To:  Governor Cuomo

From:  Jaspreet Sra

Date:  June 10, 2021

Re:  Federal Mandates to increase access to health care for all individuals

Statement of Issue:  The health care system in the United States is fragmented and does not focus on prevention. Having access to health care service is a basic human right, yet it remains restricted to many individuals. There are several barriers to health care services such as shortage of physicians, inadequate health care insurance, sexual orientation, rural and underserved areas, citizenship status, language barriers, cultures, religion and disabilities. Overcoming these barriers will allow better access to health care and prevent care from being compromised. The Patient protection and affordable care act of 2021 aimed to eliminate the insurance related barrier. It expanded access to medicaid coverage and also gave access to the uninsured population to purchase insurance. This act decreased the number of uninsured population. However, barriers still exist and more policies need to be implemented to ensure that every individual gets this basic human right. In order to get access to care three components need to be met, entry into the healthcare system, supply of services and timely provision of care.

• The United States is a member of the United Nations:  In 1948, The Universal Declaration of Human Rights (UDHR)  was adopted by the UN which states that fundamental human rights are to be universally protected. This was accepted by the United States, yet there is failure to ensure every resident gets access to health care.
• Transportation as a barrier to healthcare access: Accessing health care also requires transportation to doctors offices, health care facilities etc. This is challenging for individuals that are disabled and those that live in rural and underserved areas as they need to travel longer periods of time.
• Increased burden of cost of health care: All through premiums can only grow by 10% per year, salaries/incomes have not been increasing at the same rate.  The burden of health care costs has been increasing for working families preventing them from purchasing insurance and hence decreasing access to health care.
• Decreases physician visit in comparison to other industrialized countries: Majority of the practicing physicians are soon going to be 65 and older. Many of them will be retiring soon, increasing the shortage of physicians.  Residents of the United States are noted to visit the physician less in comparison to other industrialized countries. The shortage increasing, will increase this rate.

Policy Options

A federal mandate for all residents of the United States to receive universal health care. By providing health insurance to all, it would relieve the financial burden and patients would not hesitate to be seen by a provider. This can be done by adopting our neighbouring country, Canada’s  health care system. Health insurance should be publicly funded and financed with the revenue from federal, state and local taxation. These funds will be given to hospitals to use towards their patients’ care, hospital requirements and salaries. Private clinics can bill the government based on the patients they care for.  Having a single payer system ensures health insurance is given to all and by keeping doctors offices and hospitals private businesses residents are able to choose between different doctors and hospitals.

• Advantages: Access to health insurance and medical services would be given to every resident. Patients will not feel apprehensive to visit a medical professional based on costs. Hence, it would be easier for patients to seek care and get access to care. Clinicians will not be able to target the wealthier population which would allow for the healthcare system to be closer to social equity. In the long run this would lead to a healthier society. Government controlling the prices of services and medications, will decrease the overall health care costs. Clinicians will also be able to reduce administrative costs as they will not be required to work with health insurance companies.
• Disadvantages: Single payer system, relies on the fact that everyone in society is healthy. If a larger population is sick, it will drain the funds at a quicker rate. All though, access to care will be greater  patients may still face longer wait times. The focus of health care shifts, towards essential living and lifesaving health rather than specialty care. It may decrease access to health care to those that require treatments for special/rare diagnoses and elective procedures.

Addressing the physician shortage aids in increasing access to health care. This needs to be approached by a multi faceted approach. A federal mandate will require the participating hospitals to increase the residency funding programs. Bridge programs need to be increased, that will allow students from high school to get direct admission to medical school after completing their undergraduate program. Local and federal governments should offer  current universities/colleges incentives to open new medical schools. This  will increase the number of medical students intending to become physicians. Implementing new innovative technologies to increase the physician’s reach will help the current physicians treat a larger amount of the population and increase medical coverage.

• Advantages:  Recruiting more clinicians will decrease wait times and increase access to care. A larger number of doctors will decrease the doctor patient ratio. This will allow doctors to see less patients and provide more attention to them. Furthermore, patients will not struggle with lack of appointment times;
• Disadvantages:  Increasing the number of providers will increase cost. Doctors need to be compensated for their work and their salary on average is 237,000. Aside from increased costs, patients will have the ability to visit multiple consultants which can lead to disorganization. Increasing the number of clinicians alone will not increase access to health care, they need to be dispersed over the country depending on the population of specific geographic areas.

A cost effective and reliable means of communication with a doctor is through tele- health. An optional federal mandate to ensure each  clinic, urgent care and hospital offers telehealth services.. This service will be offered to both current and new patients. The doctors available for the service should be both specialist and primary care physicians.

Advantages:  Telehealth is more convenient and accessible. It is cost effective and allows for health care savings. It increases access to health care. Patients will not have to experience long wait times and will have increased access to specialist care. Health care issues can be addressed quickly and geographic disparities can also be addressed.

Disadvantages: In order to offer tele- health services, mass technical training needs to be done. IT staff needs to be hired and new equipment needs to be purchased. This requires both time and money. Patients may meet different providers on telehealth and hence care continuity will suffer. Different providers may not have access to the patient’s medical history and Tele- health does not allow for a physical check up. Both of these factors decrease the quality of care.

Policy Recommendation: 

A leading barrier to access to care is cost and health insurance. It is necessary to ensure that each resident of the United States receives health insurance. Currently, the United States is labeled as a country that is leading in chronic diseases.The single payer system is successful if the majority of the population is healthy. However, by adopting this system it will cause the healthcare system to focus more on prevention of chronic diseases. In the long run it will help reduce the cost of health care. With the focus being greater on prevention, it would be unlikely that a patient requires the care of a specialist. Prolonged wait times are not directly impacted by universal health care but due to the provider concentration in the geographic area. Furthermore, universal health care will not decrease the focus towards innovation. The benefits of universal health care overshadow the possible risks that come along with it

Works Cited

AAMC Report Reinforces Mounting Physician Shortage. AAMC. (2021, June 11).

https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-phy

sician-shortage.

Barbosa, W., Zhou, K., Waddell, E., Myers, T., & Dorsey, E. R. (2021). Improving Access

to Care: Telemedicine Across Medical Domains. Annual Review of Public Health, 42(1),

463–481. https://doi.org/10.1146/annurev-publhealth-090519-093711

Government of Canada. (2019, September 17). Canada’s Health Care System. Canada.ca.

https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/

health-care-system/canada.html.

Mangiofico, D. G. (2020, July 30). Physician Shortage Requires Multi-Prong Solution. AJMC.

https://www.ajmc.com/view/physician-shortage-requires-multiprong-solution.

Telemedicine Benefits and Disadvantages: 10 Pros & Cons. eVisit. (2020, October 1).

https://evisit.com/resources/10-pros-and-cons-of-telemedicine/.

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5).

International Health Care System Profiles Canada. Home.

https://www.commonwealthfund.org/international-health-policy-center/countries/canada.

Tikkanen, R., Abrams, M. K. (2020, January 30). U.S. Health Care from a Global Perspective,

2019: Higher Spending, Worse Outcomes? U.S. Health Care from a Global Perspective,

2019 | Commonwealth Fund. https://www.commonwealthfund.org/publications/

issue-briefs/2020/jan/us-health-care-global-perspective-2019

What is Universal Health Care? Definition, Pros, and Cons – 2019. MasterClass. (2020).

https://www.masterclass.com/articles/

what-is-universal-health-care#what-is-universal-health-care.