Introduction
In the United States health care is a major issue, especially when it comes to voting and socio-political debates (Shafer and Hinde, 2022). Historically, in the United States a mixed public and private approach has been used in health care. In this system, citizens qualify for health insurance from both public insurance programs such as Medicare and Medicaid and private insurance companies such as Blue Shield, Kaisers Permanente, and Blue Cross. The mixed public/private approach has not been effective in providing health insurance for the majority of US residents (Klunk, 2022). Recent studies have shown that the approach faces significant challenges to health care, prohibitive costs, and limitations to allowable benefits (Cram et al., 2022: Bloom et al., 2018). Previous studies have identified US alone as one of the developed nations that have failed to provide health coverage to all its citizens (Zahner et al., 2022: Segal et al., 2022). The recent inflation and slowing of the economy has worsened and continue to threaten this health crisis (Klunk, 2022).
Approximately 27 million people in the United States did not health insurance in 2018 (Cram et al., 2022). Additionally, studies have shown that close to 21% of Americans struggle to meet their health care needs (Bloom et al., 2018). The rate is higher is higher for minority groups such as Latinos and black Americans (Segal et al., 2022). Previous studies have also estimated that 8.5% of Americans lacked health care insurance in the year 2018 (Bloom et al., 2018). As of the 2020, approximately 7% of the California population lacked health care insurance (Zahner et al., 2022). Approximately, more than 200 billion dollars is lost in the US economy every year due to poor health and decreased life expectancy of the insured. Without any reforms in the health care insurance coverage, the figures could rise to 500 billion dollars every year (Klunk, 2022).
Previous health care insurance programs such as the Affordable Care Act increased health care access in the United Stated and enabled insurance market exchanges and citizens without health insurance sponsored by their employers could shop for subsidies and insurance to assist them in affording health care insurance (Pelissari and Olivera, 2022). Although the Affordable Care Act significantly increased health care access, it did not stop the development of a public, government-funded health care option (Cram et al., 2022). Additionally, despite the health reforms put forward by the Affordable Care Act, medical bills remain one of the leading causes of debt for Americans (Klunk, 2022).
Additionally, health care in California is so expensive since there’s a lack of provider competition. A few medical groups and hospitals compete in California every year leading to increased health care costs that insurance firms must pay for their members (Bloom et al., 2018). A subsidized universal health care coverage to citizens regardless of their ability to pay, employment status, and social economic status is essential in reducing health disparities and promoting health outcomes (Shafer and Hide, 2022). This essay aims to review the California Universal Health Care bill, summarize its main points, and review its pros and cons.
Policy initiative or legislation of the main points
The policy initiative of the California Universal Health Care bill aims to create a single-payer system, which is the government that would do away with private insurance companies in California. All California residents will be provided with a government-funded health care insurance that will eliminate the need for private insure companies (Klunk, 2022). Citizens of California will enroll for the universal health care program and receive health care benefits such as visits to the general medical doctor and obtain treatment from any licensed doctor within the state, emergency medical care, and reduced prescription costs. Insurance firms will be denied the opportunity to replicate any services that are provided by the California universal health care (Zahner et al., 2022).
The universal health care program will be called CalCare and aims to provide health care insurance to over forty million state residents in California. The program aims to take over health insurance from government policies such as Medicaid, Medicare, and private insurance companies whether funded by employers or via the Affordable Care Act marketplace (Klunk, 2022). The policy aims to place approximately 400 billion dollars in the hands of a state governing board. The governing board will consist of nine members appointed by the legislature and the governor. The legislature will discuss the majority of the details of the program and the board will be mandated to lay down policies of the program.
The policy has been coupled with an amendment to California’s constitution so as to raise money for the policy’s initiatives. The “Assembly Constitutional Amendment 11,” introduces a number of new taxes such as a 2.3% personal income tax for residents who earn 149, 509 dollars or more annually, and excise tax on businesses that make over two million dollars yearly (Shafer and Hide, 2022). Therefore, the policy will have the wealthiest individuals and businesses in California heavily taxed and spare the lowest-earning California residents. The policy is backed up by the California Nurses Association citing that the current health insurance system is all-for profit that has cost lives and delayed patient care or sometimes denied patient care since they could not meet the cost of health care.
The policy is intended to provide health coverage to low income earners in California and also extend the initiative to every individual in California regardless of their immigration status. The policy proposes a budget of 2.2 billion dollars every year to extend the eligibility of the program to every low income earning resident in California after years of regular increases including first undocumented children and then seniors in the program (Bloom et al., 2018). If the policy is approved by California’s legislature, it would extend health insurance to approximately 700,000 new people. If the policy is approved by June, 2022 it would take effect by 2024 (Segal et al., 2022).
The policy has the capacity of addressing some of the harsh shortcomings of the health care system in the United States. The program will relieve health care providers such as doctors the hustle of employing a number of billing clerks to assist in tracking reimbursement from health insurance companies (Cram et al., 2022). The program would also provide a single payer the support to control prices through negotiations and giving regular standards that would regulate the suitability of treatments. It would provide California citizens the opportunity of selecting an insurance plan that doesn’t eliminate doctors they need to manage their illness.
Pros
The universal health care act in California will provide a wide range of benefits to its residents. The universal health care act will address health care inequalities. The health insurance program will be able to address the ever increasing chronic illness crisis, effectively address the increased economic costs associated with chronic disease crisis, decrease huge health inequalities that exist between different socio-economic status of the California residents, and it will also enhance opportunities for preventive health strategies. Previous studies have identified that universal health care has the capacity to significantly address the epidemic extent of non-communicable diseases such as obesity, type 2 diabetes mellitus, and cardiovascular diseases, all of which significantly strain both the national and state economy (Bloom et al., 2018: Pelissari and Olivera, 2022) .
The economic burden related with unhealthy population is specifically evident among individuals with low socio-economic status. A low socioeconomic status is associated with numerous unfavorable health determinants such reduced access to health care and the quality of health coverage available, which significantly affects life expectancy and health care outcomes (Shafer and Hide, 2022). Therefore, populations in California that are of low socio-economic status are in dire need of quality and accessible health insurance.
Increased burden on the economy is as a result of lack of health insurance and poor health among individuals of low socio-economic status (Cram et al., 2022). For instance, patients with diabetes and live in low socio-economic status are at increased risk of death than patients with diabetes and hail from higher socio-economic status. Additionally, patients with chronic diseases such as diabetes who lack health insurance account for more than half of all the emergency department visits annually than patients with diabetes who are insured.
The universal health care bill will significantly reduce overall health costs since a single player will control prices through regulations and negotiations. The bill will reduce the need for billing clerks, which will significantly lower administrative costs. Currently, the average employer uses up to 9.9% of their payroll to meet the cost of health care for its employees, under the universal health care programs the figure is estimated to fall to 1.25% (Segal et al., 2022). The universal health care only has a single player and health care providers will be dealing with only one government agency.
The universal health care bill will also standardize health care services across California. The current health care system with a mixed private and public approach is very competitive and expensive, which has made health care services to be profit-based. Health care providers have to utilize the latest technology, give expensive medical services, remunerate doctors more, and compete against each other for individuals of higher socio-economic status (Klunk, 2022). Initiating a universal health care system transforms health care services from being profit-based to providing equal health care for everyone.
Previous studies have indicate that utilizing a universal health care system creates a healthier workforce. Preventive health care initiatives decreases the need and usage of expensive emergency department services. When a population lacks access to preventive health care, there’s increased emergency department visits since patients don’t have anywhere else to go and they are forced to utilize the emergency department as their primary care provider (Bloom et al., 2018). This creates health inequalities, which significantly increases the cost of health care.
In vulnerable populations such as those with low socio-economic status and minority group, access to preventive health care reduces health problems in the future and enhances outcomes in such communities. Universal health care also has the potential to guide a community toward making healthier choices (Klunk, 2022). Through universal health care, the government can invest in public and patient health education, health infrastructure, and health care. This can significantly push a population towards making healthy choices and leading health lifestyles.
Cons
The population of California is defined by different ethnic identities and different socio-economic status, which means different health care needs and challenges. Therefore, implementation of the universal health care could fail to be feasible for the entire population because of the existing differences. Besides, the implementation of the program would incur huge costs. The costs are associated with the technological and physical infrastructure that will be made to the health care system both at the state and health care facility level (Pellisari and Olivera, 2022). There will also be increased costs with providing health care insurance and treating a population that previously lacked insurance and had poor health. Expanding the range of health care services provided such as hearing, vision, and dental will significantly increase the cost of health care.
The bill proposes more taxes to the wealthier population and corporations of California and sometimes these taxes may fail to meet the cost for the program, which will extend taxes to unintended populations such as those from low socio-economic status. The universal health care may also increase the waiting time for patients to receive health care services, especially in the short term as a result of an increase in the number of emergency department and primary care visits due to elimination of financial difficulties to seek health care (Cram et al., 2022). Besides, waiting times will increase as the list for elective procedures will be longer. It may also significantly deter medical entrepreneurship and innovation.
Critics of the universal health care program have argued that it could significantly raise the cost of living in California and result in job losses. Besides, the program doesn’t guarantee that the more than 150 billion dollars in taxes would benefit anyone. The program also denies individuals who would want private health insurance programs or opt out of the universal health care system (Bloom et al., 2018). The universal health care system utilizes health people to cover for the costs of the individuals who are severely sick. In California, 60% of chronic diseases are made up by chronic diseases.
As much as the universal health care system will be in place, the majority of the costs will be spent on chronic diseases, which will significantly raise the cost of health care. People may also lack motivation to stay healthy. With the availability of doctor and emergency department visits, individuals might overuse these services. The program advocates for reducing the cost of health care, which might significantly decrease the availability of care (Segal et al., 2022). The cost of health care might overwhelm government budgets. The California government may be forced to divert the majority of their budget to service health care. In the setting of financial strains, the government may be forced to limit some health care services due to reduced probabilities of success. Health care services such as the cost of end-of-life care and treatment of rare conditions may be limited to save up on costs.
Conclusion
The universal health care program has the potential to extend quality and cost-effective medical services to the majority of residents of California. The programs doesn’t deny any patient health care services and health insurance based on their ability to meet the cost (Klunk, 2022). However, the program has to be funded by taxpayers through increased taxation and significantly utilizes the government’s budget. Universal health care has the potential to provide health insurance for a significant and a wider range of the population that lacks insurance and have poor health (Bloom et al., 2018).
The program has the potential to reduce health disparities and inequalities in access to health care among the various segments of the population, which is useful in promoting value-based care. The program has the potential of embracing value-based care (Bloom et al., 2018). Value-based encompasses affordable ad appropriate health care. To increase the efficiency of the universal health care program, the government should integrate services and health care system including public health, primary and hospital care. Universal health care advocates for preventive health services, which are useful in promoting long-term health of a population and improving the economy of a nation (Segal et al., 2022). Preventive health programs decrease costs related to segments of the population that lack health insurance and are associated with poor health. Universal health care provides a path towards economic sustainability and a healthier population.
References
Bloom, D. E., Khoury, A., & Subbaraman, R. (2018). The promise and peril of universal health care. Science, 361(6404), eaat9644. https://www.science.org/doi/abs/10.1126/science.aat9644
Cram, P., Selker, H., Carnahan, J., Romero-Brufau, S., & Fischer, M. A. (2022). Getting to 100%: Research Priorities and Unanswered Questions to Inform the US Debate on Universal Health Insurance Coverage. Journal of General Internal Medicine, 1-5. https://link.springer.com/article/10.1007/s11606-021-07234-1
Klunk, C. (2022). Health Care: Neither Right, Privilege nor Commodity. Pediatric Neurology, 128, 75. https://www.pedneur.com/article/S0887-8994(21)00188-0/abstract
Pelissari, D. M., & Oliveira, P. B. (2022). Universal health coverage: an effective intervention for a tuberculosis-free world. The Lancet Global Health. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00564-7/fulltext
Segal, J. B., Sen, A. P., Glanzberg-Krainin, E., & Hutfless, S. (2022, January). Factors Associated With Overuse of Health Care Within US Health Systems: A Cross-sectional Analysis of Medicare Beneficiaries From 2016 to 2018. In JAMA Health Forum (Vol. 3, No. 1, pp. e214543-e214543). American Medical Association. https://jamanetwork.com/journals/jama-health-forum/article-abstract/2788097
Shafer, P. R., & Hinde, J. M. Medicaid Applications Spike during Marketplace Open Enrollment: Lessons from Covered California. https://preprint.press.jhu.edu/sites/default/files/ShaferFinalCEPPR.pdf
Zahner, G. J., Croughan, P. W., & Blumenthal, D. M. (2022). Medicare Advantage for All: A Potential Path to Universal Coverage. JAMA, 327(1), 29-30. https://jamanetwork.com/journals/jama/article-abstract/2787446
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