White Paper
Meredith Ivey
Appalachian State University
Healthcare is a universal factor in each country’s government, as it gives its’ citizens the ability to obtain medical services in order to keep them well, or get better. The United States’ healthcare system is referred to as the Affordable Care Act. The current health system consists of Medicaid, Medicare, the Children’s Health Insurance Program, and the Veteran’s Health Administration. The primary focus of the health system in the United States is to make medical care available to everyone who needs it. Medicare provides financial health assistance to individuals who are primarily of the geriatric population, and Medicaid provides assistance to individuals who are below the poverty line and cannot afford medical services otherwise. Both Medicare and Medicaid cover both acute medical services, as well as long-term services, such as skilled nursing care. The Affordable Care Act, according to the Henry J. Kaiser Family Foundation (2013), “focuses on provisions to expand coverage, control health care costs, and improve health care delivery system.”
The overall goal for the Affordable Care Act is to provide affordable health care services to all who need it. The Affordable Care Act, in regard to providing all citizens with the care that they need at an affordable cost, can be a great thing. However, it is important to understand what is working with this program, and what is not working. Just like in any healthcare system, there are various strengths and weaknesses to the system. The United States healthcare system is not an exception. The overall positive to the Affordable Care Act is that it allows all individuals to get the healthcare services that they need, at a price that they can afford. Other positives of the healthcare system is that it provides pediatric care, maternity care, mental health care, as well as preventative services (Lalli, 2013). For example, the Affordable Care Act allows all uninsured children to have access to healthcare services. According to Rose Schneider Krivich and Gretchen L. Schwenker (2013), “The Patient Protection and Affordable Care Act (ACA), popularly known as Obamacare, will dramatically improve access to health insurance for children. In 2010, it was estimated that there were more than 8 million uninsured kids in the United States. Older children aged 13 to 18 years comprised a greater percentage of the uninsured when defined by age, and other factors of race/ethnicity and income level also played a role. The ACA provides the opportunity to reach many more children from all backgrounds. More importantly, under ACA mandates, preventive health services are set to become available to millions of children.” The ability for children to receive the services they need to get and maintain a healthy lifestyle is very important, as they are the individuals who will keep the population alive in years to come.
Another example is the Affordable Care Act’s effect on Maternity and New Born services. Before the Affordable Care Act came into light, women rarely had maternity insurance when it came to their insurance plans. According to Louise Norris, writer for healthinsurance.org, “In 2013, the National Women’s Law Center reported that just 12 percent of individual market plans included maternity benefits. And that was despite the fact that nine states required maternity benefits to be included on all individual plans.” Therefore, only a mere 2 percent of insurance plans covered maternity services for women. Once the Affordable Care Act came in to place, maternity care became one of the primary benefits that must be listed on insurance plans. The requirement of insurance companies to provide some form of coverage for both maternity and newborn services, as well as pediatric services, allows for the nation to grow in a healthy way.
Although the Affordable Care Act provides the United States with some positive features, it also shows some negative features as well. One of the biggest arguments with the Affordable Care Act is the increase in premiums with insurance companies and how much money is spent within the healthcare system in comparison to other countries (Senger, 2012). According to the Editorial Board of the New York Times (2017), “The United States spends much more on medical care than other rich countries, like Britain, Australia, and the Netherlands, according to a recent Commonwealth Fund report, yet its citizens live shorter lives and suffer from more illnesses and injuries than people in other industrialized nations.” As shown in the statement from the New York Times, it is very clear to see that the United States expenditures in health care are greater than those of other countries. Additionally, The Editorial of the New York Times (2017) also discusses how the United States does not offer a universal form of healthcare for its citizens, ensuring that all individuals are covered. Another weakness shown within the Affordable Care Act is that the healthcare system has caused a vast number of individuals to lose their current healthcare insurance plan. According to Glenn Kessler of the Washington Post (2015), premiums have increased as high as 50 percent and millions of individuals have lost their health plans. The purpose of the Affordable Care Act was supposed to help individuals obtain health insurance, not lose it.
So, now that some of the pros and cons of the Affordable Care Act are visibly seen, how can we potentially make the health system better? A single-payer system could be very beneficial for citizens within the United States as it enables all of its citizens to receive health care services. According to the Physicians for a National Health Program (2016), “Single-payer national health insurance, also known as “Medicare for All,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands, Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.” Looking back at the first statement from The Editorial from the New York Times, in regard to health expenditures and citizens in the United States exhibiting more illnesses and injuries, the single-payer system could assist in helping this problem. A single-payer system allows for individuals to receive care, which in return, potentially decreases the amount of illnesses and injuries presented in the United States.
Another factor that could influence our health care system in a more positive way is finding a system that has all citizens pay for their health insurance, but at a lower cost. This includes Medicaid and Medicare individuals as well. If all citizens pay in to the system, the rates for health insurance, including premiums and deductibles, could potentially be more attainable. This also could enable all citizens to be able to receive some form of healthcare. In addition to a single-payer system and creating a way for all citizens to pay for their insurance at an affordable rate, decreasing the use of unnecessary services and treatment techniques in various healthcare settings would be beneficial as well.
Decreasing unneeded services and treatments within a facility can allow the United States to decrease their overall expenditures in healthcare. Chris Flemming (2011) states, in his article “Reducing Health Care Costs While Improving Care,” that challenging medical specialists to come up with a “Top Five” list could assist in cutting out unneeded expenditures in their respective fields. Flemming states, “These lists would consist of five diagnostic tests or treatments that are very commonly ordered by members of that specialty, that are among the most expensive services provided, and that have been shown by the currently available evidence not to provide any meaningful benefit to at least some major categories of patients for whom they are commonly ordered. In short, the Top Five list would be a prescription for how, within that specialty, the most money could be saved most quickly without depriving any patient of meaningful medical benefit” (2011). Flemming (2011) proceeds to discuss that it has been found that producing a Top Five list could help cut costs by as much as $6.75 billion every year. The United States currently spends around 3 trillion dollars on health care service, and cutting out 6 billion dollars annually by decreasing unneeded services and treatments will enable the United States to not only decrease their healthcare expenditures, but to also provide care to patients with treatments that are guaranteed to benefit them.
The healthcare system is not a matter that can be taken care of overnight, and it is not something that can be fixed with just a few minor tweaks. It is going to take a lot of suggestions from various sources, and it ultimately comes down to what works and what does not. Implementing a single-payer system, decreasing unneeded services and treatments in the system, and creating a system where all citizens pay for their insurance at an affordable cost are not the only suggestions that can aid with reforming our current health care system, but they are a great place to start.
References
Centers for Medicare and Medicaid Services (2017). National Health Expenditure Data. Retrieved December 6, 2017 from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html
Fleming, Chris (2011). Reducing Health Care Costs While Improving Care. Health Affairs. Retrieved December 6, 2017 from https://www.healthaffairs.org/do/10.1377/hblog20111109.014987/full/
The Editorial Board (2017). Looking Beyond the Obamacare Debate to Improve Healthcare. The New York Times. Retrieved December 6, 2017 from https://www.nytimes.com/2017/08/26/opinion/sunday/obamacare-universal-health-coverage.html
Kessler, Glenn (2015). Fact checking the Obamacare rhetoric, pro and con. The Washington Post. Retrieved December 5, 2017 from https://www.washingtonpost.com/news/fact-checker/wp/2015/06/26/fact-checking-the-obamacare-rhetoric-pro-and-con/?utm_term=.88237e477f0a
The Kaiser Family Foundation (2013). Summary of the Affordable Care Act. Retrieved December 4, 2017 from https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/
Krivich, R.S., Schwenker, G.L. (2013). Obamacare: What’s in it for kids? Modern Medicine Network. Retrieved December 4, 2017 from http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/content/tags/affordable-care-act/obamacare-what-s-it-kids
Lalli, Frank (2013). The Health Care Law’s 10 Essential Benefits. AARP. Retrieved December 4, 2017 from https://www.aarp.org/health/health-insurance/info-08-2013/affordable-care-act-health-benefits.html
Norris, Louise (2016). How Obamacare changed maternity coverage. Retrieved December 4, 2017 from https://www.healthinsurance.org/obamacare/how-obamacare-changed-maternity-coverage/
Physicians for a National Health Program (2016). What is Single Payer? Physicians for a National Health Program. Retrieved December 5, 2017 from http://www.pnhp.org/facts/what-is-single-payer
Senger, Alyene (2012). Five Devastating Effects of Obamacare on Young Adults. The Heritage Foundation. Retrieved December 5, 2017 from http://www.heritage.org/health-care-reform/commentary/five-devastating-effects-obamacare-young-adults