“Your Healthcare. Your Choice.”

Shan Calliard

Who is really the biggest loser?

Since the dawn of life, eating has become an integral part of life in many cultures. In Britain, there are many coffee shop shops where many people like to gather to and catch up on life over some fish and chips. In Asia, it is a culture that that is comprised of many culinary traditions, with a concentration of keeping their meals basic and plain. In the Caribbean, most of the once colonized islands are known for national dish. Bahamas has been known for their conch delicacies, Jamaica, Ackee and Saltfish, Canada: Poutine and maple syrup, Germany: Sauerkraut, Italy: Pizza and Pasta, Mexico: Taco and burrito just to name a few. The United states as resourceful as we are have the hot dogs, hamburgers, donuts, turkeys, pumpkin pies, and apple pie as some of their national dishes.

The point of the matter is that Americans have some of most money in the world and yet we including myself are some of the unhealthiest individuals. As time has progressed, it seems as if things are getting better at the same time while getting worse. Because of modern medicine it was just recently stated in the news that Americans currently have the lowest cholesterol level when compared to about two decades ago. Drugs like Lipitor and Pravastatin are some of the most common cholesterol lowering drugs that has afforded us with this new statistic. Even though these drugs have indeed given us this fortunate opportunity, we including myself again are still leading living our live according to what we want to eat and not what we should eat. If for some reason we get sick, we will find some way to continue our eating habit by taking some drug or whatever instead of eating healthier. It doesn’t take a genius to know that health care costs have become one of the greatest concerns for Americans especially with this electoral year. In fact, it is so much of a concern that many people will swing their vote this year simply on their views on healthcare. What the author would like to know is why do we have to wait for the government to step in to adjust our health care crisis? Perhaps we can do something for ourselves and eat healthier/exercise a little more or if some of us already live a pretty healthy lives, why not help someone and show them how to live a healthier and a more balanced life. Having said all of this, who is really the biggest loser? Thank you for your time. The author truly looks forward to hearing from you.

http://www.articleworld.org/index.php/National_dish

http://www.lipitor.com/

http://www.americanheart.org/presenter.jhtml?identifier=163

by Shain Waugh

What is it?

Bipolar is a mental illness classified as a manic-depressive disorder. This brain disorder causes unusual shifts in a person’s mood, energy, and ability to function. The symptoms of bipolar disorder have been known to be extremely severe in coping challenges. The severe condition tend to affect personal relationships, jobs, academic performance, and even suicide.

About 5.7 million American adults ages 18 and older are affected by this disorder any given year. The disorder usually develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is a long-term illness that must be carefully managed throughout a person’s life.

Symptoms

Manic
• Increased energy, activity, and restlessness
• Excessively “high,” overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can’t concentrate well

Depression
• acting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness

Causes

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

Results & treatments

Results from a new analysis of two major clinical trials have shown that patients with bipolar disorder who received long-term treatment with SEROQUEL plus a mood stabiliser were significantly less likely to have a mood event than patients on a mood stabiliser alone. The data, which highlight the potential of SEROQUEL for maintenance therapy of patients with bipolar I disorder, were presented on Sunday, 27 January 2008 at the 3rd Biennial Conference of the International Society for Bipolar Disorders (ISBD) in Delhi, India.

Treatment
According to experts, “Bipolar disorder is a chronic, lifelong illness and patients suffer frequent relapses when they can become depressed or manic. Maintenance therapy is an important part of managing these patients and can offer long-term relief from these recurrences,” said Professor Eduard Vieta, Clinical Institute of Neuroscience, University of Barcelona, Spain. “Our analysis of data from more than a thousand patients suggest the potential of treatment regimens which include SEROQUEL along with a mood stabiliser to reduce the likelihood of mood events.”

Long-term treatment with SEROQUEL was generally well tolerated - the most commonly reported adverse events in patients treated with SEROQUEL plus a mood stabiliser during the randomised treatment phase were headache (7.4%), nasopharyngitis (7.1%) and upper respiratory tract infection (6.7%). The most common adverse events during the open-label stabilisation phase were sedation (23.8%), somnolence (18.7%), dry mouth (16.5%) and weight increase (13.9%). The analysis also showed a greater incidence of fasting blood glucose increases to hyperglycaemic levels.

References

1. Brecher M, et al. Quetiapine in the maintenance treatment of bipolar I disorder: combined data from two long-term phase III studies. Presented at the Conference of the International Society for Bipolar Disorders, Delhi, India, 27-30 January, 2008.

2. Vieta E, et al. Efficacy and safety of quetiapine in combination with lithium/divalproex as maintenance treatment for bipolar I disorder. Presented at the Conference of the International Society for Bipolar Disorders, Delhi, India, 27-30 January, 2008.

3. Suppes T, et al. Maintenance treatment in bipolar I disorder with quetiapine concomitant with lithium or divalproex: a placebo-controlled, randomized multicenter trial. Presented at the Conference of the International Society for Bipolar Disorders, Delhi, India, 27-30 January, 2008.

4. www.webmd.com/bipolar-disorder/default.htm

by Shain Waugh

According to the California health care Foundation, there is a new project designed to prevent diabetes-related blindness with the goal of serving 100 clinic and 100,000 patients.

Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With Type 1 diabetes, your body does not make insulin. With Type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

Diabetes is a major health threat in the Central Valley,” according to Veenu Aulakh, M.P.H., CHCF senior program officer. “In addition to some of the highest rates of diabetes in the state, the problem is compounded by high numbers of poor and uninsured patients, a shortage of health providers, and a rural setting that poses transportation obstacles to getting care.”

Diabetes is the leading cause of blindness in the U.S. It can cause a number of eye problems, some of which can lead to blindness if not addressed. They include Glaucoma, Cataracts, Diabetic retinopathy. Studies show that regular eye exams and timely treatment of diabetes-related eye problems could prevent up to 90% of diabetes-related blindness.Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

Diabetic retinopathy, which includes hemorrhages and lesions in the eye, is the leading cause of blindness among working-age adults, with 24,000 diabetics becoming legally blind each year in the United States. But with regular screening to identify those most at risk, blindness can often be prevented. “Half of all patients with diabetes don’t get recommended yearly eye exams,” said Jorge Cuadros, O.D., Ph.D., clinical professor of optometry at UC Berkeley. “The statistic is even worse in poor and rural communities.”

EyePACS

EyePACS, a license-free Web-based software program for capturing and delivering retinal images. The project provides special digital retinal cameras to be used during regular primary care visits at the clinics. The high-resolution retinal photos are transmitted to optometrists and ophthalmologists at UC Berkeley for interpretation, diagnosis, and possible referral to specialists for further treatment.

Clinics are using the retinal images as powerful tools to engage patients in diabetes self-management. “We show patients their own photo, compared with a photo of a healthy eye,” said Noguera. “Diabetes is largely invisible, but this is something tangible that they can see.” CHCF is funding a $1.8 million expansion of this project and recently selected a group of California safety-net and rural clinics as participants in the first wave of expansion.

by Shain Waugh

General Consumer

The cost of health care in the United States of America is continue to rise. With the integration of health retail clinics into the health care community, has saved the general consumer millions of dollar by simply staying out of the emergency room. Most clinics accept insurance, walk-ins, and for simple procedures patients are usually seen within 15 minutes.

The general consumer’s view of healthcare is changing on a globalized scale. The consumer is expecting more information access, embracing globalize medical tourism, better access to medical facilities, and improved customer service. The health care industry has responed strongly to the demands and desired trends of the community by integrating retail health centers in shopping malls, grocery stores, and pharmacies. The availability of such clinics have created a new business market for the general consumer, in turn, empowering the general public decision on healthcare.

Changing the System

In the changing of the systems, the clinic are orchastrated by nurse practitioners, which are nurses with advanced degrees who can write prescriptions. The salary of a nurse practitioners is usually half the cost of an internal medicine physician. The clinics are typically open 7 days a week and patient, 15 minute visit, and prescriptions can be obtained prior to leaving the facility.

Embracing Change

The American Medical Association, the American Academy of Family Physicians and the American Academy of Pediatrics, which opposes retail clinics as a source of medical care for children of all ages, have issued similar guidelines related to retail clinics. All three organizations are particularly concerned about increased fragmentation of care.

The three association recommends that its 100,000 plus physician to expand office offer, embrace same-day appointment, and take part in the general community in order to compete with the retail clinics. The health systems currently face a few options in embracing retail clinics. The options entail either medical facilities choose not to become competitive or find methods to integrate into the retail clinic arena.

Summing Up

As retail health centers continue to evolve, and as more organizations test the market, multiple clinical and business models will provide health care organizations the opportunity to evaluate alternatives. Rather than viewing retail clinics as a threat, hospital and other medical facilities leaders should view the clinics as revolution for health care.

By Shain Waugh

China’s Emperors

According to ancient history, emperors of great wealth compensated physicians only when the emperors were well, and charge them when sick. The development of illness at this time meant the medicine did not work and the physician was failing at their job. The emperors vision was to remain health at all times regards of the efforts of the physician. In many cases, the influences of the great emperor’s vision exist in an array of universal healthcare system such as England, which the government compensates the physician for the total number of patients that remain healthy (i.e. stopping smoking).

United States

In the United States, the concept of the informed consumer will in turn lead to enhance quality of service within a medical facility. This means that purchaser, consumer, or general public will get better care if the proper care is designed to meets one’s needs and expectations. The vision for the health care industry is that health plans, clinicians, and institutions will provide better care to attract more patients. However, in most cases, the process still doesn’t make a significant difference. (Refer to Right Medical Physician)

What is Health Care Quality?

As a health care provider, there are an array of definitions of health care quality and the definition lye in the perception of the evaluator. There are some cases that good quality involves the wait time to see the doctor, the quality of food within the hospital, doctor response in calling back, type of medication prescribed, number of referrals from other doctors, or the amount of time the doctor spends with the patient.

The quality of healthcare must be evaluated as taking your brand new 2008, red, GMC Arcadia to the dealership to evaluate an abnormal sound coming from the engine. The technicians in the shop are the nurses, doctors, pharmacists, and physical therapists for this vehicle. These people are either friendly or not, knowledgeable or not, license or not, but the true questions is if they can fix the car right the first time or over time with multiple visits.

Oregonian Reports

According to the Oregonian reports, there are an array of hospitals and physician practices that are increasingly releasing cost and quality data, but reports along with surveys illustrate that the data is not yet affecting the consumer decisions The performance ratings remain crude, potentially misleading, and difficult for experts to understand. For example, “Oregon’s hospital quality rating Web site details hospitals’ experience with procedures, but consumers are limited when trying to select a top performer, in large part because mortality ratings for hospitals are similar.” In most cases, a medical facility with a high morality rates doesn’t make the facility a bad, unsafe, and dangerous facility to be admitted.

The reasoning is that most facilities with high morality are trauma centers and/or crisis centers that are best fit to address a critical situation. On the other hand, facilities with low morality isn’t a good indicator as well because many of these facilities push patients out once stabilized. In recent studies, New York and California showed that public reporting barely affected the flow of patients to hospitals with high death rates and that some hospitals with low death rates did not increase their patient flow.

According to studies, “most patients are not aware of quality comparisons and that those who are familiar with them seem distrustful and find them confusing.” The challenge with this quote from the Oregonian reports is that the general public is over load with healthcare information and left without a reliable source of information involving healthcare trends, changes, and helpful information. It’s proven via surveys that patients prefer advice from trusted friends, family, and personal physicians over published data or government sources.

Tying it Up

The health care providers including the U.S. government, insurance companies, and many pharmaceutical are working to improve the quality of healthcare today. However, the challenge will be for the general community to play a strong role in demanding the level of quality for yourself, friends, and family members. According to a 2004 study of 12 large U.S. communities, 54.9% of the people actually received the care the they designed, needed, and researched.

The Oregonian reports are a true indicator of how the U.S. health industry is in an uncontrolled status of confusion. We as a health community are so concerned with rising health cost, large premiums, medical errors, and so forth that we as a community become overwhelmed with unreliable healthcare information. Health information should come from one reliable source regulated by the government in a sense. These are many of the challenge the American people face within the land of opportunity, but the quality health care helps people feel better and enjoy a better quality of life, which is what is most important.

by Shain Waugh

In waving bye to 2007 and welcoming 2008, the presence of 2007 still is fresh in the minds of us all. In looking beyond health care and at the world in general, we have achieved so much as globalized nation. However, we have also lost a great deal as well including our respect as an Americans among other countries, the lost of a great politician in Pakistan’s Benazir Bhutto, lost for respect for George W. Bush, decline in the value of the U.S. dollar, and lost a great son, daughter, mother, and father in the Iraq war.

For the industry of health care, 2008 will integrate a great deal of technological integrations the will improve patient safety, reduce medical errors, improve physician evaluation process, justify the difference between medical facilities, reduce the shortage of medical professions, and the possibility of universal health care system in U.S.A.

With this in mind, enjoy this new year, be safe, and let’s make 2008 the best year yet.

Happy New Year!  

by Shain Waugh

Business Entrepreneur

Who said that a physician isn’t a business entrepreneur or independent contractor? The ability to connect with patients on a personnel level is a critical point in remaining competitive, establishing practice separation, and the development of medical marketing intelligence. The ability to connect with patients on their level of thinking, assessing the demand for services, and the ability to supplying or meet the needs for those demand are critical for today’s modern day practices.

As illustrated in past posts “Choosing the Right Medical Doctor“, the greatest challenge for clients today is finding or being able to distinguish between physician practices. So, many physicians have resorted to online video to assist in promoting their business, educating patients about medical disorders, and connecting with patients on a more personal and private level.

The ability to personalize one’s medical practice with online video enables business to establish an array of core competencies such as giving patients an inside view their practice prior to coming to the medical office, understanding the medical team at hand, and develop more of an ease and understanding about a facility’s mission, vision, and practice philosophy.

The major challenge with personalizing one’s practice has been the embracement of technology, increase cost of marketing, and fear of facility misrepresentation. In addition, there are an array of active business that attempt to solve this health care misunderstanding, however, there isn’t a one consistent company or philosophy that assist in truly meeting the needs of our active clients concern with healthcare.

There are many cases were healthcare providers hire companies to produce videos, integrate business within search-engine to increase visibility, while others utilize You Tube or Medem to push the online message. As an example, when searching for a new health care provider, we as consumers ask friends, associate, or consult with insurance companies. However, there is still a limited line in addressing the major problem of identifying to correct physician practice on a globalized scale.

Summing Up

As the healthcare industry evolves and embraces video technology, it will become a standard in delivering a quality message to the general consumer. Physicians will be forced to become more competitive with there medical practice including justifying their business culture, improving quality, organization’s vision, and being health responsible for medical errors. If video becomes a standard of medical facilities then the industry will become as the hotel industry, which is viewed as if a hotel is not visible online then no customer will utilize the facilities services. In time, the government of each country must regulate and make stronger requirements in order to distinguish medical practices.

There are a great deal of consumers inquiring about a quality physician and the only information that they receive is an address, phone number, and a wish of luck. As 2008 approaches, the legacy method of identifying a physician must soon migrate into a more modern standard requirement. However, this all depends on who embraces technology, has the budget funding, government regulations standards in place, and the politicians lobbying for change.

References

http://icyou.comhttp://youtube.com/user/dramatichealth
http://www.medem.com/phy/phy_vrc.cfm
http://www.nyashgroup.com (in development)

By Shain Waugh

Primary Issue

The critical nursing personnel shortage in America is nothing new to those affected by the shortage. It is evident that the long waits in the emergency room, medical surgical or telemetry unit’s patients not being seen by a nurse for hours, patient’s given the wrong medication, nursing staff burnout, and so forth is a significant sign of the challenges involving this shortage. A study in the Journal of the American Medical Association predicted a 20% shortage in the number of nurses needed in the healthcare system by the year 2020. The U.S. Bureau of Labor Statistics reports that more than one million new and replacement nurses will be needed by 2012.

The immediate challenge is that as more than 77 million baby boomers approach retirement age, it is anticipated that the demand for healthcare, particularly home and community-based care, will almost certainly outpace the supply of quality caregivers. The key question is to determine do you trust your hospital, physician, clinic, and or pharmacy. For many, it’s a challenging question when there is no true method of evaluating these critical factors.

 Those Affected

The ratios of nurses to patients dictate the number of patients a hospital’s unit can handle in a given day. In some states these ratios have been legislated while in other, unions mandate it. There are exceptions and work conditions for nurses and patients are still poor and unsafe. As case in point, there have been studies that illustrate direct correlations between staffing of nurses and medical errors.  Example:

In the 3^rd quarter of 2007, a South Florida hospital, which will remain unknown among this document, admitted a patient to its medical surgical unit for a non-critical diagnosis. There were two nurses that called off that particular day, which mean the other nurse took on three additional patients totaling ten patients for the night. Due to the stress, limited staffing, and not enough time to evaluate patients, one patient die within the hospital. The patient was not discovered until 7 hours later. The result included the nurse losing her nursing license, hospital being suited for millions, and the facility developing a bad name within its community. The parties involved were affected simply by the shortage of nurses and/or medical professional staff that shift. So, as medical facilities struggle to fill nursing vacancies and other medical positions, the greater the chance for an unsafe working and medical practice environment.

The shortage of nurses is growing worldwide on a global scale. The immediate problem is that for many of the poorer countries such as the Philippines and South Africa, there has been a migration of nurses from these countries to other countries such as U.S., Canada, and Australia. The more financially stable countries have been trying to meet critical needs for nurses by encouraging nurses from these countries to emigrate. Unfortunately, this processes is increasing the problems and not contributing a solution.

Hospitals argue that pressures from their relationships with managed-care providers leave them no choice but to experiment with various staffing practices, which result in varied degrees of success. It is believe that medical facilities cutting back on nursing staff to achieve higher profits. As a medical professional, there have been situations where staff ratios are reduced because the acuity of the patients doesn’t call for such staff. As a case in point, if a nursing in cardiovascular ICU is use to taking care of one open heart patient at a time, then if there are three telemetry patient on the that unit then this one nurse to three patient is efficient.

Possible Solution

In evaluating solutions, there is an array of theories to assist with the challenge. If we take the model of New Jersey hospital, it consists of a two-year program where the students attend one 12-hour clinical day per week at a participating hospital, and the hospital is responsible for training the student. The remaining part of the program consists of online classes.  

The promotion of the nursing profession to men is critical. The nursing profession has a women dominated culture. There are approximately 5.4% of the 2.1 million registered nursed employed in the United States that are men. This is according to the National Sample Survey of Registered Nurses.

The initiation of incentive by the government would assist in the promotion of nurses. A suggestion would be to reduce the amount of taxes that nurse are required to pay. If the normal tax bracket is between 25%-30%, then nurse should be required to pay only 15% tax. This tax reduction will increase a nurse salary without forcing the hospitals or medical facilities to increase wages.

In 2002 the Nursing Reinvestment Act was signed by President Bush to address the problem of our nation’s nursing shortage. This initiative was intended to promote people to enter and remain in nursing careers, thus reducing the growing shortage. The law establishes scholarships, loan repayments, public service announcements, retention grants, career ladders, and grants for nursing faculty. The challenge with this Act is that it has stipulations and not all individuals that become a registered nurse are able to utilize or benefit from the act. 

According to Forbes magazine, medical tourism will be a $40 billion industry by 2010. This is a promising illustration of how people concerned with rising health care cost are able to manage their health care crisis. The soaring medical cost in America are forcing Americans to travel abroad for elective and/or major surgeries. The abroad physicians and hospitals are willing to conduct procedures at 10% to 30% of the cost in America. Its estimate that 750,000 Americans traveled abroad for medical care in 2007.

Medical Cost in U.S. versus Other Countries:

• Bone Marrow transplant $ 400,000 versus $30,000*
• Liver Transplant $500,000 versus $40,000*
• Heart-valve Replacement $200,000 versus $10,000*
• Open Heart Surgery $50,000 versus $44,400*
• Neurosurgery $29,000 versus $8,000*
• Knee Surgery $16,000 versus $4,500*
• Metal Dental Bridge $5,500 versus $500*
• Full Face Lift $20,000 versus $ 1,250*

*South Africa, India, and Thailand.

There are an array of medical tourism companies that assist travels find the hospital, clinics, or medical facilities that find the desired procedure. These hospitals are accredited under the international arms of JCAHO, which also regulates U.S. hospitals. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have a significant impact on the health care landscape in industrialized and developing countries around the world.

India has been known for their rejuvenating treatments such as yoga and ayurvedic massage, but the quality of their heart by-pass surgery has draw the attention of many throughout the world. According to economist, for the cost of a face lift in the U.S., one can due the following

• Passport U.S. $ 130
• Indian Visiting Visa $ 150
• Flight to India $1,500
• Hotel (6-10 day) $1,000
• Accommodations $1,000
• Face Lift $1,250

Total $ 5,010
Savings $14,990 (approximately)

The most significant aspect of undergoing treatment in India is the low cost compared to either the U.S.A. or Britain. There is a great deal of money that’s saved with medical tourism such as 60% over the normal cost. The treatments includes the procedure, treatment, transportation, and hospital stay as illustrated above. It appears that India found a significant niche in improving its economy, visitors, and technological health integrations with medical tourism.

by Shain Waugh 

The United States is identified as the only industrialized nation without a universal health care system (UHCS). UHCS is a state in which all residents of a geographic or political entity have their health care paid for, regardless of medical condition or financial status. It is approximated that 45 million American are without health insurance, which 80% (36 million) are employed. The challenges facing the 45 million involves the inability to fill prescription, get medical advice, and preventive care.The challenge with the U.S. healthcare system is that the country spends $2 trillion on health care every year, health care costs are skyrocketing, health insurance premiums are rising, lack of affordable health care availability, and there are major flaws in quality with health care providers. As an example, over 100K Americans dies from medical error each year.

With this in mind, the philosophy of universal health care is successfully practiced in many countries such as Canada, the United Kingdom, France, Italy, Argentina, Australia, Brazil, Cuba, Sweden, Germany, and an array of other countries.Sweden as an example is a country of about 9.1 million people on the Scandinavian Peninsula of Northern Europe. Geographically, it is slightly larger than California, U.S.A. It is a single-payer system of health care in which the government pays the majority of all health care costs. The country has struggled in the past with health care expenses causing a strain on government budgets, rationing health care, instituting waiting lists for medical appointments and surgery. 

Canadians as another example, strongly support the core values including equality, compassion, and social solidarity. The interesting concept is that the country’s medical system is built from the understanding of citizenship as opposed to social programs. The system is largely government-funded, with most services provided by private enterprises. The challenge with this system includes long waiting time for major non-emergency surgery, technological adaptations, and challenges with coverage during travel.

The U.S. Health Systems should focus on prevention and public health from its communities perspectives. Politicians such as Presidential hopeful Barack Obama “Every American should have health care coverage within six years.” The challenge with the statement is that mandates will be required. With mandates comes increased expenses and conservatives, which means there will be an array opposers to universal health systems causing misleading attacks, resistance, and a long-winded acceptance process. For Senator Clinton, her plan is to secure health insurance for all Americans while severely limiting the ability of insurers to deny coverage or charge higher premiums to people with chronic illnesses or other medical problems. The plan would preserve a large role for private insurance companies, which will promote the use of health information technology, and low-cost generic drugs.At present, the U.S. health care system faces an unmeasurable struggle in addressing universal health care.

The U.S. politicians hold the strategic and tactical keys in integrating and improving the countries health care system, but how influential will their influence be in making a change. Obama’s plan creates mechanisms to make both private and public health insurance readily available, individual mandate, and focuses on children. Clinton’s plan does the same, but requiring every American to buy health insurance. Which country’s or U.S. politician’s integration strategy is the most efficient, is still up for globalized discussion.