A Healthy Future for America Recently the United States Federal government passed a bill that will expand

publicly funded healthcare to almost all of its citizens by the year 2019. While some view this move as an infringement on the freedom of the American people, a large portion of the citizens believe that it is a step in the right direction. Healthcare policy in the United State is a governmental control that some believe is an infringement on their fundamental rights by controlling their freedom to choose what kind of care they receive. Others believe that public healthcare is a necessary institution that will make sure that even those who cannot afford it will have access to general healthcare. Although current healthcare legislation will allow most Americans access to general medical care, the quality and extent of that care will be greatly diminished because of the limited resources and enormous pressures that physicians will have to deal with. Public healthcare can be a wonderful institution, if it is done correctly. Allowing many more citizens access to healthcare at little to no cost is a guaranteed way to raise the overall health of the nation and provides for the care of every person that contributes to the nation by working and paying taxes, and that children will be provided medical care no matter what their circumstances are. The latest change to public health policy in America is the Patient Protection and Affordable Care Act, which aims to substantially lower the number of uninsured starting in the next year through 2019 by forcing insurance companies to accept more insurance requests, loosening the criteria for Medicaid acceptance, and penalizing those who do not make sure they are covered medically. Essentially the only people left without health insurance would be those who do not take the initiative to sign up for public assistance programs and those who refuse to purchase their own health insurance when that are able to. This is a big step in the advancement of good health throughout America. However, the idea of public healthcare also brings in a whole new set of restrictions that

United States physicians might not be ready to accept and integrate into their existing practices. In their commentary The Real Meaning of Rationing, David Melzer and Allan Detsky explore the way that healthcare is rationed in America and have formulated a conclusion on why people feel the way they do about government interactions: Perhaps the specter of rationing concerns Americans because they believe that health care services will be withheld from them and delivered to other persons, ie, that the distributional consequences will make them worse off (Meltzer). It is true that if the resources are too limited that physicians are going to have to take on the burden of deciding who is going to be able to be treated and to what extent. This is best illustrated by the example presented by Robert Brook in What if Physicians Actually Had to Control Medical Costs? by demonstrating the process a physician might have to go through when presented with two prospective patients: A physician has been told that enough money is available to treat 100 patients who have either condition A or condition B and treating each patient costs US $1000. Based on epidemiological data, the physician is expected to have 100 patients with condition A and 100 patients with condition B during the calendar year. The health benefit of treating patients with condition A is 4 times as great as the health benefit of treating patients with condition B. There is only $100 000 available, which is only enough money to treat half of the 200 patients. The first patient the physician observes on the first day of the year has condition B. What does the physician do? (What if) In the end, only 100 patients would be treated, but are physicians really going to be expected to make that call? A good program would make it so this type of decision would not have to be made because all 200 patients would have access to and receive treatment. One aspect essential to successful care of patients is money. Without money, physicians
Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman, 12 pt Formatted: Indent: Left: 0", Hanging: 0.39", Line spacing: Double Formatted: Font: Times New Roman, 12 pt Formatted: Font: Times New Roman, 12 pt

are not able to requisition the proper supplies and equipment needed to do their jobs. The American government does not currently spend enough money on healthcare and if it does not increase spending on public health, either people are not going to be able to get the care they need or doctors are not going to be properly compensated for the work they do. Some people might not realize, or care, how much their doctors are paid, but the reality is that they have earned that money and are not willing to work if they do not receive what they deserve. Dr. Craig Zeman expressed in a recent interview that he is concerned about the future of healthcare in America. He stated that the government will be indirectly limiting the amount of money that physicians make and that they are going to make it so we make the same amount of money and firemen and police officers. While many physicians do not oppose public healthcare, they are aware of the sacrifices that they are going to have to make in the years to come. Part of the problem with the limited resources afforded physicians is going to be the fact that people are likely to overuse the new system. Since they are used to the current system where they may use it anytime they want and can choose what type of coverage they want, American citizens are going to feel very limited when the new legislation comes into affect. In order to make sure that everyone is treated equally, physicians are going to have to make the call on who gets treatment when and how much time is going to be spent on treating them, not based on the way they are paid, but on how much the person actually need the treatments. This can be a very hard decision for medical professionals because they feel as though they are obligated to help everyone that comes to them, but the reality is that it is impossible for every doctor to see every patient that comes to them asking for help. These extreme pressures that are placed on the physicians have caused them to reevaluate their profession. It is becoming more and more common that instead of pursuing a doctoral degree in medicine, people training to enter the medical field will decide to practice as a
Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman

physicians assistant (PA) or a nurse practitioner (NP). From my experiences at both Saint Johns Pleasant Valley Hospital and Regional Medical Center, I have discovered that even physicians will go back to school to become certified as PAs or NPs. They are going to suffer a pay cut, but the ratio of time, effort, and training needed makes the lower salary tolerable. Unlike physicians, PAs and NPs do not have to deal with other costs such as malpractice insurance, while still maintaining essentially the same relationships they already have with patients as physicians. This can also be used as an idea to further refine patient care policies. Physicians assistant have started to take the place of doctors in some units of the hospital. For example, in the emergency room they are allowed to prescribe some medications, treat injuries, and cover most of the patients that come to the ER simply because it is all they may afford. Replacing physicians with PAs would allow for more funds to be put toward those valuable resources they are going to be without. I have also observed that the hospital has had to make some major cutbacks. In the Acute Care Unit in Pleasant Valley, one half of the unit has been closed until they can afford to house more patients. In all of the units in Regional, have begun to cut back the amount of linens they use, saving on laundry costs, and utilizing the COPE intern pipeline to reduce staffing costs and increase patient satisfaction. These are small but important steps that will help medical institutions make it through this rough patch and make sure that the patients are not going to be the ones who are suffering. The effects of these struggles have started to be brought to the attention of medical professionals in the form of commentary, demonstrating how the manneor in which doctors are paid affects the way they go about treating patients. In his article, Physician Compensation, Cost, and Quality, Robert H. Brook, a doctor of medicine and science at the RAND Corporation, states that he has observed this inequality already taking place. He distinguishes between the three traditional methods of payment as being paid by salary, capitation, or feeFormatted: Font: Times New Roman Formatted: Font: Times New Roman Formatted: Font: Times New Roman

for-service, s.howing that there needs to be some sort of standardized way of dealing with patients so that everyone can be treated equally. These are factors that have to be taken into account when new policies are being formed and launched. What it comes down to is the patients quality of treatment. There was a study done in London measuring the satisfaction of patients with both public and private healthcare delivery and the factors that contribute to the evaluation of treatment and outcome. The findings are that: Public, as opposed to private, healthcare users experience unsatisfactory outcomes in relation to service climate factors (e.g. getting attention from doctors, time taken to get appointments, access to core treatment and opening hours)[] both public and private healthcare users indicate major problems in accessing healthcare despite the myriad intervention strategies aimed at ameliorating the situation in both sectors. Therefore, access-to-care problems are significant and need to be addressed by managers and healthcare providers in order to improve the quality of service delivery and patient satisfaction. Private care users fare better than public users in obtaining medical care at short notice, having more agreeable opening hours for treatment and getting appointments for treatment with less difficulty. (Owusu-Frimpong 203) What we need to do is make sure that lower income individuals are able to obtain the same level of treatment as those who can afford healthcare. Everyone deserves the best care available, so we just need to make sure that care is made available when it is needed. Americas healthcare system is consumer based, not unlike the rest of the industries, which means that it is funded by those who elect to purchase health insurance. When one purchases health insurance, all of the money is pooled and you are covered if something goes wrong. Not everyone uses that coverage to its fullest extent, so the left over money is seen as a profit for the insurance company. Since the industry is private, it means that those extra funds go
Formatted: Font: Times New Roman, 12 pt Formatted: Font: Times New Roman, 12 pt

into the pockets of its share holders, but if it was publically funded, that extra money would go towards improving the care that would be given to the patients. Along with health insurance companies, many hospitals are also privately managed and funded, meaning that their executives are get more money, the more patients the hospital has. One of the reasons that hospitals use COPE interns is because it improves the patient satisfaction, meaning that more people are likely to choose that hospital, meaning that the executives make more money. The management of healthcare coverage and deployment is only one problem that needs to be addressed right now. Americans just need to be made aware of the problems there are with the American health care system, what is being done to solve the problems, and how they can be further resolved. The recent legislation shows that this is possible and that if we work at it public healthcare can be successful in treating patients in a satisfactory manner. Hopefully we will really have a healthy future ahead of us.

Works Cited Brook, Robert H. Physician Compensation, Cost, and Quality. JAMA. 304.7 (2010): 795-796. Print. ---. What if Physicians Actually Had to Control Medical Costs? JAMA. 304.13 (2010): 14891490. Print. Meltzer, David O. and Allan S. Detsky. The Real Meaning of Rationing. JAMA. The American Medical Association, 1 Nov. 2010. Web. 14 Nov. 2010. Owusu-Frimpong, Nana, Sonny Nwankwo, and Baba Dason. "Measuring Service Quality and Patient Satisfaction with Access to Public and Private Healthcare Delivery." International Journal of Public Sector Management, 23.3 (2010): 203-220. Emerald Fulltext. Web. 07 Nov. 2010.
Formatted: Font color: Gray-80% Formatted: Normal, Indent: Left: 0", Hanging: 0.5", Line spacing: Double