U.S. Health Care System

¶ … cornerstone beliefs of the American healthcare system -- indeed the American system of government in general -- are the values of individual liberty and private enterprise. This is why private, employer-provided insurance has dominated the healthcare market up until this time, despite the fact that the other major industrialized Western democracies consider healthcare a right, not a privilege, and have enacted either substantial government regulations to ensure that all citizens are ensured or created a system of government-provided insurance known as the single payer system. This ideal of 'choice' in the United States has made extremely high-quality healthcare available to a lucky few who can afford such care or who have jobs which offer extensive healthcare benefits. This, until recently, left many Americans uninsured. The profound resistance to the Affordable Healthcare Act amongst a substantial minority indicates the extent to which fears of 'socialism' outweigh the positive concept of providing healthcare for all, regardless of employment or income status.

American healthcare is extremely expensive, results in poorer health for the uninsured and ironically 'selectively' insures through government insurance a handful of persons (the poor through Medicaid; the elderly through Medicare and veterans). Rising costs due to inefficiencies of care and a lack of coverage caused America, "according to the Business Roundtable Health Care Value Index" to be judged inferior in terms of competitiveness to Canada, Japan, Germany, the United Kingdom and France" because of the financial drain healthcare extracts from businesses who must provide benefits to employees and the excess bureaucratic waste financing care through private insurance companies generates within the healthcare system itself (Healthcare value index, 2009, Business Roundtable). Yet Americans -- even those who benefit from social programs -- remain stubbornly fearful of the specter of 'government' controlling medicine, although healthcare insurance companies (monolithic bureaucracies themselves) exercise tremendous sway over how care is provided.

Q3. Managed care entities use a variety of mechanisms to monitor and control utilization of services. One such example is capitation or "a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided" (Alguire 2013). This is to ensure that physicians are not incentivized to provide more care that might be necessary simply to profit. The downside is that there is an incentive to accepting more patients than the physician can feasibly care for to get the payment and that because there is no financial incentive to provide additional care, the physician might withhold needed services. In another model of this attempt at cost control, physicians might even be financially rewarded by MCOs for keeping costs down rather than for providing services alone, which again raises fears that necessary services will be rationed.