Healthcare

Delivered March 3rd, 2018. Contributors: Nellene B., Boone F., Kara B. and

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Healthcare Zeitgeist

Our research suggests that a majority of Americans believe that the cost of healthcare is too high. The most popular response to this issue seems to be a call for the government to either provide universal healthcare or intervene in some other way to ensure that all Americans have access to healthcare. 

METHODOLOGY
In order to create a sense of the current zeitgeist around healthcare in the US and California, we relied on statistical information about healthcare attitudes and beliefs in the US and California. Specific information on Northern California was not available. We looked at majority opinions in order to calculate the predominant ideals and beliefs.

AMERICAN ATTITUDES TOWARD HEALTHCARE AFFORDABILITY
Recent surveys suggest that many Americans are anxious about the affordability of healthcare and health insurance. A May 2017 article in Consumer Reports suggests that Americans are becoming increasingly concerned about the cost of healthcare, citing 57% of Americans who worry whether “they and their loved ones will be able to afford insurance.” This article ties some of these concerns with worries about how preexisting conditions may or may not be covered if Congress repeals and replaces the Affordable Care Act. On a similar vein, a 2016 report claimed that “one in five [US adults] say they struggle to afford prescription drugs” and that “health care costs cause serious financial problems for more than a quarter of Americans.” (This report noted that many Americans were pleased with the quality of their health care, but these figures suggest that those who experience health care struggles find those struggles to be significant.)

AMERICAN ATTITUDES TOWARD POSSIBLE SOLUTIONS
The majority of Americans believe that the government should play some role in helping Americans access affordable healthcare, though they might not agree on the extent of that role. One survey found that 78% of respondents wanted the government to ensure access to “affordable, quality care.” Another poll says that 62% of Americans prefer “guaranteeing a certain level of health coverage and financial help for senior and lower-income Americans.” For some, this means universal healthcare. Bernie Sanders recently cited a poll that found that “60% of Americans [...] support ‘expanding Medicare to provide health insurance to every American.’” These exact statistics might seem to contradict the Kaiser poll which says that 49% of respondents wanted to repeal the ACA, but together, the general sentiment is that the government needs to do something about making healthcare more affordable, even if people can’t agree how that would look.

It should be noted that most people in these surveys are looking to the federal government to help with the health care crisis, and it is hard to know whether that means that they feel any kind of personal responsibility toward solving the problems. One survey did suggest that only 18% of Americans “are very engaged in their personal health” while 17% “do not place high importance on personal health at all.” While this suggests that some people might not be as invested in healthcare concerns as others, it does not necessarily reflect the overall attitude of Americans. Another study claimed that Americans value the elderly’s access to healthcare even if it means higher government spending, and this might indicate that people view taxes as a way to help solve the issue.

CALIFORNIA ATTITUDES TOWARD HEALTHCARE
California is in a healthcare crisis. An LA Times article explains that California will lose $20 billion if the ACA were repealed, and that this is especially significant because California has acted on “the promise of health insurance reform.” Another article shows that the largest concern for most Californians is the cost of health insurance, followed by the fear of not having health insurance. Californian beliefs and attitudes seem to reflect those of the nation.

CONCLUSION
In the United States, the most significant concerns are access to affordable healthcare, access to health insurance—especially for senior citizens and those with preexisting conditions--and access to affordable drugs. The most popular proposed solution is government intervention, with a significant percentage favoring universal health care.

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Healthcare Conversations

OverviewHealthcare is among the most urgent and divisive issues plaguing the current U.S. political climate. In particular, Americans have become increasingly concerned with and vocal about the quality, costs, access and providers of health insurance services. The introduction of the Affordable Care Act (ACA), or "Obamacare," was controversial in itself, and recent attempts at repeal by the Republican party have given new life to the issue. In light of such events, poignant conversations have been sparked about what the ideal American healthcare system looks like. For the most part, those Americans who support a government-run system want to be a part of the solution (contributing both ideas and money). Those that favor a private system tend to desire a more passive role in reform. 

Subjects of conversationStances on healthcare in the U.S. are diverse, but are typically based on the following variables: 

1) Cost — Across the board, Americans desire to reduce the cost of their own healthcare. One of the primary concerns with a state-run healthcare system is that insurance costs will increase for middle- and upper-class families in order to foot the cost of insuring lower-income families. 

2) Quality — Many people fear that the implementation of Obamacare would come at a sacrifice in quality of care services (i.e. longer waits, more difficulty accessing physicians and care providers)

3) Access — The debate hinges on a fundamental question: is healthcare an inalienable right, or simply a luxury? Conversations are centered upon two polarizing answers. First, that accessing healthcare is an inalienable right that should be enjoyed by all, regardless of socioeconomic standing, or second, that healthcare is a right reserved for those who can afford such a service. A common fear is that increasing access would increase cost and decrease the quality of care. 

4) Providers — Many Americans know what they want in a reformed healthcare system, but do not know what a reformed system should look like. Should there be a single nation- or state-wide payer of care (like with Medicare and Medicaid, respectively)? Is a government-sponsored marketplace with a variety of plans (like ACA) the best option? Should accessibility to personal health accounts be increased (i.e. Health Savings Accounts for all)? Should the industry be completely privatized?

5) Citizens roles — Closely linked to the debate about what entity should provide provisions, is the debate about how those entities are funded and regulated. The split lies between those who favor an active role in the process through democratic practices and funneling tax money into government-funded programs and those who favor a passive role, leaving everything to private companies. 

Views expressed in conversationEach of these 4 factors contributes to a diverse array of opinions. Healthcare represents an extremely complex problem with no single, all-encompassing solution. Here are some representative opinions of a few individuals, as summarized from publicized interviews:

 Emilia Dicola, 28  
Emilia is an aspiring singer who scrapes by on gig money. She has no complaints regarding ACA, as she qualifies for the free government health insurance available for low-income Americans. She reaps the benefits of the current solution and has no desire to find a new one. 

 Gwen Hurd 
Gwen has to spend more than $6000 per family-member annually for coverage. She believes that people who earn nothing and contribute nothing are a burden to the system and that people who work hard and struggle for every penny end up barely surviving due to increased costs. Mrs. Hurd is happy to pay her share but dislikes the idea of footing the bill for others. Essentially, she wants cheaper healthcare but doesn't want to contribute financially to the solution. 

 Tim Williams  
Tim wants the government to step up and believes healthcare to be a necessity like clean water. He thinks the government should step in and arbitrate the process and has no problem playing an active role in a solution to increase access to care. 

 Monna French  
Monna's husband received more coverage than he bargained for when he bought insurance from a private provider but understands that others are not often so lucky. She believes programs like Medicare and Medicaid are less a universal right and are instead a universal agreement that the less fortunate should be assisted. She supports a limited government role in healthcare provisions. 

 Maria Dutton 
Maria retired from the army due to a health issue, and her husband's military insurance covered most of their heavy premiums, but eventually, they had to file bankruptcy. Her husband could not accept that one person's right to health becomes another person's responsibility, and believes everyone should contribute to the treatment they personally receive. Maria is reluctant to accept that healthcare is a right and doesn't like the idea of people getting healthcare without having to work for it. Together, they believe that government is crossing a boundary by providing universal care. They would love to see their own costs go down but don't want to be a part of a solution adjudicated or paid for by the government. 

 John McDonough 
John is of the view that America gets dismal outcomes for the enormous amount they spend on health care. He wants to remain passive in a finding a solution. 

In addition, other Americans believe that because their coverage is expensive, it is of high quality; that their own coverage is good, but that the system as a whole is not; that the prospect of losing the ACA would be a step backward; or, the security of the ACA is worth the cost and marginally reduced quality of care. 

All in all, opinions are diverse, and above all, changing. With the prospect of losing the ACA, a majority of Americans (60%) now favor the program. Overwhelming majorities of low-income families and minorities support government healthcare, and whites are split almost 50-50 on the issue. 
ConclusionThe recent attempt by the Republican party to repeal the ACA has galvanized public conversation about the American healthcare system. The debate centers around the topics of insurance, cost, quality, access, and providers' focus on citizen concerns. Opinions of what a fair solution looks like are incredibly diverse, as one would expect with such a complex problem. For the most part, those Americans who support a government-run system want to be a part of the solution (contributing both ideas and money). Those that favor a private system tend to desire a more passive role in reform. 

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Community Healthcare

Generally, patients of community healthcare centers express positive attitudes towards the quality of care received, largely due to the low costs and high access to care. These healthcare centers are also more likely to accept new patients with low income, which also increases positive attitudes.

OVERVIEW OF COMMUNITY HEALTHCARE

In the U.S., it is reported that community healthcare centers serve over 27 million patients, and 104 million patients visit these center annually. This is likely due to the fact that community healthcare centers are more likely to accept new patients, when compared to other primary care providers. With 83% of community healthcare patients being uninsured or publicly insured, those living without insurance who also live near a community healthcare center are less likely to have unmet medical needs because of these community centers.

The use of community healthcare centers has been growing in recent years, with the total number of patients served increasing from 20.2 million to 24.3 million between the years of 2011 and 2015, a growth of 20.3%. Between 2012 and 2015, the percentage of uninsured patients who use community healthcare centers rose from 14% to 20%. This not only shows that Americans are aware of what community healthcare centers are, but they also have been increasing their use of them in recent years.

The centers themselves have been growing as well. Between 2011 and 2015, the number of grantee organizations increased from 1,128 to 1,375. The number of healthcare sites have also grown during that time frame, increasing from 7,621 sites to 9,754.

IMPRESSIONS OF COMMUNITY HEALTHCARE

Generally, people express positive feelings towards community healthcare centers. In a 2016 survey, 73% of community healthcare patients report using these centers as their primary source of care. These individuals state that they feel these centers provide high quality care. Notably, patients of community healthcare centers report 18% lower rates of E.R. visits and 67% lower rates of multi-day hospital stays when compared to non-community healthcare patients. For

Additionally, the total cost of care, including costs outside of the healthcare center, is 20% lower than that at independent practices or outpatient clinics. This provides an incentive for uninsured patients to return to these centers even after obtaining insurance, particularly when noting that these centers increase access to primary care and have been shown to perform as well as or better than other providers regarding quality and access to care.

According to a 2017 survey, 60% of Americans say that the government, which is a major funder of community healthcare centers, should hold responsibility for ensuring healthcare coverage for all citizens.

CONCLUSION

In conclusion, the majority of patients who use community healthcare centers express positive attitudes towards these providers of healthcare. They report experiencing a high quality of care at a lower cost than they would spend at other healthcare providers. Community healthcare centers report growth within the centers and the number of patients in recent years, showing that awareness of these centers is growing and patients are using them more often.