Blog assignment #7: 2010 healthcare reform bill

This week, in public heatlh, we learned about health insurance, access to care, and the new health care reform. One statistic presented in class was comparing Per capita health spending to Per capita GDP. Compared to the other OECD countries, US is an outlier, in this case. This indicates that the United States spends way too much money on health care; however, international comparison (in a different statitstic) shows that average life expectancy of the United States is low relative to other developed countries. To tackle this irony, and to provide Americans better health care services more effectively, president Obama and the Congress have been working on and have finally gotten passsed "the 2010 Health Care reform bill." First of all, this bill will expend insurance to 32 million uninsured Americans. Under this health care reform bill, small businesses will get tax credits covering up to 50% of employee premiums. Also, it will constrain the growth of Medicare (which will be very helpful in paying for reform) by various ways, one of which, the donut hole coverage. Seniors with this coverage will be given rebate but be given limited precription medication coverage. As we have seen in class, among the uninsured, many of them are actually young adults because after thier parents' coverage, they do not feel the need of being insured. To solve this problem, the cut off age for young adults tto be covered by their parents' insurance became the age 27, indicating more young adults will be insured. New insurance plans will include checkups and other preventive care with no co pays. To improve transparency in insurance companies, from now on, they need to reveal how much money is spent, and there will be more and enhanced fraud abuse checks. Some small businesses might not be happy with health care reform bill because it will require them more than 50 workers to provide medical insurance for their employees or pay a 2-thousand dollar fine per worker. Also, now that the budget became tighter and the transparency is more emphasized, insurance companies are not satisfied. I think educated middle class will be the most happy with it because among the uninsured, most of them are uneducated, and therefore they do not realize how important it is to be insurance in a long term. They tend to see what's directly in front of them. Also, minorities and women are very in favor of this bill because this bill emphasiezes equity: for example, it is now illegal for insurance companies to make health care more expensive for women. I think it is a good piece of legislation; however its too ideal. it will be very hard to first implement this. I think it will cause so much chaos, especially, educating the uninsured will be extra hard...This will affect my family because we currently have Masshealth(we are from Massachusetts), which is a state-level insurance; Massachusetts provide insurance even for the people with no social security number(we are international students).

blog assignment #6

The economic recession has been the major effect on the health care system. Along with the economic recession, the congress is legislating helath care policies that can greatly affect the health care system; therefore, private and public health spending, or both, seem to change dynamically. The article that we are reading this week offered projections for private, public and national health spending. These projections were based on 2009 medicare trustees Report and total health spending is expected to grow faster after 2010 because of expected increase in personal income along with the economic recovery. Also as baby boommer generation move from private coverage to medicare, the private spending growth will seem to slow down, where as public spending growth will acclerate. Surprisingly, health spending is expected to grow to 4.5 trillion by 2019. However, public health spending seems to increase to 52 percent of all health spending by 2019 because of continued influence of the recession and possible demographic changes.The author of the article says, these projections do not include health care reform proposals and defense appropriations act, which extended COBRA coverage subsidization andlimited Medicare physician payment rates. Two primary factors that affect personal health care spending (purchase of health care products and services) are medical prices and utilization. Medical prices are influsenced by economywide factors. Then the author looks at various insurance payers: medicare, medicaid, private health insurance companies and people's out of pocket spending. As mentioned above, the author believes medicare spending growht will be expected to average 7.4 percent due to the baby boomers despite 21.3 percent reduction in physician payement rate recetly. The federal and state Medicaid is at its fastest growth rate for now; this is a result of rising unemployment. The article says, however, the medicaid spending growth seems to slow to 7 percent by 2012 as the economy improves. Another cause in increase of medicaid spending is increased number of the aged in the program; they tend to be more costly than other age groups. Due to reduction in the number of people with private health insurace, private health insruace premiums comparably increase. The article projects premium growth to reach 7.1 percent by 2015. At the same time, the services that require out-of-pocket costs are in less demand; enrollemnt growth in medicaid seems to increase.
Continued increases in healthcare spending and continued proportional increases in public spending suggest that the health care system in the united states is not working out efficiently, despite high demand of health care services, first of all. Also, as mentioned above, increases in pulbic spedning opposed to private insurance spending indicates that the economic recession is still influencing health care system. I think the most pressing issues for health care reform should be educating people about insurance and how being uninsured can actually lead to higher costs and how it can affect the society.

Blog assignment #5 -- Global health

A decade ago, lack of resources was the biggest public health concern. However, today, thanks to varous donations, there are enough money and resources; however, due to uncoordination, the money is directly towards high-profile disases than public health. The world now emphasizes conquering of the common diseases in developing countries with various reasons: moral duty, public diplomacy and self protection. However, the efforts are focused more on specific diseases than on broad measures. Also health care workers tend to flood to west, causing brain drain in developing countries.Among those global health projects, there hardly are methods of their efficacy; the world's poor does not have a way to tell what they want, what they actually need. Thanks to recent AIDS pandemic, there was a surge of funding from various sources such as Bill and Melinda Gates Foundation, Bush administration, and world bank. But the discrepency between the developed and the developing is still in dillema. A study showed that fewer than 40,000 subsaharan africans were reciving AIDS treatment when some 25 million in the region were infected with HIV and 600,000 of them needed the drugs immediately. However, the article looked at this surge positively, this is a "marvelous momentum for health assitance" and says 3 million of Africans could easily be on the medication. Bush administartion's fund estimates that it now supports 20 percent of HIV/AIDS programs and 66 percent of funding for TB and malaria research. However, most of funds come under conditions and must be spent according to donors' priorities, politics, and values; moreover, not all the funds end up being spent effectively. A lot of money leaks out in the process. Also, as mentioned above, lack of coordination of donor activities is another problem. For example, most of the globla HIV/AIDS related funding goe sto stand-alone programs such as HIV testing sites, ARV dispersal stations, HIV/AIDS education projects and the like. The article suggests that donors and UN agencies should at least try to integrate thier programs into general public health systems, therefore providing better coordination of the programs. Also donors and public health officials also try to build local industries, franchiese and such profit centers as well as local health infrastructures.

Now, among the various reasons given by the author why global public health keeps worsening despite bountful monetary resources, this week's blog assignment question asks which one i believe the most valid. I believe lack of coordination is definitely most valid. Developing countries often lack not only proper health care system and health care workers, but they also have bad economy and political infrastructures. Although it seems like a little process, giving out appropriate medical care to people consists of multiple steps. As the article said, donations and funds tend to disease or process specific; therefore, to make an improvement, it requires coordination of these funds and various activities. The second question asks what are the most important indicators of the status of the health care system in developing countries and why are they so important. The question said "markers," and i do not really understand what it exactly means but I am guessing markers are like indicators. I think types of common diseases in one region and maternal mortaliy/life expentanc are the most important indicators. Types of common disease in one region reflects the conditions of health care centers/system, including available vaccines and treatments. Also maternal mortality is also heavily dependent on hygeine, health care system, treatments and the like, therfore indicating the current status of healtch care system in those developing countries. HIV and TB are examples of how faulty systems and lack of sustainablity of current donor practices can lead to more deadly disease states. In South Africa's KwaZulu-Natal Province, during mass vaccination, due to financial constraints, health care workers re-used syringes which might have led to more people's HIV infection. Also that region's general health system is so poor that TB treatment was poorly handleed that only a third of patients got the whole regular/complete TB antibiotic therapy; this led to promotions of drug-resistant strains.