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Introduction

The Center on Budget and Policy Priorities (2008) estimated that 15.3 percent of Americans were uninsured in 2007, or 45.7 million Americans. President Barak Obama and Vice President Joe Biden have proposed a plan to address the need to increase medical coverage and access to care for many of those who are uninsured or of lower income status (Obama & Biden, 2009). This program, which implements a form of socialized medicine, is not new. It has been adopted by many other countries with varying success. The reasons behind the violations of universal health care directives have been historical in nature. These include; rationing of medical care, distributive justice, scarcity of resources, and coverage for catastrophic illnesses, funding for the program and containing costs. A discussion of the recent efforts towards the achievement of a universal health care coverage would shed more light on this topic.

DISCUSSION

Bodenheimer and Grumbach (2005, p. 151) define rationing as the limitation of resources, including money, going to medical care such that not all care expected to be beneficial is provided to all patients; and the distribution of these limited resources in a fair manner. In the United States, money is becoming scarce, rather than Health commodities (Bodenheimer & Grumbach, 2005, p. 151.) In other countries, health commodities are scarce, and must be rationed in an equitable fashion. The scarcity of money available for medical care in the United States has significant implications with regard to justice in health care among patient populations.

Distributive justice is the determination of who receives what amount of health care, wealth, education, and who pays for medical care (Bodenheimer & Grumbach, 2005, p. 148.) A central question that varies from one health system to another is whether resources should be allocated based on need or based on one’s ability to pay. In the United States, resources are allocated for the neediest and seniors via Medicare, Medicaid and SCHIP. Otherwise, just allocation of health resources is based on one’s ability to pay. According to Royner (2008) the true costs of the plan are very difficult to measure. The United States is projected to pay about 460 billion dollars for Medicare in the year 2010, and spends 21% of the federal budget on health coverage to include Medicare, Medicaid and SCHIP (Westmoreland, 2006). In the year 2006, the United States engaged in about 600 billion dollars of deficit spending (Westmoreland, 2006). Can the United States afford to add to its health system expenditures in order to increase access to care?

A second challenge lies in the marketing needed to get the legislation passed. Former President Bill Clinton failed to pass similar health care reform legislation in 1994. Democratic House Majority Whip James Clyburn endorses an incremental approach to health reform legislation (Kaisernetwork.org, 2009). Concerns exist as to whether trying to pass large scale expensive changes may reduce the potential for such legislation to be passed. Former President Clinton has gone on the record as opining that the Obama health care reform proposal has a better opportunity to pass than his proposed legislation did due to the poor economy and ballooning deficit spending that currently exist (Kaisernetwork.org, 2009).

SUMMARY

The three things I have learnt and totally agree with is that there is a general abidance on the need to institute a universal health coverage, most Americans cannot afford quality health care and that efforts to achieve a universal health coverage have historically been violated.

Given the statement on what I have leant, statement, one might anticipate resistance on the part of Managed Health Care special interests to a government payer tax based health care system. Distributive justice, as it stands in the United States, leaves about 46 million people without affordable access to health care. Health care in the U.S. is not rationed due to limited medical facilities, providers, or resources; but rather by scarcity of money. Specifically, citizens who do not qualify for government funded programs like Medicaid/Medicare and who are uninsured find themselves without access to health care. As the United States under the leadership of President Obama, embarks on a pathway that will result in a paradigm shift away from capitalist based medicine and toward a more socialist form of medicine, the aforementioned are only a few of the challenges that exist.

RECOMMENDATIONS

The author believes the health reform package, as it is presented, faces numerous obstacles. The costliness of the plan, the poor state of the current economy, and the difficulty in marketing and passing health reform legislation are only a few. In addition, there are a good number of Americans who now have good access to care, and may be subject to changes that reduce the freedom of choice and standard of care they are accustomed to in order to make health care more equitable in our country. These individuals may be resistant to downgrading the care they currently enjoy. Also, special interest groups serving managed care organizations will most certainly be resistant to the government payer plan and exert their influence upon legislators. Countries who have adopted similar health care reform have discovered difficulty in cost containment and challenges in rationing health care resources.

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