Definition of terms
According to WHO, health is defined as a general state of wellbeing especially in human beings whereby one is socially, mentally, and physically well. Additionally, health can also refer to a state whereby the physiological and metabolic functions of the human body are functioning optimally.
Health care entails the activities of medical professionals, dentists, nurses, and pharmacists, which are aimed at treating or preventing diseases.
This is a state characterized by poor health irrespective of its cause in a given proportion of persons within a specific locality.
Mortality refers to a mortal state or the death rate at a specific period of time within a given locality irrespective of the cause.
The U.S. Health Care System
The United States’ health care system is “dysfunctional” because it is the most expensive in the world yet it does not satisfy the needs of the people it is intended for. For instance, according to the OECD/WHO in 2000 report, the United States’ health care system lies in the 37th position in the world behind Costa Rica and Slovenia (OECD, 2007; World Health Organization, 2010). Here, the WHO ranking system considers a country’s average lifespan and the cost of delivering health care services per person per annum. According to the report, the United States’ average lifespan is 77.8 years and the cost of health care per person per annum is $ 4887.
These values are far much higher compared to other developed countries such as Spain, Canada, and Japan. Moreover, despite the high cost of health care, the country has the highest infant mortality rates when compared to other countries such as Denmark, Japan, Sweden, and France. Other problems facing the healthcare system in the U.S. include lack of accessibility to all citizens, lack of responsiveness, lack of fairness in health care financing relative to other OECD countries, and low public satisfaction with the available health care services (OECD, 2007, p. 13).
Moreover, in the 2008 WHO annual report, the rate of spending on health care services increased in most countries relative to their GDP. Therefore, the average expenditure as a representative of the GDP increased from 7.8% GDP in 2000 to about 9.0% GDP in 2008 (OECD, 2007; World Health Organization, 2010). Subsequently, the U.S. reported the highest expenditure on health care in 2008 whereby a total of $ 7,538 per capita per annum was spent.
This value is equivalent to more than double the average spending of other OECD countries (OECD, 2007, p. 16). Moreover, the United States’ expenditure represents about 16% of the GDP and it is followed closely by France (11.2% GDP), Switzerland (10.7% GDP), Austria and Germany (10.5% GDP), and Canada (10.2% GDP). The least spenders among the OECD member countries include Chile, Korea, Turkey, and Mexico, which spent less than 6% of their GDP on health care (World Health Organization, 2010, p. 33).
In addition, the same report shows that in 2006, the infant mortality rate in the United States was 6.9 deaths per 1000 live births making it the third country with the highest infant mortality rates in the OECD member country ranking. On the other hand, Turkey and Mexico reported the highest rates at 22.6 and 18.1 deaths per 1000 live births respectively (OECD, 2007). Additionally, the same report shows that life expectancy rates in the United States stand at 78.1 years as of 2007. This value is slightly below the average age in other OECD countries, which is 79.1 years. In addition, Japan has the highest value of life expectancy, which stands at 82.6 years followed closely by Switzerland with 81.9 years.
The statistical data given in the discussions above shows that health care expenditure is not directly related to better mortality and morbidity rates. Besides, most studies show that better health (low mortality and morbidity rates) depends on several medical and non-medical factors. Therefore, better health correlates with better healthcare performance, the attributes of the health care facilities, and the attitude of the community towards health care. Thus, health care expenditure becomes a factor that influences mortality and morbidity rates when the financial resources are channeled towards improving the medical and non-medical determinants of health care and health care facilities (Shi & Singh, 2008).
Additionally, cultural beliefs and values, gender, age, and health status can influence the outcomes of health care systems as observed in the Native American communities. According to the cultural beliefs and practices of Native Americans, better health refers to a state of balance, which harmonizes the body and mind. Additionally, these people believe that when an individual is in harmony from within, the same conditions are externalized and there is a high probability that he/she will be at peace with everything (OECD, 2007, p. 45). Therefore, better health, which is also considered to occur in duality, enables individuals to carry out their life activities more efficiently.
Besides, most Native Americans claim that there are two parts of better health, which merit equal attention and thus they are both held with much love and acceptance. In that case, an individual feels lively and fulfilled regardless of his/her health status. It then follows that these beliefs make most Native Americans ignorant and disinterested in contemporary health care services (Shi & Singh, 2008, p. 427).
More importantly, Native Americans believe that ill health is a result of evil ideas and thoughts in an individual’s mind. Therefore, to be fully healed, an individual is advised to think about the good part of life to strike a balance between the good and bad ideas in his/her mind. Moreover, traditional medicine women and men play a greater role as the community’s caregivers for diseased individuals. Overall, the community’s believes and the role played by medicine-men and women may hinder health care service delivery to most Native Americans (Shi & Singh, 2008, p. 430).
The history of National Health Insurance initiatives in the United States
The campaigns for national health insurance initiatives started in 1912 with many reformers rallying for the introduction of compulsory insurance policies during Roosevelt’s presidency (Hoffman, 2003, p. 1). Additionally, in 1920, other progressive campaigners for health insurance such as the Committee on the Costs of Medical Care proposed that the insurance initiatives should be voluntary and based on groups.
These early proposals were met with strong opposition from doctors, labor organizations, nurses, and the private sector and thus they failed to take effect (Hoffman, 2003). Subsequently, other national health insurance reforms were initiated under different economic and political environments with little success. These reforms include the NHI and the New Deal (1934-139); NHI and the fair Deal (1945-1950); the Great Society: Medicare and Medicaid (1960-1965); the Competing NHI Proposals (1970-1974); Cost-Containment Trumps NHI (1976-1979); and the Health Security Act (1992-1994) (Hoffman, 2003, p. 5).
Therefore, most historians argue that the national health insurance reforms in the 1900s failed to go into fruition because most of these reforms were addressing complex issues that the general public could not understand or comply with as a whole.
Moreover, other reforms failed because they held varied ideologies while others lacked the support of interest groups. Furthermore, the failure of most reforms can be attributed to the presence of weak presidencies during the time of their introduction coupled with the decentralization of the powers of the Central government. However, some health care insurance reforms survived these challenges and contributed successfully to improved and accessible health care services. These reforms include the Children’s Health Insurance Program, Medicare, and Medicaid programs.
Hoffman, B. (2003). Health Care Reform and Social Movements in the United States. American Journal of Public Health, 93(1), pp. 1-14.
OECD. (2007). Health at a glance: OECD indicators. New York: OECD Publications.
Shi, L. & Singh, D. (2008). Delivering healthcare in America: A systems approach. Mississauga, Ontario: Jones and Bartlett Publishers.
World Health Organization. (2010). The WHO annual report 2008: Statistics and data. Web.