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HCMG101 Health Care Systems Question: 1.What is the current legislative or regulatory issue, and why is it being debated? 2.Who is most affected by the legislation? 3.What are the current socioeconomic, political, cultural, and ethical issues surrounding this topic? 4.Who are the stakeholders? Answer: Introduction Universal health care is currently an issue of public debate and a serious concern in the US. This is owed to the fact that the US despite being one of the wealthiest countries in the world, has one of the highest inequalities in access to quality healthcare. These disparities exist in different population groups in the country. It is manifested across different demographic dimensions such as race, ethnicity, geographical location, disability status, gender and sexual orientation. The Medicare-for-All bill has been proposed as redress for these issues. This paper presents the political, socioeconomic and cultural-ethical issues around the Medicare debate and what it portends for stakeholders in the process.   Current Legislative Issue Bernie Sanders proposed the Medicare-for-All bill in September 2017. According to Friedman (2017), Medicare-for-All sought by the bill is a system where all Americans benefit from privately offered health services that are financed by the public coffers. It seeks to enroll all Americans on a public insurance system, hence correct the imbalance in the uninsured Americans which stands at 12%. In this proposed plan, no deductibles are allowed; opting out is exclude too. According to Gresham (2017) healthcare disparities matter because disparities in healthcare provision do not just affect the disadvantaged groups alone; they hinder the collective gains made towards achieving better health care for the entire population and in effect, increases the burden of healthcare through unnecessary costs. Particularly, the low income earners and the people of color record the highest numbers of persons with no health insurance or are under-insured. These disparities in healthcare have characterized the conversation around universal healthcare and are the principal reasons for which it is sought. The Most Affected Persons The most affected by this proposed healthcare are the high income earning citizens and the healthcare providers and doctors. The legislation proposes that the publicly financed but privately delivered healthcare shall be funded by taxing every working citizen and pooling the resources to a common public insurance plan (Seidman 2013). High income earners will be taxed higher to pay for the health services of the low income earners, the underinsured and the uninsured. The common practice world over with single payer health insurance systems (like the proposed Medicare-for-All) is that healthcare is paid for by the working population. In the US case, the bill proposes to implement the plan through a combination of strategies: compulsory health insurance and taxation. The contention of the high income earners with this approach comes two-fold: firstly, they do not need a compulsory health insurance cover because they can afford to pay high premiums for expensive comprehensive health covers (Seidman 2013). The other contention is that they will have to pay more taxes to the public health insurance plan to pay for the medical care of others. The healthcare providers in the US are also going feel the effects of the bill if passed. The healthcare sector in the US has largely been profit driven for a long time (Longman 2017). The Medicare-for-All bill however will give the government power to control the cost of medical services both through negotiation and regulation. The government’s involvement comes with the elimination of administrative costs from which the healthcare providers have for a long time been making money. If the bill is passed and operationalized, the government through its buying power will have considerable influence on the cost of medicine and medical services; through standardization of procedures of billing and streamlining of rules for medical insurance coverage (Jaffe 2018). Medicare for all will also compel health care provider and doctors specifically to charge standard prices for the same services which are not the situation as is today. Doctors will also be left with no choice but to deal with the government agency. The danger that lies herein is that the quality of healthcare is likely at stake. US doctors (who are currently largely motivated by profits) are likely to compromise on the quality of services they offer because the practice may no longer be as lucrative as it is now. Socio-Economic Issues One of the major socio-economic issues pertinent to the Medicare-for-All bills is the healthcare disparities which in most instances are tied to economic disparities. The term healthcare disparity is used in reference to health care provision between different segments of the population or other dimensions (Welch 2016). Fundamentally, healthcare disparities manifest between population groups in their abilities (or lack thereof) to access medical health services, medical insurance coverage and quality medical care.   The population of uninsured Americans as at 2016 stood at 28 million, most of them people of color (Hispanics, Asians and black Americans). These health care disparities result in an increased burden of disease for the disadvantaged population which makes the economic situation worse for affected groups (Tillow 2012). Tied to the issue of healthcare disparities is the social issue of exclusion. In a country where the disparities between the insured and the uninsured are so evident, this is a real concern. People of color who make up the highest percentage of the uninsured in the US experience a feeling of social exclusion in the society (Stark 2016). The uninsured rates among the people of color are still high despite the gains made by the Affordable Care for All (ACA). 17 % of Hispanics are still uninsured, the percentage of uninsured Asians stands at 8%, while for the no elderly blacks, it is 12%. Political Issues There are a number of political issues that are pertinent to the quest for universal health care in the US. The Medicare-for-All bill was drafted and proposed by Sen. Bernie Sanders (independent from Vermont). Before the bill was proposed, Americans in 2010 were introduced to the Affordable Care for All Act which later became famous as Obamacare. Although ACA has yielded laudable results in increasing the percentage of Americans with access to health insurance, it is not a universal health care plan (Pollack 2015). Since the Trump administration came to office in 2017, GOP senators and congressmen have fought to have ACA repealed for the same reasons that they are now opposing Medicare-for-All. Despite this opposition from the GOP legislators and the presidency, Medicare-for-All now has the support of 52% of republicans and 85% of democrats (Jenkins 2017). There are two facets to this: firstly it could be that a compromise position has been struck between democrats and republicans given that the proponent of the bill is independent. Alternatively, this is a reaction to the up-coming mid-term elections in the US and both democrats and republicans are trying to stay on the right side of the citizens who badly need healthcare. Cultural And Ethical Issues Ethical and cultural concerns regarding Medicare-for-All today have a lot of similarities to the kind of issues that existed around ACA a few years ago. Proponents and supporters of Medicare-for-All hold the ethical position that public resources ought to be utilized to cushion the poor, unemployed and disadvantaged in society (Singleton 2018). They hold the value that as many as cannot afford health care insurance should be entitled to government money (public money) to guarantee them access. The opposing ethical perspective is that entitlement to public money cannot and should not be the remedy to individual problems. Concerns have been voiced that when access to universal health is granted, people are likely to take it for granted and misuse it (Pollack 2015). Those who hold this view argue that patients will see no harm in missing doctor’s appointments because they are free after all. Similarly, it is arguable whether or not it’s right to allow patients with detrimental behavior to occasion long waiting hours for specialized services at the expense of deserving patients. The ethical question of whether it is morally right to make healthy individuals to pay for the medical expenses of the unhealthy population also arises. Stakeholders Virtually all citizens who are taxpayers in the US are stakeholders in the Medicare-for-All bill. However it portends more for the high income earners because if it passes, their taxes will have to go up: high income earning households will have to pay more to finance the health care of low income earners and the unemployed (Seidman 2015). Insurance companies also have a stake; with Medicare-for-All, healthcare providers and doctors will have to deal with the government agency, contrary to the current practice where they deal with health insurance companies. This has potential to reduce business for health insurance firms. Healthcare providers are major stakeholders in this process too. If passed into law, Medicare-for-All is going to transform the way the sector which has largely been profits driven performs (Longman 2017). The bill gives the government considerable power over the pricing of medical services and the quality of services. As the last stakeholder, the government through Medicare will be able to deliver universal healthcare to its citizens. Conclusion The Medicare-for-All is a bill drafted in pursuit of universal healthcare for all in the US. It has been subject of debate since its introduction to in September 2017. As discussed in the paper, it has potential to remedy the disparities in healthcare provision by taxing the rich more to pay for the medical expenses of the poor. As Medicare-for-All provides reprieve for low income earning households, it places burden on the high income earners. This in part occasions the political, socio-economic and cultural-ethical issues raised in the debate. Ultimately the poor are the biggest gainers while healthcare providers and high income earners are the biggest losers.   References Friedman, G. (2017). Medicare for All Could Be Cheaper Than You Think. Dollars & Sense, (333), 5–6. Retrieved from Gresham, G. (2017, August 24). Medicare for all. New York Amsterdam News, pp. 10–34. Retrieved from Jaffe, S. (2018). Prospects for US single-payer national health care. Lancet, 392(10149), 722–723. Jenkins, N. (2017). A Lot More Democrats Now Back Bernie Sanders’ “Medicare for All” Plan. Time.Com, 1. Retrieved from Longman, P. (2017). How Big Medicine Can Ruin Medicare for All. Washington Monthly, 49(11/12), 29–34. Retrieved from Pollack, H. (2015). Medicare for All–If It Were Politically Possible–Would Necessarily Replicate the Defects of Our Current System. Journal of Health Politics, Policy & Law, 40(4), 923–931. Seidman, L. (2013). Medicare for All. Challenge (05775132), 56(1), 88–115. Retrieved from Seidman, L. (2013). Medicare for All: A Public Finance Analysis. Proceedings of the Annual Conference on Taxation, (106), 1–30. Retrieved from Seidman, L. (2015). The Affordable Care Act versus Medicare for All. Journal of Health Politics, Policy & Law, 40(4), 911–921. Singleton, M. M. (2018). Expanded and Improved Medicare for All: Beware of Greeks Bearing Broccoli. Insurance Advocate, 129(15), 8–30. Retrieved from Stark, P. (2006). Medicare For All. Nation, 282(5), 14. Retrieved from Tillow, K. (2012). The solution: improved Medicare for All. Massachusetts Nurse Advocate, 83(4), 2. Retrieved from Welch, M. (2016). Bernie’s Bad Ideas. Reason, 47(12), 32–40. Retrieved from

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