Essay: Healthcare in the United States

In the United States, the controversies surrounding the delivery of healthcare has sparked widespread debate throughout America and around the world. Often times, debates bring up comparisons between American and foreign healthcare systems. Several foreign healthcare systems are applauded for creating greater results for individual patients and the populations. The structure of the American healthcare system creates issues when providing healthcare.
The quality of a nation’s healthcare is described and measured through five dimensions. These five dimensions are care process, access, administrative efficiency, equity, and healthcare outcomes. The care process is the quality of care delivered to a patient. This includes components such as coordinated care (sharing of info among healthcare providers) and patient preferences (“Mirror, Mirror 2017”). Access is a healthcare system’s affordability and timeliness. Affordability is the inexpensiveness or expensiveness of care while timeliness is the amount of time a patient receive services. Administrative efficiency is the measure of a healthcare provider’s effort and time spent toward the arrangement of paperwork in the system. Speedy, efficient, and through processing of paperwork results in higher administrative efficiency performance. Equity is the measure of equality between individuals of different incomes or socio-economic standings. This means that those with lower incomes will receive similar high-quality care to those of high-income individuals. Healthcare outcomes are the results of provided healthcare services to individuals and populations. The healthcare outcomes reflect the delivery of healthcare within a nation. These five dimensions are all vital to determining the performance of a system and are often used as tools to debate the effectiveness of the United State’s healthcare system and contrast it to foreign services.
Personally, I believe that the most important healthcare dimension is the healthcare outcome. I believe that this dimension is the most important because it reflects on the care provided to the individuals or populations. Healthcare outcomes are often times the result of the four dimensions preceding it. Globally, in this dimension, Australia ranks the highest in healthcare outcomes (“Mirror, Mirror 2017”). According to the article, Australia has a single-payer insurance program that covers all citizens. This program is likely correlated to Australia’s great success in healthcare outcomes in the system. This program is also similar to the policies of the American Medicare system (“Mirror, Mirror 2017”). Even with the medicare system, America ranks last in healthcare outcomes. America’s shortcomings in healthcare outcomes are attributed to various factors such as lack of equity for low-income individuals, over-billing, excessive insurance claims, and many more (“Mirror, Mirror 2017”). By having poor marks in the first four dimensions, the health outcomes dimension greatly reflects this. To combat poor rankings in performance and improve healthcare systems, the United States pushed for healthcare reform. One such reform is the Patient Protection and Affordable Care Act (PPACA).
The Patient Protection and Affordable Care Act, also known as Obamacare, was signed into effect in 2010 (“The Patient Protection and Affordable Care Act”, 2019). The PPACA aims to provide medical insurance to all American citizens. Two of the many components of the PPACA include free preventative services to insured patients and giving the states that opt-in an opportunity to receive funds for medicaid programs for the uninsured. Free preventative services offers care such as immunizations and women’s contraceptives at no cost to the patient (“Summary of the Affordable Care Act”, 2015). Offering free preventative services could increase participation for services such as vaccinations and cancer screenings. Vaccinations would lessen the chance of contracting a disease while screenings can detect medical conditions before more severe damage can be done. Another component is the opt-in for a state to receive funds will allow states to expand medicare programs for uninsured residents (Garfield, Damico, & Orgera, 2018). This gives low-income residents and opportunity to acquire low-cost health insurance. Low-cost medical insurance for low-income citizens would improve health outcomes for their demographic. While the passing of the PPACA intends to provide greater accessibility to medical insurance coverage, it has been met with resistance.
Some Americans are concerned about components of the PPACA; one such component is the individual mandate that requires Americans to obtain a minimum level of health insurance or face a tax penalty. As of December of 2018, The PPACA was declared to be unconstitutional by a district judge after the tax penalty was removed through the Tax Cuts and Job Act (TCJA) (Fishman & J.d., 2017). The TCJA makes obtaining healthcare voluntary and would not require the tax penalty to be put in place. The debate over the PPACA continues on as the United States searches for solutions that universally satisfy all of America.
The current state of healthcare reform in the United States seems to be “messy” at this time and has a long way to go. I believe that the political turmoil in America will continue to hinder the reform process until Americans and the government become less politically polarized and work together towards a solution. I believe that the provisions of the PPACA is helpful for those who have low-incomes and need assistance when it comes to medical insurance. I am a bit torn on the issue of the PPACA because some provisions such as the individual mandate that requires a minimum level of insurance punishes those who do not comply through tax penalties. Both providing Americans affordable healthcare and also giving people the freedom to choose if they want insurance or not is important to me. If the tax penalties are imposed, Americans who would like to opt out of insurance would have no choice but to comply. If the tax penalties and minimum insurance level requirement are not enacted, quality of care for those in need potentially decreases. If one is enacted over the other, there will always be stakeholders that lose in each situation. This assignment allowed me to see why healthcare debates in America and around the world continue to escalate. I only hope that we as Americans find a solution to satisfy both the needs of providing effective and efficient healthcare while also upholding personal freedoms to opt-in or out.