William Guttilla_Week 7_Health Care Around the World

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Health Care Around the World William Guttilla Health & Illness in Social Context (SOC2400) Professor: Jennifer Worley

When it comes to health care, the United States spends more money than any other country, yet the United States has the lowest life expectancy rates, this includes suicide which is also higher than other countries. Although the U.S. is a “leader” in the health care industry, one has to think, if the U.S. is that much of a leader in health care, why are the American people so unhealthy and not live as long as others around the world? The need to make money by insurance companies as well as pharmaceutical companies has to be addressed, although the government does have insurance coverage for those that cannot afford it or do not have jobs, there is still many under-insured individuals since insurance coverage does not cover all expenses. One of the key features of the health care system in the United States and in another country is the absence of universal health insurance. The World Health Organization, WHO, defines universal health coverage as allowing all people to have access to quality health services they need, when and where they need them, without financial responsibility or hardship. Universal health care covers all essential health services, including health promotion to prevention, treatment, and rehabilitation and palliative care. These services alone in the United States are available, but unfortunately not to everyone. Those that have access to these services also pay a price to receive them. The price they pay is usually out-of-pocket costs associated with these services that are not entirely covered by health insurance, which is also paid for out of pocket. There is no out-of-pocket costs within the universal healthcare system. The United States does not see how important access to health services and information is to all, it seems like it is a privilege to have health insurance rather than a universal basic human right. In Germany, not only is health care universal, but it is also mandatory to have health insurance. According to

commonwealthfund.org, approximately 86% of Germany is enrolled in what’s called statutory health insurance, this insurance provides inpatient, outpatient, mental health, and prescription drug coverage. The government has virtually no role in the direct delivery of health care, administration of health care services is handled by non-governmental insurers known as sickness funds. These sickness funds are financed through general wage contributions by the population, however, there are copayments that apply to inpatient services and prescription drugs. The United States unfortunately does not have a mandate to ensure all its citizens have health insurance, making the costs of health care unwarranted. If every person in the U.S. had insurance, it may be justified as everyone would have access to treatment that could be costly, but also routine treatment such as well visits, physicals, etc., thus, making funding available to cover these services, not seem as if it is about making a profit. The U.S. and Germany are similar as both governments do provide health insurance, but they are not the same with how the coverage is provided. The United States has more political say in the health care industry than actual health care providers. Decisions of medical necessity are often dictated by finance people that can decide to allow a test to be performed or reject the coverage of the test based on a financial decision, not a medically necessary decision. There are also diagnostic testing and hospital stays that are determined by the insurance company, not the doctor, and the insurance company can say it is not needed or the person doesn’t need to stay longer than a set amount of time. This is the U.S. system of health care, politicians making promises to voters to try and change a system that is very corrupted and driven by greed, rather than providing services based on the type of insurance one has and what is covered that determines if the treatment is necessary. The insurance industry in the U.S. is very powerful, it is a money-making engine that

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benefits those that are with them and their policies, not the policies that could and should be put forth by the government. The German health care system is notable for sharing of decision- making powers among the federal government, state governments, and the self-regulated organizations of payers and providers. While most German citizens have statutory health insurance, there are other citizens that can opt to have private insurance. This makes sense since those that choose to have private insurance can pay for their own insurance coverage, there is a minimum gross earning that can qualify you to have private insurance, but, unlike the U.S., those that have coverage through the benefit funds or private insurance all receive care from the same providers, it doesn’t matter like in the U.S. what doctor you can see, it is kind of like a universal network of providers that all providers are in the network. If you want to see a certain doctor, you can, unlike in the U.S. you cannot see a provider if they are not in your network. You can see an out of network provider, but it is usually at the full cost of the individual. Payment structure is also much different in the U.S. and Germany, doctors do get paid in both countries, but the U.S. allows the insurance companies to decide how much they pay a doctor or hospital for their services. Fee-for-service is the primary payment method as doctors are paid a set amount for each of the services they provide. These fee schedules can vary by payer in the U.S., often payers that pay less than others do not have as great of a provider network as others. Doctors can choose to see Medicare or Medicaid patients in their offices, if they choose to do so, they have to become a participating provider, if you choose not to, this excludes those patients with either type of coverage. In Germany, there is a universal fee schedule which means all doctors receive the same reimbursement for the same services they provide. Whether you have statutory health insurance or private health insurance, there is only one provider network and one fee schedule. This will never happen in the U.S. because, as I

mentioned earlier, the insurance companies dictate all policy, and the government does nothing to regulate the insurance companies. According to healthsystemtracker.org, the life expectancy in the U.S. has decreased over the last two years, since the Covid-19 pandemic, but prior to Covid, the U.S. life expectancy was on the decline. The average life expectancy in the U.S. decreased to 76.1 years in 2021, down 2.7 years from 78.8 years in 2019 and down 0.9 years from 2020. The average life expectancy in other countries was 82.4 years in 2021, down 0.2 years from 2019, and up 0.4 years from 2020. The average life expectancy for a U.S. male is approximately 73.2 years and a female is 79.1 years. In Germany, the average life expectancy for a male is 78.2 years and a female is 83.2 years. These statistics show the better the health care system and their outcomes, the longer people live. It is no wonder so many people out live Americans, their health care systems are driven by positive and healthy outcomes, where the U.S. health care system is driven by politics and profit. Two aspects of the U.S. health care system that need improvement are laws making it illegal for someone not to have health care insurance and the government must step in and make universal policy changes for all insurance companies. Health care insurance should be a basic human right for all in the U.S., just as much a right as freedom of speech or freedom from religious belief. There is so much money that is spent on our country’s defense, the environment, and even money sent to other countries, yet there is never enough money to help keep our citizens healthy. If people are not healthy, how can we defend our country? Why are other countries receiving money from our government instead of our own people? It again comes down to politics for those involved, not what is best for our country. The government should sanction and limit insurance companies on medical decisions that are made by non- medical personal. The United States can learn so much from a country such a Germany, the

decision-making should be done by all, the federal government, state governments, and the insurance industry, instead, we have the insurance industry making all decisions that greatly affect the health and well-being of all of our citizens. There should also be one universal provider network and one universal payment structure. Just because someone has what is deemed a “better” health insurance plan does not justify why all services shouldn’t be covered by any other plan. All doctors should be required to see all patients regardless of their health coverage and they should all be paid the same. If this were to be implemented, there would be fewer sick individuals that would require constant medical care as if they are treated properly at the first sign of illness, they wouldn’t “burden” the health care system as they unfortunately do now because of the lack of coverage and spending limits that have been implemented by the insurance companies. When it comes to implementing a policy to successfully address a problem in the U.S. health care system, it would be very difficult. For example, using the area of improvement previously discussed, universal policies and fee schedules, this is something that I don’t see happening if the insurance companies are allowed to dictate policy. The United States is a highly diverse and complicated society, there are many groups that have a voice to “weigh in” on significant health care policy issues. This is one thing that makes our country great, the freedom to express yourself, however, that expression does not have to correct and can benefit those who have that voice – such as the insurance company industry. The goal of health policy is to protect and promote the health of individuals and communities, this can be accomplished in ways that respect human rights, such as self-determination, privacy, and nondiscrimination. The problem is our government officials are not equipped to make these determinations since we have an expansive range of policymaking bodies and groups that seek to influence policies mainly to

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favor themselves. For example, pro-life groups are allowed to voice their opinion on the controversial issue of abortion. If there are enough people influenced by their beliefs, then abortion can become illegal, such as in the state of Louisiana. The influencers worked with the politicians to make the abortion issue illegal and as a result that influence was also on the voters who in turn voted to make abortion illegal. If a state was able to change a health care policy that has been around for over 50 years on one ideology, why can’t the voting citizens of the country vote to change its health care policies and insurance policies? There are too many policies that are not based on objective information or sound scientific evidence, instead they are based on individual interests that influence others to form strong groups that can eventually dictate policy. There should be no conflict of interest when it comes to health care coverage, but there is nothing but conflicts of interest since the insurance companies make the policies and the government does nothing to prevent it. The United States is the land of opportunity, but it is not the land of opportunity when it comes to health care or even health care for its own citizens. Immigrants who come to the U.S, legally or illegally, often receive some type of health insurance, mostly Medicaid, yet the tax paying citizens are either under insured or not able to afford health insurance at all. This is a policy our government can change, but because of politics, it will not. Other countries do not provide health care for anyone other than its own citizens, our government can put a stop to this. I don’t mean to sound insensitive, but our citizens should come before any country’s citizens and that does not happen. The only way to hold decision makers accountable for poor health care policies is to vote them out of office, but the influence and money that are behind some of these individuals and where the money is coming from ultimately defeats any chance of this happening. The only chance the U.S. would have in creating a health care system that is build on scientific evidence, objectiveness, and no

conflicts of interest. Since our government has three branches, the executive, the legislative, and the judiciary branch, we should think about adding a fourth branch of government, the medical branch. This branch of government should have all say over policies and fee schedules, as well as all medical decision making and coverage determinations. This branch of government should be elected by the people and there should be very strict requirements for a position and the other three branches cannot overturn any decisions made by this branch. There should be no politicians in this branch, all elected individuals should medical people that understand how to treat a person, there should be experts from all disease states that can be objective about a course of treatment. These individuals should not have any influence by any insurance company and make decisions based on the illness and the required treatment for the illness. There should be one universal network of providers that all get paid the same, this goes for hospitals and other specialty facilities. No longer should a person worry about health care based on their insurance, all patients should be able to see any doctor they want. If a doctor is unwilling to do this, there should be penalties towards that individual as all doctors take an oath to protect patients and cause them no harm, there isn’t any oath that is taken to make as much money as possible or don’t treat a patient because their insurance won’t pay. A policy such as the one discussed is, unfortunately, not a reality. Our country concentrates so much on finances that policy makers don’t have time to think of our health and well-being. Politicians are too busy making money off of the health care industry and lining their own pockets rather than thinking of the pockets of their constituents. These people would not be where they are today if they were not elected, so let’s elect others that will care more for the people than themselves. This is not all politicians, unfortunately the ones that have no say or influence are too many compared to those that do. Our government is so set in its ways that

there will never be the possibility of forming a fourth governing body that would help the longevity and life expectancy of its citizens, but if there was a chance that this governing body could become a reality, our country could become greater than it already is. There would be objectivity and no bias when it comes to health care policy, these individuals would also be more open to learning about how other countries manage their health care and help implement some of the policies that have been working for years in these countries. Maybe a chance to have a diplomatic equivalent from each country to teach the U.S. how to provide health care at a reasonable cost to its citizens. I still say we should use the taxes that are collected on tobacco and alcohol to health the health care industry of the United States, they could also take the tax from cannabis if the government were to federally legalize it. There is so much money collected from items that are taxed, yet we never seem to have the financial infrastructure to help our own citizens that are ill. I based this speech on different resources that were available to me, including my textbook, “The Sociology of Health, Illness, and Health Care: A Critical Approach”, as well as other websites and articles. The National Library of Medicine had a nice article on the formulation of health policy by the three branches of government which led me to the thought of a fourth branch of government to directly deal with the health care industry. There is so much information available to our decision makers currently in charge of creating and implementing health care policy, it’s too bad they don’t seem to know its available, or they just choose to ignore it and make decisions based on their own agendas.

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References https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare- countries/#Life%20expectancy%20(2021)%20and%20per%20capita%20healthcare%20spending %20(2021%20or%20nearest%20year,%20PPP%20adjusted) Institute of Medicine (US) Committee on the Social and Ethical Impacts of Developments in Biomedicine; Bulger RE, Meyer Bobby E, Fineberg HV, editors. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington (DC): National Academies Press (US); 1995. The Formulation of Health Policy by the Three Branches of Government. Available from: https://www.ncbi.nlm.nih.gov/books/NBK231979/ https://www.commonwealthfund.org/international-health-policy-center/countries/germany Weitz, R. (2020). The sociology of health, illness, and health care: A critical approach (8th ed.). Cengage Learning https://www.who.int/health-topics/universal-health-coverage#tab=tab_1

William Guttilla_Week 7_Health Care Around the World

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