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Karim Mahmoud
Professor Griffin
English1102
May 3, 2014
Investigation into Different Healthcare Models

John Doe is a male in his mid 30s. He has a wife and 2 children. He recently found out
his wife is pregnant with a third. They purchased a house a few years ago when they started a
family in the suburbs of a big city. He has a good paying job with a major corporation and so he
is fortunate. John has no idea how his world is just about to come crashing down around him.
John goes to work just like any other day. His job requires that he frequently has to make long
distance trips to multiple locations via a car. On one particular trip, John has a seizure. This is
odd because he never had a seizure before. The medics come and take him to the hospital. The
doctors scan his head and find that he has a mass in his brain. Several more doctor and specialist
appointments later, and it turns out that mass is brain cancer. The brain cancer becomes larger
very quickly. In a matter of weeks, John is having memory issues, gait problems, and frequent
seizures. Because of his seizures, he loses his drivers license. Because he lost his drivers license,
he loses his job. Because he loses his job, he loses his health insurance. The health insurance that
he rarely used but payed premiums into for greater than 10 years. They have no choice. Johns
wife goes back to work in order to help make ends meet. Health care for brain cancer is
extremely expensive. Because John lost his health insurance, he decided that he has to apply to
medicaid because he needs assistance. Medicaid refuses his application due to his assets. They
state that he would have to liquidate his retirement and home before medicaid will accept him.
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He started a law suit that he is still fighting today. He is no closer to obtaining health insurance
and is having great difficulty obtaining care for a life threatening illness. I am a paramedic and I
had the fortunate experience for caring for this man. I will never forget his story. He was the first
patient that I encountered that really challenged my belief that Americas healthcare system is
the best in the world. I realize now that it is only the best healthcare system in the world for those
who have the means and those who have the means are few and far in between.

Health care is a very volatile topic. Recently, the republicans are refusing to pass a clean
spending bill in congress so that they can delay Obamacare, and are willing to shutdown the
government to do so. There appears to be no end to this dark tunnel. I believe that healthcare is
such a volatile topic due to different ideologies about government and its role in healthcare. My
research reveals only 3 different types of healthcare models, a completely private model based
on health insurance from private corporations primarily payed for by the individual or employer,
a completely public model based on government insurances payed via taxes, and a hybrid of
these two models (NIH, 14). Although each of these 3 models have been implemented in many
unique ways, they are distinct enough from each other to compare/contrast due to their
fundamental differences. The intentions of this paper is to provide information about different
healthcare systems and how effective they were in providing healthcare to their population at the
lowest cost. Effectiveness in healthcare will be measured using morbidity and mortality and cost
refers to the true cost which includes both healthcare provided for and money lost from those
who are ill and unable to work.
Before I can implore you to evaluate different healthcare system models, I need to
provide you with evidence of the failure of our current healthcare system. There are many
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documented sources that show the consequences of being uninsured, the cost effectives of health
insurance, and the publics stake in health insurance. Studies performed by the Urban institute
revealed that having health insurance would improve the health of the uninsured. By improved
their health status, their work effort and annual earnings improve by about 20% (Hadley, 8). The
American Journal of Preventative Medicine has an article that shows that by insuring the
uninsured, the cost effectiveness is favorable (Muennig, Franks, and Gold, 20). A classic article
by Harry Becker summarizes why healthcare is important. Insurance against unpredictable and
unmanageable costs of illness insures the confidence needed to buy and enjoy the consumer
goods and services which constitute the standard of living for todays family (Muennig, Franks,
and Gold, 14). Given all this data of the consequences of uninsurance, it is amazing that 20
percent of americans are uninsured. (NIH, 2) Studies have shown that by having a reduction in
healthcare costs, we increase the populations work effort and annual earnings by about 20%
(Hadley). Current practices by health insurance companies stifle the economy and take money
that can be used to provide care to people and funnel it to a select few. Congressional hearings of
former physicians working for large HMOs and investigative reports over the last 10 years
revealed information that studies have analyzed to shed light on current health insurance
practices. Researchers found that health insurance companies would selectively contract with a
limited set of hospitals in order to reduce their expected utility (Wedig). There is no other nation
in the world that has a system like that in the U.S. The U.S. spends the most on its healthcare
both through private and public funding, yet its morbidity and mortality indexes are one of the
lowest of westernized nations (Health Costs, 45).


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Our current healthcare model leaves a large group of individuals uninsured. According to
data from the National Institute of health, 20 percent of Americans are uninsured (NIH).
Universal Health care is the only health care model that provides access to healthcare for all. No
other health care model can effectively insure the entire population (NIH, 37). Insuring the entire
population is a necessary goal of a healthcare model because there is certainty that everyone will
be ill and require medical care over the course of their life. Due to current moral laws, healthcare
providers are required to provide care should someone come to the hospital. Therefore, even
though we have many individuals uninsured, we still provide them with medical care at a
premium cost. The medical care we provide is at a premium cost because they usually do not
have a capacity to pay and they are treated when the illness has become critical. Medicine has an
article that shows that by insuring the uninsured, the cost effectiveness is favorable (Muennig,
Franks, and Gold, 72).

By insuring the entire population, we lower healthcare costs. We already described how
those with illnesses wait until they are critically ill before they seek care and how hospitals are
mandated to provide that care regardless of compensation. By providing them with access to
care, those patients can obtain preventative care. Preventative care has been shown to be cheaper
and more effective in keeping a population healthy and productive (Lee et al.). It is also
important because a critical illness can destroy the standard of living for an individual and his
family. An article published in the Journal of Preventative medicine revealed that Insurance
against unpredictable and unmanageable costs of illness insures the confidence needed to buy
and enjoy the consumer goods and services which constitute the standard of living for todays
family (Muennig, Franks, and Gold).
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Ultimately, our current healthcare system is based on profit. Health insurance companies
are willing to do whatever they could to reduce their payout. The current healthcare system
leaves 20 % of the population uninsured. Healthcare costs are on the rise with no signs of any
stopping to the inflation. Clearly, the hybrid model employed in the U.S. does not appear to be
fulfilling its role of providing the best healthcare at the lowest cost. Analysis performed by the
NIH implicates the differing burden of cost. Specifically, the public health insurance system
funded by taxes provides healthcare to the demographics of individuals that have the highest
risk, elderly patients, the poor, and the disabled. However, the private health insurance
companies provide care for the young, working adults who have the lowest risk and thereby have
greater profit margins. Because a private health insurance system and a hybrid system share the
same failings, lack of universal coverage and high cost, does the third option of public health
insurance provide a better alternative?

UHC has demonstrated its ability to improve access and decrease healthcare costs in
multiple studies and case examples throughout the world (Arroyave et al.) Analysis of UHC
systems showed two prominent examples. One is Columbia and the other is Taiwan. The best
part of UHC is that it does not come with a caveat. The level of care provided by UHC is
equitable to our current healthcare system, if not better. Studies have shown that those who are
insured under our current healthcare system would have no change in morbidity and mortality,
but those that were uninsured would have dramatic improvements in those same statistics.
Another case study similar to Columbia is that of Taiwan. The researchers there found that after
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a universal health care policy was implemented, mortality indexes decreased significantly and
then stabilized in the 10 years after implementation (Arroyave et al.).

Looking at studies in other countries, we find that Columbia implemented a policy of
mandatory health insurance though public healthcare. The researchers found that after the new
policy was implemented, mortality indexes decreased significantly and then stabilized in the 10
years after implementation. (Arroyave et al. ,e100) They also found that coverage increased from
47% in 1994 to 98% in 2010 (Arroyave et al. ,e100). The poorest people in the country had an
increase in coverage from 6% to 70% from 1993 to 2007. (Arroyave et al. ,e100) This evidence
is not just statistical analyses performed on hypothetical populations. This is real data of real
change in healthcare policy and the resultant improvement in mortality.

Previous examples highlighted the strength of UHC. However, Taiwan provides the best
example because previous examples discussed third world countries implementation of UHC and
Taiwan is not a third world country. The country initially had a private health care system. The
country established a universal healthcare system in 1995. It now covers 98% of the population
and enrollees enjoy almost free access to healthcare. Obviously more individuals have access to
care but did it improve the health of the population? Taiwans experience proves that for them,
UHC was much better then PHI. The authors of the study found that the universal healthcare
system showed a reduction in deaths, particularly in those age groups least likely to have been
insured previously (Lee et al.).

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The research I found was astounding. Evidence across the world is unanimous, UHC is
most successful in providing the lowest morbidity and mortality to a population at the lowest
cost. Every westernized nation of the world employs a universal health care system. It allows for
access to care, it improves the health of the population, and there is evidence throughout the
world that it does so.Why is it that we here in America are vehemently opposed to it? Why is it
that studies performed here in this country are very contradictory as to whether UHC would
provide better healthcare than our current system? Further investigation into the players in the
U.S. Healthcare system may reveal those who are opposed and their motivations for doing so.
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Works Cited
Arroyave, Ivan et al. The Impact of Increasing Health Insurance Coverage on Disparities in
Mortality: Health Care Reform in Colombia, 1998-2007. American Journal of Public
Health 103.3 (2013): e100e106. Print.
Becker, Harry. The Publics Stake in Health Insurance. Nursing Outlook 60.5 (2012): 305
308. ScienceDirect. Web. 12 Sept. 2013.
Hadley, Jack. Sicker and PoorerThe Consequences of Being Uninsured: A Review of the
Research on the Relationship Between Health Insurance, Medical Care Use, Health,
Work, and Income. Medical Care Research and Review 60.2 suppl (2003): 3S
75S.mcr.sagepub.com.librarylink.uncc.edu. Web. 12 Sept. 2013.
Health Costs: How the U.S. Compares With Other Countries. (n.d.). Retrieved February 25,
2013, from http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-
compares-with-other-countries.html
Hidden costs, Value lost : Uninsurance in America / Committee on the Consequences of
Uninsurance, Board on Health Care Services, Institute of Medicine of the National
Academies. (2003). Washington, D.C. : National Academies Press, c2003.
Institute of Medicine (IOM). 2004. Insuring Americas Health: Principles and
Recommendations. Washington, DC:
National Academy Press.
Lee, Yue-Chune et al. The Impact of Universal National Health Insurance on Population
Health: The Experience Health Costs: How the U.S. Compares With Other Countries.
(n.d.). Retrieved February 25, 2013, from
http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-
other-countries.html
of Taiwan. BMC Health Services Research 10.1 (2010): 225. www.biomedcentral.com. Web. 12
Sept. 2013.
Long, Sarah S. Underinsurance of Children Is Common and Effects Their Access to Care and
Their Health. The Journal of Pediatrics 162.2 (2013): 220. ScienceDirect. Web. 12 Sept.
2013.
McCabe P. Working But Uninsured: Millions of Employed Americans Uninsured and Unable
to Get Medical Care. Robert Wood Johnson Foundation. April 27, 2005.
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Muennig, Peter, Peter Franks, and Marthe Gold. The Cost Effectiveness of Health Insurance.
American Journal of Preventive Medicine 28.1 (2005): 5964. ScienceDirect. Web. 12
Sept. 2013.

U.S. Census Bureau. Income Stable, Poverty Up, Numbers of Americans With and Without
Health Insurance
Rise, Census Bureau Reports. August 26, 2004.
Wedig, Gerard J. The Value of Consumer Choice and the Decline in Hmo Enrollments.
Economic Inquiry 51.1 (2013): 10661086. Wiley Online Library. Web. 24 Oct. 2013.