The Medicare and Medicaid systems are among the most important elements of the US health care system, although they are often subject to excessive criticism. The advantages of these systems are more significant than the disadvantages, and a detailed analysis of the included processes and the results and consequences of their operation is difficult to overestimate. Most importantly, the programs helped the state overcome the problem of total non-provision of medical services to more vulnerable categories of the population, such as the elderly and less wealthy groups. Today, people with average incomes are also in a difficult situation in terms of obtaining medical services. In most cases, health insurance services are provided by the employer and are too expensive to pay for on your own. The creation of a national healthcare insurance system, which would provide services to all citizens, is an urgent need of society. This paper analyzes the reasons why the national healthcare insurance program should be implemented and presents critics on how the initiative should be realized.
Historical Background and Reasons for Expansion
Medicare and Medicaid are two programs that constitute the only insurance system for elderly and needy people in the US. Initially, Medicare, which was launched in 1965, was a kind and generous solution, as it allowed older people to get the medical care that they were deprived of. Medicaid which was established in 2001 had a similar effect on people of younger generations who were facing financial difficulties (Agraval et al., 2020). However, time passed on, and eventually, some critics noticed that Medicare focuses exclusively on older people – a category that requires the highest amount of medical attention, and that receives the highest percentage of medical care, including the most expensive cases. This focus was implied to lead to an increase in the cost of premiums paid by these people since the mentioned tendency dramatically increases the potential of insurance cases to happen.
Therefore, today many scholars think it is feasible to expand the two programs, which operate similarly, into national health insurance available for all Americans. There are fears that such a move can increase the load on governmental spending since the programs are partially sponsored by it. However, the experts say that since the whole population will take part, the probability of the insurance cases will be significantly lower, meaning that the premiums will become significantly lower as well.
In other words, now high premiums reflect the higher costs since the care receivers who participate in the programs are among the groups with the highest demand for medical care. But when all groups of society will enroll, the average costs per person will become much lower. People who require less care may disagree saying why should they pay more, but, in the end, everyone becomes older and therefore will sooner or later benefit from the expansion initiative. No less importantly, most adults receive insurance packages at their jobs, and when losing one they become tremendously vulnerable and unprotected in case of illness. Therefore, implementing the expansion initiative will make a lot of people more protected and positively assured about their future.
Access, Utilization, Technology, Cost, and Growth Concerns
Importantly, a realization of the national health insurance initiative will probably have significant implications on access, utilization, technological advancements, cost, and growth in the US economy and through the national healthcare system. Now, health insurance packages are only available for older people, those in need, and those who are currently enlisted at some type of official job. Inviting more participants to healthcare insurance will presumably increase access, while also balancing and eventually increasing premiums.
No less importantly, increased access and revenues may lead to the involvement of a higher number of caregivers leading to better competition terms and improved quality of healthcare. Waiting time can increase as well, but only in the beginning. Interestingly, technological advancements can also be stimulated in the framework of the initiative since new higher premiums may cover the related costs. Most importantly, the increased access will stimulate the overall growth of the industry and the US economy.
In other words, the national healthcare insurance initiative is highly feasible. This can be proven by the current positive influence of Medicare on the US healthcare. For instance, today less than 1% of older Americans lack insurance or access to treatment, while medical costs have decreased for older adults by 40% (Agraval et al., 2020). Medicare has also promoted forward-looking payment systems for billing health care providers, including the innovative development of the resource-based relative cost scale, which has led to more transparent and fair calculations of the cost of treatment outside the health insurance system. This insurance system also contributed to the transformation of the entire hospital system by attracting funds from the users of the system. In addition, Medicare stimulated the introduction of new medical procedures and technologies.
Reimbursement Methods of Future National Health Insurance
Currently, Medicare uses particularly effective reimbursement methods, such as resource-based relative value scale (RBRVS) introduced for physician payments. The system proved its efficiency by establishing a more manageable relationship between costs, quality of services and premiums. Today, the program reflects financial transactions in the amount of one eighth of the federal budget or 3% of GDP (Agraval et al., 2020). The effectiveness of the reimbursement system presented by Medicare is also proven by the fact that it led to a reduction of private firms in pension medical care from 66% in 1988 to 21% in 2009 (Agraval et al., 2020). Equally important, the program ensures stable receipt of insurance payments by users, unlike private companies that have the risk of corporate restructuring or bankruptcy.
Reimbursement methods of Medicare also have certain disadvantages that should be listed. These include the growth of the cost ratio, which leads to a negative balance with a projected growth of 5.5% of GDP until 2035 (Agraval et al., 2020). Mistakes that led to such a situation can be considered unsuccessful attempts to unite competing suppliers due to conflicting interests. Therefore, experts suggest several improvements in the financial part of the program. These include implementing privatization with a voucher system for beneficiaries, increasing program revenues, reducing costs, including through negotiations with pharmaceutical companies, and implementing best practice processes.
It is interesting that some reforms of the program have already been carried out, which led to stable improvements in medical practice. In recent years, fraud and abuse schemes have been eliminated, the system of interaction with pharmaceutical companies has been improved, reimbursement methodologies have been changed to pay-for-performance systems, and the implementation of best practice processes has begun. Importantly, the increase in the right to receive insurance and the eventual extension of this right to all citizens will significantly contribute to the growth of the program’s revenues and the reduction of costs in the future through the introduction of innovations.
Necessary Operational Changes
Although most current services provided in the framework of Medicare involve adequate operational practices, some changes may still be necessary. For example, there is a need for stimulating research on the implementation of new medical procedures and technologies. The industry is always in need of investment in premises, equipment, technology, personnel, and treatment. Given the rising costs of hospitals and the demand for medical services, operational changes can be associated with hiring more employees, which will also reduce problems related to the shortage of nurses due to excessive workloads (Griffiths et al., 2020). Due to the increase in the intensity of treatment and costs, the quality of services gradually increases, which leads to further longer-lasting treatment results.
The new ability for people to pay for treatment through a unified insurance system will enable new technologies and practices to be implemented. Currently, problems in operational practices that need to be solved also include excessive use of medical resources, including excessive administrative and paperwork costs due to different billing systems. Another problem is the tendency to provide redundant services due to fear of potential medical malpractice lawsuits. Inconsistency among the interest groups that defend the system at the federal level is another problem.
The mentioned problems in many dimensions reflect problems in the health care system as a whole and need to be solved at all levels. For example, the introduction of stimulating the development of technologies will help to overcome the problems of poor health outcomes among the most vulnerable population groups (Valdovinos et al., 2020). Preventive medicine is another aspect that needs improvement and could be more widely implemented with the adoption of the new national insurance system. Alignment of administration and document management practices is another problem that can be easily solved by attracting additional investments that will appear thanks to the initiative.
To be more precise, physicians and nurses can implement new payment and EHR administration systems. Hospitals can also introduce new technologies in treatment by purchasing appropriate equipment, such as robots for patients in infectious disease wards and new sensor systems for intensive care units, pre- and post-operative units (Makhni et al., 2021). In the future, patients will receive better care through telemedicine practices, and experience the benefits of compliance with higher standards when visiting patients at home within the framework of family-based care. National healthcare initiative can also stimulate cooperation between government and insurers. For example, insurers can propose new systems of compensation and government support and strategic plans to increase revenues and reduce costs through a more competent approach to providing services to the population.
Thus, the reasons why national healthcare insurance programs should be implemented were analyzed, and the critics regarding the ways of such implementation were presented. The reasons include the potential to improve the country’s health care system from a financial perspective, and the possibility of parallel implementation of new service delivery practices. Reimbursement systems can also be reformed, drawing on Medicare’s experience and correcting existing errors. The introduction of national health insurance can become no less successful reform than Medicare, and lead to the maximum balance in terms of access, utilization, technology, cost, and growth concerns. A comprehensive review of existing processes can lead to increased access to health services, including preventive medicine, lower costs due to successful competition among service providers, and increased opportunities for the introduction of innovative practices and technologies due to increased income from service recipients.
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