Recently I attended a Naturalization Ceremony, my first ever. Forty people from 15 different countries met all the requirements to become citizens of the United States.
The ceremony was solemn but joyful with a local high school choir singing “Music to My Soul” as the whole audience clapped along. The Oath of Allegiance that I’m sharing with you here is sobering . Judge Michael said that we natural born citizens should take it to heart also.
In honor of my new fellow citizens, I’m sharing a post I wrote about the American healthcare system-not perfect, but one we can “support and defend” with pride.
Every year on July 4th we celebrate Independence Day- the day the original 13 American colonies established an independent country.
They subsequently established a government, military, educational system, highway system, public works, and a healthcare system.
We Americans may pride ourselves on not having “socialized” medicine or “national healthcare”, but we do have a health care system that is a combination of public and private funding and administration. And even private healthcare must comply with a myriad of local, state, and federal laws and regulations.
I believe we have one of the best healthcare systems in the world because of the people who work in healthcare- the people who devote years to education and training and who work tirelessly 365 days a year, 24 hours a day to make and keep us well. Their commitment, compassion, dedication and competence benefits all of us and deserves our gratitude.
According to recent statistics, the United States government accounts for-
40% of healthcare spending
$1.3 trillion /year
Covering 100 million individuals
Through 4 federal agencies
Department of Health and Human Services
Department of Defense
Veterans Administration
Department of Homeland Security
(JAMA (Journal of the American Medical Association), June 21, 2016)
Healthcare for active duty military and veterans
During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.
Healthcare for civilians
Under President Barack Obama, Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens. Newly elected President Donald Trump vowed to “repeal and replace” this law while some changes have been made, it is still in force.
Two other government healthcare programs- Medicare and Medicaid are over 50 years old.
Medicaid provides insurance coverage for adults and children who are unemployed or low income.
Medicare covers disabled children and adults and persons 65 years and older.
The numbers are rather staggering.
- Together these programs cover at least 30% of Americans.
- Together they comprise 25% of all federal spending.
- Together they pay 40% of total U.S. health care spending.
An infographic from the Kaiser Family Foundation and JAMA explains this further.
(Cubanski J, Lyons B, Neuman T, et al. Medicaid and Medicare at 50. JAMA. 2015;314(4):328. doi:10.1001/jama.2015.8129)
Disabled children and adults may qualify for Medicare. 
Children may be eligible for Medicaid if their families cannot obtain health insurance for them.
You may not be eligible for either of these programs now, but chances are eventually you or someone close to you will.
- Anyone can become disabled from a serious illness or freak accident.
- You or your spouse may lose your job and your employer sponsored health insurance.
- Your child may have a disability that will prevent them from working when they grow up.
- We may all live long enough to qualify for Medicare on the basis of age alone. Your parents or grandparents are near or already at Medicare age.
It’s important to understand how Medicare works, since it’s not automatic; even if you qualify, you need to sign up to be covered (with a few exceptions). The rules are summarized here. Or consider an easy to understand book.
Government healthcare administration –The United States Department of Health and Human Services (HHS)
Several government agencies regulate, monitor, promote and/or support both public and private healthcare (most but not all of these are under HHS.)
Food and Drug Administration- FDA
Centers for Disease Control and Prevention- CDC
National Institutes of Health- NIH
Occupational Safety and Health administration-OSHA
Drug Enforcement Agency-DEA
Important Federal Healthcare Laws
The Affordable Care Act- ACA
Health Insurance Portability and Accountability Act-HIPPA
Emergency Medical Treatment and Labor Act- EMTALA
Health Information Technology for Economic and Clinical Health- HITECH
Americans with Disabilities Act-ADA
Family Medical Leave Act-FMLA
The origin of United States healthcare
In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths” of “Life ,Liberty, and the Pursuit of Happiness” and to promote “Safety and Happiness” .
In the Constitution they vowed to “promote the general Welfare” .
I wonder if they envisioned their new government would spend so much time and money providing and regulating health care –
most of which was not available or even imagined at that time?
Let’s celebrate!
Dr. Aletha
