Question

Write a 1,000- to 1,200-word essay comparing the U.S. health system to another country’s health system.

1. Describe the type of health care coverage and quality between the U.S. health system and one other country.
2. What percent of gross domestic product is used for health care, and what is the average life expectancy ? Be sure to include the terms of costs, service levels, equity, access, and resource inputs for both countries.
3. Explain if the other country has achieved adequate health outcomes, and if it has managed to do so for less money.

Use a minimum of three scholarly sources, including the textbook.

Answer 1

Rather than one system, United States citizens and residents are insured under a variety of sometimes overlapping systems. The United States is also the only developed country where a significant number of citizens are permitted to be uninsured and where a person’s employment can determine whether they have insurance and what insurance they have. As of 2015, 90.9% of Americans had health insurance, with 55.7% receiving coverage through their employer, 16.3% through direct purchase, 16.3% through Medicare, 19.6% through Medicaid, and 4.7% through the military.⁹ The individual sources of coverage add up to more than the total coverage because of overlaps (for example, “dual eligibles” who are enrolled in both Medicare and Medicaid).

The majority of Americans and their dependents are insured through their employer, with the employer generally bearing a significant portion of the cost. Federal law requires insurance to continue to be offered to former employees, but the entire cost is bore by the insured, who often choose to not pay the premium unless they are sick. Employer-based insurance isn’t directly subsidized, but receives a “hidden” subsidy, estimated to be worth $260 billion dollars per year, due to premiums being tax exempt. This tax exemption is not available for insurance purchased in the individual market.

Title XVIII of the Social Security Act was passed in 1965 and introduced Medicare and Medicaid, which have both expanded since.¹⁰

• Medicare, which is funded by payroll taxes, premiums, and general tax revenues, provides coverage for people 65 and older and also those with qualifying conditions and disabilities under the age of 65. Medicare eligible people may also purchase supplemental insurance from insurance companies or heavily subsidized full-replacement insurance called Medicare Advantage.
• Medicaid is an insurance program for the poor administered by the states and funded with federal and state general revenues. Eligibility for Medicaid was significantly expanded under the Affordable Care Act in 2010 for states that chose to participate.

Besides expanding Medicaid, the Affordable Care Act (ACA) in 2010 introduced an insurance mandate and government-run insurance marketplace with subsidies for those without other coverage. It also eliminated most forms of underwriting and prohibited insurers from refusing coverage for preexisting conditions. Prior to the implementation of the ACA, the uninsured rate was 13.3%.¹¹

The Veterans Health Administration (VA) provides care for nearly 9 million veterans annually. The system is an example of socialized medicine, with 1,700 hospitals, outpatient clinics, counseling centers, and long-term care facilities owned directly by the federal government and most providers employed by the government. Due to a severe limitation in resources, Congress has directed that priority in treatment is given to veterans most in need, with those with significant disabilities at the top of the list.

Approximately 1/3 of doctors in the US are primary care and the rest specialists. 70% of hospital are non-profit, 15% are for-profit, and 15% are government-owned.

The United States spends far more on health care than any other country. In 2015, total spend was 17.8% of GDP, $3.2 trillion dollars, for an average of $9,990 per person.¹² Of this spend, 49% came from public sources, 39% from private insurance, and the remainder from out-of-pocket costs