Healthcare Reform in the United States

Healthcare Reform in the United States

Abstract

This paper examines the nature of healthcare reform in the United States, analyzes the two essential elements of healthcare reform, evaluates various healthcare reform strategies, and provides an example of healthcare reform at the state level. While the Affordable Care Act (ACA) represented a significant step forward in expanding health insurance coverage, there is still much work to be done to address the underlying problems with the healthcare system in the United States. The two critical elements necessary for successful healthcare reform are universal access to affordable healthcare and cost containment measures. Universal access to affordable healthcare is essential for ensuring that everyone has access to necessary healthcare services, while cost containment measures are crucial to ensuring the sustainability of the healthcare system. Various healthcare reform strategies, such as single-payer systems, value-based care, and telemedicine, can help to improve access to care, reduce costs, and improve health outcomes. The paper presents an overview of each strategy, including its benefits and drawbacks. A single-payer system can eliminate private insurance companies and reduce administrative costs. Value-based care incentivizes providers to focus on preventive care, chronic disease management, and reducing hospital readmissions, while telemedicine can help to improve access to healthcare services, especially in rural areas or areas with a shortage of healthcare providers.

Keywords: health care reform, United States, Medicare, Medicaid, health care plan,

Affordable Care Act, ACA, single-payer system, value-based care, telemedicine, universal access, cost containment, health care costs, health outcomes, health insurance coverage

 Introduction

The American nation has struggled with health care reform for many years. There have been more reform attempts, such as the Clinton health care plan and the more recent Affordable Care Act, despite efforts to provide coverage for certain groups and the creation of Medicare and Medicaid. Even while the ACA marked a great advancement in extending health insurance coverage, there is still much to be done to solve the fundamental issues with the American healthcare system. This essay examines the nature of health care reform in the United States, explores the two components necessary for reform, rates several approaches, and offers an example of reform at the state level.

The Nature of Healthcare Reform in the United States

Healthcare reform has been a significant issue in the United States for decades. In the early 20th century, some efforts were made to provide healthcare coverage to certain groups, such as workers and their families. The Medicare and Medicaid programs were established during the 1960s to provide coverage to the elderly and low-income individuals (Baicker et al., 2023). In the 1990s, there were further attempts at reform, including the Clinton health care plan, which aimed to provide universal health care coverage but ultimately failed to become law. Further, Obamacare, commonly known as the Affordable Care Act (ACA), was passed in 2010 and marked a fundamental reform in the healthcare industry. The ACA aims to increase access to health insurance, raise the standard of care, and lower healthcare expenditures. The Affordable Care Act has greatly impacted the healthcare system, with millions of Americans now having access to health insurance coverage despite experiencing significant criticism and controversy.

In recent years, there have been further efforts at healthcare reform, including proposals for a single-payer system and efforts to address rising prescription drug costs. The COVID-19 epidemic has also brought attention to the need for healthcare system reform, with issues like access to care and the cost of treatment taking center stage. Even while the ACA marked a great advancement in extending health insurance coverage, there is still much to be done to solve the fundamental issues within the American healthcare system.

The Two Needed Elements in Healthcare Reform and Their Importance

Two crucial elements are necessary for successful healthcare reform in the United States. These are universal access to affordable health care and cost containment measures. These elements are critical to addressing the challenges facing the healthcare system and improving health outcomes for all Americans. Universal access to affordable healthcare is essential for ensuring everyone can access necessary healthcare services. Currently, millions of Americans lack health insurance coverage, leading to delayed or deferred medical care, poorer health outcomes, and higher costs. Universal access to health care would help ensure everyone has access to preventive services, medical treatments, and other health care services, regardless of their ability to pay. This would help to reduce health disparities, improve health outcomes, and promote overall health and wellness.

Moreover, measures to control costs are equally crucial for guaranteeing the long-term viability of the healthcare system. The cost of health care in the United States is among the highest in the world, and it is increasing every year. This not only puts a strain on individuals and families but also on the entire healthcare system. Thus, cost-containment strategies can help to lower healthcare costs while preserving high-quality care, including lowering administrative expenses, adopting payment reform, and promoting value-based care (Cwalina et al., 2022). This would help ensure the healthcare system is financially sustainable, accessible, and affordable for all Americans.

Healthcare Reform Strategies

Single-Payer System

In a single-payer system, the government oversees and finances all people’s access to health care. This would eliminate private insurance companies, reduce administrative costs, and ensure everyone can access necessary healthcare services. Additionally, a single-payer system might bargain for cheaper pricing for medical procedures, prescription medications, and medical equipment, which could assist in lowering overall healthcare expenses. (Cai et al., 2020). However, opponents argue that a single-payer system would limit choice and innovation in the healthcare system and may lead to long wait times for medical services.

Value-Based Care

Value-based care is an approach that rewards healthcare providers for achieving better health outcomes at a lower cost. With this strategy, healthcare professionals are encouraged to concentrate on chronic illness management, preventive treatment, and decreasing hospital readmissions. Value-based care has been found to boost patient happiness, lower costs, and improve health outcomes (van Steenbergen et al., 2022). However, opponents argue that it may not work in all healthcare settings, and providers may be incentivized to avoid treating sicker patients who are more costly to treat.

Telemedicine

Telemedicine involves the use of technology to deliver health care services remotely. This can include virtual doctor visits, remote patient monitoring, and electronic consultations between providers. Telemedicine can help enhance access to healthcare, particularly in remote areas or places with a shortage of medical professionals (Ayabakan et al., 2023). It can also reduce healthcare costs by reducing the need for in-person visits and hospital readmissions. However, opponents argue that telemedicine may not be suitable for all healthcare needs, and all insurance plans may not cover it.

Conclusively, several different healthcare reform strategies can help improve access to care, reduce costs, and improve health outcomes. A single-payer system, value-based care, and telemedicine are just a few examples of the many strategies that could be employed. It is important to carefully evaluate each strategy’s potential benefits and drawbacks and tailor reform efforts to the unique needs and challenges of the healthcare system.

Healthcare Reform at the State Level

I’ll give an instance of value-based care-related healthcare reform in the United States. The Hospital Value-Based Purchasing Program is one of many value-based care-related policies introduced by the Affordable Care Act (ACA). President Barack Obama proposed the ACA, which Congress ultimately approved in 2010 (Lappeman et al., 2023). In 2012, the Hospital Value-Based Purchasing Program was launched. The program’s ultimate goal was to encourage hospitals to lower expenses while raising care quality. Depending on how well they perform on several quality indicators, including patient outcomes, patient satisfaction, and hospital readmissions, hospitals are either rewarded or penalized under the program.

The program has had some success in improving healthcare quality and reducing costs. However, some critics argue that the program may not be effective in improving healthcare quality in all settings and may penalize hospitals that treat sicker patients. Additionally, some hospitals may not have the resources to implement the necessary changes to improve their performance on quality measures. Despite these challenges, the Hospital Value-Based Purchasing Program remains a key component of the broader effort to promote value-based care in the United States.

Conclusion

In the past, efforts have been made to establish systems like Medicare and Medicaid and to extend coverage to particular groups. Healthcare reform has been a long-standing topic in the United States. The two essential components for successful healthcare reform in the United States are universal access to inexpensive healthcare and cost-containment measures. To increase access to care, cut costs, and enhance health outcomes, a number of healthcare reform strategies have been put forth, including telemedicine, value-based care, and single-payer systems. It is essential to carefully assess these tactics and mold reform initiatives to the particular requirements and difficulties of the healthcare system.

References

Ayabakan, S., Bardhan, I. R., & Zheng, Z. (Eric). (2023). Impact of Telehealth and Process Virtualization on Healthcare Utilization. Information Systems Research. https://doi.org/10.1287/isre.2023.1220

Baicker, K., Chandra, A., & Shepard, M. (2023, January 1). Achieving Universal Health Insurance Coverage in the United States: Addressing Market Failures or Providing a Social Floor? National Bureau of Economic Research. https://www.nber.org/papers/w30854

Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J. S., & Kahn, J. G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), e1003013. https://doi.org/10.1371/journal.pmed.1003013

Cwalina, T. B., Jella, T. K., Acuña, A. J., Samuel, L. T., & Kamath, A. F. (2022). How Did Orthopaedic Surgeons Perform in the 2018 Centers for Medicaid & Medicare Services Merit-based Incentive Payment System? Clinical Orthopaedics and Related Research®, 480(1), 8–22. https://doi.org/10.1097/CORR.0000000000001981

Lappeman, J., Goder, A., Naicker, K., Faruki, H., & Gordon, P. (2023). Using Sentiment Analysis to Understand Public Policy Nicknames: Obamacare and the Affordable Care Act. Journal of Nonprofit & Public Sector Marketing, 1–17. https://doi.org/10.1080/10495142.2023.2178588

van Steenbergen, G. J., Cremers, P., Dekker, L., & van Veghel, D. (2022). The next phase in the implementation of value-based healthcare: Adding patient-relevant cost drivers to existing outcome measure sets. International Journal of Healthcare Management, 1–7. https://doi.org/10.1080/20479700.2022.2073004

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The purpose of this assignment is to familiarize yourself with the intricacies of health care reform.
Write a 1,000-1,250 word paper that addresses the following:
1. Analyze the nature of health care reform in the United States, both in the past and present.
2. Discuss the two needed elements in health care reform and why they hold importance.
3. Evaluate a minimum of three different health care reform strategies and provide a rationale for each.
4. Choose one of the three areas (above) and provide a specific example of health care reform at either the state or national level: (a) What was it called? (b) Who introduced it? (c) When was it introduced? (d) What was its ultimate purpose? and (e) Did it succeed? If not, why not?
Incorporate two or three peer-reviewed scholarly resources in your paper.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.