While spending more than 17% of its GDP on medical care, the U.S. remains the only wealthy democratic nation in the world where a significant portion of its residents lacks health insurance coverage. Nearly 17% of the population are not covered by any form of health insurance at any given time, and “another twenty-five million American adults are ‘underinsured,’ covered by insurance policies that inadequately protect them against the high costs of medical care” . In the history of health care reform in the United States, multiple innovative reform acts, such as the Health Security Act proposed by President Clinton in 1993 and Fair Deal by President Truman in 1949, have been carried out by influential leaders. Unfortunately, these attempts were all suppressed due to the public fear of “socialized medicine” and putting the nation’s financial situation at stake. With the introduction of Patient Protection and Affordable Care Act (PPACA) by the Obama administration, people mindlessly celebrated this revolutionary idea and failed to consider the financial factor which may ultimately cause the downfall of this particular health care reform system.
The stigma of U.S. health care system began with a combination of access and cost crisis: health care historically has not been affordable and accessible to every individual residing in the country. Specifically, poor portability of health care benefits restricted people’s rights to receive health care benefits. For example, most people gain access to insurance through employments or their spouses’ job, so if their family structures or work situations change, they are likely to lose their health care privilege. Similarly, Medicaid enrollees could potentially lose their benefits if they move to another state or if their income rises above the legal maximum. Geographically, rural areas or poorer inner-city neighborhoods tend to have fewer health care providers per capita, whereas other areas are facing an over-concentration of doctors and health care providers. Because of their competition for patients, doctors are forced to increase their service charge in order to maintain a certain level of income . This creates a substantial disparity in health service costs across the nation, and poses a great struggle for government regulation on health care system. The perpetual battle for power between the government and private health care industries prevents the U.S. health care system from meeting its people’s expectations, and it is up to whether or not both sides can reach a consensus to offer the nation the social security it deserves while keeping most of the benefits they desire.
After decades of struggle to implement a new health care platform that would expand insurance coverage tremendously within the nation, Congress finally passed the first U.S. comprehensive health care reform bill, PPACA, marking a historic moment in U.S. social policy. To not repeat the mistakes of previous politicians, the Obama administration “moved legislation quickly through the House and Senate while the president’s political capital remained high” . Additionally, the administration proposed a more realistic vision for the system by claiming that it would “pursue ‘near’ universal coverage” and “avoid centralized cost control measures, while seeking to maintain support for reform among health industry groups.” These expectations were not seen as “too disruptive to the existing system,” “too unacceptable to the health care industry,” or “too radical to win a majority in Congress” . PPACA could improve the current U.S. health system through the adoption of health insurance exchanges. This program demands all health insurance companies to display their costs of purchase publicly side-by-side with other companies. This way, consumers can compare and contrast multiple purchase options, ranging from cheap to expensive, high quality to low quality. Simultaneously, the competition for consumers would drive the average insurance price low as well as increase insurance standardization and consumer protection. In addition to health insurance exchanges, people would expect to witness the individual mandate in action. Under this mandate, all Americans are required to be covered by any form of health insurance. If any individual fails to comply, the government would impose a fine on him or her. However, who and what agency would be responsible in reinforcing this policy have yet to be determined.
Historically, compared to the health care platforms in other developed countries, the U.S. health care system has been known to be more entrepreneurial, for-profit, and less centralized. Due to the high involvement of private enterprise in health care services, U.S. health care system was shaped into a highly competitive environment in which health care industries viewed generating revenues as their priorities . In an attempt to prevent the decentralization of government control on health services, other developed nations, such as Canada and Taiwan, adopted the national health insurance program to render the state government more power to regulate health services within the nation.
Despite the fact that social conditions play a crucial role in determining health outcomes in one place, “infant mortality in Canada is 5.1 per 1,000 births compared with 6.4 in the U.S., and average life expectancy is three years longer in Canada.” The Canadian single-payer model allows “the public health insurance systems [to] cover 70% of all health care costs, including most costs for hospital and medical care and some costs for prescription drugs, dental care, long-term care, and mental health services,” through a combination of federal and provincial taxes . The direct benefit would be offering every legal individual access to health care regardless of financial situation and employment status. In order to sustain this particular health care platform, the government levies taxes based on each individual’s income, so wealthier citizens are responsible to pay a higher proportion of their income. Additionally, this model provides the health care industries a number of benefits. For example, an insurance company will no longer need to “spend money selling or advertising” their products, “paying profits to stockholders, sending bills to multiple insurers and individuals, or tracking down those who don’t pay their bills.” As a result, the administrative cost of operating a health care business is significantly reduced. Even though paying the doctors on a fee-for-service basis is making the government control on medical prices more difficult, collected data still suggests that Canadian health care system is far more effective and efficient than the U.S. system . Moreover, in an attempt to enhance effectiveness and organization in doctor’s appointments, the Taiwanese government distributes a health IC smart card to every health care system enrollee. In the beginning of every appointment, physicians scan the card with a reader and immediately gain access to the patient’s complete medical history and prescriptions. A creative invention as such not only creates a comprehensive security system to guard the cardholder privacy, but also assists the central government in facilitating the execution of single-payer national health care system.
It is evident that the U.S. government attempted to shift the direction of its health care system towards something similar to those of Canada and Taiwan. While the administration proposed the idealistic outlook of insuring the majority of U.S. citizens through the implementation of PPACA, it failed to consider several factors that may deter the progress of this health care reform. In order to provide access of affordable quality health insurance to millions of uninsured through the marketplace, the U.S. would have to create more taxes, specifically targeting the high-earners. With that, people would expect to pay more income taxes while their salaries remain unchanged. Since PPACA withdraws health care insurance companies’ rights to deny service to sick individuals, the cost of everyone’s health care insurance is to be raised inevitably because insurance companies need to cover the treatment costs for more sick people. With the expansion of Medicaid program, “adding 16 million to 20 million individuals to the Medicaid roster,” Connors and Gostin suggested that this expanded eligibility may potentially limit access to essential services due to the lack of primary care doctors . A study conducted by Milken Institute School of Public Health at George Washington University found that less than twenty five percent of new doctors work in primary care. From the given data and evidence, because the number of primary care physicians in practice is now fewer than ever, expanding Medicaid would most likely create more stress and burden for both patients and doctors. Ultimately, PPACA emphasizes more on making sure it covers most people than it does on addressing the cost of care. The unclear financial agenda and cost estimation might lead this newly established system to yet another health care reform failure. These potential shortcomings do not predict the imminent failure of PPACA; however, the government is responsible for preparing appropriate solutions to these issues before they even occur.
Since the proposal of PPACA in 2010, there has been an on-going debate on whether or not all individuals in the nation have a right to health care and no court has ever recognized such a right. Obama administration argued that “each individual has a right to at least a minimum level of health care,” whereas its counterparts argued for the opposite. According to Daniels and Roberts’ logic, “if we would not force a baker to give bread to the hungry, how can we force doctors to give their services away?” If a member of a society demands a right to health care, he or she would have the duty to pay the costs of that care. Although it is certainly unfortunate that some people are born with disability, illness, or a disadvantaged background, “the society cannot be expected to take responsibility for correcting all inequities caused by biological or social differences in fortune” . If PPACA were to put the U.S. federal budget at stake for the upcoming fiscal years, then this operation would be deemed as unnecessary and destructive not only to the federal government, but to the nation as a whole.
References Theodore Marmor & Jonathan Oberlander. The Patchwork: Health Reform, American Style. Social Science & Medicine. [November 2010; April 2014] Available from: http://healthsciences.utah.edu/hcr/2012/resources/marmor.oberlander.pdf  Elenora E. Connors & Lawrence O. Gostin. 2010. Health Care Reform a Historic Moment in US Social Policy. JAMA. [June 2010; April 2014] Available from: http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1383&context=facpub  Rose Weitz. The Sociology of Health, Illness, and Health Care: A Critical Approach. Cengage Learning. [January 2012; April 2014] Available from: http://www.cengage.com/search/productOverview.do?Ntt=285048956145138491411014396061974476897&N=16+4294922390+4294967277&Ntk=P_EPI
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Bryan Huang is an undergraduate student at Northwestern University. Follow The Triple Helix Online on Twitter and join us on Facebook.