Universal healthcare coverage in the United States has been an increasingly popular topic of research and discussion in the past decade. Various government programs and the introduction of the Affordable Care Act in 2010, were aimed at reducing health care disparities across people with low income. Nevertheless, there are still millions of uninsured people all over the country, and many of them report problems with medical care availability. Thus, the increase of government spending on health coverage is not proportional to the increase in healthcare quality and coverage, which is one of the core problems in the United States health system.
The Affordable Care Act of 2010
The Affordable Care Act (ACA), also known as Obamacare, was signed by U.S. President Barack Obama in March 2010. The act’s main goal, the estimated net cost of which was more than a trillion dollars, was to promote universal health coverage and reduce health disparities (NCSL, 2011). However, other sections of the act targeted consumer insurance protections, improved the quality of health care, and promoted the health workforce (NCSL, 2011). The ACA also imposed rules and restrictions on food businesses, for instance, by requiring restaurant chains with 20 or more units “to label menus with calorie information and to provide other information, upon request, such as fat and sodium content” (NCSL, 2011, p. 2). So far, the program was accepted in 31 states, with 19 states not expanding their Medicaid plans, which results in over 3 million people remaining uninsured because their state of residence refused to accept the ACA (Kliff, 2014).
Nevertheless, the act had an overall positive influence on the U.S. healthcare coverage and managed to reduce some of the reported disparities. For instance, according to the National Center for Health Statistics (NCHS, 2017), the percentage of uninsured adults aged 18– 64 decreased from 20.4% in 2013 to 12.3% as of September 2016. More importantly, though, “During this 3-year period, corresponding increases were seen in both public and private coverage among adults aged 18– 64” (NCHS, 2017, p. 2).
The rate of uninsurance in the people with poverty status and those near poverty also decreased substantially, from over 40% in 2010 to 26% and 23% accordingly (NCHS, 2017). Racial and ethnic disparities have also decreased for all backgrounds: the percentage of uninsured Hispanic people fell from over 40% to 24.7%, whereas the number of uninsured black people decreased at a similar pace, from just under 30% in 2010 to 15.1% in 2016 (NCHS, 2017). As a proof of the ACA’s effectiveness, the NCHS (2017) report also shows that the states where the percentage of uninsured is significantly higher than the national average are the ones that did not accept the expansion. Nevertheless, despite such major spending, there are still some principal gaps in the U.S. health coverage and the patients’ quality of care.
Methods
To study the issue of a weak correlation between the government’s spendings and the quality of care, it is necessary to obtain two types of data. First, the information on the instances of poor coverage and poor quality care should be collected to evaluate the problem’s extent. Some sets of information, such as the proportion of uninsured people, should be obtained from statistical reports, such as the National Center for Health Statistics, Centres for Disease Control and Prevention, and other official reports. Other information may include the quality and availability of care as perceived by the different groups of people. Such information may come from interviews and secondary sources, such as journal articles where the researchers have already conducted interviews with people from target populations, particularly from immigrant minorities, that are usually at the highest risk of not obtaining proper medical care.
Secondly, it is also necessary to collect information and theories on the causes and potential solutions. The best way to obtain this type of information is by searching peer-reviewed articles on the subject. A range of peer-reviewed journal articles can provide various viewpoints on the issue and thus can help build a well-rounded view of the problem. Moreover, the data and discussions shown in peer-reviewed articles are normally based on official statistical data, other research, or direct interviews, which means that the possibility of bias, in this case, is minimal.
Background of the Problem
The United States is the highest in countries’ ranking by health expenditures, spending over 17.7% of the economy on health systems each year (Kliff, 2014). Nevertheless, the number of average doctor visits – 4.1 per person – is very low compared to Canada and Germany, with 7.4 and 9.1 average visits per person accordingly (Kliff, 2014). The price of drugs in the United States is unbelievably high compared to other countries: for instance, the average price for Nexium in the U.S. is $215, whereas, in England, the same amount of drug would cost $42 (Kliff, 2014).
Kliff (2014) explains that the main reason for such a high price is that the government has no system of price control in place to moderate the price of drugs; instead, the insurers are left to bargain with the pharmaceutical companies, which usually does not have any decreasing effect on the prices the latter set. However, for there are other sources of wasted spendings in the U.S. health system that account for hundred billion of money being lost in the system: thus, unnecessary services have an annual cost of $210 billion, whereas high administrative costs take away further $190 billion (Kliff, 2014). Inefficiently delivered services and missed prevention opportunities account for $185 billion (Kliff, 2014).
The Controversy of High Health Expenditure
The described loss of money in the health system is the main reason for the controversy regarding healthcare spending. Given that, despite such massive spending, the U.S. remains quite low in countries’ rankings by the health care index, it is clear that the expenditures do not promote better health of the population. The ACA has made some progress towards eliminating the problem by introducing new laws for employers, as well as new work formats for health professionals. Thus, the ACA increased the proportion of spending allocated to preventative services to lower the loss of money due to missed prevention opportunities (NCSL, 2011). It also increased the funding of nurses’ training programs and new primary care models to achieve better quality and care (NCSL, 2011).
However, despite its obvious effectiveness, the ACA is still criticized in certain public circles, for instance, by the members of the Republican party. BBC (2016) writes that “The party and a veritable industry of conservative think tanks and advocacy groups have fought the law since Mr. Obama first proposed it in 2009” (para. 11). The main reason behind the opposition is that ACA affects the private business by setting up policies and requirements that are expensive to fulfill (BBC, 2016). Kliff (2014) points out another problem with government-provided care, stating that the current health care system is based on the Tax Code established in 1954, it is outdated and needs to be reformed to avoid the increase of spending in the future.
Solutions
Kliff (2014) argues that one of the best ways to address the health system’s current issues is by introducing taxation for employer-provided insurance. On the other hand, Berwick and Hackbarth (2012) propose to simplify the administrative structure of health providers to prevent losses from administrative complexity and overtreatment. They argue that the multi-level structure results in poor health coordination and obstructs healthcare delivery efficiency, thus causing both the rise in costs and the low quality of health coverage overall (Berwick & Hackbarth, 2012). Finally, one solution to improve the quality of provided care would be to introduce a new payment scheme for medical practitioners, including benefits for successive treatment and penalties for poor treatment.
Conclusion and Recommendations
Overall, it is clear that the U.S. health system needs substantial reform. First, it is necessary to persuade the remaining 19 states to accept the ACA to promote universal coverage. Second, it could be helpful to revise the medical practitioners’ quality of service by examining qualitative results, rather than quantitative. Finally, controlling the drug prices set by pharmaceutical companies would also help to prevent the substantial loss of money due to increased treatment costs. Overall, these recommendations could help the U.S. to reach high-quality universal care for all residents.
References
Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste in US health care. Journal of American Medical Association, 307(14), 1513-1516.
National Center for Health Statistics (NCHS) (2017). Health insurance coverage: Early release of estimates from the national health interview survey, January–September 2016. Web.
National Conference of State Legislatures (NCSL) (2011). The Affordable Care Act: A brief summary. Web.
Kliff, S. (2014). 8 facts that explain what’s wrong with American health care. Physicians for a National Health Program. Web.