6. What can we learn from other countries in formulating recommendations to improve the U.S. health care system?

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. When comparing the United States to nations such as Australia, Canada, Germany, New Zealand and the United Kingdom, our health care system ranks last or next-to-last in five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country that does not have universal health insurance coverage, partially accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. is behind in adoption of information technology and use of nurses to improve care coordination for the chronically ill. The U.S. health system is the most costly in the world, but relative analyses again and again shows that the United States underperforms in relation to other countries on most dimensions of performance.

What the United States must learn from these other countries is that they need to do things more efficiently in order to reduce the cost of health care overall. They must work to improve quality and access. Everyone should have access to good, quality healthcare at a price that they can afford. This country needs to leverage information technology in order to help improve in the areas that they are lacking so that they can become competitive with other countries around the world.

For a country that spends as much on health care as we do there is no reason that the quality and outcomes of health care should be what they are. We have the technology we just need to figure out to make it as useful as possible in order to benefit as many people as possible.

7. Why not allow health care costs to continue to grow until they reach 20% or more of the gross domestic product?

Allowing health care costs to continue to grow will do nothing except hurt everyone in the country in the end. The American people have seen their out-of-pocket expenses climb, health care costs rise, and premiums double at a rate four times faster than their wages have. Currently, half of all personal bankruptcies stem from medical expenses. Too many Americans are forgoing routine check-ups that they know they should get, or going without that prescription that would make them feel better, or finding some other way to scrimp and save on their health care costs.

What has become a growing emergency for the American people is also turning into an unsustainable burden for America's businesses. Increasing health care costs are controlling more and more of the money that companies could be using to innovate and grow, making it harder for them to contend around the world. These costs are causing the small businesses that are accountable for half of all private sector jobs to drop coverage for their workers at a disturbing rate. The explosion in health care costs has put the federal budget on a disastrous path. This is largely due to what we're spending on Medicare and Medicaid, which is expected to continue climbing in the years ahead as baby boomers grow older. As a nation, are now spending a far larger share of our national wealth on health care than we were a generation ago. At the rate we're going, we are expected to spend one fifth of our economy on health care within a decade. And yet we're getting less for our money. In fact, we're spending more on health care than any other nation, even though millions of Americans don't have the affordable,

What should be the role of state governments in health care? Discuss the arguments pro and con for standardizing Medicaid across states.
The history of health care regulation in the United States begins with the state level of government. The state has traditionally had jurisdiction over physicians, nurses, and other health care professionals, as well as hospitals and clinics, and sanitation, disease surveillance, food safety and other general health matters. This is for two reasons. First, most health care functions were limited to local populations, so it was logical for the state to regulate them. But, more importantly, the state government has legal jurisdiction over local matters of public health and safety. Each state government has the general power to protect the health, safety, morals and order of the population within its geographic boundaries. This power gives the states very broad authority to pass many kinds of laws to protect the health and safety of its residents, as long as the laws do not interfere with the rights of individuals that are guaranteed by the constitution.

One of these programs that the states oversee is that of Medicaid. There has been talk of standardizing the Medicaid program across the states instead of letting each individual one regulate it as it is now. The use of standardized federal enrollment forms would help to capture key beneficiary information, such as phone number and e-mail address. A second thing that standardization would help to do is that of simplifying the recertification process. It is important to keep beneficiaries enrolled in Medicaid to promote continuity of care and avoid lapses in coverage.

The down side of trying to implement standardization is that there would be an initial cost of putting in a universal computer system that would allow all the states to be on the same page at the same time. This would be a necessary component of universally carrying out the Medicaid program as a whole.

9. How can we improve government regulation of health care organizations, pharmaceutical companies, health insurers, and health care professionals?

Under principles of U.S. law, states play the primary role in regulating health insurance. However, there are hosts of federal laws with a limiting and pre-emptive effect on state insurance regulatory powers. Depending on the state's labor patterns, federal law may have a considerable impact on limiting a state's power to affect insurance regulation. The extremely fragmented and segmented nature of the health insurance market, coupled with a raft of pre-emptive statutes, poses both financial and legal challenges to states. Even where state regulators can access employer plans, as with products sold by licensed health insurers, insurers may strongly resist regulation to avoid what they perceive as changes that will affect both their employer-insured and self-insured markets.

Improvement in government regulations need to take place in the form of closing the gaps that exist because of the fragmentation and segmentation that currently exists. Things need to be made easier and more universal. Everyone needs to be on the same page and playing by the same rules. Standardization is the key to better regulation. Everyone needs to understand what the rules are and how to play by them no matter what state they are in or what part if the country they are in. Having universal regulations for all sectors of the health care system would allow for best practices to be implemented which would not only help to better manage the system, but would also allow for decreased costs along with improved quality of care and patient safety. Basic changes in regulations could result in states being able to better manage health care at the state level which would lead to improved outcomes for those who utilized the health care system. Having access to quality health care that is affordable is a goal of all Americans not matter what state they reside in.

References

Kovner, Anthony R. And Knickman, James R. (2008). The Future of Health Care Delivery in the United States. New York: Springer Publishing.