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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