Health care delivery in the US has become one of the most expensive tasks for the state. Although the nation has the most technologically advanced health care services, the American system still underperforms despite the resources they have. There are gaps in financing and service delivery which act as barriers to improving medical services, reducing disparities, controlling costs, achieving universal insurance policies and also meeting the needs of families and patients. The current civil and social rights issues impact differently on the health care status of the public and should, therefore, be addressed.
Healthcare reforms refer to the creation and changes of health major health policies that affect the experiences of a patient in the medical arena. The recent reforms apply to the landmark legislation of Patient Protection and Affordable Care Act (PPACA) (Jakovljevic et al., 2016). This was signed in the year 2010 on 23 rd of March. It became law on the 1st of July 2010. All the current and upcoming elements associated with the staggered implementation of the PPACA are abreast with the Patient Advocate Foundation. They work to ensure that patients, healthcare providers, and all the stakeholders of the healthcare delivery get the information that they need.
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According to the PPACA data as of 2014 end of July about 8 million people had registered themselves for healthcare just in one year period in the US. Of the 8 million people about 4 to 5 million people were before that not insured at all. As a result to this, the PPACA made billions of US currency in the new payments. There is a health policy concern that can be termed as a Democrat vs. Republican battle. The major concern for any stakeholder in this health industry in the US is whether the impact is worth the cost incurred by the people. Everyone in the US has concerned whether the costs will start being utilized by the citizens through the use of the insurance services. Also of concern is there whether the government should run health care policies. For this issue, there was a divide towards the approach in the US. Seventeen states chose to create their own Obama care exchange, and the rest decided to partner with the government. A state-based form of healthcare policy had a higher percentage of people enrolling in this program as compared to the state that chose to partner with the state (federal marketplace). In April 2014, after encountering a lot of setback in technicality and application being put paused due to many obstacles, Oregon chose to close down its cover Oregon that was in the side of government partnership and cross over to the other form of Obama care. In May the same year, Nevada State did the exact thing. At the end of it all, it was proven that the Obama care (federal exchange) was a success as compared to the alternative that was not so successful.
The two divides, i.e., Republicans and the Democrats, seemed to agree in, for instance, the ban on the discrimination by insurers, the discrimination due to age and abolishment of the cps of lifetime share love and support from both divides. It is a common agreement by both divides that every US citizen should enjoy health insurance without favor or discrimination. A ruling by the US Supreme Court made the ruling that the health plan given by employers need not include contraception coverage. The argument behind that was that it was against the freedom of religious people who in this case own company to make them contraceptive payment to their employees whereas their faith does not allow such in certain circumstances. One thing that is certain whether one is a democrat or a republican the politicians are not at all times honest so when the then president Barack Obama made the statement that one would be given a right to maintain his/her health policy as he/she liked it, there were concerns whether this was just a statement to amuse citizens or whether the president meant his words, this statement over the years has proven to have been just a statement noting that insurers do not fully allow the insured to specify what they want on their cover and the Trump government is only adding salt to injury. The state that was under the federal health policy would enjoy subsidies when the insurers in these state purchased covers. These concerns were addressed by the Obama government where they subsidized the health coverage for them. Despite this concern being addressed by the government, the 36 states that did not create their insurance marketplaces was that the subsidies were not flagged off by the PPACA. The PPACA expressed that they wished that each state created its insurance marketplace, with the alternative being a fallback plan. The law is also not clear on who should enjoy subsidies. This law that is not specific gave a loophole for it to be manipulated by the 36 states that did not have their insurance marketplace. A ruling by the US stated that the federal government was not at liberty to dispose of subsidies alluding to this law citing was unclear
A name that came in the mouth of people when this issue was raised was Jonathan Gruber of the PPACA. The man stated what was now clear that those states failing to set up their insurance marketplace were sentencing their citizens to challenges in accessing subsidies as well as the benefit from the other benefits of this major health policy. Gruber urged all state irrespective of their party subscription to set up an insurance marketplace. An issue that came to mind was whether hospitals were justified to get more funds as compared to physicians and surgery institutions while giving similar services. The ASCs were given a half less than hospital are given for the same service. Hospital claim that the extra half allocated to them was to cater for the extra services that they offer apart from physician and surgery these included; specialized care and trauma amongst others. This unbalanced payment for the same payment for the same service has been a subject for debate with either side giving out concrete facts for their stand.
Health equity is the process of attempting to reduce health inequalities by avoiding differences in health due to differences in levels of social advantages giving the disadvantaged worse health services. There is, therefore, a relationship between health equity and human rights which focuses on the impacts both fields pose on the social conditions and both health and health inequalities.
Health disparities refer to the differences in health that hurt the socially disadvantaged groups. They are systematic and avoidable issues that base their differences on such as skin color, religion, nationality, and race/ethnicity. They are also based on the socioeconomic positions that are reflected by wealth, income, education, or occupation. Other characteristics that are associated with discrimination and marginalization such as sexual orientation, gender, gender identity, political affiliation, disability, geography, and age can also be the basis of health disparities. Such categories are a reflection of the social advantage or disadvantage when they determine the position of an individual or a group in a social hierarchy.
Health disparities are not referring to all differences that exist in the healthcare setting. They only include the specific subset of health differences that are particularly relevant to the social justice since they can arise from the unintentional or intentional marginalization or discrimination levels. In any case, they are likely to bring vulnerability and social disadvantage. Health disparities and its determinants form the basis for assessing equity in health. The underlying principle is the commitment to eradicate disparities in the health sector. Social justice in health is achieved through health equity. Bringing the health disparity issue within the context of human rights and ethics help in addressing justice, this exposes the few resources given to address ethnic or racial disparities by distributing these resources less widely among other disadvantaged groups. It is noted that the struggle for racial justice which is the attempt to eradicate racial and ethnic disparities in the health sector is critical and has less to lose from making the principles open.
The most appropriate ethical and human rights ideologies support giving more attention to the most vulnerable groups who encounter several obstacles. Evidence has been documented on the several obstacles encountered by these people of disadvantaged ethnic or racial groups in the United States. These ideologies can offer protection to initiatives to address ethnic or racial disparities in health from the different challenges that form real threats. Health disparities affect greatly the socially disadvantaged group by exposing them to more disadvantages health wise hence making it more challenging for them to overcome the challenges (Long, Stockley, & 2012). This support of social disadvantage makes health disparities a social justice issue which should be addressed since it impacts negatively on the health care status of the public.
Jennifer Prah Ruger as one of the scholars has been consistent in defending the right to health and the necessity of reducing inequalities in the health sector. She argues that everyone should have access to the means to avoid premature death. She calls this theory of health and social justice the health capability paradigm. She believes that the society can build efficient health institutions and systems that would help in achieving health abilities. Despite her major focus on the provision of medical care, she also educates on other measures that would result in good health such as clean air, nutritious food, safe drinking water, using preventive measures and even surveillance. To attain health justice, good health policies are needed instead of good policies for health. This helps in recognizing that there are other factors that help in the contribution of good health other than the health sector. The World Health Organization (WHO) summarizes that the environments in which people are born, live and work in are the relative source determinants of them having either good or ill health or even of them having long and productive live or short miserable lives. These health policies impact positively on the public when they are implemented and acted upon.
Nurses can help in advocating for change by creating awareness on the need to reduce disparities in the determinants of health. They can do this by enlightening people that health determinants are not only medical but can also be factors such as clean air or even the environments where people are born, work and live in. This can, therefore, be used in addressing health disparity issues. They can also help in elaborating that the disadvantaged groups are not always uniformly disadvantaged (Lai, 2012). In other words, explaining that a socially disadvantaged group may not be necessarily unable to fare on well on all health indicators as compared to another group even though the health disparities are systematic. Also, nurses can help in educating people on the importance of having health equity. With health equity, health inequalities caused by differences in levels of social advantage will be eradicated thus the disadvantaged group would also receive quality health services.
Health is important for individuals and also the whole community. Good health provides people with a true value of comfort, joy, and contentment. None the less, good health also allows humans to exercise their rights to both social and economic and also civil and political rights (Schoen et al., 2011). It is necessary for the civil and social rights of people which impact on their health to be addressed for good health to be achieved. Many of the health policy issues stated above are still unconcluded despite the new government taking power. Regardless of the major issues in hand in the health sector one cannot give a blind eye to all the development on matters health policy especially on the Obama government, much more is expected of the Trump government with concern over what will happen to Obama care.
References
Jakovljevic, M., Vukovic, M., Chen, C. C., Antunovic, M., Dragojevic-Simic, V., Velickovic-Radovanovic, R., ... & Antunovic, M. (2016). Do health reforms impact cost consciousness of health care professionals? Results from a nation-wide survey in the Balkans. Balkan medical journal , 33 (1), 8.
King, D., Ramirez-Cano, D., Greaves, F., Vlaev, I., Beales, S., & Darzi, A. (2013). Twitter and the health reforms in the English National Health Service. Health policy , 110 (2), 291-297.
Lai, T., Habicht, T., Kahur, K., Reinap, M., Kiivet, R., & van Ginneken, E. (2012). Estonia: health system review. Health systems in transition , 15 (6), 1-196.
Long, S. K., Stockley, K., & Dahlen, H. (2012). Massachusetts health reforms: uninsurance remains low, self-reported health status improves as state prepares to tackle costs. Health Affairs , 10-1377.
Schoen, C., Doty, M. M., Robertson, R. H., & Collins, S. R. (2011). Affordable Care Act reforms could reduce the number of underinsured US adults by 70 percent. Health Affairs , 30 (9), 1762-1771.
