Introduction
Health care reform has remained to be an issue in the United States for the first time since 1994, when President Clinton proposed major reforms, there is provable consideration in reforming health care in America.
Research reported some constant challenges where unions of all influences are providing their own positions on the issue. Political activists and leaders are presenting concerns and solutions about these issues surrounding health care system. Some states have implemented different health care reforms and other states are on their way doing the same.
Interest in health care reforms is determined by three major issues, such as medical cover, cost, spending, and quality of health care services. With reference to coverage, it is estimated that above 50 million people were uninsured in 2007 and this makes up above one-seventh of the total population (Garber & Skinner 28).
The figure of uninsured population may have been increased by recession. Proposed reform favors private insurance and coverage under government medical plans to help people receive essential care and reduce difficulties paying for health care they obtain. In June 2012, the Supreme Court greatly legalized the President Obama’s extensive health care service, the Affordable care Act, in varied decisions that Court viewers were speeding up to analyze.
Another issue is cost and spending since the costs increase for almost everybody in unanticipated and irregular change. The affected people are employees, taxpayers, health care providers, retirees, and employers. Costs are major basis of concern for families that are preparing for retirement or where somebody is severely sick.
National health care expenditure currently surpasses $2.5 trillion and this makes up around 18% of the GDP (Gross Domestic product) and expenditure has increased from around 13% of GDP in 1990 (Groszkruger 25).
The third concern addresses quality of health care. Even though the United States allocates significantly more on health issues per individual than any other developed country, it is considered average or relatively worse on different qualities of care measures. Medication and medical issues hurt several people yearly and they can lead to death.
Although the above issues raise major challenges, the proposed reforms are considered effective in solving the current issues in health care sector. Some critics argue that the solution for the three issues may contradict one another. For example, giving coverage for 50 million uninsured may probably increase costs since more people look for care and the demand for the services would be high.
However, 50 million insurance covers enlarge national expenditure since public subsidies may be needed to give support when obtaining insurance. Efforts to limit costs can hinder efforts to improve quality since new projects always need extra, not less, resources.
This paper discusses the current health care conditions in the United States and importance of health care reforms that are expected to be implemented in the country. Health care reforms presented by President Obama are expected to solve health care challenges through different ways, including solution to obesity, rationing of care, insurance reforms, and shortage of medical professionals to provide quality and reliable services.
President Obama’s Health Care Reforms
Before discussing the main concerns that determine health care reforms, we will look at the reforms proposed by President Obama’s administration. PPACA (Patient Protection and Affordable Care Act) is among the proposals that are intended to be enacted by American Congress, which was initiated by the Senate and afterward approved by the House of Representatives.
This proposal obtained a vote of 219 out of 431 in 2010 (Groszkruger 25). Later, President Obama signed the Act into law and made it among the first healthcare laws to be implemented in the United States.
Health care reforms address major issues such as chronic conditions, intervention opposed to hospice, unnecessary payment structure, and insurance policies governing employers and employees. Other health care reforms also cover areas such as incentives that address more health care rather than better health care and concentrate on the attributes of chronic health conditions.
Different strategies have been included in health care reforms to extend and improve the current health care system in the United States and these strategies include advance application of telemedicine technology, controlling health insurance agents, rationing of care, and tort reform. Various general strategies have also been proposed as well.
In 2009, President Obama provided his strategy for reforms and outlined electronic record-keeping, reduction of defensive medicine, and better classification and communication of the highest affordable treatments (Schmidt, Shelley, & Bardes 294). Health care reforms have covered the provision of medical insurance and coverage to most people in the United States as well as reducing obesity conditions and prevention of costly health conditions.
President Obama also expressed is purpose to a joint session of Congress in the end of 2009, which included the elimination of discrimination by insurance agents based on preexisting conditions, and self-governing commission to establish abuse, misuse, and fraud. The proposal also included formation of an insurance exchange for minor enterprises, individuals, deficit, neutrality, and other major reforms in health care system.
Latest Health Care Law
The High Court’s ruling was a remarkable success for the President Obama and Congressional Democrats, where most of the people considered that it served as a key legislative support of President Obama’s term. The Supreme Court ruled that a massive extension of Medicaid envisaged in the health care reform was an option, not an order, for all states in America.
The Medicaid expansion is a key section of the health care reform, making up around 50% of all uninsured Americans likely to gain health coverage, as stated by the Congressional Budget Office. It provided that around 17 million uninsured Americans will gain medical coverage via Medicaid that is financed by the federal government, which will allocate $930 billion from 2014 to 2022 (Andrews).
While maintaining Medicaid expansion, the ruling of the court narrowed the strength of the federal government to secure agreement through punishing states that decline to adhere to. Chief Justice Roberts stated that the federal government possibly will not force states to obey by cutting off the entire federal finances they obtain for active Medicaid plans or projects.
The endangered loss of too much federal money (above 10% of state budgets) “is economic dragooning that leaves the states with no real option, but to acquiesce in the Medicaid expansion,” the chief justice said (Andrews). “A state could hardly anticipate that Congress’s reservation of the right to ‘alter’ or ‘amend’ the Medicaid program included the power to transform it so dramatically,” according to the Chief Justice (Andrews).
The Chief Justice Roberts stated that Congress has placed “a gun to the head” (Andrews) of states through instructing them to comply with the Medicaid expansion or they will not receive the entire Medicaid finances. Chief Justice said that “states must have a genuine choice” (Andrews).
The court case had depended on the alleged individual mandate, a condition that every American should receive medical insurance or will obtain a penalty. Republicans are planning to appeal this court decision since they stated that it is unconstitutional extension of federal authority.
President Obama’s administration stated that it was required to mend fundamental faults and unfairness in the companies that provide or supply insurance to the people of the country and that it was vital to conditions like the necessity that insurers maintain every person requesting for the medical coverage without relating to the pre-existing health situations.
The court’s ruling did considerably limit one key section of the law. The court’s decision provides all states some elasticity not to develop Medicaid plans, without compensating equal financial fines that the law ordered.
Even with the ruling provided by the court, the discussions over health care reforms become more intense, with Republicans declaring to continue their fight the Obama’s health care reform. Just on July 11, not more than 14 days after the Supreme Court ruling, the bill was passed by the House to repeal health care law proposed by President Obama and was accepted by a vote of 244 to 185. Five democrats were among the people who voted to repeal the health care law.
Some critics started preparing a challenge to President Obama’s explanation of a different vital provision, where the federal government will subsidize medical coverage for most low and middle income Americans.
Commencing in 2014, the law directs most people to possess medical coverage and provides the subsidies to support Americans pay for insurance bought through markets that are called insurance exchanges. The debate arises whether the subsidies will be accessible in exchange program and managed by the federal authority in states that are not successful or decline to implement their own exchanges.
Critics state that the law enables subsidies just for Americans who receive medical insurance through state-managed exchanges. The White House states that the law may be interpreted to enable subsidies for Americans who also obtain coverage in federal exchanges.
Health care law aspires to enlarge medical coverage to accommodate above 30 million Americans, mainly by enlarging Medicaid and offering federal subsidies to support people receiving low-income and middle-income to purchase private medical coverage, which offers better opportunity to the people with lower income.
It will generate insurance exchanges for insurers to “bundle” services instead of charging based on personal or individual process. However, several states’ executives are afraid that Congress will decrease the federal share and transfer more expenses to the states as it looks for approaches to decrease the federal budget deficit.
Cost and Efficiency
Greater percentage of GDP (around 19%) in the United States is allocated to health care system and this makes it the biggest spender in the world, excluding East Timor. The number of workers who get medical cover is reducing and the expenses for health coverage from employers are increasing speedily. Since 2000, premiums for domestic insurance have moved up by 78%, wages have increased by 20%, and costs have increased by 18% relative to 2008 research by Mayes (61).
Private insurance in the United States differs highly in its health coverage and some studies projected that 16 million American adults were underinsured in 2004.
The underinsured adults were considerably more probable than Americans with sufficient insurance to decline medical care, Americans undergoing coverage caps for these substances such as medicine, and people reporting financial pressures due to health costs. Some have asserted that this process of involving greatly the participation of the government in the health care setting will eventually cause unnecessary expenses that come from the government.
Lowering Obesity
Prevention of overweight and obesity offers a major chance to decrease expenses. Different studies on obesity and overweight have reported that around 10% of healthcare expenses in 2000 were brought about by obesity and overweight.
About $92.5 billion were allocated to obesity-related problems in 2001 and this makes obesity to be among the expensive causes of health problems. Almost 50% of these expenses were provided by the government through plans of Medicaid or Medicare and a study by CDC approximated these expenses had almost doubled to $145 billion by 2007 (Schmidt, Shelley, & Bardes 294).
The study presented by CDC established a chain of costly conditions that are more probably to happen because of obesity and released some strategies to solve the issue of overweight and obesity. These include promoting children to be active, encouraging healthy diet, creating healthy diet more accessible, and promoting safe society to maintain physical activity.
Proposed health care reforms would allow promotions and policies that make noticeable decrease in obesity and overweight and this will reduce health care expenses. Almost 25.5% of American adults in 2006 were obese and around 23.6% in 2004. However, state obesity rates are estimated to be between 18.5% and 30% (Welch and Gruhl 551).
Obesity rates were nearly similar among both genders and some people have suggested an alleged “fat tax” to give incentives for safe practices through increasing the tax on foods such as soft drinks. These foods are believed to cause overweight and different studies have suggested individuals based on body measures that are very similar to the practice performed in Japan.
Insurance Reforms
Americans who are not able to get employer-sponsored insurance might purchase insurance through the exchange that would contain competing plans that provide a range of premiums, provider networks, payments and deductible alternatives.
Consumers who choose more expensive programs would pay the related greater premiums according to their choices of insurance or services. Minor firms and other companies would have an alternative to provide coverage to their employees through the exchange, but every firm would select its own program that favors them.
The political discussions concerning health care reforms have entailed the greater degree of co-pays for important services (for example preventive processes), and particular insurance industry functions (for example putting of caps on coverage). The debate has also involved the denial of several insurance companies to provide coverage to pre-existing conditions or providing extra premium charges for such pre-existing conditions (Garber & Skinner 28).
Supporters for proposed health care reforms claimed that moving the United States to a single-payers health care structure would offer universal coverage. They also argued that health care reforms assure all-inclusive coverage and mutual access to every medically essential process.
These reforms also provide clients free selection of providers and hospitals, without raising the entire expenditure. Moreover, moving to a single-payer structure would abolish errors or omissions by managed care assessors, which reinstate common doctor-patient relation.
Several legislative proposals that are being critically reviewed suggest penalizing major firms that do not offer a lowest standard of health care coverage. The legislation would also tax highly certain insurance plans to finance subsidies for low income Americans and provide coverage for the poor Americans as well. These will be provided on a descending scale to Americans receiving less than three times the federal poverty level to allow low income earners purchase health coverage if they are not insured by their firms.
Legislation that would offer an option of non-profit insurer formed on Medicare, but financing through insurance premium has been a debatable concern.
Some strategies have been created within health care reforms to the Medicare Advantage program that will decrease public subsidies provided to private insurance programs trading these programs through demanding insurers to compete. It is approximated that this process has raised the productivity of private insurance firms trading such programs to the people across the country.
Warren Buffett, famous entrepreneur and supporter of health care reforms, stated that the greater costs paid by firms in America for their workers’ medical coverage put them at a competitive difficulty.
He evaluated almost 19% of GDP allocated by American government on health care system with the 10% of GDP allocated by most countries in the world and pointed out that America has less nurses and doctors per patient (Welch and Gruhl 551). Billionaire Warren Buffett stated that the type of expenditure, matched up to most countries in the world, is the same as a tapeworm eating at the economy unit in the United States.
Rationing of Care
Healthcare rationing can be described as the control of medical care service delivery according to any measure of subjective or objective procedures, and rationing of care is among the issues that have brought debates and studies within the health care cycle.
Some people reported that health care reform programs, provided by President Obama, lengthen the management of American government over health care assessments and this is considered a kind of healthcare rationing. President Obama stated that most people in the United States are not insured or do not have access to medical coverage since they are denied these services by insurance companies or undergo greater premiums due to health pre-existing conditions.
Peter Singer argued that health care system in America is under rationing and suggested for advanced rationing procedures. He stated that health care is a limited resource and every limited resource is rationed directly or indirectly. In the United States, almost all medical facilities are privately owned and this brings about rationing based on price. Rationing of care means obtaining value of money that the country allocates to health care providers through establishing limits where treatments must be financed from the people’s money.
If health care is rationed, Americans will be providing blank checks to pharmaceutical firms for their unapproved drugs, nor paying for whatsoever processes that health care professions select to prescribe (Welch and Gruhl 551). When public supports subsidized health care or give it openly, it is wrong or unwise not to attempt to obtain value for money.
Health care discussion on these reforms in the United States must begin from the basis that different kinds of health care rationing are both unavoidable and enviable. Rationing of care across the country would greatly provide equal and fair care to the people of the United States and can reduce the cost of health insurance and general expenditures that are allocated to the health care system.
Shortage of Doctors and Nurses
The United States is experiencing high shortage of medical practitioners and most analysts predict that these shortages would become even worse in the future and can evidently bring about an increase in prices for these services that are provided in health care centers. Some studies have reported that the United States is undergoing a serious shortage of doctors and around 1,400 general surgeons were available in 2009.
The American Academy of Family Physicians (AAFP) estimated a shortage of around 35,000 health care practitioners by 2025 and the proposed health care reforms have addressed the issues of primary care doctors to provide quality and accessible care for all people across the United States (Feldman 187).
Health care reforms have an intention to allocate more funds to finance medical schools to provide more graduates that would increase the number of doctors and nurses. Therefore, this will accommodate the required standard in health care system.
Among the issues that are addressed in health care reforms are the shortages of medical practitioners, particularly doctors and nurses. In 2002, the United States had 2.3 doctors for every 1000 patients and this made the U.S. positioned 52nd, whereas France and Germany had around 3.5 and three respectively, and were listed among the top 20 countries worldwide (Feldman 187).
The United States had an average 2.4 doctors per 1000 people in all hospitals around the country compared to the average figures of OECD that had around three doctors per 1000 patients in 2008 (Feldman 187).
Some studies also approximated that shortage of nurses would be around 220,000 nurses by 2030 and around 130,000 vacancies available in 2030. More than 35% nurses should graduate every year to maintain the demands for the nurses in the country. A research by Garber and Skinner (28) provided various strategies needed in the health care reforms to address the issue of shortage of nurses and doctor.
These included application of advanced technology in training sessions, providing healthy work environments, and funds from federal and state-level for nursing trainees and instructors. Health care reforms also provided that public-private relationships should be developed and arrange more flexible duties for higher practice doctors and nurses.
Health care reforms have also addressed the issue of shortage of acute care hospital beds per capita, where the United States has fewer acute care hospital beds compared with most OECD countries (Mayes 25).
Health care reforms have proposed that the government should allocate more funds to increase the average acute care hospital beds in the country to accommodate the demands since the population is increasing rapidly in the country. More funds should be allocated to health care to solve the issue of shortage of nurses, doctors, and hospital facilities as stated in health care reforms.
Most studies have reported that the proposed health care reforms would solve different problems surrounding the shortage of doctors, nurses, and hospital facilities to bring about better and reliable health care to the people of the United States. Despite the costs that will be allocated to these initiatives, the outcome will be desirable and unavoidable. The results are expected to be more positive than what some critics predict to be negative.
Conclusion
Health care reforms started decades ago, but some reforms were unsuccessful during the presidency of Clinton. Some health care reforms were enacted, but more reforms are required due to various needs in the country.
There are shortages of medical professionals, low standard of acute care hospital facilities, higher percentage of uninsured people, discrimination contained in insurance companies, costly health care insurance for employers, and other critical issues surrounding health care system in the United States. President Obama has proposed some changes on health care system to solve critical issues surrounding health care system.
Although the latest health care law that President Obama proposed has been favored by the Supreme Court, it has received different critics from the Republicans. Republicans and other critics stated that this law will provide more expenses to the states and provides the federal government more privileges that are against the constitution. They also stated that it will reduce the people who will receive medical coverage.
Some critics have argued that some health care reforms will cause more taxpayers’ money to be allocated to the health care system. For example, giving coverage for 50 million uninsured may probably increase costs since more people look for care.
Health care reforms also enlarge national expenditure since public subsidies may be needed to support people obtain insurance. However, if the government limits the funds to address these reforms, improved and better services would not be achieved since new projects often require extra, not less, resources.
Works Cited
Andrews, Philip Scott. Health Care Reform. 11 July 2012. Web. <https://www.nytimes.com/topic/subject/health-care-reform>.
Feldman, Arthur. Understanding Health Care Reform: Bridging the Gap Between Myth and Reality. Burlington, MA: CRC Press, 2011. Print.
Garber, Alan and Jonathan Skinner. “Is American Health Care Uniquely Inefficient?” Journal of Economic Perspectives 22.4 (2008): 27–50. Print.
Groszkruger, Dan. “Perspectives on healthcare reform: A year later, what more do we know?” Journal Of Healthcare Risk Management 31.1 (2011): 24-30. Print.
Mayes, R. “National Health Insurance: A Brief History of Reform Efforts in the U.S.” American Journal of Public 3.1 (2009): 56-67. Print.
Schmidt, Steffen, Mack Shelley and Barbara Bardes. American Government and Politics Today. Bolton, MA: Cengage Learning, 2012. Print.
Welch, Susan and John Gruhl. Understanding American Government. New York: Cengage Learning, 2011. Print.