Every society is affected by any national changes or new movement introduced; therefore, an issue one may think is unrelated to his environment can very well affect him through chains of cause and effect.Health care is an immediate issue that concerns all of us. We all experience it and need it. Let’s serious ask ourselves if the current health care system is satisfactory and available to everyone. Should health, medicare and treatments be available to only selected groups? Many people are voting for the presidential candidate who can restore the present health care system or who can pioneer a better healthcare distribution for our country. Personally, I hope to see a change that health care is available and affordable to everyone.Being able to receive basic health care is a fundamental need of all people. Fulfilling this fundamental need makes people feel secured, and it makes sense that people with better health can contribute more to the society. A realistic and reachable standard of health should be set for all people. This effort needs a non profit driving entity to establish and to maintain it. People’s life and health should not be compromised for the profit of few organizations.Before moving to Japan, I was covered under my parents’ insurance policy in the United States. Their policy covered children of the family until the age of twenty-four. Upon graduating from university, I moved to Japan and started my first job there. I joined the Japanese national health insurance through the company I worked for. There are basically two types of health insurance in Japan: national health insurance and employer-sponsored health insurance. Usually, under employer sponsored insurance, the insurance premium is calculated according to income, number of dependents, and the company’ subsidies. For someone who is self-employed or unemployed, the national health insurance costs a minimum of 13300 yen, or about $110 per month plus a small percentage of income for those who are self-employed. In other words, everyone can get insurance from around $100 dollars a month. Unlike the Medicaid program in the U.S. which is only available to certain low-income groups with specific requirements for eligibility, the Japanese health insurance is available to every citizen and legal residents. There is a ceiling to what the Japanese National insurance covers, but it covers all the basics and beyond.In most cases in Japan, patients choose their doctor and hospital. There is no limitation to the doctors or hospital they can visit. This is a true competition among the clinics, hospitals, and medical practitioners, not for profit, but for quality. The same insurance that people have in Japan gives them the freedom to get second opinions and naturally eliminates those doctors whose practices are in question. The doctor visits, treatments, and medicine are not free; one is responsible for thirty percent of their medical bills. Japanese health costs are much lower than the costs in the United States. Thirty percent of the medical bill is still a reasonable amount one can afford. There are also special cases or categories of illness for which the insurance would give more coverage. If one is late on his payment, his insurance will not automatically be invalid. The insurance will still cover the person as long as he makes up the missed payments. After all, some people do run into difficulties in life at one point or another. Sounds to good to be true? Well, It’s real.Taiwan, a place with no world recognition politically, has one of the top public health care system in the world. After moving to Taiwan due to my husband’s transfer a year a go, I learned and appreciated the system where universal or national health care is available to all more than ever. When speaking of universal, national, or pubic health insurance, people often turn their attention to the well-debated and discussed health care system in Canada. There are those whose views are negative, claiming that the medical service in a single-payer insurance system may not perform at its ultimate, and those whose views are positive, saying that they do not live in fear of ever having to face bankruptcy for outrageous medical bills. From my informal inquiries, more Canadian I came across favor their national health care system. Most of those who favor their national health care system commented that people of Canada are more secured in having their basic physical and psychological needs met.In Taiwan, there is also government-sponsored universal health care for not only their citizens but also for foreign residents who live in Taiwan. Foreign residents can apply for the government-sponsored insurance after proving their legal status of residing in Taiwan. The insurance fee starts from the basic 600NT, or around $18 a month. For people in higher income brackets, their insurance is calculated based on a percentage of their income over the 600Nt. Fees are waived for retired soldiers, those who are physically challenged, and people who have economic disadvantages.Interestingly, Taiwan’s national health insurance has only been established for little more than two decades, since 1985. The government policy-makers studied health care system from different foreign countries and composes the first Taiwan national health care from the ideas and methods of the system of other countries. It was said that Taiwan’s national insurance system is like a completed puzzle made from pieces of which fit its country and people. This insurance now covers the entire population, including foreign legal residents. According to research funded by Taiwan’s National Health Research and Taiwan’s Bureau of National Health Insurance, the cost of health care did not rise after the universal coverage was established (Jui-Fen & Hsiao, 2003.) What does that tell us?A basic health care program can greatly reduce the consequences of illness left untreated. Basic health care does not mean free of charge or mindless spending without control. To build a healthy nation, we should take a closer look at the current U.S. health insurance. After all, a sound nation starts with the health of its people.

One of the foremost challenges faced by health care professionals is to formulate a well-devised, well-thought out plan for assisting both the patients as well as the health care givers. Care planning is an essential part of health care, but is often misunderstood or regarded as a waste of time. Without a specific document delineating the plan of care, important issues are likely to be neglected. Care planning provides a sort of ‘road map’, to guide all who are involved with the patient’s/resident’s care. The health care plan has long been associated with nursing; however, all health care professionals need to be assisted in the care giving process. In today’s world, highly expensive Health Insurance policies are not viable for most individuals. Therefore, the government needs to play a crucial part in ensuring that ‘health care’ is impartially and effectively provided to all citizens.At the beginning of the 20th century, a new concept, the concept of ‘health promotion’ began to take shape. It was realized that public health had neglected the citizen as an individual and that the state had a direct responsibility for the health of the individual. Consequently, in addition to.disease control activities, one more goal was added to health-care planning- health promotion of individuals. It was initiated as personal health services such as mother and child health services, mental health and rehabilitation services. C.E.A.Winslow, one of the leading figures in the history of public health in 1920, defined public health care planning as: ‘the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort.’The first step in the health care planning program is accurate and comprehensive assessment. Once the initial assessment is completed, a problem list should be generated. This may be as simple as a list of medical diagnosis. The problem list may include family/relationship problems,which are affecting the parent’s overall well-being.Following the problem list, the health-care professional must ask,’ will I be able to solve this problem?If yes, then the goal of the health-care professional must be to solve that particular problem. Moreover, this goal should be specific, measurable and attainable. The approaches towards achieving that goal should also be measurable and realistic. An example of a problem that could improve, would be health-care deficit related to hip fracture. With rehab, this problem is likely to resolve.In case a medical problem is irreversible- such as diabetes- the next step would be to eliminate further complications or possible health deterioration. In the case of such health problems, the goal should be to retain the level of health at an optimum level.In case of an illness, where further health complications are inevitable, the goal should be to improve the quality of life. It is note-worthy that for all medical problems, approaches must be ordered by the physician. The health care planning process is never completed until the patient is discharged from the current care setting. Periodic schedule re-evaluation is also necessary once the patient is discharged.In the final analysis, the ultimate purpose of the health care plan is to guide all who are involved in the care of the patient and to provide appropriate treatment.

My parents were in their early 40s in 1969, the year we moved to the massive Co-op City housing development in the Bronx. My brother and I were preteens.When it was completed a few years later, Co-op City had more than 15,000 apartments, most of them in high-rises scattered across 300 formerly swampy acres that had once been the Freedomland amusement park. Within a few years, the community’s schools and shopping centers appeared. Most of Co-op City’s occupants were working-class laborers and civil servants, drawn mostly from elsewhere in the borough. Direct and indirect subsidies made their new apartments affordable.My brother and I both left for college within a decade. Our parents stayed until 1990, when they retired, departed for the suburbs of central New Jersey and rebuilt their lives around the activities of the local senior citizens’ center. But many of their peers stayed in Co-op City, and quite a few of the kids my brother and I grew up with ended up staying with their parents, or inheriting apartments when their parents died.For thousands of people like my parents, Co-op City became a “naturally occurring retirement community,” also known as a NORC. The survivors of their generation who have stayed put, now advanced far into old age, have had the benefit of family, friends, familiar neighborhood institutions and a host of social services to sustain them. The phenomenon of this open-air retirement home that came into being quite by accident has been apparent for more than a decade. The New York Times wrote about it as far back as 2002. (1)In New York, Medicaid pays for a lot of the services these people need. To the extent that Medicaid is a low-income health care program, this is not necessarily surprising. Yet what makes New York’s situation different is that Medicaid often covers even those services that don’t have much to do with health care as most people understand it. In literature about the “Health Homes” initiative, introduced in 2012, the state’s Medicaid administrators described the function of a “care manager,” an individual who coordinates those seeing to an individual’s medical, behavioral health and social service needs. The theory is that by making sure people can live independently in their own homes, Medicaid saves money on hospital costs, ambulance rides, repetitive doctor visits and, most of all, nursing home care.The same thing is happening in the mental health arena. Several years ago, New York expanded Medicaid coverage to provide housing for individuals with mental illness. In addition to the Health Homes program, New York also offers “supportive” housing that combines subsidized housing with a host of services, including medical, but also legal, career and educational, among others. Keep people off the streets and make sure they take their meds and get regular meals, the theory goes, and you’ll ultimately save money on emergency room and other acute-care costs.Brenda Rosen, the director of the organization Common Ground, which runs a supportive housing building called The Brook, told NPR, “You know, we as a society are paying for somebody to be on the streets.” (2) And the outgoing New York State commissioner of health published an article in December 2013 arguing that housing and support services are integral to health, so Medicaid should help support the costs.The state may be on board, but the arguments in favor of these programs haven’t made much headway with the federal government, which normally shares Medicaid expenses with the states. The feds won’t pay for these housing services, on the grounds that housing is not health care. Bruce Vladeck, who formerly administered the federal Medicaid (and Medicare) programs, said, “Medicaid is supposed to be health insurance, and not every problem somebody has is a health care problem.” (2)That’s true. Not all care that leads to better health is health care. Good nutrition, having the time and place to get a full night’s sleep, and access to clean air and water are all essential for health, but we do not expect health insurance to pay for these things. Providing housing to people who need it is what we used to call social work, and most people don’t view social workers as health care providers.But it is easier to gain political support for providing health care – with its image of flashing ambulance lights and skilled professionals dressed in white – than for subsidized housing for the aging or the disabled, especially the mentally disabled. So it is easier for Gov. Andrew Cuomo’s administration to organize these services under the label of Medicaid Health Homes. They are not homes at all in any traditional sense. Care managers are typically not doctors or nurses, but they are trained in social services or health care administration. Health Homes is a potentially worthwhile initiative that comes with clever, voter-ready branding.The approach itself is not nearly as novel as the marketing. We have known for decades that good community support, including safe housing and close supervision for people who need it, is a lot less expensive than parking people in hospitals, nursing homes and other institutions. As New York State Medicaid Director Jason Helgerson pointed out when arguing in favor of Medicaid-funded housing support, Medicaid (and taxpayers) bear the cost of long, expensive hospital and nursing home stays. Giving people support to stay in their own homes is also a lot more humane in many, if not most, cases.The challenge is to develop and market these programs in ways that sustain public support in the face of their predictable abuse. People misusing a service does not make it bad, but it does make it harder for politicians to defend. Disability insurance is also a good thing, but the Social Security disability program is just a couple of years away from going broke, in large part because of the wave of malingering that accompanied and followed the recent recession. Offer a benefit and people will want to use it, even if they are not genuinely part of the target population.Well-supported housing with an effective array of social services for people who need them can do a lot of good, and can save society significant money as long as we are not prepared to make people in need survive on their own. NORCs can make excellent places for the elderly to live out their days, and housing for mentally ill and developmentally disabled people can keep them safely off the streets and out of the ERs.But the feds are right that efforts to do so are not health care. It’s human care. If we don’t manage it effectively – keeping the malingerers out and holding costs at sustainable levels – some humans are going to be left on their own, no matter what we call it.Sources:1) The New York Times, “Haven for Workers in Bronx Evolves for Their Retirement”2) NPR, “New York Debates Whether Housing Counts As Health Care”