Healthcare

System in America

Alec Bradley
University of Kentucky
05/03/2016

Running Head: Healthcare in America

The healthcare system of the United States is a broken system that requires a
great deal of attention, especially from the next generation of doctors, insurance
providers, politicians, and other health care professionals. There are three essential
problems that the United States faces in terms of their healthcare structure,
especially before the implementation of the Affordable Care Act that include
coverage, cost, and quality (Moloney, 2016). An arguable fourth major problem
surrounding the healthcare system in the United States, which is still a problem
even after the employment of Obamacare, is that most Americans think of
health/healthcare as a moral issue, but we treat it as a business with a free market
economy used to purchase health insurance (Moloney, 2016).


In terms of the coverage of health insurance in America prior to the
Affordable Care Act (ACA) in 2009, there were two government-sponsored
programs used to provide health insurance to citizens called Medicare, and
Medicaid. Even with these two programs, and a free market of insurance providers
to select an individual health insurance plan, there were still forty-four million
people without health insurance in America (Green, 2015). For all of those people
that had ended up in the emergency room that did not have a health insurance plan
and were not able to pay for their care, the government had to subsidize and absorb
the care provided through taxes (Green, 2015). Along with this major problem,
insurers were allowed to deny access of health insurance due to a pre-existing
health condition (Green, 2015), which only contributed to the disparity of people
without health insurance in America.


In terms of the collective cost of healthcare in the United States, we spend
more than seventeen percent of our total gross domestic product (GDP) on
healthcare, and still do not have universal health insurance (Green, 2015)! Other
countries such as Canada, France, and Australia are able to spend less than ten
percent of their GDP, and still achieve similar or better health outcomes than
America (Green, 2015). There is a major disparity in the amount of money The
United States spends on their healthcare compared to the results we attain,
especially when observing other countries. For example, when it comes to
discussing the paradox of the healthcare system of America, The mighty USA is a
fourth rate power This is particularly paradoxical because the American medical
establishment boasts many assets that no other country can match, [however] our
system doesnt cover everybody. There are tens of millions of Americans who cant
go to the doctor because they cant pay for the office visit or prescription (Reid,
2009). In terms of individual costs, as oppose to the cost to the entire nation; heath
related debt is the number one cause of bankruptcy in the US (Green, 2015).


When discussing the quality of healthcare prior to the ACA, the American
health care system was designed in a way to fix a problem after it had already
happened, as oppose to diagnosing the fundamental cause of disease, and catching
the problem before it caused a negative health outcome for an individual (Moloney,
2016). A few examples of how this is true in the United States is that we are not
checked annually for prostate cancer at a young age, even if we are predisposed to

Running Head: Healthcare in America

it; we do not typically run an EKG on a patients heart that has a family history of
suffering from heart disease; and we typically do not run colonoscopies on patients
predisposed to colon cancer, or other GI diseases until our mid-thirties. Another
issue of the quality of care in America can be attributed to the patient doctor
interaction. While many patients do have a good interaction with their primary care
physician, many patients lie, or simply do not go to their doctor for lack of trust in
their doctor.


The Affordable Care Act was implemented in 2010 and was set into motion in
an attempt to fix, or at lease better the healthcare crisis that the United States was
facing. The major goal of the ACA was to fix the three problems of coverage, cost,
and quality of the American healthcare system through the following mechanisms
(Moloney, 2016).


The ACA has attempted to fix the coverage issue of health insurance by
reducing the amount of uninsured citizens through the expansion of Medicaid,
creating new coverage options via state exchanges, and attempting to have all
Americans pay into the health insurance system (Moloney, 2016). In a state
exchange, private health insurance companies compete for peoples business, and
could not discriminate based on gender or preexisting conditions (Green, 2015).
Several attempts have been made to encourage all people to pay into the national
health insurance program. One of them includes fining those that do not pay,
however poor families that cannot afford to pay for insurance, but do not qualify for
Medicaid, will be forced to pay a fee although they may want or need health
insurance, so most attempts have not been completely effective. In terms of the
effectiveness of the ACA in helping increase coverage of health insurance to
Americans, it is projected by 2019 that around forty million Americans currently
uninsured will be insured due to the Affordable Care Act (DeMichele, 2016).


To fix the crisis of the skyrocketing cost of health insurance, the ACA has
made an attempt to cut back on unfair insurance company practices (Moloney,
2016). The ACA has done this by limiting the factors that insurance companies are
able to base premiums on. For example, insurance companies are allowed to set
premiums using the following criteria: age, location, tobacco use, individual vs
family enrolment, and the plan category (bronze, silver, gold, platinum, and
catastrophic); but are not allowed to raise insurance premiums because of current
health, medical history, and gender (U.S. Centers for Medicare & Medicaid Services,
2016). The ACA has also provided a valid plan to pay for the Medicaid expansion
including forcing companies with more than fifty employees to provide affordable
insurance to their employees, or pay a penalty, implementing a tanning salon tax,
and a tax on people making more than $200,000 per year ($250,000 if married)
(Green, 2015). This plan seems to be working, as less than the expected number of
employers dropped insurance plans for their employees (Green, 2015), but is still
too early to determine with certainty.

Running Head: Healthcare in America

In terms of improving the quality of healthcare in the US, the ACA has focused
on boosting public health and research (Moloney, 2016). As discussed in class,
education is one of the primary factors contributing to an individuals health.
Implementing programs focused on public health can significantly increase a
populations health and in doing so eliminate the fundamental cause of disease,
which would in turn decrease the annual cost of healthcare. Some preventative
services are now 100% covered, creation of new non-profit organizations support
comparative effectiveness of research as well as evaluating evidence based
treatments, and [the ACA] offers five year grants to reduce malpractice suit
(Moloney, 2016). This can contribute to education of the general population,
emphasize the use of preventative medicine as oppose to diagnosing a disease once
the patient is sick, and increasing the patient doctor relationship by decreasing
malpractice suits. The ACA has shown in certain studies to have a positive overall
impact on health (Green, 2015), so the ACA seems to be working in terms of
increasing the quality of health.


One of the definite positive facets accomplished by the ACA is that it
encompasses a broader range of people to cover with health insurance while at the
same time providing a plausible way to pay for the nationalized health insurance.
One of the negative aspects of the Affordable Car Act is that it does not provide a
sustainable health care system for America to adopt. Rather, the ACA provides a
band-aid, or patchwork over top of the current healthcare problem. The ACA also
forces companies with more than 50 employees to provide health insurance to all
employees or pay fines instead. This has a negative effect on small businesses
because it encourages small businesses not to grow, or in some cases to become
smaller, and large corporations to become larger.


In an ideal reform of the healthcare system, we should focus more on
creating a positive patient-doctor relationship as oppose to using the law as an
excuse/barrier to avoid discussing certain issues with a patient or doctor. Another
effective way to reform healthcare in America would be to look at other countries
and adopt mechanisms that are effective in reducing cost, and improving quality and
coverage. This is seen in Taiwan, where their healthcare system gives everyone free
access to healthcare, has a short to no waiting list to be seen by a doctor, and uses a
smart card to combat rising administrative costs. Because of their system, there are
no bankruptcies attributed to health costs, and Taiwan spends 6.23% of their GDP
on healthcare (Palfreman, 2008).

In my opinion we should devise a healthcare system where everyone is
covered, however there would be two options in choosing providers: either an
insurance plan provided by the government, or an insurance plan provided by a free
market insurance company. In an ideal implementation of this model, insurance
costs would be kept low, quality of care would be kept high, and this model would
provide coverage to everyone. Healthcare is also not a place for either political party
to try and control. In the world of politics, it does not matter whether the ACA, or
any other healthcare platform is effective. Each party will attempt to overturn any

Running Head: Healthcare in America

model of universal healthcare put into place by the other, and this political contest
does not seem to be changing anytime soon. If healthcare truly is a moral or ethical
subject, which most people would agree on, then we must treat it as such. This
should not be a business used to exploit and bankrupt individuals, but rather one
that works to achieve better health as a nation.

Running Head: Healthcare in America

References:

1. DeMichele, T. (2016). Affordable Care Act Facts. Retrieved May 03, 2016,
from http://obamacarefacts.com/affordable-care-act-facts/
2. Green, J., & Vlogbrothers. (2015). Is Obamacare Working? The Affordable
Care Act Five Years Later. Retrieved May 03, 2016, from
https://www.youtube.com/watch?v=wMuXcuudvCc.
3. Moloney, M. (2016). Race and Health, Part III. Personal Collection of M.
Moloney, University of Kentucky, Lexington, KY.
4. Palfreman, J. (Director). (2008). Sick around the world [Video file]. Artarmon,
N.S.W.: Frontline.
5. Reid, T. R. (2009). The Healing of America. A global quest for better, cheaper
and fairer healthcare. The Paradox, Ch. 3. doi:10.1007/s12682-010-0044-8.
6. U.S. Centers for Medicare & Medicaid Services. (2016). How Health Insurance
Marketplace Plans Set Your Premiums. Retrieved May 03, 2016, from
https://www.healthcare.gov/how-plans-set-your-premiums/.