Introduction
The health care reform agenda has been a political issue in the United States for decades. Politicians and special interest groups alike have attempted to improve access to care through lowering costs. They have also called for improving the quality and safety of care delivery. After many years of failed attempts by former U.S. presidents, President Obama finally signed the Affordable Health Care Act into law on March 23, 2010, setting the stage for health care reforms in the U.S.
The law intended to make health care affordable by reforming the government’s Medicaid program to cover more citizens not eligible for the Medicare program. There have been many setbacks since the signing of this legislation, ranging from its constitutionality to budgetary implications resulting from the need to make insurance accessible to all U.S. citizens (Kronenfeld, 2002). Just recently, there was a debate on cutting costs on Medicaid insurance through stricter eligibility: a move that would eliminate insurance coverage for many low-income citizens. In The New York Times article, “Cuomo’s budget strategy, getting adversaries to suggest cuts, is paying off,” Thomas Kaplan highlights Governor Cuomo’s budgetary suggestions, which calls for billions in cuts for Medicaid (Kaplan, February 27, 2011).
As Kaplan reports, Cuomo’s Medicaid committee recommended more than two billion U.S. dollars in Medicaid spending cuts and Cuomo in disbelief said: “It worked out better than I even thought to tell you the truth” (Kaplan, 2011). This paper, therefore, examines the role of public insurance programs in health care delivery in the United States. It is true that millions of U.S. citizens are uninsured and not eligible for the Medicare program, but should we push more people out of the government cover by cutting expenditure and making Medicaid eligibility stricter. How important is health insurance and how does it affect health care delivery?
Public insurance programs and health care services delivery in the United States
Despite many criticisms, the Federal Government has played a critical role in ensuring accessibility to health care services for citizens in the United States. Through its Medicaid and Medicare programs, the Federal Government has guaranteed the delivery of health care services to the neediest in the society. The Federal government remains the largest payer for health care services in the United States (Kronenfeld, 2002).
Through its Medicare program, the federal government provides a nationalized medical cover to the elderly (65 and above years of age), the disabled, and people who have special medical conditions including reconstructive surgery (Kovner and Knickman, 2008). Medicare, since its launch in the 1960s, has made a significant contribution in lowering the cost of health care service delivery in the United States.
In general, the Medicare insurance program covers approximately 40 million citizens (Kovner and Knickman, 2008). However, the eligibility criteria, to some extent, have made it impossible for some citizens who are in desperate need of health care but cannot afford it. Moreover, Medicare requires that patients pay their medical bills then claim reimbursement. In most cases, the reimbursements are low in comparison to the high deductibles adding to the high cost of health care services (Marmor, 2000).
Apart from Medicare, the federal government also provides health care services to the low-income percentile of its population through its Medicaid program. Unlike Medicare, individual states manage Medicaid and set their eligibility criteria. Medicaid has also made some positive contributions in ensuring the delivery of primary health to low-income families. I am even surprised that people like Governor Cuomo are thinking about cutting costs and driving more low-income families out of the cover. I support the proposed reform, which intends to increase eligibility for Medicaid and make it a more nationalized universal cover. We cannot underrate the role of insurance in health care service delivery.
Through medical insurance, especially public insurance programs, health care services become cheaper as people only pay a small percentage of the services where necessary. This increases accessibility to health care services. We are aware that most people avoid medical checkups due to high costs. If only we would have universal coverage, this would be a thing of the past. Besides, health insurance programs ensure improved access to health care improve the quality of health care services, and lower the cost of health care (Lundy and Janes, 2009).
Even though expansion of the Medicaid health insurance program as stipulated in the Affordable Health Care Act would lower costs of health care service delivery and increase access to health care services, we must be aware of the potential trade-offs. Expansion of Medicaid to cover prenatal care and childcare, even to illegal immigrants, will increase accessibility to health care, but we must be ready to spend more on taxes.
Medicaid is a social security program that does not require the beneficiaries to contribute substantially to the services (Kronenfeld, 2002). Expanding its coverage means expanding government expenditure and we will have to dig deeper into our pockets. Nevertheless, we should ask ourselves this question, are we ready to trade-off increased taxpayers’ costs for improved health care accessibility? It is better to spend more on taxes, but have a healthy population.
Public health insurance and Reconstruction Plastic Surgery
I work with plastic surgeons that perform breast reconstruction surgery on patients who had breast cancer and had mastectomies to remove either one or both of the breasts. As you are aware, Medicaid does not provide medical cover for such procedures. It thus becomes too expensive for low-income citizens to pursue such reconstructive surgery, despite their determination to live a quality life.
Besides, Medicare insurance reimbursement for plastic surgery is very low despite high deductibles from members. It is thus difficult for most patients to receive quality health care since they have to meet the bills but only gets small reimbursement from the Medicare insurance program. Surely, our public insurance program needs to readdress its policy to ensure that people get access to affordable and quality health care services whenever they need them.
Conclusion
There is a lot of debate about the expansion of public insurance through expanded Medicaid eligibility. While many perceive it to be too expensive to implement, health care service providers should welcome this reform given its potential opportunity to improve accessibility to and quality of health care services. This reform will for sure improve health care service delivery among low-income citizens. I even wonder why some states are thinking about cutting expenditure costs on the Medicaid program. Instead, they should work out means to ensure that the poor get access to cheap and quality health care whenever they need it.
However, we cannot fail to recognize the high expenditure challenge that this program presents. Both the federal government and individual states will have to increase their budgetary allocation to take care of the additional population in the program. Successful implementation of the program also needs proper coordination to ensure that the program achieves its intended goals.
References
Kaplan, T. (2011). Cuomo’s Budget Strategy, Getting Adversaries to Suggest Cuts, Is paying Off. The New York Times. Web.
Kovner, A. R., & Knickman, J. R. (Eds.) (2008). Health care delivery in the United States, 5th Edition. New York, NY: Springer Publishing.
Kronenfeld, J. (2002). Health care policy: issues and trends, volume 759. Westport, CT: Praeger Publishers.
Lundy, K. S., and Janes, S. (2009). Community health nursing: caring for the public’s health, Second Edition. United States: Jones and Bartlett Publishers.
Marmor, T. R. (2000). The politics of medicare, Second Edition. New York: Aldine de Gruyter.