Abstract: The author discusses historical factors contributing to the health care crisis in America and reasons for the skyrocketing costs of health using an analogy of David versus Goliath. Even though Americans spend trillions on health care, the author states that America is ranked 37th in the world in terms of its health care delivery system. The author uses the methods used to manage the health care system in discussing how such a system could impact higher education and offers some solutions to same.
Key Words: Nursing, Health Care Access, Higher Education
AMERICA: WORLD LEADER
The United States Government has been likened to David's opponent Goliath. Mandelbaum (2005), in his popular book, The case for Goliath: How America acts as the world's government in the 21st century, argues that the United States is the "world's government." This powerful position is evidenced by Goliath's/America's strength and enormous contributions, especially the preeminent military power in keeping "the world in order." The author highlights the United States' military forces that serve as a "public health service" for the world by forestalling outbreak of war, preventing nuclear expansion, assuring protection against radical regimes, and safeguarding the world oil supply (Mandelbaum, 2005). He further emphasizes that the United States is the foremost provider of the world's currency and leads in bailing out bankrupt countries (Mandelbaum, 2005). However, the pessimist inquires - is "Goliath" fighting and assuring public health for his friend's in the world while the social welfare of his own family and countrymen suffer?
America, "the great empire," is the world's leader in medical technology including minimally invasive surgery, genetic testing and mapping, gene therapy, vaccines, artificial blood and transplantation of organs and tissue, such as bone marrow from animals to human (Institute for the Futures, 2000). In addition, the United Stated leads in medical information technology with automation of basic business practices, and clinical information interfaces, including electronic medical records with enormous data mining potential (Institutes of the Futures, 2000). Although America leads the way in advanced technology and research, the health care delivery system is ranked only 37th in world class health care - just in front of Slovenia and behind Costa Rica (World Health Organization, 2000). Health disparities between the majority and ethnic minority groups have been substantiated but continue to persist (Institute of Medicine, 2003).
It is generally accepted that Americans expect to receive readily available, high quality health care. When critical life-sustaining interventions are needed, Americans expect access and choice. Few expect to be turned away from an emergency room because of the inability to pay the entire bill or the up-front co-pay. Yet, the pessimist observes that many Americans are turned away from health care daily. Although the Hill-Burton Act prohibits denial of free care in emergency rooms, Americans are turned away from emergency rooms daily through a process of "rational rationing" of health care. Americans expect the best care that our great nation has to offer, yet we do not expect to pay unaffordable prices for services provided. Many Americans are forced to decide between shelter, food, heat, or transportation and paying for health care (Appleby, 2005a).
The pessimist also observes a disconnection between expectations, availability of health care resources, and leadership that can achieve results. In the meanwhile, institutions of higher education are vexed with excessive employer sponsored benefits costs, economic down-turns, and reduced appropriations (Pulley, 2005). Students, parents, and employees are expressing concern over higher education costs (Strauss & Howe, 2005). College health is challenged by indications of escalating mental illness and substance abuse on campuses throughout the country, while colleges and universities have difficulty affording the needed behavioral health infrastructure (Blom & Beckley, 2005; American College Health Survey, 2004). …