Brasfield 6-end

This section begins by stating a major problem with American Health Care: coverage for the aging population.  Brasfield states that nursing homes are an expensive and relatively recent institution, beginning in the mid twentieth century.  Care for the elderly has evolved from what once was a family responsibility to what is now a complex, socially regulated institution, as seen in its effects on the Hill-burton hospital construction act, the MAA, and other acts specifically created to pay for our aging population.  With the government providing payment in most of these legislative additions, it questions the validity of switching what was once a familial matter to a financial burden on the public.  A particularly interesting statistic that Brasfield mentioned on this matter was the fact that private insurance pays for less than 10% of all long term care services. In my opinion, this really brought home both the biases of private health insurance for making it difficult for the elderly to obtain coverage and the magnitude of financial burden the elderly and disabled have on the national economy.
In the next chapters, Brasfield describes the ACA and speculates about its future along with citing some examples of health care systems of other countries.  He list ways which the law would be repealed if Republicans were to take the majority, stating that the most viable path would be through the legal action of questioning the reforms constitutionality.  Brasfield also offers some inconclusive speculation on the bill's effect on the national deficit.  With the current state of the US economy I feel the financial side of this bill is the most important, and with our aging population it seems unpromising that the ACA can lower the national deficit.  Through this course, I have decided that my opinion as a whole on health reform would be to provide only the essentials to those who don't contribute to the tax base while leaving the maximum choice to those who do.  I feel that money should buy people convenience and comfort and those that don't have it should be left with something to gain; otherwise what would be the incentive for earning it?  Through the readings, I have decided that the ACA has a noble purpose but its financial issues are too unclear for it to be a completely agreeable bill, especially given the current economic climate.

Brasfield 3-5

In this section Brasfield focuses on the specific institutions of Medicare and Medicaid and each of their respective contributions to the issue of uncontrolled costs.  In Ch. 3 he describes the evolution of medicare and how, during the Bush campaign, it was proposed to include prescription drugs.  one major issue he chase to highlight was whether the biggest monetary risk should be put on the government or the insurance plans.  A compromise, called the doughnut hole, was thought up to solve this issue.  It suggests that after a copayment of 25% the person would be fully responsible to pay out-of-pocket and once they reached a certain amount medicare would pay 80% to the enrollee's 5%.  This out-of-pocket "doughnut hole" gap was used to bridge the gap between the insurance plan paying the majority in the beginning to the government paying the majority in the end.  I found this to be an interesting way for a cost solution to develop, but I feel it still puts too much pressure on the enrollee for them to have to pay completely out of pocket for up to $4550.  It was also interesting to see the origin of the social insurance vs. privatization.  The premium support system idea on the side of privatization is similar to the current system with the difference of allowing plans to discrimination against unhealthy participants, but is this a thing insurance plans should be prohibited from doing even if it helps them control their costs?
In the next chapter it was interesting to learn at just how huge the medicare program had grown to.  A particularly surprising figure was the fact that medicaid funds 4/10 births in the US.  With close to half of the births in the US to be from families under medicaid show that a disproportionate amount of people are being born into poverty, and with cases made for the inescapable nature of the American poverty cycle, this could become a major factor in increasing health care costs.  This also brings up the recurring issue for the government funding of contraceptive measures.  Overall what I gained from this reading, and many of the preceding assignments, is that there are an overwhelming amount of historical and monetary aspects to health reform and these contribute to the ambiguity of the decision making process when a reform is put to a vote.

Brasfield 1-2

 In this book Brasfield  presents the information in a very scientific fashion.  In the first chapter he goes over many of the historical event we learned in previous books.  He does not give many personal examples of how the health care system has affected him, but he gives many researched statistics on the economics of our current healthcare system.  Among these statistics, one I found surprising was the concentration of healthcare spending in our population.  The bar graph displayed that half of all health care cost is accounted for by only 5% of the population.  This brings about the issue of how health insurance should charge its users.  If it functioned like other insurances by charging those who used it most often a larger fee, the sickest people would eventually go broke (as many do currently).  Also, it doesn't seem right to charge patients for pre-existing conditions if it is not their fault.  Is a patient to blame for their health condition? In my opinion this is what sets health insurance apart from other insurances.  Unlike something like auto-insurance, a patient is not always to blame for their health.  There are other factors like bad genetics or bad environment that can affect a patients health.  So it seems if health insurance was to function this way there would be a fair amount of discrimination towards the people who would need the service the most, which suggest the government should be involved to avoid this.

Altman Part 4

In this section of the book, Altman described all aspects of the Obama plan for health reform.  He summarized Obama's plan at the end of Ch. 11 as essentially a near universal system achieved through an expansion of Medicaid, insurance reform, and employer mandates.  A main issue with the Obama plan was how to control the already high costs.  Altman was apparently a big contribution to this issue in the obama plan, as he claims to have recommended the cost control measure in the Obama plan.  Altman is realistic on this topic, stating that high reductions of costs are fairly unlikely in the future.  The main thing that stuck out to me in this section was the amount of negotiating that had to be done in order for any reform to pass through our bureaucracy.  Obama's plan couldn't be as comprehensive or universal as he wanted it to be because he basically had to deradicalize his reform ideas to an addition to existing medicare and medicaid in order for it to be politically viable to pass.  What also caught my attention was the amount of social implications that come along with homogenizing a healthcare system.  Issues such as paying for contraceptives bring a whole element of morality in the issue of what the government should use its taxpayers money for.  These social issues become major problems when a reform is votedon in the house. In my opinion I contribute these problems to the lack homogenization in our country.  The different areas of our country (rural vs urban) have their own culture that affect their inhabitants opinions.  Since individual states have a more homogenized culture within them than the United states as a whole, I feel it would be best to leave more power in the states' governments on this issue.

altman pts 2-3

This section of the book went into more detail of the specific laws that have been attempted or passed on the subject of healthcare reform.  Among these laws was the Hill-Burton act, which had something to do with the government funding of hospitals. It was Interesting to see how certain court cases like the one involving Marilyn Rose can expand the powers of a bill.  I was surprised at the effect this law could have on individuals such as the pregnant woman who was sued for overstaying her medicaid coverage at a hospital.  This section also gave insight to the intense amount of politics in many of these bills.  The efforts of the AMA in denying the surgeon general's conclusions on smoking and cancer to win a congressman's support was especially shocking.  It was also interesting to see the role of race on the southern states acceptance of federal controlled health, as seen in the pursual of Wilbur Mills vote. Aside from the legislative pressures, the sections also discuss the financial issues with the bill after it passed, such as the federal "matching" of state funds that could result in the federal government bearing close to 75% of the burden in some cases.  This results in the annual $2.5 trillion we currently spend on healthcare.   This turned out to be a problem, especially in recession years.  The magnitude comparison Altman gives in section 3 on the size of a trillion was eye-opening.  Through this section Altman goes over the specific variables that make cost control so difficult for the American Health care system.  Altman concludes the section by comparing the present prices of the US healthcare system to the costs of other developed countries: it is apparent that there needs to be a change.

Altman part 1

Altman began the book by telling about his personal dilemma of deciding on whether or not to put his 96 year old mother through triple bypass heart surgery.  He did this to introduce the problems with American healthcare. He personally faced a decision on whether to put his fragile mother through a possibly life threatening procedure or to let her die naturally.  He said cost was not a central issue in his problem despite the fact that it is among the most prominent problems in the American system.  The rest of the section was devoted to thoroughly describing the attempts of the Nixon and the Clinton administration to improve the american healthcare system.  In Altman's description of the Nixon attempts he mentions the emergence of the HMO idea.  I found his description of HMO's interesting because before reading I had only heard of the name.  I feel the HMO model is a good concept for governmental cost control in its set salaries for doctors; however i also feel that this practice could harm the quality of care that doctors give by decreasing the incentive for quality care and also decreasing the incentive for student to become doctors.  

Altman also described the attempts of the Clinton administration and I was surprised at how fiscally centered many of his plans were. Due to party stereotypes, I would have assumed the Clinton administration would have been less fiscally responsible. At the end of this section Altman described earlier attempts at universal health care by the bolsheviks, and by FDR (which we read about in the last book).  I found it interesting to see how the issue evolved both inside and outside the US.  

 

Paper topic

My initial topic idea is to write on the conflict between the AMA and the proposal of Medicare.  I have also been thinking about writing on the Americans with disabilities act and the problems and benefits it brought about.