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Why I Support Healthcare Reform

After months of discussion and negotiation, the US Senate voted on its healthcare reform bill on Christmas Eve. The US House of Representatives passed its version of healthcare reform in November which means it is likely that a bill will be on President Obama’s desk in early 2010. This legislation would mark the first major expansion of healthcare coverage in the United States since Medicare and Medicaid were created in 1965.

I worked on the last healthcare reform effort as a member of the Clinton Healthcare Reform Task Force and Legislative Director to Congressman Eliot Engel (D-NY). I believe this legislation is important and will be an improvement over our current healthcare system which does not work and cannot be sustained in its current form.

Helping the Uninsured

There are current 47 million Americans who have no health insurance. The uninsured are both an economic and social problem. They are an economic problem because the uninsured raise the cost of health insurance by over $1,000 per year for every family. Most uninsured people get care through emergency rooms which are required to treat everyone regardless of their ability to pay. These are hidden costs which are passed along to everyone in the form of higher insurance premiums.

The uninsured are a social problem because people die when they do not have health coverage and cannot get the medical services they need. A recent study by Harvard Medical School found that 45,000 per year die because they don’t have health insurance. That is unconscionable in a country as wealthy as the United States

The bills being discussed in Congress will provide a substantial expansion of healthcare coverage. By 2019, the House bill would provide coverage to an addition 37 million Americans while the Senate bill would provide insurance for an additional 31 million. The bills would ensure that approximately 95% of Americans have health insurance.

Cost Control

The US spends more for healthcare than any of its major competitors and gets less for it than any other industrialized country. In 2007, the US spent $2.2 trillion dollars on healthcare which represents 16.2 percent of our economy. Healthcare costs have been increasing sharply in the past decade and the current trends are unsustainable.

Both the House and Senate bills have cost containment measures in them. It is expected that the House bill will reduce the federal deficit by $104 billion over ten years while the Senate bill reduce the federal deficit by $127 billion over ten years. Additionally, the bills are expected to lower insurance premiums for most Americans including a reduction of almost 50% in the individual insurance market.

Consumer Protections

Both the House and Senate bills provide important consumer protections to help ensure that people get the coverage they purchase and deserve. Some of the most important include:

  • Elimination of “pre-existing conditions” a practice used to deny coverage for chronic conditions including diabetes, high blood pressure and arthritis?
  • Providing a yearly limit on consumer out of pocket medical expenses.?
  • Removing dollar caps on how much medical treatment insurers will pay for.?
  • Preventing the use of medical underwriting, a practice that allows insurers to charge more to people who are sick or suffer from chronic conditions.
  • Requiring insurers to spend a minimum amount of insurance premiums on medical care. The target is expected to be set around 85% of premiums.

The bills would also establish federal regulation of health insurance instead of the uneven state by state system which exists today. This will help ensure that consumers get strong protections regardless of where they live.

Why The Senate Bill Is an Improvement Over the Current System

Few people are arguing in favor of maintaining the status quo in our current healthcare system so most of the debate has centered on which direction reform should take. In many ways I prefer the House bill because it provides coverage to a larger number of people and establishes a public insurance option which will provide more competition in the private insurance market.

The Senate bill does not include a public option but is still a major improvement over our current healthcare system. It aggressively tackles the problem of the uninsured, helps control medical costs, and provides important consumer protections regardless of what state a person lives in.

History shows the chance to enact major changes to our healthcare system comes along every 15-20 years. There is a tendency to run away from healthcare reform after it has failed. We cannot afford to wait a decade or two to address this issue again. I support passing the Senate bill and working to improve it because enacting a flawed healthcare reform bill now is far better than to trying to pass the perfect bill and ending up with nothing.

Healthcare Services in Mexico

Mexico is one of those countries which has in many ways made great progress but without grabbing the headlines. This is a situation and strategy which has been replicated in the Mexican healthcare system, a system which is seen by many as one of the leading healthcare services in the area. However, Mexico is a large country and as with other neighbouring countries in the region there is a major difference between those in poverty and those at the higher end of the income scale. So what provisions have been made for the various sectors of Mexican society?

General healthcare in Mexico

Under government regulations free health care is available to all members of the Mexican population and all non-nationals who live there. However, there are various layers to the Mexican healthcare system which many believe reduce the impact and the strength of funding for the service and can in many cases complicate the issue. There are also growing concerns about the variations in standards of treatment available to those in the larger cities and those in the more rural areas.

Social security healthcare in Mexico

As we mentioned above, free health care is available to all in Mexico although rather bizarrely the authorities have introduced added protections and added services for those employed by the authorities. Many people will also be surprised to learn that Mexico has one of the oldest hospitals in the world which dates back to 1791 and indeed has one of the oldest healthcare systems.

Private sector healthcare

As the Mexican economy began to grow so did demand for private sector healthcare although it is still only a fraction of the size of countries such as the USA. However, there are signs that the authorities are looking to encourage private healthcare insurance in Mexico to try and reduce the burden on the state budget and allow the authorities to target specific areas of the population.

Future healthcare in Mexico

While there is no doubt that great progress has been made with regards to medical provisions and medical services in Mexico there is also no doubt that large variations still exist between the standard of health care expected by those in the inner cities and those in more rural areas. This is by far and away the most disappointing aspect of the healthcare system in Mexico although there are also concerns regarding the many layers of administration from the government down to local authorities.

Expats in Mexico

Many expats in Mexico will look towards the private healthcare sector to ensure they are able to receive emergency treatment as and when required. If you are looking towards private medical healthcare many believe there is better value if you go through Mexican insurance companies rather than international healthcare companies, who may offer a one policy fits all for those travelling around the world.

Conclusion

As with so many countries in the Americas there is no doubt that the gap between healthcare for those on the poverty line and those at the higher end of the income spectrum is still very visible. However, progress has been made and the authorities seem adamant that those who require specific funding for medical healthcare will receive this in the future, while those who can afford to at least contribute will be asked to do so.

Healthcare and Cultural Diversity

More than ever before healthcare professionals are subjected to dealing with a number of vast and various cultural diversities. As cultures within the U.S. continue to grow the understanding of how to deal with them must also grow. If cultural differences are not communicated appropriately it can cause uncomfortable and confusing situations for both the healthcare provider and patient. This can cause the patient to suffer due to loss of trust and respect causing the patient to be less likely to follow a treatment plan. Culturally competent healthcare is considered a human right, and increasing numbers of culturally inappropriate lawsuits filed in court are being won. Some cultures, such as Ethiopian, Islam and Chinese have very different laws, views and beliefs about healthcare. Because there are so many differences there are many legal implications that could possibly arise from cultural ignorance in healthcare.

Ethiopian traditional belief is that health results from equilibrium between the body and the outside world and that illness arises from disequilibrium. Ethiopian culture also believes in the use of herbs and spices for medicinal purposes which can sometimes have adverse interactions with western medicine. For example, large amounts of garlic and ginger are used for the common cold which can act as an anti-coagulant in high doses. Cinnamon is also used for the common cold which increases stomach acid and may inhibit tetracycline (an antibiotic used for many bacterial infections). Basil is used for headaches and insect repellent which acts as an anti-coagulant and has hypoglycemic agents due to the oil extract increasing blood clotting time and synergistic interactions with insulin. Most studies show people of different cultures do not tell their physician about their traditional medicine use out of fear of being judged. One legal implication that can arise while treating an Ethiopian may be a physician treating for a bacterial infection with tetracycline unknowing that he or she is taking large amounts of cinnamon for a suspected oncoming cold. If the cinnamon interacts with the tetracycline the bacterial infection can spread causing further harm even potentially fatal harm resulting in a legal dispute.

The Islamic culture considers an illness as a punishment for their sins. Abortion and assisted suicide is not permitted. Pork and alcohol is forbidden and Muslim women can’t be touched by men who are not immediate family members. Muslims also fast from dusk to dawn for one month a year. Some legal issues that can arise may be a result of a physician prescribing insulin or heparin which contains pork ingredients to a practicing Muslim, or a cough syrup containing alcohol. A Muslim may not be aware that our western medicine contains these products. In addition, if a Muslim is fasting at a time of illness causing weakness and dehydration this can be seen as the physician not providing proper care, all possibly resulting in a legal dispute.

Some Chinese theories about health are based on the observed effects of Qi. They believe Qi defends the body from pathological factors, provides movement and supports growth and development. They believe things like poor diet, poor lifestyle or strenuous work can deplete one’s Qi. Yin and Yang is probably the most significant theory followed, it is the balance between opposites like cold vs. hot or excess vs. deficiency. The Chinese believe some bodily organs contain more Yin and others posses more Yang and will relate this to hot and cold with health complaints. For example one may complain of a “weak kidney” and insist their kidneys be tested when in reality they may be having back or knee pain or diarrhea. A “hot liver” is a common complaint which can refer to itchiness, skin eruptions or emotional stress. Medicine is also considered to have hot and cold effects. This makes it common for Chinese people to take less medication then prescribed to “balance” out the effects, and many would not tell their physician because they believe they are in the best position to judge their own health needs. So there could be a possibility of legal disputes if a liver complaint is made and the physician orders diagnostic tests and possible medication for the liver if in fact the complaint was made only due to emotional stress or itchiness. There can also be a possible legal dispute if the physician did not explain the importance of taking all of a prescription and the patient started taking less to balance their Yin and Yang and the medical issue persists or gets worse.

In conclusion, as one can see there are many different healthcare beliefs in different cultures. Some of these differences can cause confusion and misunderstandings for both the physician and patient. And although most western physicians will try to address an ailment of someone from a different culture in their best interest, it may conflict with their beliefs. Healthcare and cultural ignorance amongst all physicians is a subject that needs to be addressed. Proper training in cross-cultural healthcare will ultimately lead to a better understanding of the patient’s needs and complaints, more respect for the physician and better adherence to treatment causing less legal disputes and a pleasurable, successful experience for the patient.

Here is a short video pertaining to health care and cultural diversity http://www.youtube.com/watch?v=XF8yZRgcSkg