Welcome to THIS IS AMERICA in VOA Special English. This week our program is about health care in the United States.
Forty years ago, a Chicago businessman had an operation for cancer. Doctors could offer no further treatment. The cancer spread. The man died about a year later. His medical care cost about ten-thousand dollars.
Six years ago, an office administrator in Washington, D.C., had an operation for cancer. Later she had treatment with radiation and powerful chemicals. Today she feels fine. Her doctors say she will probably live many more years. But her care cost several hundred thousand dollars.
Medical science today saves many more lives. But this can also mean major debt. Government programs provide health insurance to the poor and elderly.
Others depend on private insurance. Companies guarantee to pay part or all of the costs of care. But the more the policy covers, the higher the price.
Around sixty percent of working Americans have health insurance through their jobs. Their employers usually pay at least part of the cost. But, as those costs increase, employers feel the pressure.
The Department of Health and Human Services reported this month on health care spending for two-thousand-two. It says spending rose nine percent that year, to one-point-six million-million dollars. Health costs per person averaged more than five-thousand-four-hundred dollars.
Some employers no longer offer health coverage. Others have increased the share paid by their employees.
Getting insurance can be difficult for those who work only part time. The same is true for people who are already sick.
Some Americans have no health insurance. The Census Bureau says fifteen percent of the population had no coverage in two-thousand-two. The number was forty-three-point-six million people.
Last week a committee of experts called for health coverage for all by two-thousand-ten. The report was from the Institute of Medicine, one of the National Academies. The report says about eighteen-thousand people each year die unnecessarily because of lack of insurance.
The experts also estimated how much money the United States loses as a result of poor health and early deaths of uninsured adults. The estimate is between sixty-five-thousand-million and one-hundred-thirty-thousand million dollars a year.
A top official in the Bush administration, however, says it is not realistic to expect universal health coverage by two-thousand-ten.
Some uninsured people get care at university teaching hospitals. A number of religious and humanitarian agencies like the Salvation Army offer free or low-cost care.
But hospital emergency rooms are where many poor people go even for minor problems. This adds to hospital costs.
The largest number of poor get medical help through public programs at several levels of government. The federal government and the states jointly offer an insurance program called Medicaid. States also administer a program to aid children whose families earn too much to receive Medicaid.
However, budget problems have led some states to reduce their services. Florida, for example, has thousands on a waiting list for the State Children's Health Insurance Program there.
Another issue for a lot of people is the cost of prescription medicine, drugs only a doctor can order. Drug companies say new medicines cost a lot to develop and market.
The industry notes that about one-tenth of every dollar spent on health care in the United States goes to prescription medicines. It says these drugs represent only a small part of health care spending.
Both major political parties have offered plans to improve the health care system.
The candidates for the Democratic nomination for president have proposed their own ideas. And President Bush recently won approval of big changes to Medicare. Medicare is the government insurance program for people age sixty-five and older. It also helps pay for some younger people who are disabled.
Congress approved Medicare in nineteen-sixty-five. Lyndon Johnson was president. Johnson proposed Medicare as one of the social reforms in a plan he called the Great Society.
President Bush signed the Medicare reform act in December. The bill received the support of an influential activist group. The group is called AARP, formerly the American Association of Retired Persons. Members of AARP are age fifty and older. As the nation gets older, voters get older. So this issue is important politically.
Parts of the new law will take effect at different times. Forty-million elderly or disabled people will receive help to buy medicine, starting in two-thousand-six. And seniors will get a chance to establish tax-free health accounts to save money for future care.
The cost of the new Medicare law is estimated at four-hundred-thousand-million dollars over ten years. Critics say that is too much. Labor unions and other groups also argue that the changes are better for drug companies than for seniors. Supporters of the new Medicare act say this is not true. They say it is important that seniors will get their first help from Medicare to pay for medicine.
The new law also lets private health plans and insurance companies play a bigger part in Medicare. Opponents say letting these companies compete with the government will damage the system. They say seniors will pay more, not less. Supporters say competition means better choices.
Under the new Medicare law, patients will have choices about their drug plan. They can stay in traditional Medicare for their doctor and hospital costs, and choose a drug policy to go with this. Or, they can join a completely private plan. This would pay for hospital treatment and doctors in addition to medicines.
Wealthier Medicare patients are to pay more than others for their medicines. But the poorest seniors would pay only a few dollars for each prescription.
When some Americans buy medicine, they do not go to the local drugstore. Some travel to Canada or Mexico to save money. Others use the Internet to order prescription drugs from Canadian suppliers. Canada negotiates for and buys large amounts of American-made drugs. Prices controls in Canada mean that drugs often cost much less there. Some people think this drives up American drug costs.
The United States Food and Drug Administration says importing drugs is dangerous and illegal. It says this is true even if the drugs are re-imported. That is, they were made in America and then shipped for sale outside the country.
But some public officials in the United States say they, too, will try to save money. Officials in Boston, Massachusetts, say they will buy drugs from Canada for seven-thousand current and retired city employees. The governor of New Hampshire says his state will use medicine from Canada for prisoners and poor people.
Another state, Illinois, has appealed to the Department of Health and Human Services in Washington. Illinois wants to import drugs from Canada legally. Illinois officials argue that the new Medicare law permits this if the drugs meet American safety requirements.
Tom Daschle of South Dakota leads the Democratic minority in the Senate. Senator Daschle says the new Medicare law is bad legislation. He says seniors will demand many changes.
Senator Dianne Feinstein of California was among Democrats who voted for the law. Senator Feinstein called it a step in the right direction. The president of A-A-R-P had stronger praise. He says it represents a victory for older citizens.
What do those people think? Many would probably agree with this retired nurse from Rockville, Maryland. She says: “We will find out when the changes take effect.”
Our program was written by Jerilyn Watson, produced by Caty Weaver. I'm Steve Ember.
And I’m Faith Lapidus. Join us again next week for another report on life in the United States on the VOA Special English program, THIS IS AMERICA.