sense because this would undermine the very

reason for doing Obamacare: so that people can have access to health care.

These new legalized immigrants would be around 11 million if the bill is

passed. That would be a significant segment of the population who would be in

the same situation that we are trying to combat now.

K. I hope they will adapt this system soon.

L. Good luck with your PC.


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Chapter Five

Analysis

The questions framed for the research were very thoughtful. Respondents were first to

be asked some general questions about the current state of the health care system in the United

States and the comparison of the American health care system with those of the other developed

countries. Questions then got specific and were related to the universal health care system in the

context of the United States. Finally, respondents had to answer if they thought the universal

health care system should be implemented by the government.

The first question in this survey asked participants to comment on their general

opinion of the health care system in the United States.

Nine out of twelve respondents said that health care in this country really does not

operate as a coherent system. Health care as it exists now is disjointed, disorganized and

in need of a great deal of simplification. It run as a business rather than a service provided

to citizens. Profit motivates the way that things function rather than a desire to help

people in need.

Three out of twelve who answered the question pointed out that the quality of

health care in this country can be very high. Good technology and modern treatments are

available—they just are not affordable or accessible for a large segment of the population.

Two out of twelve commented on the role of individuals in taking responsibility

for their own care. Patient education and involving individuals more in making their own


61

health care decisions could be better integrated into the way that health care is offered in

this country.

Two out of twelve respondent made the point that, as well as being more humane

than the current system, better organizing the way that health care works in the United

States could save us a great deal of money over time, both in costs and in lost productivity.

It was also noted that perhaps the government has a basic moral responsibility to

make good basic health care available to more of its citizens.

The second question in the survey asked the participants to evaluate the current

health care system in the United States. Participants evaluated the system primarily in

terms of quality, technology, trained medical personal, and drugs. The major concerns for

eleven out of twelve individuals are related to access and cost. As expressed by one of the

respondents, health care in the United States is “excellent in terms of quality, poor in

terms of accessibility.” Respondents implied that rising costs are making health care

inaccessible to millions of individuals and households in the United States.

The middle and the lower classes are suffering as a result of the health care system

becoming unaffordable. Health care costs have been rising significantly over the years

because the lack of reimbursement from private and government insurance companies.

Also, they evaluated by call the system by calling it “Sick care” and stating that the

current system is “Healthy for the insurance company‘s wallets.”

Ten out of twelve respondents suggested that the current health care system in the

United States is not in good shape.


62

The third question asked the respondents to compare the American health care

system with the system prevalent in other developed nations. While two out of twelve

respondents lacked clear ideas about the system in other countries, those who were aware

of the health care system of other developed countries strongly criticized the American

health care system. The major difference that has been pointed out by ten out of twelve

respondents is that other developed countries provide universal access to their citizens.

One of the respondents said that the health care system in the United Kingdom provides

universal coverage to its citizens and its funding is taken care of through taxation. On the

other hand, the United States provides no such coverage. Another major difference

highlighted by several respondents is that the United States spends considerably more

money on health care than any other country; still, the system is less accessible. One out

of twelve respondents was embarrassed to say that these developed countries have found a

way to accommodate the health care needs of all of their people, while the United States is

still struggling to make health care accessible to all. However, one of the respondents said

it would be unfair to compare the systems prevalent in different countries because of

different populations, governments, and tax systems.

The fourth question aimed at obtaining the opinion of the respondents with regard

to the benefits of the universal health care system. Eleven out of twelve respondents

believed that it would bring more people under health insurance coverage. Many

suggested that this system has the potential to solve the health care issues in America.

Several problems, such as rising costs, lack of access to healthcare services, and lack of

insurance coverage to the millions can be effectively dealt with through the universal

health care system.


63

Five out of twelve respondents believed that a greater percentage of the population

will have access to high-quality primary and preventative care once Obamacare is

implemented. Other benefits that came up from their responses included that families will

not go bankrupt as a result of someone getting chronically ill, that the payment system will

become simplified and that a universal healthcare system actually will save employers

money, as their employees will not lose time to illness. In addition, since everyone will

get covered by insurance, that change in and of itself will create more jobs. Another

benefit that was mentioned was that instead of focusing on bills and whether the patient

has the ability to pay, doctors will be able to focus on treating the ill without worrying

about other things. Respondents also discussed the fact that administrative costs resulting

from the inefficient and complex system will come down and that each citizen will be

provided with an equal chance to get health care services when needed. The productivity

of the nation will go up. It can safely be concluded from their responses that they are

supporting the hypothesis that the universal health care system can deal with the core

issues of rising costs and inaccessibility in the American health care system.

The fifth question in the survey was an extension of the fourth question. It asked

the respondents about the problems associated with the universal health care system. The

most common concern among the respondents was related to the financing of the system.

It will cost a lot of money and the burden will fall on the taxpayers ultimately. Four out of

twelve respondents had the view that the waiting times for treatment will increase

considerably because millions of people will come under the system suddenly. Other

concerns expressed by two out of twelve respondents included that the system would be

difficult to implement under the current political system and that resources and health care

professionals are not enough to satisfy the demand of millions of new patients.


64

The sixth question asked the respondents to provide the reasons why health care

costs are rising at such a rapid pace in the United States. This question attracted varied

opinions among the respondents. First, the high costs of technology and software

development companies were mentioned. Second, the U.S. health care system do not have

health managerial plan to reduce their health cost. Third, the administrative fees are huge.

Fourth, the use of for-profit business is an important factor of every aspect of healthcare.

Fifth, the health care cost rising because the health insurance companies thinking about

benefit not the patient.

The seventh survey question asked the respondents if they think that the taxpayers

are ready to bear the burden of financing such a reform. Responses were mixed. Some

answered in affirmative tone while others thought that they may not be able to bear the

burden. Six respondents believed that taxpayers could help in financing of such reform. A

three suggested that the increased efficiency of the system will help the government save a

lot of money, which will help in financing the reform.

There were four respondents who did not believe that taxpayers were ready to bear

the increased burden. They were concerned that about the workers who were already

paying high percentage of taxes to the government.

The eighth question on the instrument asked the respondents if they thought there

is any other alternative (beside the universal health care system) that can solve the

problems associated with millions of uninsured citizens. Ten out of twelve respondents

believed that the universal health care system was the best available choice for the United

States. One respondent suggested that a greater access to primary/preventative care for

everyone could make a big difference too. Five respondents suggested that without


65

universal care, not everyone will be covered. That was unacceptable to him as everyone

should be guaranteed the right of life by the government.

Other suggestions came up as well. One alternative suggested was that access to

primary care programs to help citizen with prescriptions, doctor visits, testing, and patient

need procedures could be increased. A second suggestion involved providing educational

classes about nutrition and healthy lifestyles. One respondent said that doctors should

provide 5% of their revenue to help the citizens who are low-income or uninsured by

giving them medical support to treat their condition. Fourth, running universal health

insurance coverage through compulsory health insurance, taxation, or a combination of

both was mentioned. Fifth, they should acquire ideas from other capitalist countries, which

have universal health care coverage for their residents. However, in essence, most

suggested alternatives were just a tweak of universal health care system.

The ninth question on the survey asked the respondents about the positive aspects

of Obamacare. Nine out of twelve believed that Obamacare would be helpful for low-

income citizens to get covered and get increased accessibility to health care services.

Three out of twelve respondents lacked enough knowledge about Obamacare to give

detailed responses. One respondent suggested that it expands Medicaid to 138% poverty

level. One respondent stated that Obamacare is a good start towards solving these

problems because preventive care is provided to women and children. Nine respondents

suggested that Obamacare will help in reducing health care costs by limiting how much

insurance companies can profit.

The tenth survey question extended the ninth question by asking the respondents

about the negative aspects of Obamacare. According to several respondents, Obamacare


66

suffers from several flaws. One of the major concerns related to Obamacare is that it

would lead to a drop in the quality of care. One respondent suggested that the

implementation would be very complicated and problematic. Another respondent believed

that innovation could be negatively affected.

The eleventh question asked the respondents if the government should adopt the

universal health care system in the United States. Ten out of twelve respondents answered

‘yes.’ However, many respondents suggested that the system needs to be implemented

correctly in order to be truly effective in dealing with health care issues in the United

States.

The 12th question asked participants if they would like to add anything. One of the

participants suggested that the greater access to primary and preventative care will make a

huge difference to America as a nation and as an economy. Another participant wanted to

imply that as the government does not look to make profits and it does not need to pay

dividends to its shareholders, healthcare costs will be lower under the universal system. In

fact, six of the participants echoed the same sentiment very assertively; that is, the

government should adopt the universal health care system. They were glad that the

movement in favor of the universal health care system has started and hoped that it would

soon be adopted. In response to this question, no participant expressed their disapproval of

the universal system.

According to the literature, the United States is the only developed nation without

universal health insurance. While the insured and wealthy people have access to the most

sophisticated and advanced treatments and have outcomes that are at least comparable to

those anywhere in the world, there are considerable pockets of the population for whom


67

access to health care and the effects on health status are much more similar to those of

poorer and less successful Third World countries.

These disparities in access to health care come even when the United States spends

substantially more on health care than any other nation. Countries that have some kind of

universal coverage generally spend less. This is because the costs of a universal system are less

than a private system. Drugs can be purchased in greater bulk, prices for services can be

negotiated at lower rates due to the larger pool and a large singular system reduces the overhead

involved in processing insurance and medical services.

Under a universal health care system, those who normally go without insurance would

now be required to pay into it in the form of taxes. The distributed costs would bring down the

personal expenses of those who already pay for insurance. Those who might object to forced

taxation should know this is no different than the shared costs of road construction, school

funding or space exploration. The total cost for health coverage would decline, and the actual

out-of-pocket expenses people pay would also go down.


68

Chapter Six

Recommendations

There are ten out of twelve participants involved in the study who agree that the

universal health care system is the only option that has the potential to solve health care

issues in the United States, particularly the inaccessibility to health care services and

rising costs. As a researcher come up with these recommendations for the future

researchers and the Secretary of United States Department of Health and Human Services

to make the American health care system more resourceful so that rising costs can be

curtailed and all citizens are able to access quality health care services, which a participant

would like to see implemented.

In planning and implementing its comprehensive health care reform, the United

States can learn from other capitalist democracies in the ways that they address universal

healthcare and price controls. “There are about 200 countries on our planet, and each

country devises its own set of arrangements for meeting the three basic goals of a health

care system: keeping people healthy, treating the sick, and protecting families against

financial ruin from medical bills.” (pbs.org, Sick around America, 2009)

As a right, all citizens must be covered for all medically necessary services

including doctor and hospital visits, preventive, long-term care, mental health, dental, and

vision services.

Eliminating private insurers and recapturing their administrative waste could

finance a single-payer system. Some new taxes may have to be levied to replace

premiums and the out-of-pocket payments currently paid by individuals and businesses.


69

Costs can be brought under control through negotiated fees, global budgeting and bulk

purchasing.

“The current patchwork system of for-profit payers and private insurers

necessarily wastes health dollars on things that have nothing to do with care: overhead,

underwriting, billing, sales and marketing departments as well as huge profits and

exorbitant executive pay.” (pnhp.org, 2011) Such wasteful expenditures on administration

can be reduced quite a bit and once a concrete system is in place, high administrative costs

can be done away with. Single-payer financing provides an opportunity to recapture this

wasted money. The potential savings could then be used to bring every citizen of the

United States under the umbrella of insurance coverage.

In implementing a universal health care system, various issues will need to be

taken care of. The government will need to decide what type of care must be provided, to

whom the care must be provided, and the basis for determining coverage. Funding for

universal health care is provided by the population, whether through compulsory health

insurance, taxation, or a combination of both. Some health care costs may be paid by the

patient and some health care costs may be covered by the universal health insurance

program.

One suggested system through which the government can implement the

universal health care program is the single payer health insurance. Single payer health

insurance is one in which the government finances health care but is not involved in

delivering the care, much like Medicare and Medicaid.


70

A universal health care system can play an important role, even in a capitalist

society. The challenge is in finding the right balance and determining how the United

States can best provide health care for all its citizens.


71

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Appendix A:

Questionnaires & Responses:

1. What is your opinion of the health care system in the U.S.?

2. How would you evaluate the current health care system in the U.S.?

3. How would you compare the American health care system with that of the system

prevalent in other developed countries for example UK, Canada, and Russia?

4. What are the likely benefits of universal health care system?

5. What are the problems associated with the universal health care system?

6. Why do you think health care costs are rising at such a rapid pace in the U.S.?

7. Are taxpayers ready to bear the burden of financing such a reform?

8. Besides universal health care system, do you think any other alternative can solve

the problems associated with millions of uninsured citizens as financial prevalent

in obamacare?

9. What do you think the positive aspects of obamacare?

10. What do you think the negative aspects of obamacare?

11. Do you think that the government should adapt the universal health care system in

the U.S.?

12. Is there anything you would like to add?