health care reform essay conclusion

Assessing Health Care Reform (1993)

Chapter: conclusion.

Constraining the rapid escalation of health care costs while extending health insurance coverage to all—the primary objectives of health care reform—will require significant improvements in the performance of our system for health care. This performance imperative is especially important because some of the factors behind rising health care expenditures, such as the aging of the population, are external to the health care system.

In the Preamble to this report, we set forth the committee's view that the fundamental goals of reform are to maintain and improve health and well-being, to make basic health coverage universal, and to encourage the efficient use of limited resources. The preceding sections of this document have provided a broad framework for assessing whether and how different reform proposals would pursue these goals. The elements of that framework—extending access to health care, containing health care costs, assuring quality of care, financing reform, and improving the infrastructure for effective change—all need to be addressed if system performance is truly to be improved. In some areas, we have made specific substantive recommendations based on the work of other IOM committees or the clear consensus of this committee; in other areas, we have laid out questions that proposals should answer.

A long-term perspective is essential. A framework for assessing reform, such as that we have suggested, will be useful both for the initial evaluation of proposals and for the assessment of progress over time. Indeed, to be most useful, as the results of reform efforts unfold the

committee's recommendations should be subject to the same type of ongoing evaluation as the reforms themselves.

The complexity of the health care system—and of health itself—presents major challenges to reform, and these challenges are intensified by the many important and often contending interests that have a stake in both the broad directions and intricate details of policy change. Reform proposals that focus primarily on financial issues and goals without recognizing that improved performance requires significant changes in how health care is organized and provided are unlikely to achieve the goals outlined here. Reform proposals must indicate their general approach to questions such as how health care professionals are to be appropriately trained and deployed (including expected responses to market signals from revised incentives), how better information is to be marshalled to improve performance, and how quality of care can be maintained and improved within resource constraints.

Finally, the reform of our health care system should be undertaken in the same spirit of continuous improvement and renewal that has so often been the keystone of success in America. The profound changes required for effective reform, even when the nation builds on the existing strengths of its health care system, demand that we learn from experience. To do that we need good information and sound analyses of results, flexibility and creativity in responding to that information, and an abiding focus on the concerns of the people whose health and well-being we seek to improve.

This book establishes a framework for assessing health care reform proposals and their implementation. It helps clarify objectives, identifies issues to be addressed in proposals, distinguishes between short- and long-term expectations and achievements, and directs attention to important but sometimes neglected questions about the organization and provision of health care services.

In addition, the volume presents a discussion and analysis of issues essential to achieving fundamental goals of health care reform: to maintain and improve health and well-being, to make basic health coverage universal, and to encourage the efficient use of limited resources.

The book is a useful resource for anyone developing or assessing options for reform.

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Critical Essays on Health Care Reform

An issue of: journal of health politics, policy and law.

Subjects Medicine and Health > Public Health and Health Policy , Politics > Public Policy , Sociology

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Health Insurance Reform Has Surprisingly Little Impact on Actual Health

T he typical American’s health compares poorly to that of their counterparts in other high-income countries, even though the U.S. spends twice as much as these countries do on medical care. Behind that middling average lies substantial health inequality. A 40-year-old American male can expect to live 15 years less if he’s one of the poorest 1% of Americans rather than one of the richest 1%. Black children who live in the richest parts of the United States have higher mortality rates than White children in the poorest parts of the country.

Many have put these observations together with another aspect of U.S. “exceptionalism”: We are the only high-income country without universal health insurance coverage. And they have concluded that the key to improving health and reducing health inequality in the U.S. is to finally enact universal coverage.

They’re wrong. While these two facts are correct, they have very little to do with each other. There are good reasons to support universal health coverage, but noticeably improving population health is not one of them.

Indeed, the evidence suggests that the health disparities among Americans are not driven by differences in access to health insurance or to medical care. Rather, the key to improving health is far more complex: It lies in changing health behaviors and reducing exposure to external sources of poor health.

Perhaps the clearest evidence for how little impact health insurance reform has on health comes from the experience of other countries which have universal health insurance but also experience substantial health inequality. Consider Sweden and Norway , two Nordic countries with universal health insurance as well as a cradle-to-grave generous social safety net. Yet differences in life expectancy between adults in the top 10% and bottom 10% of the national income distribution in those countries are similar to the disparities in the United States.

Read More: Long Waits, Short Appointments, Huge Bills: U.S. Health Care Is Causing Patient Burnout

Or consider the enormous differences across the country in remaining life expectancy for elderly Americans, all of whom are covered by the same Medicare health insurance program. Researchers have identified which cities in the U.S. are better or worse for elderly longevity , and also which tend to provide more medical care than others . But, the evidence indicates, the places you’d want to move to in order to increase your life expectancy in retirement aren’t the same as the places to move to if you want to receive more medical care.

Indeed, there is widespread agreement among researchers that medical care, let alone health insurance, is not the only—or even the most important—determinant of health. Rather, the key to better health and smaller health disparities lies in the air we breathe, the food we eat, and the cigarettes we do or do not smoke. Which means that the key public policies for improving health must be those that tackle these sources of poor health through pollution regulation, or soda and cigarette taxes. The path to major health improvements doesn’t run through health insurance and health care policy.

How can this possibly be?

It is not because health insurance is not important for health. Of course it is .  But its effects are too small for health insurance reform to make much of a dent in the large U.S. income-health gradient, or to substantially improve the poor health of average Americans.

Behind this relative unimportance of health insurance coverage for health is a startling, but little-understood reality: No one in America is actually uninsured when it comes to their health care. Rather, the nominally “uninsured”—those who lack formal health insurance coverage—nonetheless receive a substantial amount of medical care which they don’t pay for.  

There is a vast web of public policy requirements and dedicated public funding to provide the nominally uninsured with free or heavily discounted medical care. And no, we’re not just talking about the emergency room. Through a piecemeal slew of policies at the federal, state, and local level, the government has created a large, complex web of publicly-regulated, publicly-funded programs that provide free or low-fee preventive care, care management for chronic health problems, and non-emergency hospital care for the uninsured and under-insured.

This point was made clear by data from Oregon, where the state ran a lottery for health insurance coverage in 2008. The process was similar to a clinical trial for a new drug, in which some patients are randomly assigned the new drug and others are assigned an older drug or a sugar pill. Except in this case, Oregon randomly assigned public health insurance coverage to about 10,000 low-income, uninsured adults but not to the thousands of others who had signed up to “win” free public health insurance. The results of this lottery made clear that providing formal health insurance coverage to the uninsured provides them with real benefits: better protection against expensive medical bills, greater likelihood of having a medical home, more access to medical care, and ultimately, improved health.

But the experiment’s results also revealed something striking about the experience of the uninsured: The uninsured receive about four-fifths of the medical care that they would get had they been insured. This medical care includes primary care, preventive care, prescription drugs, emergency room visits, and hospital admissions. And they pay for only about 20 cents out of every dollar of medical care that they receive. In other words, they are not actually uninsured. Rather, there’s a lot more commonality in the medical care received and (not) paid for by the insured and the uninsured than those labels might suggest.

And once we realize that everyone in America can access medical care, it becomes much clearer why formalizing this access – while important for other reasons – is unlikely to make an important difference for people’s health, or substantially reduce the large disparities in population health.

The surprisingly limited role for health care policy or health insurance in driving population health is not a new observation. A half century ago, the economist Victor Fuchs – who at age 99 is now widely considered to be the founding father of the economic study of health – made this point in his now-famous “ Tale of Two States. ” He described two neighboring states in the Western U.S. that were similar along many of the dimensions believed to be important for health – including medical care, income, schooling, climate, and urbanicity. Yet in one state, the people were among the U.S. healthiest. Their neighbors in the other state were among the least healthy, with annual death rates that were 40% to 50% higher.

You may get an inkling of where Fuchs was going with this comparison when we tell you that the two states were Utah and Nevada. And that the residents of Utah were the ones enjoying much better health.

Fuchs famously attributed the lower-mortality rates of the clean-living, predominantly Mormon residents of Utah to their better health behaviors. Their Nevada neighbors enjoyed what he referred to as “more permissive” norms. Rates of smoking and drinking were much lower in Utah than in Nevada. And differences in mortality between the two states were particularly pronounced for diseases for which there was a direct link to such behaviors, such as lung cancer and cirrhosis of the liver.

Fuchs’s simple tabulations of publicly reported death rates by age and gender for Utah and Nevada appear antiquated by modern data science standards. But his central argument has stood the test of time. A subsequent half-century of confirmatory work has hammered home an important but often overlooked point: when it comes to improving health outcomes and reducing health disparities, health insurance policy is not the lever to lean on.

Adapted from We’ve Got You Covered: Rebooting American Health Care by Liran Einav and Amy Finkelstein, in agreement with Portfolio, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © Liran Einav and Amy Finkelstein, 2023.

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United States Health Care Reform Progress to Date and Next Steps

The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care.

To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act.

Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016.

The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600–$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain.

CONCLUSIONS AND RELEVANCE

Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges.

Health care costs affect the economy, the federal budget, and virtually every American family’s financial well-being. Health insurance enables children to excel at school, adults to work more productively, and Americans of all ages to live longer, healthier lives. When I took office, health care costs had risen rapidly for decades, and tens of millions of Americans were uninsured. Regardless of the political difficulties, I concluded comprehensive reform was necessary.

The result of that effort, the Affordable Care Act (ACA), has made substantial progress in addressing these challenges. Americans can now count on access to health coverage throughout their lives, and the federal government has an array of tools to bring the rise of health care costs under control. However, the work toward a high-quality, affordable, accessible health care system is not over.

In this Special Communication, I assess the progress the ACA has made toward improving the US health care system and discuss how policy makers can build on that progress in the years ahead. I close with reflections on what my administration’s experience with the ACA can teach about the potential for positive change in health policy in particular and public policy generally.

Impetus for Health Reform

In my first days in office, I confronted an array of immediate challenges associated with the Great Recession. I also had to deal with one of the nation’s most intractable and long-standing problems, a health care system that fell far short of its potential. In 2008, the United States devoted 16% of the economy to health care, an increase of almost one-quarter since 1998 (when 13% of the economy was spent on health care), yet much of that spending did not translate into better outcomes for patients. 1 – 4 The health care system also fell short on quality of care, too often failing to keep patients safe, waiting to treat patients when they were sick rather than focusing on keeping them healthy, and delivering fragmented, poorly coordinated care. 5 , 6

Moreover, the US system left more than 1 in 7 Americans without health insurance coverage in 2008. 7 Despite successful efforts in the 1980s and 1990s to expand coverage for specific populations, like children, the United States had not seen a large, sustained reduction in the uninsured rate since Medicare and Medicaid began ( Figure 1 8 – 10 ). The United States’ high uninsured rate had negative consequences for uninsured Americans, who experienced greater financial insecurity, barriers to care, and odds of poor health and preventable death; for the health care system, which was burdened with billions of dollars in uncompensated care; and for the US economy, which suffered, for example, because workers were concerned about joining the ranks of the uninsured if they sought additional education or started a business. 11 – 16 Beyond these statistics were the countless, heartbreaking stories of Americans who struggled to access care because of a broken health insurance system. These included people like Natoma Canfield, who had overcome cancer once but had to discontinue her coverage due to rapidly escalating premiums and found herself facing a new cancer diagnosis uninsured. 17

Percentage of Individuals in the United States Without Health Insurance, 1963–2015

Data are derived from the National Health Interview Survey and, for years prior to 1982, supplementary information from other survey sources and administrative records. The methods used to construct a comparable series spanning the entire period build on those in Cohen et al 8 and Cohen 9 and are described in detail in Council of Economic Advisers 2014. 10 For years 1989 and later, data are annual. For prior years, data are generally but not always biannual. ACA indicates Affordable Care Act.

In 2009, during my first month in office, I extended the Children’s Health Insurance Program and soon thereafter signed the American Recovery and Reinvestment Act, which included temporary support to sustain Medicaid coverage as well as investments in health information technology, prevention, and health research to improve the system in the long run. In the summer of 2009, I signed the Tobacco Control Act, which has contributed to a rapid decline in the rate of smoking among teens, from 19.5% in 2009 to 10.8% in 2015, with substantial declines among adults as well. 7 , 18

Beyond these initial actions, I decided to prioritize comprehensive health reform not only because of the gravity of these challenges but also because of the possibility for progress. Massachusetts had recently implemented bipartisan legislation to expand health insurance coverage to all its residents. Leaders in Congress had recognized that expanding coverage, reducing the level and growth of health care costs, and improving quality was an urgent national priority. At the same time, a broad array of health care organizations and professionals, business leaders, consumer groups, and others agreed that the time had come to press ahead with reform. 19 Those elements contributed to my decision, along with my deeply held belief that health care is not a privilege for a few, but a right for all. After a long debate with well-documented twists and turns, I signed the ACA on March 23, 2010.

Progress Under the ACA

The years following the ACA’s passage included intense implementation efforts, changes in direction because of actions in Congress and the courts, and new opportunities such as the bipartisan passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. Rather than detail every development in the intervening years, I provide an overall assessment of how the health care system has changed between the ACA’s passage and today.

The evidence underlying this assessment was obtained from several sources. To assess trends in insurance coverage, this analysis relies on publicly available government and private survey data, as well as previously published analyses of survey and administrative data. To assess trends in health care costs and quality, this analysis relies on publicly available government estimates and projections of health care spending; publicly available government and private survey data; data on hospital readmission rates provided by the Centers for Medicare & Medicaid Services; and previously published analyses of survey, administrative, and clinical data. The dates of the data used in this assessment range from 1963 to early 2016.

Expanding and Improving Coverage

The ACA has succeeded in sharply increasing insurance coverage. Since the ACA became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, 7 with most of that decline occurring after the law’s main coverage provisions took effect in 2014 ( Figure 1 8 – 10 ). The number of uninsured individuals in the United States has declined from 49 million in 2010 to 29 million in 2015. This is by far the largest decline in the uninsured rate since the creation of Medicare and Medicaid 5 decades ago. Recent analyses have concluded these gains are primarily because of the ACA, rather than other factors such as the ongoing economic recovery. 20 , 21 Adjusting for economic and demographic changes and other underlying trends, the Department of Health and Human Services estimated that 20 million more people had health insurance in early 2016 because of the law. 22

Each of the law’s major coverage provisions—comprehensive reforms in the health insurance market combined with financial assistance for low- and moderate-income individuals to purchase coverage, generous federal support for states that expand their Medicaid programs to cover more low-income adults, and improvements in existing insurance coverage—has contributed to these gains. States that decided to expand their Medicaid programs saw larger reductions in their uninsured rates from 2013 to 2015, especially when those states had large uninsured populations to start with ( Figure 2 23 ). However, even states that have not adopted Medicaid expansion have seen substantial reductions in their uninsured rates, indicating that the ACA’s other reforms are increasing insurance coverage. The law’s provision allowing young adults to stay on a parent’s plan until age 26 years has also played a contributing role, covering an estimated 2.3 million people after it took effect in late 2010. 22

Decline in Adult Uninsured Rate From 2013 to 2015 vs 2013 Uninsured Rate by State

Data are derived from the Gallup-Healthways Well-Being Index as reported by Witters 23 and reflect uninsured rates for individuals 18 years or older. Dashed lines reflect the result of an ordinary least squares regression relating the change in the uninsured rate from 2013 to 2015 to the level of the uninsured rate in 2013, run separately for each group of states. The 29 states in which expanded coverage took effect before the end of 2015 were categorized as Medicaid expansion states, and the remaining 21 states were categorized as Medicaid nonexpansion states.

Early evidence indicates that expanded coverage is improving access to treatment, financial security, and health for the newly insured. Following the expansion through early 2015, nonelderly adults experienced substantial improvements in the share of individuals who have a personal physician (increase of 3.5 percentage points) and easy access to medicine (increase of 2.4 percentage points) and substantial decreases in the share who are unable to afford care (decrease of 5.5 percentage points) and reporting fair or poor health (decrease of 3.4 percentage points) relative to the pre-ACA trend. 24 Similarly, research has found that Medicaid expansion improves the financial security of the newly insured (for example, by reducing the amount of debt sent to a collection agency by an estimated $600–$1000 per person gaining Medicaid coverage). 26 , 27 Greater insurance coverage appears to have been achieved without negative effects on the labor market, despite widespread predictions that the law would be a “job killer.” Private-sector employment has increased in every month since the ACA became law, and rigorous comparisons of Medicaid expansion and nonexpansion states show no negative effects on employment in expansion states. 28 – 30

The law has also greatly improved health insurance coverage for people who already had it. Coverage offered on the individual market or to small businesses must now include a core set of health care services, including maternity care and treatment for mental health and substance use disorders, services that were sometimes not covered at all previously. 31 Most private insurance plans must now cover recommended preventive services without cost-sharing, an important step in light of evidence demonstrating that many preventive services were underused. 5 , 6 This includes women’s preventive services, which has guaranteed an estimated 55.6 million women coverage of services such as contraceptive coverage and screening and counseling for domestic and interpersonal violence. 32 In addition, families now have far better protection against catastrophic costs related to health care. Lifetime limits on coverage are now illegal and annual limits typically are as well. Instead, most plans must cap enrollees’ annual out-of-pocket spending, a provision that has helped substantially reduce the share of people with employer-provided coverage lacking real protection against catastrophic costs ( Figure 3 33 ). The law is also phasing out the Medicare Part D coverage gap. Since 2010, more than 10 million Medicare beneficiaries have saved more than $20 billion as a result. 34

Percentage of Workers With Employer-Based Single Coverage Without an Annual Limit on Out-of-pocket Spending

Data from the Kaiser Family Foundation/Health Research and Education Trust Employer Health Benefits Survey. 33

Reforming the Health Care Delivery System

Before the ACA, the health care system was dominated by “fee-for-service” payment systems, which often penalized health care organizations and health care professionals who find ways to deliver care more efficiently, while failing to reward those who improve the quality of care. The ACA has changed the health care payment system in several important ways. The law modified rates paid to many that provide Medicare services and Medicare Advantage plans to better align them with the actual costs of providing care. Research on how past changes in Medicare payment rates have affected private payment rates implies that these changes in Medicare payment policy are helping decrease prices in the private sector as well. 35 , 36 The ACA also included numerous policies to detect and prevent health care fraud, including increased scrutiny prior to enrollment in Medicare and Medicaid for health care entities that pose a high risk of fraud, stronger penalties for crimes involving losses in excess of $1 million, and additional funding for antifraud efforts. The ACA has also widely deployed “value-based payment” systems in Medicare that tie fee-for-service payments to the quality and efficiency of the care delivered by health care organizations and health care professionals. In parallel with these efforts, my administration has worked to foster a more competitive market by increasing transparency around the prices charged and the quality of care delivered.

Most importantly over the long run, the ACA is moving the health care system toward “alternative payment models” that hold health care entities accountable for outcomes. These models include bundled payment models that make a single payment for all of the services provided during a clinical episode and population-based models like accountable care organizations (ACOs) that base payment on the results health care organizations and health care professionals achieve for all of their patients’ care. The law created the Center for Medicare and Medicaid Innovation (CMMI) to test alternative payment models and bring them to scale if they are successful, as well as a permanent ACO program in Medicare. Today, an estimated 30% of traditional Medicare payments flow through alternative payment models that broaden the focus of payment beyond individual services or a particular entity, up from essentially none in 2010. 37 These models are also spreading rapidly in the private sector, and their spread will likely be accelerated by the physician payment reforms in MACRA. 38 , 39

Trends in health care costs and quality under the ACA have been promising ( Figure 4 1 , 40 ). From 2010 through 2014, mean annual growth in real per-enrollee Medicare spending has actually been negative , down from a mean of 4.7% per year from 2000 through 2005 and 2.4% per year from 2006 to 2010 (growth from 2005 to 2006 is omitted to avoid including the rapid growth associated with the creation of Medicare Part D). 1 , 40 Similarly, mean real perenrollee growth in private insurance spending has been 1.1% per year since 2010, compared with a mean of 6.5% from 2000 through 2005 and 3.4% from 2005 to 2010. 1 , 40

Rate of Change in Real per-Enrollee Spending by Payer

Data are derived from the National Health Expenditure Accounts. 1 Inflation adjustments use the Gross Domestic Product Price Index reported in the National Income and Product Accounts. 40 The mean growth rate for Medicare spending reported for 2005 through 2010 omits growth from 2005 to 2006 to exclude the effect of the creation of Medicare Part D.

As a result, health care spending is likely to be far lower than expected. For example, relative to the projections the Congressional Budget Office (CBO) issued just before I took office, CBO now projects Medicare to spend 20%, or about $160 billion, less in 2019 alone. 41 , 42 The implications for families’ budgets of slower growth in premiums have been equally striking. Had premiums increased since 2010 at the same mean rate as the preceding decade, the mean family premium for employer-based coverage would have been almost $2600 higher in 2015. 33 Employees receive much of those savings through lower premium costs, and economists generally agree that those employees will receive the remainder as higher wages in the long run. 43 Furthermore, while deductibles have increased in recent years, they have increased no faster than in the years preceding 2010. 44 Multiple sources also indicate that the overall share of health care costs that enrollees in employer coverage pay out of pocket has been close to flat since 2010 ( Figure 5 45 – 48 ), most likely because the continued increase in deductibles has been canceled out by a decline in co-payments.

Out-of-pocket Spending as a Percentage of Total Health Care Spending for Individuals Enrolled in Employer-Based Coverage

Data for the series labeled Medical Expenditure Panel Survey (MEPS) were derived from MEPS Household Component and reflect the ratio of out-of-pocket expenditures to total expenditures for nonelderly individuals reporting full-year employer coverage. Data for the series labeled Health Care Cost Institute (HCCI) were derived from the analysis of the HCCI claims database reported in Herrera et al, 45 HCCI 2015, 46 and HCCI 2015 47 ; to capture data revisions, the most recent value reported for each year was used. Data for the series labeled Claxton et al were derived from the analyses of the Trueven Marketscan claims database reported by Claxton et al 2016. 48

At the same time, the United States has seen important improvements in the quality of care. The rate of hospital-acquired conditions (such as adverse drug events, infections, and pressure ulcers) has declined by 17%, from 145 per 1000 discharges in 2010 to 121 per 1000 discharges in 2014. 49 Using prior research on the relationship between hospital-acquired conditions and mortality, the Agency for Healthcare Research and Quality has estimated that this decline in the rate of hospital-acquired conditions has prevented a cumulative 87 000 deaths over 4 years. 49 The rate at which Medicare patients are readmitted to the hospital within 30 days after discharge has also decreased sharply, from a mean of 19.1% during 2010 to a mean of 17.8% during 2015 ( Figure 6 ; written communication; March 2016; Office of Enterprise Data and Analytics, Centers for Medicare & Medicaid Services). The Department of Health and Human Services has estimated that lower hospital readmission rates resulted in 565 000 fewer total readmissions from April 2010 through May 2015. 50 , 51

Medicare 30-Day, All-Condition Hospital Readmission Rate

Data were provided by the Centers for Medicare & Medicaid Services (written communication; March 2016). The plotted series reflects a 12-month moving average of the hospital readmission rates reported for discharges occurring in each month.

While the Great Recession and other factors played a role in recent trends, the Council of Economic Advisers has found evidence that the reforms introduced by the ACA helped both slow health care cost growth and drive improvements in the quality of care. 44 , 52 The contribution of the ACA’s reforms is likely to increase in the years ahead as its tools are used more fully and as the models already deployed under the ACA continue to mature.

Building on Progress to Date

I am proud of the policy changes in the ACA and the progress that has been made toward a more affordable, high-quality, and accessible health care system. Despite this progress, too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain un-insured. More work to reform the health care system is necessary, with some suggestions offered below.

First, many of the reforms introduced in recent years are still some years from reaching their maximum effect. With respect to the law’s coverage provisions, these early years’ experience demonstrate that the Health Insurance Marketplace is a viable source of coverage for millions of Americans and will be for decades to come. However, both insurers and policy makers are still learning about the dynamics of an insurance market that includes all people regardless of any preexisting conditions, and further adjustments and recalibrations will likely be needed, as can be seen in some insurers’ proposed Marketplace premiums for 2017. In addition, a critical piece of unfinished business is in Medicaid. As of July 1, 2016, 19 states have yet to expand their Medicaid programs. I hope that all 50 states take this option and expand coverage for their citizens in the coming years, as they did in the years following the creation of Medicaid and CHIP.

With respect to delivery system reform, the reorientation of the US health care payment systems toward quality and accountability has made significant strides forward, but it will take continued hard work to achieve my administration’s goal of having at least half of traditional Medicare payments flowing through alternative payment models by the end of 2018. Tools created by the ACA— including CMMI and the law’s ACO program—and the new tools provided by MACRA will play central roles in this important work. In parallel, I expect continued bipartisan support for identifying the root causes and cures for diseases through the Precision Medicine and BRAIN initiatives and the Cancer Moonshot, which are likely to have profound benefits for the 21st-century US health care system and health outcomes.

Second, while the ACA has greatly improved the affordability of health insurance coverage, surveys indicate that many of the remaining uninsured individuals want coverage but still report being unable to afford it. 53 , 54 Some of these individuals may be unaware of the financial assistance available under current law, whereas others would benefit from congressional action to increase financial assistance to purchase coverage, which would also help middle-class families who have coverage but still struggle with premiums. The steady-state cost of the ACA’s coverage provisions is currently projected to be 28% below CBO’s original projections, due in significant part to lower-than-expected Marketplace premiums, so increased financial assistance could make coverage even more affordable while still keeping federal costs below initial estimates. 55 , 56

Third, more can and should be done to enhance competition in the Marketplaces. For most Americans in most places, the Marketplaces are working. The ACA supports competition and has encouraged the entry of hospital-based plans, Medicaid managed care plans, and other plans into new areas. As a result, the majority of the country has benefited from competition in the Marketplaces, with 88% of enrollees living in counties with at least 3 issuers in 2016, which helps keep costs in these areas low. 57 , 58 However, the remaining 12% of enrollees live in areas with only 1 or 2 issuers. Some parts of the country have struggled with limited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan. Public programs like Medicare often deliver care more cost-effectively by curtailing administrative over head and securing better prices from providers. 59 , 60 The public plan did not make it into the final legislation. Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited. Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government. 61

Fourth, although the ACA included policies to help address prescription drug costs, like more substantial Medicaid rebates and the creation of a pathway for approval of biosimilar drugs, those costs remain a concern for Americans, employers, and taxpayers alike— particularly in light of the 12% increase in prescription drug spending that occurred in 2014. 1 In addition to administrative actions like testing new ways to pay for drugs, legislative action is needed. 62 Congress should act on proposals like those included in my fiscal year 2017 budget to increase transparency around manufacturers’ actual production and development costs, to increase the rebates manufacturers are required to pay for drugs prescribed to certain Medicare and Medicaid beneficiaries, and to give the federal government the authority to negotiate prices for certain high-priced drugs. 63

There is another important role for Congress: it should avoid moving backward on health reform. While I have always been interested in improving the law—and signed 19 bills that do just that—my administration has spent considerable time in the last several years opposing more than 60 attempts to repeal parts or all of the ACA, time that could have been better spent working to improve our health care system and economy. In some instances, the repeal efforts have been bipartisan, including the effort to roll back the excise tax on high-cost employer-provided plans. Although this provision can be improved, such as through the reforms I proposed in my budget, the tax creates strong incentives for the least-efficient private-sector health plans to engage in delivery system reform efforts, with major benefits for the economy and the budget. It should be preserved. 64 In addition, Congress should not advance legislation that undermines the Independent Payment Advisory Board, which will provide a valuable backstop if rapid cost growth returns to Medicare.

Lessons for Future Policy Makers

While historians will draw their own conclusions about the broader implications of the ACA, I have my own. These lessons learned are not just for posterity: I have put them into practice in both health care policy and other areas of public policy throughout my presidency.

The first lesson is that any change is difficult, but it is especially difficult in the face of hyperpartisanship. Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported. For example, they supported a fully funded risk-corridor program and a public plan fallback in the Medicare drug benefit in 2003 but opposed them in the ACA. They supported the individual mandate in Massachusetts in 2006 but opposed it in the ACA. They supported the employer mandatein Californiain 2007 but opposed it in the ACA— and then opposed the administration’s decision to delay it. Moreover, through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts. We could have covered more groundmore quickly with cooperation rather than obstruction. It is not obvious that this strategy has paid political dividends for Republicans, but it has clearly come at a cost for the country, most notably for the estimated 4 million Americans left uninsured because they live in GOP-led states that have yet to expand Medicaid. 65

The second lesson is that special interests pose a continued obstacle to change. We worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured. Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits. 66 We need to continue to tackle special interest dollars in politics. But we also need to reinforce the sense of mission in health care that brought us an affordable polio vaccine and widely available penicillin.

The third lesson is the importance of pragmatism in both legislation and implementation. Simpler approaches to addressing our health care problems exist at both ends of the political spectrum: the single-payer model vs government vouchers for all. Yet the nation typically reaches its greatest heights when we find common ground between the public and private good and adjust along the way. That was my approach with the ACA. We engaged with Congress to identify the combination of proven health reform ideas that could pass and have continued to adapt them since. This includes abandoning parts that do not work, like the voluntary long-term care program included in the law. It also means shutting down and restarting a process when it fails. When HealthCare.gov did not work on day 1, we brought in reinforcements, were brutally honest in assessing problems, and worked relentlessly to get it operating. Both the process and the website were successful, and we created a playbook we are applying to technology projects across the government.

While the lessons enumerated above may seem daunting, the ACA experience nevertheless makes me optimistic about this country’s capacity to make meaningful progress on even the biggest public policy challenges. Many moments serve as reminders that a broken status quo is not the nation’s destiny. I often think of a letter I received from Brent Brown of Wisconsin. He did not vote for me and he opposed “ObamaCare,” but Brent changed his mind when he became ill, needed care, and got it thanks to the law. 67 Or take Governor John Kasich’s explanation for expanding Medicaid: “For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them.” 68 Or look at the actions of countless health care providers who have made our health system more coordinated, quality-oriented, and patient-centered. I will repeat what I said 4 years ago when the Supreme Court upheld the ACA: I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere. As this progress with health care reform in the United States demonstrates, faith in responsibility, belief in opportunity, and ability to unite around common values are what makes this nation great.

Disclaimer: The journal’s copyright notice applies to the distinctive display of this JAMA article, and not the President’s work or words.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The author’s public financial disclosure report for calendar year 2015 may be viewed at https://www.whitehouse.gov/sites/whitehouse.gov/files/documents/oge_278_cy_2015_obama_051616.pdf .

Additional Contributions: I thank Matthew Fiedler, PhD, and Jeanne Lambrew, PhD, who assisted with planning, writing, and data analysis. I also thank Kristie Canegallo, MA; Katie Hill, BA; Cody Keenan, MPP; Jesse Lee, BA; and Shailagh Murray, MS, who assisted with editing the manuscript. All of the individuals who assisted with the preparation of the manuscript are employed by the Executive Office of the President.

Health Care Reform Essay

Health Care Reform

to teach and now it is utilized in health care every day. Technology plays a major role in the health care reform Act to reduce costs, improve access, and save lives. The Patient Protection and Affordable Care Act , and its constitutionality ruling by the United States Supreme Court last June 28, 2012, mandates requiring all electronic medical records for all health care agencies in 2014 ( Jha, 2013, p 1628) . David Blumenthal (2009) surveyed all acute care hospitals in the American Hospital

The On Health Care Reform

The idea of passing the health care reform was to expand health care coverage, however, in order to do so, many changes must be implemented in order to fulfill the ACA 's promises. The first of which is allowing all individuals to acquire health insurance no matter the age, pre-existing conditions, or other unfair practices. Statistics show that “half of Americas” have a preexisting medical condition in which with the passage of the ACA, it allows individuals to acquire health insurance without the

United States Main article: Health care reform in the United States Health care reform in the United States Healthcare reform in the US Debate over reform History Latest enacted legislation Patient Protection and Affordable Care Act (Senate bill - H.R. 3590) Health Care and Education Reconciliation Act of 2010 (H.R. 4872) preceding legislation Social Security Amendments of 1965 Emergency Medical Treatment and Active Labor Act (1986) Health Insurance Portability and Accountability

Healthcare Reform 1 Healthcare Reform: Moving Closer to a Solution English 102-940 Professor Marilyn December 1, 2007 December 1, 2007 Professor Marilyn Sahiba Department of English and Critical Studies Parkland College Champaign, IL 61821 Dear Professor Sahiba, I am pleased to present to you my final research paper on Health Care Reform: Moving Closer To A Solution, the topic for which was approved by you on November 8, 2007

The Reform Of The Health Care Reform Essay

The latest health care reform has done what few policies manage to do – sicken both republicans and progressive democrats. While we can all agree that a reform of the health care system is sorely needed, we must also acknowledge that “Obamacare” is not the cure-all we so desperately require. Rather, President Obama, like a medieval barber, prescribed a health care reform that treated the symptoms of our flawed system rather than the actual disease. The subsidization of health insurance providers

Health Care Reform 2010 There is so little contradiction that government should be engaged in one way or another in creating a solution that gives Americans in need of medical assistance the right to life, liberty and the continued pursuit of happiness. The disagreements come in recognizing the failure of government to properly

Health Care Reform A newest way to finance health care now days is the health care reform which it is also called Obama Care. The Affordable Care Act was signed into law in 2010. The main objective behind the Affordable Care Act was to ensure that affordable health care insurance was available to every U.S citizen. This law is an extensive document that contains many regulations and laws that relate not only to health care but also to the regulation of insurance companies. One of the best

Healthcare Reform And Health Care Reform

constant battle over health care reform, healthcare in the United States has become a growing problem that must be addressed. While the main controversy seems to be the politics of healthcare reform and whether the government should have total control, the one thing that I believe should be the focus, is the quality of care that is embedded in the patient doctor relationship. It’s quite troublesome when large health insurance companies are swaying politicians to vote for less health care regulation and

Essay On Health Care Reform

implementation of the Affordable Care Act (ACA) in 2010, there has been a continuous debate about the effects it will have on the United States economy. Many people argue that expanding insurance coverage for all people will create crippling cost burdens for the economy and taxpayers. While others believe that the ACA will in fact give the economy a much-needed boost. In 2006 as a measure to improve overall healthcare, the state of Massachusetts implemented the Health Care Insurance Reform Act. This paper looks

Health Care Reform And The Underinsured

Health Care Reform and the Underinsured Health Care reform is a major topic of discussion in today’s society, especially with the relatively novel release of the Patient Protection and Affordable Care Act (ACA) by the Obama administration. Historically, the health care system has disproportionally favored those of higher class and income, resulting in diminished health care for those that could not afford it. The Institute of Medicine’s (IOM) 2002 report, Unequal Treatment: Confronting Racial

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Health Care Reform Essays (Examples)

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Health care reform.

Healthcare eform List and briefly describe 3 of the recommendations for health care reform made by experts The Annals of Internal Medicine suggests one way to enable more uninsured Americans to afford health insurance is to explore the use of new "revenue sources, including but not limited to savings from capping the tax exclusion of employer-based health insurance, taxing tobacco, and redirecting existing health resources [which] should be mobilized to ensure coverage for all Americans" (Arrow et al. 2009). To create a larger risk pool and to offset rising healthcare costs, the Annals recommends creating state or regional insurance exchanges to pool risk. "Exchanges in which insurance companies offer a standard benefits package with guaranteed issue, portability, and renewability and no exclusions for preexisting conditions can expand the offerings to small groups and persons at lower rates. Along with mandatory coverage for standard benefits, the exchanges must implement risk-adjusted payments to minimize adverse….

Arrow, Kenneth. (et al. 2009). Towards a 21st century healthcare system. The Annals of Internal

Medicine. 150 (7): 493-495. Retrieved:  http://annals.org/article.aspx?articleid=744430 

Summary of new healthcare reform law. (2012). Kaiser Permanente. Retrieved:

 http://www.kff.org/healthreform/upload/8061.pdf

Health Care eform ecommendations Healthcare eforms and ObamaCare The healthcare system in the United States is not a healthy system, but one fraught with problems which could cause a catastrophic failure. In order to prevent the collapse of the American healthcare system, for years experts have made recommendations in the hope that government officials would implement them. It was not until President Obama pushed through his healthcare bill, called the "Patient Protection and Affordable Care Act" but generally referred to as "ObamaCare," that the government attempted to implement the many various recommendations put forward by the numerous expert groups. One group of experts on the American healthcare system, the American College of Physicians (ACP), has put forward a number of recommendations that they agree would be beneficial to the overall healthcare system. An examination of Obama Care" can demonstrate to what extent the new law fulfills the recommendations of this prestigious group. The….

"ACP Issues Recommendations for Healthcare Reform." (3 Feb. 2009). Medscape Today

News. Retrieved from  http://www.medscape.com/viewarticle/587754 

Health Home: Using the Expanded Care Model of the Collaboratives." The

Disparity Reducing Advances Project. Retrieved from  http://www.altfutures.org/draproject/pdfs/Report_08_05_ComprehensiveHealthHome_UsingExpandedCareModelCollaboratives.pdf

Healthcare Reform Initiatives in California The citizens of California are fortunate to have one of the best healthcare systems in the United States. This paper reviews the laws and initiatives that relate to the healthcare coverage and facilities that are available to Californians. This state has led the way in progressive laws that give consumers the tools to stay as healthy as possible. The Reform Initiatives in California First of all, California was the first state to set up its health insurance exchange, which will begin enrolling people in the fall of 2013 for coverage in 2014. The federal Affordable Care Act (ACA) mandates that "health insurance exchanges" be established (by federal or state governments) and be ready to help consumers choose the right plan by 2014; these exchanges are "virtual marketplaces" where citizens can buy health insurance at "competitive prices" (Colliver, 2012, p. 2). The exchanges will receive federal subsidies but essentially….

Works Cited

California Healthline. (2012). LIHP in Sacramento County to Cover Only Poorest Residents.

Retrieved November 6, 2012, from  http://www.californiahealthline.org .

Colliver, Victoria. (2012). California is most prepared for health care law. San Francisco

Chronicle. Retrieved November 6, 2012, from  http://www.sfgate.com .

Healthcare Debate he United States Healthcare Debate Healthcare is necessary for humanity's survival in the best conditions possible. Various countries across the world have different system, with most consisting of an institutionalized or socialist system. However, the United States stands almost unique in its privatized, corporate-oriented and often patient-neglecting healthcare system. Various leaders in our country's history have strived to change this, yet none have been as successful as President Obama, though reform still has a long way to go. However, the mere fact that leaders have fought so hard for healthcare reform proves just how important an issue it is, and how detrimental it will be for generations to come if individuals will have to pay excessive premiums. his paper will present two explanations, namely, the three recommendations of healthcare reform from various groups, as well as how the President has considered and how he will be considering them in the….

The points presented above make perfect, sense, especially since they are offered by those who know what is needed most in healthcare, as well as the fact that they focus on patients, rather than corporations. Furthermore, many other groups agree with them, especially in the medical and social fields. One such groups is the American College of Physicians, which not only reiterates the above-mentioned points, but also recommends further innovations, such as better payment policies and an expansion of physician in-home care.[footnoteRef:2] [2: ACP Issues Recommendations for Healthcare Reform (n.a.). (2009). MedScape News. Retrieved October 23, from .]

President Obama has tried to pass new health care legislation that fits with the recommendations, and especially ensure proper healthcare for all Americans, an effort which many have undertaken, as expressed above, but in which few have succeeded. President Obama has not stressed the first and second recommendations as much as the third, on which he has placed considerable effort and toward which point he has passed legislation. Essentially, this legislation ensures that one cannot be denied insurance based on pre-existing conditions, and ensures as well that if an affordable option is not available, then the state must provide an option which is considered affordable to all, both ideas which are not novel, but are essential ideas that have been carried out and that will have an positive impact upon our healthcare as a nation and on its reform.[footnoteRef:3] [3: Points taken from: Health Reform in Action (n.a.). (2011). White House. Retrieved October 23, from .]

Healthcare reform is a pressing need for the United States, both in the fact that many have been unemployed for months, and many need this in order to fare for their well-being. The President's efforts are applauded by many, but much needs to be done in order to ensure that the recommendations above are carried out.

Health Care eform Healthcare reform Current national health care coverage component: Impact on young people (ages 18 to 26) Historically, young adults have a greater likelihood of being uninsured than their older counterparts. They are just starting out in their careers, and often must take jobs with minimal benefits to secure a position. Because they are young and healthy, they may feel that purchasing health insurance is not worth the cost, or simply cannot afford it because of the expense of their costs of living and the need to pay off their student loans. The rate of uninsured young people was particularly high in the wake of the recent recession, given that many college graduates were forced to take substandard jobs or could not find work after graduation. In light of this, one of the most popular components of the Affordable Care Act (ACA) was allowing young people to remain on their parent's insurance….

Culp-Ressler, Tara. (2012). Obamacare led to record drop in uninsured young adults. Think Progress. Retrieved: ttp://thinkprogress.org/health/2012/09/10/818231/study-obamacare-drop-uninsured-young-adults/?mobile=nc

Kennan, Joanne. (2012). Five myths of the individual mandate. Politco. Retrieved:

 http://www.politico.com/news/stories/0612/77997.html#ixzz2FXbzLtBl

Health Care Reform Policies Whatever Their Nature

Health Care eform Policies, whatever their nature, constitute very significant aspects to the entities over which they are supposed to act upon. These principles, in their roles of guiding decision making and governing the outcomes of such processes are so vital, especially when properly adopted by the concerned parties. This aspect applies to both the private and the public sector, a case in point being the health care reform policy. Health care provision, all through the globe comprise of very sensitive factors and as such, the need for the adoption of policies which surrounds the activities associated with the field goes without saying. Likewise, proper procedures ought to be put in place with the views of ensuring that such policies are adequately adopted and that they serve the purposes which led to their adoption in the first place. Like all the major policies, most of which associate with the functions of….

Anderson, G.F Et Al (2008). It's The Prices, Stupid: Why the United States Is So Different from Other Countries, Health Affairs, Vol. 22

Howard, C (2005). The Policy Cycle: A Model of Post-Machiavellian Policy Making? The Australian Journal of Public Administration

Reid, T.R (2009). The Healing of America: a Global Quest for Better, Cheaper and Fairer Health Care, New York: Penguin Books

Stolberg S.G & Pear, R (2010, March 24). Obama Signs Health Care Overhaul Bill, With a Flourish, Washington D. C: New York Times,

Healthcare Reform Lowering Costs in

The amendments have had practical impacts such as repealing the tax mandate of the employer, health insurance tax of small businesses and decreasing the burdens on individuals and businesses. The compliance cost for small business owners has risen by 36% higher than that of larger corporations. Similarly, the average U.S. citizen has already been overtaxed. Since the passing of the Affordable Care Act, Americans have not enjoyed the benefits that come with it. While the country is characterized by a highly partisan political climate, the congress is full of voice of reason. These voices claim that the Act should be amended so that the pain can be reduced in the future. More policy makers have been encouraged to pull in their efforts. After years of the groundbreaking changes on the Care Act, one of the advantages associated with this law is that it supports a low rate of uninsured Americans.….

Healthcare Reform Revised

Healthcare eform evised We know that the burden of diseases is increasing all over the world. The percentage of people suffering from diabetes, cardiovascular and pulmonary diseases has considerably increased in the last decade. It is noteworthy here that the importance of preventive care now comes at par with the importance of curative care. Considering the prevalence of diseases and the health status of the American population, President Obama introduced a health care reform that is known as the Affordable Care Act or Obama Care. The role of medical care as a determinant for health has not been established as a fact yet it has been proved that early intervention, preventive care and the required management can go on to reduce the severity and even cure chronic disease. Due to this reason, medical care does have a very crucial role to play in the health status of the population. (Bunker, Frazier….

Bunker, J., Frazier, H. And Mosteller, F. (1995). The Role of Medical Care in Determining Health: Creating an Inventory of Benefits. In: Amick, B., Levine, S., Tarlov, A. And Walsh, D. eds. (1995). Society and Health.. New York: Oxford University Press.

Floyd, E. (2002). Healthcare reform through rationing..Journal of healthcare management/American College of Healthcare Executives, 48 (4), pp. 233 -- 241.

Obama, B. (2008). Affordable health care for all Americans.JAMA: the journal of the American Medical Association, 300 (16), pp. 1927 -- 1928.

O'harra, C. (2013). An Obamacare Expert Tells All: What You Need To Know About The Affordable Care Act. [online] Retrieved from:  http://www.forbes.com/sites/learnvest/2013/10/11/an-obamacare-expert-tells-all-what-you-need-to-know-about-the-affordable-care-act  / [Accessed: 13 Oct 2013].

Healthcare Reform Simkins v Moses H Cone

Healthcare eform "Simkins v. Moses H. Cone Memorial Hospital" The case of Simkins v. Moses H. Cone Memorial Hospital was a case that attempted to end the segregation of African-American and Whites in the U.S. hospitals and medical professions as a whole. The case challenged the use of public funds to maintain and expand the segregated hospital care in the United States. Source of the laws related to the case are: Title VII of the Civil ights Act of 1964, The Hill-Burton Act (Hospital Survey and Construction Act) of 1946. The executive, legislative and judicial branch of government played important roles in the case. The judicial branch of government interpreted the law and declared the case in favor of Simkins. The legislative branch of government passed the Civil ights Act of 1964 to end all form segregation in the United States while the executive branch of government implemented the Acts. The concept of the case….

American Medical Association (2012). Opinion 9.031 - Reporting Impaired, Incompetent, or Unethical Colleagues.USA.

Chen, B.K. (2013). Strict Liability for Medical Injuries? The Impact of Increasing Malpractice Liability on Obstetrician Behavior. Stanford University.

Reynolds, P.P. (1997). Hospitals and Civil Rights, 1945-1963: the case of Simkins v Moses H. Cone Memorial Hospital.. Annals Of Internal Medicine [Ann Intern Med] . 126 (11): 898-906.

High Beam (2013).Hospital and Medical Service Plans. Cengage Learning.

Health Care Reform For Quite

There are a number of issues involved in health care including taxation, the fear of socialized medicine and the budget. Many Americans are opposed to higher taxes for the wealthy due to the fact that they will be the ones paying for most government spending including the proposed heath care bill. These people also argue that it's the wealthy that create jobs through investing and if their taxes are raised, there will be less investing and job creation. As stated earlier, though Republicans believe that the American health care system needs reform, they feel that the best solution is not to hand it over to the government. The handing over of the health care system to the government has led to the fear of socialized medicine. The Republicans also believe that the American government is nearly bankrupt although the president has stated the proposed health care bill will reduce government….

Works Cited:

Iglehart, John K. "The Struggle for Reform ? Challenges and Hopes for Comprehensive Health Care Legislation." The New England Journal of Medicine. Massachusetts Medical Society, 23 Apr. 2009. Web. 14 Apr. 2010. .

Kakasuleff, Jenny. "Health Care Reform Series: A History of Health in the U.S. Part 1." Examiner.com: Insider Source for Everything Local. Clarity Digital Group LLC D/b/a Examiner.com., 30 June 2009. Web. 14 Apr. 2010. .

"Why Are Republicans against Healthcare Reform as Outlined by Obama?" Answers.com: The World's Leading Q & A Site. Answers Corporation. Web. 14 Apr. 2010. .

Health Care Reforms on November

In the U.S., administrative costs are 31% of health care costs, compared with 19% in Canada. The proposed health care reform is also expected to improve health outcomes. By shifting some of the focus of the system away from maximizing shareholder value and towards improving health outcomes, Americans should live longer, have better access to care, see improved quality of life and have lower mortality rates for a number of diseases. In addition to providing better health care, the reform plan will have several positive economic impacts. The Boston Globe calculation (Bilmes & Day, 2009) determined that life lost due to inadequate insurance cost the U.S. economy $140 billion per year, less than the cost of the Obama health care plan. In addition, the high cost of health care insurance is a competitive disadvantage for American companies. It is one of the reasons why tens of thousands of automobile manufacturing jobs….

Pear, R. & Herszenhorn, D. (2009). Senate health plan seeks to add coverage to 31 million. New York Times. Retrieved November 19, 2009 from  http://www.nytimes.com/2009/11/19/health/policy/19health.html?_r=1&hp 

Press Trust of India. (2009). U.S. Senate unveils $849 billion health care reform bill. Business Standard. Retrieved November 19, 2009 from  http://www.business-standard.com/india/news/us-senate-unveils-849-bn-health-care-reform-bill/78744/on 

Friedman, M. (1970). The social responsibility of business is to increase its profits. New York Times Magazine. Retrieved November 19, 2009 from  http://www.colorado.edu/studentgroups/libertarians/issues/friedman-soc-resp-business.html 

Bilmes, L. & Day, R. (2009). The cost of not enacting health care. Boston Globe. Retrieved November 19, 2009 from  http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/11/07/the_cost_of_not_enacting_health_care_reform/

Healthcare Reform Ways the Healthcare

Transparency empowers consumers to become better shoppers. Economists assert that transparency stimulates productivity, for example, in exchange for money, one individual obtaining fair value. In every aspect, except healthcare, Davis points out, transparency, is supported. The contemporary dearth of transparency in healthcare has led to many Americans not being able to effectively shop for the best quality of service at acute care hospitals. Davis argues that transparency permits consumers, particularly those uninsured individual, to know actual charges, as well as the quality of services they will received. The critical issue in Health Care eform, according to some, Davis (2008) notes, is power. When consumers know less about the facts, those who do know possess the greater power. These with more power generally consist of "the hospitals, the insurers, and the healthcare policy makers" (Ibid., ¶ 14). Consumer-driven healthcare aims to switch the power to the consumer and the partnering provider….

Aday, L.A. & Cornelius, L.J. (2006). Designing and conducting health surveys: A

comprehensive guide. San Francisco, CA: John Wiley and Sons.

Alltucker, K. (2010). Ex-Mayo CEO: Health plan lacking. The Arizona Republic. Retrieved January 18, 2010 from  http://www.azcentral.com/business/articles/2010/01/19/20100119biz-mayo0120.html 

Baucus, M. (2009). Healthcare reform a moral imperative, an economic necessity: Healthcare

Health Care Reform Life and

As the sole owners of a license to practice medicine on which industries and other business entities build profits, they need to take solid steps to assert their rights. They listed strategies to put their situation and demands across to the current government. These strategies include a letter writing campaign, civil disobedience, a website for physician consensus, petitioning elected officials to take action on their concerns, email campaigns sent to the President and Congress, forming a physicians' union, refusing insurance and political games, and a one-day strike off their patients to draw attention to their objective (2009). Summary and Viewpoints A recent interactive survey showed that half of all American adults want the current healthcare system reformed (usiness Wire, 2010). The Institute of Medicine Committee likewise found that the system badly needed repairs (English, 2001). In addition to 13 recommendations and 10 rules, it sought a $1 billion innovation fund, a….

BIBLIOGRAPHY

Business Wire (2010). Half of all U.S. adults want healthcare reform in the next two years. Harris Interactive: CBS Interactive. Retrieved on February 17, 2010 from  http://findarticles.com/p/articles/mi_mOEIN/is_201002/ai_n49497510/?tag=content;col1 

Brauser, D. (2009). Healthcare leaders propose extensive U.S. healthcare reforms. 150:

493-494, 498 Annals of Internal Medicine: Medscape Medical News. Retrieved on February 15, 2010 from  http://www.medscape.com/viewarticle/590760 

English, T. (2001). What's wrong with the healthcare system? Part 2: OIM Report

Health Care Reform to Place

And, secondly, what's the rush? If this is so good for us and everyone understands the program, then what is the answer to those two questions? The answers are, in order, because most Americans have no clue what the program is due to the fact that the menu changes so often and so quickly and all we get is sound bites. What's the rush? So politicians like Mr. Obama and Ms. Pelosi can get another notch on their belts. Two thousand pages of health care legislation? Who could possibly understand it all? Or read it all? While Washington pols pile up trillions in debt, the American people are suffering through 10% unemployment which our children will have to pay for. Yes, health care reform is needed -- modification of our current system to place more deserving people under the umbrella. Universal health care? ased on other countries' experiences, and our own government's….

Bibliography

Brown, J. "The case of the missing moral authority." 10 November 2009. catholicsagainstobamacare. 11 November 2009 .

CBS news. "Post office desperate for financial help." 25 March 2009. CBS news. 8 November 2009 .

Doig, Dr. Anne. "Inaugural Address: Efficiency, effectiveness, and effecting change." 19 August 2009. Canadian Medical Association. 8 November 2009 .

McGowen, Charles. "Do we want England's Healthcare?" October 2009. aproundtable.org. 10 November 2009 .

Healthcare Reforms

Health care reform is a global and constant issue. Most communities are planning, preparing, implementing, legislating and assessing the health care reform as a policy improvement that is a continuous cycle. Globally, the objectives of health care reform are becoming familiar – controlling the growing costs, improving the quality of health care and increasing access to health care services. Universal Health Coverage Universal health care coverage is a health care system which provides financial protection and health care services to every citizen within a country. It provides a package of benefits to everyone with the end goal being providing improved access to health care, reduced cost and improved outcomes of health. However, universal healthcare does not provide coverage for everyone for everything (Pineault, et al., 1993). It only implies that everyone is able to access healthcare. Some universal coverage systems are funded by the government while others are based on what the….

I need some suggestions for health care policy essay topics. Can you offer any?

1. The Role of Technology in Transforming Health Care Delivery Discuss the latest technological advancements in health care, such as telemedicine, AI-powered diagnostics, and wearable health trackers. Explore how technology can improve access to care, reduce costs, and personalize treatments. Analyze the ethical implications of using technology in health care and the potential for data privacy and algorithmic bias. 2. Addressing Health Disparities through Policy Interventions Identify the root causes of health disparities based on race, ethnicity, socioeconomic status, and geographic location. Evaluate the effectiveness of existing policy interventions aimed at reducing disparities, such as Medicaid expansion and community health centers. ....

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Healthcare eform List and briefly describe 3 of the recommendations for health care reform made by experts The Annals of Internal Medicine suggests one way to enable more uninsured Americans to…

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Health Care eform Policies, whatever their nature, constitute very significant aspects to the entities over which they are supposed to act upon. These principles, in their roles of guiding decision…

The amendments have had practical impacts such as repealing the tax mandate of the employer, health insurance tax of small businesses and decreasing the burdens on individuals and…

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120+ healthcare argumentative essay topics [+outline], dr. wilson mn.

• August 3, 2022
• Essay Topics and Ideas , Samples

If you’re a nursing student, then you know how important it is to choose Great Healthcare argumentative essay topics.

After all, your essay will be graded on both the content of your argument and how well you defend it. That’s why it’s so important to choose topics that you’re passionate about and that you can research thoroughly.

What You'll Learn

Strong Healthcare argumentative essay topics

To help you get started, here are some strong Healthcare argumentative essay topics to consider:

• Is there a nurse shortage in the United States? If so, what are the causes, and what can be done to mitigate it?
• What are the benefits and drawbacks of various types of Nurse staffing models?
• What are the implications of the current opioid epidemic on nurses and patients?
• Are there any ethical considerations that should be taken into account when providing care to terminally ill patients?
• What are the most effective ways to prevent or treat healthcare-acquired infections?
• Should nurses be allowed to prescribe medication? If so, under what circumstances?
• How can nurses best advocate for their patients’ rights?
• What is the role of nurses in disaster relief efforts?
• The high cost of healthcare in the United States.
• The debate over whether or not healthcare is a human right.
• The role of the government in providing healthcare.
• The pros and cons of the Affordable Care Act.
• The impact of healthcare on the economy.
• The problem of access to healthcare in rural areas.
• The debate over single-payer healthcare in the United States.
• The pros and cons of private health insurance.
• The rising cost of prescription drugs in the United States.
• The use of medical marijuana in the United States.
• The debates over end-of-life care and assisted suicide in the United States.

As you continue,  thestudycorp.com  has the top and most qualified writers to help with any of your assignments. All you need to do is  place an order  with us.

Controversial Healthcare topics

There is no shortage of controversial healthcare topics to write about. From the high cost of insurance to the debate over medical marijuana, there are plenty of issues to spark an interesting and thought-provoking argumentative essay.

Here are some Controversial healthcare argumentative essay topics to get you started:

1. Is healthcare a right or a privilege?

2. Should the government do more to regulate the healthcare industry?

3. What is the best way to provide quality healthcare for all?

4. Should medical marijuana be legalized?

5. How can we control the rising cost of healthcare?

6. Should cloning be used for medical research?

7. Is it ethical to use stem cells from embryos?

8. How can we improve access to quality healthcare?

9. What are the implications of the Affordable Care Act?

10. What role should pharmaceutical companies play in healthcare?

11. The problems with the current healthcare system in the United States.

12. The need for reform of the healthcare system in the United States.

Great healthcare argumentative essay topics

Healthcare is a controversial and complex issue, and there are many different angles that you can take when writing an argumentative essay on the topic. Here are some great healthcare argumentative essay topics to get you started:

1. Should the government provide free or low-cost healthcare to all citizens?

2. Is private healthcare better than public healthcare?

3. Should there be more regulation of the healthcare industry?

4. Are medical costs too high in the United States?

5. Should all Americans be required to have health insurance?

6. How can the rising cost of healthcare be controlled?

7. What is the best way to provide healthcare to aging Americans?

8. What role should the government play in controlling the cost of prescription drugs?

9. What impact will the Affordable Care Act have on the healthcare system in the United States?

Hot healthcare argumentative essay topics

Healthcare is always a hot-button issue. Whether it’s the Affordable Care Act, single-payer healthcare, or something else entirely, there’s always plenty to debate when it comes to healthcare. Here are some great healthcare argumentative essay topics to help get you started.

1. Is the Affordable Care Act working?

2. Should the government do more to provide healthcare for its citizens?

3. Should there be a single-payer healthcare system in the United States?

4. What are the pros and cons of the Affordable Care Act?

5. What impact has the Affordable Care Act had on healthcare costs in the United States?

6. Is the Affordable Care Act sustainable in the long run?

7. What challenges does the Affordable Care Act face?

8. What are the potential solutions to the problems with the Affordable Care Act?

9. Is single-payer healthcare a good idea?

10. What are the pros and cons of single-payer healthcare?

Argumentative topics related to healthcare

Healthcare is always an ever-evolving issue. It’s one of those topics that everyone has an opinion on and is always eager to discuss . That’s why it makes for such a great topic for an argumentative essay . If you’re looking for some fresh ideas, here are some great healthcare argumentative essay topics to get you started.

1. Is our healthcare system in need of a complete overhaul?

3. Are rising healthcare costs making it difficult for people to access care?

4. Is our current healthcare system sustainable in the long term?

5. Should we be doing more to prevent disease and promote wellness?

6. What role should the private sector play in providing healthcare?

7. What can be done to reduce the number of errors in our healthcare system?

8. How can we make sure that everyone has access to quality healthcare?

9. What can be done to improve communication and collaboration between different parts of the healthcare system?

10. How can we make sure that everyone has access to the care they need when they need it?

Argumentative essay topics about health

There are many different stakeholders in the healthcare debate, and each one has their own interests and perspectives. Here are some great healthcare argumentative essay topics to get you started:

1. Who should pay for healthcare?

2. Is healthcare a right or a privilege?

3. What is the role of the government in healthcare?

4. Should there be limits on what treatments insurance companies must cover?

5. How can we improve access to healthcare?

6. What are the most effective methods of preventing disease?

7. How can we improve the quality of care in our hospitals?

8. What are the best ways to control costs in the healthcare system?

9. How can we ensure that everyone has access to basic care?

10. What are the ethical implications of rationing healthcare?

Medical argumentative essay topics

• Is healthcare a fundamental human right?

2. Should there be limits on medical research using human subjects?

3. Should marijuana be legalized for medicinal purposes?

4. Should the government do more to regulate the use of prescription drugs?

5. Is alternative medicine effective?

6. Are there benefits to using placebos in medical treatment?

7. Should cosmetic surgery be covered by health insurance?

8. Is it ethical to buy organs on the black market?

9. Are there risks associated with taking herbal supplements?

10. Is it morally wrong to end a pregnancy?

11. Should physician-assisted suicide be legal?

12. Is it ethical to test new medical treatments on animals?

13. Should people with terminal illnesses have the right to end their lives?

14. Is it morally wrong to sell organs for transplantation?

15. Are there benefits to using stem cells from embryos in medical research?

16. Is it ethical to use human beings in medical experiments?

17. Should the government do more to fund medical research into cancer treatments?

18. Are there risks associated with genetic engineering of humans?

19. Is it ethical to clones humans for the purpose

Argumentative essays on mental illness

• Should there be more focus on mental health in schools?
• Are our current treatments for mental illness effective?
• Are mental health disorders more common now than they were in the past?
• How does social media impact mental health?
• How does trauma impact mental health?
• What are the most effective treatments for PTSD?
• Is therapy an effective treatment for mental illness?
• What causes mental illness?
• How can we destigmatize mental illness?
• How can we better support those with mental illness?
• Should insurance companies cover mental health treatments?
• What are the most effective treatments for depression?
• Should medication be used to treat mental illness?
• What are the most effective treatments for anxiety disorders?
• What are the most effective treatments for OCD?
• What are the most effective treatments for eating disorders?
• What are the most effective treatments for bipolar disorder?
• How can we better support caregivers of those with mental illness?
• What role does stigma play in mental illness?

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Marching, but where? Moscow I fear

What's up with the Health Care Transformation Task Force? In the midst of all the excitement, there are very few thoughtful observers who raise questions about the march.

Well, the theory is that risk-based payment mechanisms like "accountable care, bundled payments and other contracts with the potential for rewards or penalties based on quality performance and better cost control" will bring about greater efficiency and higher quality in the health care system. It is argued that the current system, mainly based on fee-for-service schemes, leads to overtreatment and waste.

I've devoted a lot of columns to the unanswered questions and potential unintended consequences associated with risk contracts. I've also been hard on the health care industry for a lack of analytical rigor when it comes to designing public policy prescriptions to deal with rising health care costs. I don't want to go through all those arguments now, but let's just outline some as yet unanswered concerns:

1. As risk is shifted from insurers to providers, what adjustment will be made in the insurers' cost of business, and how will those adjustments be passed along to consumers. A reduction in risk should be accompanied by a reduction in capital reserve requirements of insurers: How and when will those huge investment accounts be reduced and redistributed to the public? Likewise, if payments are made on the basis of annual population rather than individual claims, when will the insurers stop adjudicating claims data and reduce the size of their staff involved in these functions? When and how will those savings be passed along to consumers?

2. The decisions by ACOs to take on more risk is already driving mergers and acquisitions as those entities try to expand their risk pools. That market concentration acts to increase the leverage of the providers over local insurers, driving up rates (whether fee-for-service, capitated, or bundled). How can we be sure that whatever savings might emerge from risk contracts are not offset by the greater market power of provider groups vis-a-vis insurers?

3. What will be the internal distribution of risk and reward for the various physician specialties within ACOs? How will that negotiation take place? Is there any reason to believe that the current fee schedules which offer higher relative payments to proceduralists than cognitive specialists will not form the base for ACO internal transfer pricing? If there is a surplus within an ACO, which doctors will get which share? Likewise, if there is a deficit?

4. Similarly, what will be the internal distribution of risk and reward for the various entities within ACOs--the tertiary care centers, community hospitals, multispecialty clinics, and post-acute care facilities. If there is a surplus within an ACO, which facilities will get which share? Likewise, if there is a deficit?

5. What will be the governing structure of ACOs? If, as is often the case, the large tertiary centers hold the cards, how can the other players within the ACO rest assured that they will be treated fairly in matters of risk and reward allocation?

6. And finally, if quality metrics are not properly drawn, don't risk-based contracts offer the potential for undertreatment of patients, swinging the pendulum too far in the other direction?

We are all pleased, of course, to see the following kind of optimism, reported by Modern Healthcare :

"As a doctor, I am very excited about the direction this is going," said Dr. Stephen Ondra, chief medical officer of Health Care Service Corp. "For much of my career, payers and providers had an adversarial relationship that often created win-lose choices."

But I fear that Dr. Ondra and his like-minded colleagues are naive. The adversarial relationship he sees today may very well be replaced by a new set of adversarial relationships -- between physician specialties; between tertiary and other health care facilities; and, sadly, between patients and ACOs. The main drivers of health care costs are not overuse related to fee-for-service care. As I have noted here, they start with the changing demographics of society. Fee-for-service is way down the list.

If we were being rational and rigorous about policy prescriptions, we would rank order these causes and determine the costs and benefits of policies that might offset them. For example, we cannot change demographic patterns, but it could make sense to introduce public health programs to promote exercise and proper nourishment. We could change the compensation system for primary care doctors so they could spend more time with patients. We could subsidize physician education so they wouldn't have to earn so much to pay off loans. We could reform malpractice laws to reduce defensive medicine. And we could certainly engage in full-scale process improvement training of doctors and implementation of those techniques in hospitals to reduce the extra medical costs associated with harming patients. (Those of us who have done the latter have demonstrated conclusively the cost savings, not to mention the mortality and morbidity benefits.)

But, our public policy leaders have not done this. Instead, they assert that pricing-based over-treatment is the key problem, and they offer capitated rate plans and bundled payments as the solution. If you look closely, you will find that most of those proposals come from payers, either insurance companies who have a corporate desire to shift risk to providers or government officials who are trying to reduce appropriations. Or from economists, who have a tendency to simplify market behavior and blame everything on pricing regimes. As I have said, when you have a hammer, everything looks like a nail.

We shouldn't dismiss a change in the payment system just because it might benefit the insurers or the government, but we also shouldn't adopt it just for that reason -- or because it fits into economists' idealized models. Instead, we should determine how big a portion of the over-treatment problem comes from the payment system versus other causes. And then we should rigorously review the experience of such regimes and evaluate their costs and benefits. We should also determine how practical it is to implement a new pricing regime.

I have a deep seated feeling that the march that is seen as so optimistic today might start to feel more like Napoleon's attack on Moscow, nicely represented in the chart above from Edward Tufte.

Paul Levy is the former President and CEO of Beth Israel Deaconess Medical Center in Boston and a patient-driven healthcare advocate. He blogs at  Not Running a Hospital .

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ESSAY; Moscow's China Card

By William Safire

• Sept. 8, 1986

Every decade or so, China undergoes a political convulsion. In 1948-49, the Communists threw out the Kuomintang; in 1956, Mao's ''Great Leap Forward'' plunged the country into a depression; in 1966, the Cultural Revolution to purify the party brought on a new Dark Ages; in 1976-78, we saw Mao's would-be radical successors, the ''Gang of Four,'' replaced by pragmatic Deng Xiaoping.

Now we are celebrating the 10th anniversary of the death of Mao, and some Pekingologists would have us believe that this decade's upheaval will not come.

Mr. Deng, at 82, has provided for his succession, we are assured: it's all set for Hu Yaobang and Zhao Ziyang to succeed him, with Hu Qili of the next generation right behind. Not to worry, goes the current Edgar Snow-job: China's new era of ''commutalism,'' communism with a capitalist face, will march undisturbed into the next millennium.

I wonder. Maybe the conventional wisdom will prove right for once. But for argument's sake, let's look at what is happening in China through a different set of glasses, seeking truth from facts.

Fact number one is that a wave of materialism is sweeping across the billion people of China. After a generation of repression, good ol' greed is back in the saddle, and an I'm-all right-Deng attitude permeates the new entrepreneurs.

As a longtime expositor of the virtue of greed in powering the engine of social progress, I cannot cluck-cluck at this. But there is a difference between the materialism of the Chinese on Taiwan, who are accustomed to free enterprise, and the lust for the good life of available goods on the mainland, where a terrible thirst has been a-building.

Let us assume that the outburst of materialism in China leads to some reaction: that some spoilsport faction emerges to summon up the ghost of Mao's ideological purity, and that this new gang of fortyish Outs finds its way back in. It is at least a possibility.

I think that shrewd old Deng is well aware of this possibility. That is why, despite his ostentatious rejection of personal cultdom, he is preparing his most dramatic assault on the memory of Mao. That father of the revolution startled the world by breaking with the Soviet Union; Mr. Deng, playing a revisionist Lenin to Mao's Marx, wants to startle the world and overwhelm internal opposition by a rapprochement with Moscow.

Accordingly, fact two: He has abandoned his demand that Russia move back its huge army from the Chinese border, thereby double-crossing his own Army leaders. He has forgotten his requirement that Soviet forces be withdrawn from Afghanistan, thereby double-crossing his Westernish ally, Pakistan.

All Mr. Deng now asks of the Russians is that they try to squeeze their Vietnamese clients to pull out of Cambodia. Of course they'll try - ''best efforts'' is an easy promise - and since the Vietnamese are notoriously independent, Moscow cannot be blamed for not succeeding. Result: Mr. Deng takes the salute from atop the wall in Red Square.

That reestablishes his Communist credentials, defanging hard-left opposition at home. And it is Middle Kingdom orthodoxy; I suspect Chinese agents in the U.S. supply the K.G.B. with intelligence, just as Peking permits our Big Ears on its soil to overhear Kremlin transmissions. Chinese policy has always been to play the barbarians against each other.

This theory would also explain fact three: Mr. Gorbachev's seizure of a U.S. newsman as hostage. It is no coincidence that this particular hostage selection follows China's arrest and expulsion of a reporter for a U.S. newspaper. The Soviet leader, advised by Anatoly Dobrynin, must have known that this slap in the face would jeopardize a summit - and went ahead with his calculated humiliation, similar to Mr. Nixon's mining of Haiphong harbor before his Moscow summit in 1972.

Because the Russians now have the prospect of a pilgrimage to Moscow by Mr. Deng, they can taunt the U.S. President with impunity. As Mr. Dobrynin probably predicted, Mr. Reagan is reduced to begging for the hostage's release, in effect volunteering testimony to a Soviet court, in his eagerness to crown his Presidency with a peacemaking summit.

Now Mr. Gorbachev can hang tough, holding a show trial and thereby delaying negotiations with the U.S. until the Deng visit - or can graciously accede to the Reagan plea, thereby establishing his dominance. And the overconfident Mr. Reagan never suspected, as he sat down to summit poker, that this time the China card was in his opponent's hand.