Over the last ten years, there have been numerous technical advances in medicine that have improved healthcare and quality of life. These are usually well publicized by those who practice medicine, nursing, and the many other healing arts. However, these developments can’t help people unless delivered to those who need them. Public policy regarding the health care delivery system has changed significantly over the last ten years.
Several of these changes have been beneficial. The creation of Medicare Part D to provide some coverage for drug costs started in January of 2006 and it has provided a little relief for those with no drug coverage at all. The Affordable Care Act (ACA, or “Obamacare”) will eventually increase coverage for those on Medicaid, or requiring mental health care, along with individuals with low incomes or poor insurance. How extensive these benefits will be cannot be determined until the government’s website is fully implemented and resistance from Republican dominated states is overcome.
Other 10-year trends are not so beneficial. Total costs for healthcare in the country are about three trillion dollars and 18% of the GNP with both figures much greater than 10 years ago, and far more then any other nation. Healthcare outcomes, however, lag far behind these other less expensive systems.
Employer-based insurance has either gradually deteriorated or become significantly more expensive, often triggering labor disputes.
Privatization has expanded with about one third of all Medicare recipients, many Medicaid recipients, and everyone on Medicare Part D all being enrolled in private, usually for-profit, insurance plans. This means that the marketplace rules medicine and services which are profitable are delivered. Those which are not profitable are often not provided and the actual healthcare needs of various populations and individuals take second place to financial considerations. The ACA also uses the private marketplace with no public option; that is an option to buy into a new government-run program or even to buy into Medicare or Medicaid. Privatization has been lauded as a way to control costs and improve quality, but the statistics mentioned above make clear that this has been a complete failure, except for those people who run the corporations.
What appears to be a beneficial trend may have some negative side effects. Over the last 10 years there has been a national policy of replacing institutional care with community-based care. Whenever possible, in-patient hospital care is replaced or supplemented with community-based primary and home care. Assisted living facilities are attempting to replace nursing homes, at least for some patients. These trends may help to control costs and improve the quality of life for many people. Yet sometimes, de-institutionalization occurs where there is insufficient community care, especially in economically poorer or rural areas. There is also a tendency to make these changes in a wide shotgun type manner with little consideration for local needs. The abrupt closing of hospitals seen in the West Village and New York City occur throughout the country and with similar declines in services.
Can these negative trends be changed in the next 10 years? The challenges for political leaders, from the new mayor to the next president are clear (WestView News, October 2013). Market driven policies must be replaced with healthcare driven policies, privatization must be stopped and reversed, and the downgrading of institutional care must be coordinated with healthcare needs and the availability of replacement services. Additionally, of course, there is always the single payer option, waiting for its chance to replace the whole damn system (WestView News, June 2013).
Republican dominated states are trying to undo the gross socialistic Obamacare system. It will break our country. Even Russia abandoned it after ten years.