Health reform in the United States has a long history. Reforms have often been proposed but rarely done. In 2010, landmark reforms were adopted through two federal laws passed in 2010: Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Reconciliation and Health Care Education Act of 2010 (HR 4872 ), which amended the PPACA and became law on March 30, 2010.
Future reforms of the American health care system continue to be proposed, with important proposals including a single payer system and a reduction of cost-for-service medical care. PPACA includes a new agency, the Medicare Center and Medicaid Innovation, which is intended to examine the ideas of reform through pilot projects.
Video Healthcare reform in the United States
History of the national reform effort
International health comparison has found that the United States spends more per capita than other developed countries but falls under similar countries in various health metrics, indicating inefficiency and waste. In addition, the United States has significant undernurance and significant non-revenue liabilities from its aging demographic and its social insurance program Medicare and Medicaid (Medicaid provides free long-term care to poor parents). The fiscal and human impacts of these problems have motivated the reform proposals.
US healthcare costs about $ 3.2 trillion or nearly $ 10,000 per person on average by 2015. Major categories of costs include hospital care (32%), doctors and clinical services (20%), and prescription drugs (10%). US costs in 2016 are much higher than in other OECD countries, at 17.2% of GDP compared to 12.4% of GDP for the next most expensive country (Switzerland). For scale, the 5% GDP difference represents about $ 1 trillion or $ 3,000 per person. Some of the many reasons cited for cost differences with other countries include: Higher administrative costs than private systems with multiple payment processes; higher costs for the same products and services; a more expensive volume/service mix with higher use of more expensive specialists; aggressive treatment of very sick parents versus palliative care; less use of government intervention in pricing; and higher income levels are driving greater demand for health care. Health care costs are a key driver of health insurance costs, leading to affordability coverage for millions of families. There is ongoing debate whether current legislation (ACA/Obamacare) and Republican alternatives (AHCA and BCRA) are sufficient to overcome the cost challenge.
According to World Bank statistics in 2009, the US has the highest health care costs relative to the size of the world's economy (GDP), although an estimated 50 million citizens (about 16% of the estimated population in September 2011 of 312 million) are underfunded. In March 2010, billionaire Warren Buffett commented that the high costs paid by US companies for the health care of their employees put them in an unfavorable position.
Furthermore, an estimated 77 million Baby Boomers reaching retirement age, combined with a significant annual increase in health care costs per person will place enormous budgetary burdens on US state and federal governments, primarily through Medicare and Medicaid spending (Medicaid provides care long term for poor parents). Maintaining the US federal government's long-term fiscal health is significantly dependent on controlled health care costs.
Cost and availability of insurance
In addition, the number of entrepreneurs offering health insurance has declined and the costs for health insurance paid by employers increased: from 2001 to 2007, the premium for family coverage increased 78%, while wages rose 19% and prices rose 17%, according to the Foundation The Kaiser family. Even for those employed, private insurance in the US varies greatly in scope; one study by the Commonwealth Fund published in Health Affairs estimated that 16 million US adults were under-guar- anted in 2003. Those less well-assured were significantly more likely than those with adequate insurance to forget health care, reporting financial pressures due to bills medical, and experiencing coverage gaps for items such as prescription drugs. The study found that underinsurance disproportionately affects those with low incomes - 73% of underinsured in the study population had annual revenues below 200% of federal poverty rates. However, a study published by the Kaiser Family Foundation in 2008 found that the plans of employers' service provider organizations (PPOs) in larger companies in 2007 were more generous than the Medicare or Standard Option of the Federal Employee Health Benefit Program. One indicator of the consequences of inconsistent healthcare coverage in the United States is a study in Health Affairs that concludes that half of personal bankruptcies are involved in medical bills, although other sources deny this.
There are health losses due to inadequate health insurance. A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States because Americans lack health insurance. More broadly, the estimated number of people in the United States, both insured and uninsured, who died from lack of medical care was estimated in the 1997 analysis to nearly 100,000 per year. A study of the effects of Massachusetts universal health law (enacted in 2006) found a 3% reduction in mortality among people aged 20-64 years - 1 death per 830 people with insurance. Other studies, just as those who examined the random distribution of Medicaid insurance to low-income people in Oregon in 2008, found no change in mortality rates.
Insurance costs have been a major motivation in reforming the US health care system, and many different explanations have been raised on the grounds of high insurance costs and how to improve them. One criticism and motivation for health care reform is the development of the medical industry complex. This is related to the moral argument for health care reform, framing health as social goodness, which is essentially immoral to be rejected by people on the basis of economic status. The motivation behind health reform in response to the medical industry complex also stems from the issue of social injustice, the promotion of drugs over preventive care. The medical industry complex, defined as a network of health insurance companies, pharmaceutical companies, and the like, plays a role in the complexity of the US insurance market and the thin line between government and industry in it. Similarly, the criticism of the insurance market undertaken under the capitalistic free market model also includes that medical solutions, as opposed to preventive health care measures, are promoted to maintain this complex medical industry. The arguments for a market-based approach to health insurance include the Grossman model, which is based on the ideal competition model, but others have criticized this, arguing that in essence, this means that people at higher socioeconomic levels will receive quality healthcare better.
- Uninsured rate
Another concern is the level of uninsured people in the US. In June 2014, Gallup-Healthways Well-Being conducted a survey and found that uninsured rates were down. 13 percent of US adults are uninsured in 2014. This is a decline from a percentage of 17 percent in January 2014 and translates to about 10 million to 11 million people getting coverage. The survey also looked at the major demographic groups and found each of them progressing in obtaining health insurance. However, Hispanics, who have the highest uninsured rates of any race or ethnic group, lag behind in their progress. Under the new health care reform, the Latins are expected to be the main beneficiaries of the new health care legislation. Gallup found that the biggest decrease in the uninsured rate (3 percentage points) was among households earning less than $ 36,000 per year.
Waste and fraud
In December 2011 Administrators left the Medicare Center & amp; Medicaid services, Donald Berwick, assert that 20% to 30% of health care spending is waste. He lists five causes of waste: (1) patient overtreatment, (2) failure to coordinate care, (3) administrative complexity of the health care system, (4) burdensome rules and (5) fraud.
An estimated 3-10% of all health care spending in the US is fraud. In 2011, Medicare and Medicaid generated $ 65 billion in improper payments (including fraud and fraud). The government's efforts to reduce fraud include $ 4 billion in fraudulent payments recovered by the Justice Department and the FBI in 2012, longer prison terms set by the Affordable Care Act, and Patric Medicare Senior - volunteers trained to identify and report fraud.
In 2007, the Department of Justice and Health and Human Services established the Fraud Medicare Fraud Force to combat fraud through data analysis and improved community policing. In May 2013, Strike Force has charged more than 1,500 people for a fake bill of more than $ 5 billion. Medicare scams often take the form of bribes and money laundering. Fraudulent schemes often take the form of billing for unnecessarily medically unnecessary services or services.
Quality of care
There is a significant debate about the quality of the US care system relative to other countries. Doctors for the National Health Program, a pro-universal universal system of paying for universal healthcare services, claim that free-market solutions for health care provide lower quality care, with higher mortality rates, than publicly funded systems. The quality of health care and managed care organizations is also criticized by this same group.
According to a 2000 World Health Organization study, public-funded systems from industrialized countries spend less on health care, both as a percentage of their GDP and per capita, and enjoy superior population-based health care outcomes. However, conservative commentator David Gratzer and Cato Institute, a libertarian think tank, have criticized the WHO comparison method for bias; WHO research marks the countries below to have private health care and pays for fees and countries assessed on the basis of comparable health care performance they expect, rather than objectively comparing the quality of care.
Some medical researchers say that patient satisfaction surveys are a poor way to evaluate medical care. Researchers at RAND Corporation and the Department of Veterans Affairs asked 236 elderly patients in two different managed care plans to assess their care, then examined treatment in medical records, as reported in the Annals of Internal Medicine. No correlation. "Patient assessment of health care is easy to obtain and report, but it does not accurately measure the technical quality of medical care," said John T. Chang, UCLA, lead author.
Maps Healthcare reform in the United States
Public opinion
Public opinion polls have shown the majority of public support varying degrees of government involvement in health care in the United States, stating preference depends on how the question is asked. The polls from Harvard University in 1988, the Los Angeles Times in 1990, and the Wall Street Journal in 1991 all showed strong support for health care systems compared to Canadian systems. Recently, however, polling support has declined for such health care systems, with the Yahoo/AP 2007 poll showing that the majority of respondents consider themselves supporters of "single payer health care", the majority supporting a number of reforms according to a joint poll with < i> Los Angeles Times and Bloomberg , and a number of respondents in the 2009 poll for Time Magazine showed support for "a single national payer plan similar to Medicare for all." Polls by Rasmussen Reports on 2011 and 2012 show diversity that goes against the health care of single payers. Many other polls show support for different levels of government involvement in health care, including a poll from the New York Times /CBS News and Washington Post /ABC News, indicating favorites for the form national health insurance. The Kaiser Family Foundation shows the majority who support the form of national health insurance, often compared to Medicare, and Quinnipiac polls in three states in 2008 found majority support for the government ensuring "that everyone in the United States has adequate health care." among potential Democratic primary voters.
The 2001 article in the public health journal Health Affairs studied fifty years of American public opinion about various health care plans and concluded that, while there appears to be general support from the "national health care plan," Respondents poll " with their current medical arrangements, do not trust the federal government to do what's right, and do not support this type of one-payer national health plan. " Politifact ranks a statement by Michael Moore "wrong" when he states that "[t] the majority of he really wants a single payer health care." According to Politifact, the response to this poll is very dependent on his words. For example, people respond better when asked if they want a "like Medicare" system.
Patient Protection and Affordable Care Act
After campaigning on the promise of health care reform, President Barack Obama gave a speech in March 2010 at a rally in Pennsylvania explaining the need for health insurance reform and called on Congress to hold a final or final vote on reform. The results of his efforts are Patient Protection and Affordable Care Act. Since the Obama party does not have a majority withstood the filibuster in the Senate, the law was amended by the Healthcare and Reconciliation Education Act of 2010 using a reconciliation process in which the Senate debate is limited and therefore filibuster is not allowed.
The law is still controversial, with some countries challenging it in federal courts and opposition from multiple voters. In June 2012, in the 5-4 decision, the US Supreme Court found that most of the laws were constitutional. However, the law continues to face legal challenges. Recent efforts to reverse the Affordable Care Act occurred during Government Shutdown on 1 October 2013. Government officials opposed to the ACA are trying to get approval of the bill to reopen the government contingent over the death of the ACA. This effort failed and the government reopened on November 16, 2013.
As a result of the law, insurance companies can no longer charge a fee by gender. A study by the National Institutes of Health reported that lifetime expenditure per capita at birth, using 2000 dollars, showed a big difference between women's health care costs ($ 361,192) and men ($ 268,679). Most of these cost differences are in short-term men, but even after adjustment for age (assuming men live as long as women), there is still a 20% difference in lifetime healthcare costs.
Terms of action become effective over time. The most significant changes, especially those affecting the availability and terms of insurance, became effective January 1, 2014. This includes the expansion of Medicaid (subject to individual country preferences) to non-dependent children and the exchange of subsidized health care. Previous changes include allowing permanent dependents on the plan to 26, cancellation restrictions (dropping the insured when they are ill), removal of lifetime coverage limits, mandates that insurance companies fully cover certain prevention services, high risk pools for uninsured persons, tax credit for businesses to provide insurance to employees, an insurance company rating program, and a minimum medical loss ratio.
The law creates a Center for Patient-Based Results Research to study comparative effectiveness research funded by life-long insurance costs that are protected (starting from $ 1, increasing to $ 2 and then adjusting by index). It also allows the FDA to approve generic biological medicines and specifically allows for 12 years of exclusive use for newly developed biological drugs.
In addition, the law explores several programs aimed at increasing incentives to provide quality and collaborative care, such as responsible care organizations. The Medicare and Medicaid Innovation Centers are created to fund pilot programs that can reduce costs; This experiment covers almost every expert health expert, except malpractice/tort reform. The law also requires replacement of Medicare reimbursements for hospitals with excess registration and finally binding Medicare replacement doctors to the quality of care metrics.
The Act is also designed to supplement the 2009 HITECH Act that encourages the "meaningful use" of electronic health records; for example, the law directs governments to use these notes to analyze the quality of health care providers.
The Affordable Care Act also aims to promote access to preventive health care. Through the provision of access to examinations for diseases such as breast cancer, promoting workplace health, and community preventive health, the Affordable Care Act contains sections that promote and promote preventive health initiatives.
Alternative and research direction
There are alternatives to exchange-based market systems imposed by the Patient Protection and Affordable Care Act that have been proposed in the past and continue to be proposed, such as a single payer system and allow health insurance to be set at the federal level.
In addition, the Patient Protection and Affordable Health Care Act of 2010 contains provisions that allow the Medicare and Medicaid Services Center (CMS) to conduct pilot projects that, if they are successfully implemented in the future.
Single-payer health care
A number of proposals have been made for the single universal payer health care system in the United States, the most recent US National Health Care Act, (known as HR 676 or "Medicare for All") but no one gets more political support many. of the 20% co-sponsored the congress. Advocates argue that preventive health care spending can save several hundreds of billions of dollars annually because publicly financed universal healthcare will benefit employers and consumers, that employers will benefit from a large number of potential customers and that employers are likely to pay less, and will be spared administrative costs of health care benefits. It is also said that inequalities between employers will be reduced. Also, for example, cancer patients are more likely to be diagnosed in Phase I where curative treatment is usually some outpatient visits, rather than in Phase III or later in the emergency room where care may involve years of hospitalization and frequent terminals. Others predict long-term savings of 40% of all national health spending because preventive health care, although estimates from the Congressional Budget Office and New England Journal of Medicine have found that preventive care is more expensive.
Each national system will be paid for partly through taxes instead of insurance premiums, but supporters also believe the savings will be realized through the prevention and elimination of overhead costs for insurance companies and hospital billing costs. The analysis of single bill payers by Doctors for the National Health Program estimates a direct savings of $ 350 billion per year. The Commonwealth Fund believes that, if the United States adopts a universal health care system, the mortality rate will increase and the country will save about $ 570 billion a year.
The recent enforcement of a single paying system within each country, such as in Vermont in 2011, can serve as a living model that supports a single federal payer scope. However, plans in Vermont failed.
On June 1, 2017, in light of Trump Administration's recent attempts to revoke the Affordable Care Act, California Democratic Senator Ricardo Lara proposed a bill to build a single paying health in the state of California (SB 562), calling on fellow senators to act quickly in defend health. The law will apply "Medicare for All," placing all levels of health care in the hands of the state. The bill submitted to the Senate of California by Senator Lara does not have the funding method required to finance a $ 400 billion dollar policy. Despite the lack of foresight, the bill gets approval from the senate and will continue to wait for approval from the state assembly.
In the wake of the Affordable Care Act, the state of California has experienced the largest increase in newly assured people compared to other countries. Furthermore, the number of doctors under MediCal is not sufficient to meet demand, therefore 25% of doctors care for 80% of patients covered through MediCal
In the past, California has struggled to maintain the effectiveness of health care, in part because of its unstable budgets and complicated regulations. The state has a policy known as the Gannian Limit, otherwise it means the 98 proposition, which ensures that some state funds are directed to the education system. This limit will be exceeded if California raises taxes to fund a new system that will require $ 100 billion in tax revenues. To avoid legal disputes, voters will be required to change the proposition 98 and release the health care fund from the necessary education donations. The State announced on August 1, 2017 that health insurance coverage will increase 12.5% ​​next year, threatening coverage of 1.5 million people
Public options
In January 2013, Representatives Jan Schakowsky and 44 other Democrats from the House of Representatives introduced Hr 261, the "Public Ops Deficit Reduction Act" which will amend the Affordable Care Act 2010 to create a public option. The bill will set a government-run health insurance plan at a premium of 5% to 7% percent less than private insurance. The Congressional Budget Office estimates it will reduce US public debt by $ 104 billion over 10 years.
Balancing physician bids and requests
The Medicare Graduate Medical Education program regulates the supply of medical doctors in the US. By adjusting the rate of replacement to build more income equality among the medical profession, the effective cost of medical care can be lowered.
Payment bundled
The main project is a project that can radically change the way the medical profession is paid for services under Medicare and Medicaid. The current system, which is also the main system used by medical insurance companies is known as cost-for-service because medical practitioners are only paid for the performance of medical procedures which, arguing means that doctors have a financial incentive to do more tests (which result in more many incomes) that may not be in the patient's best long-term interests. Current systems encourage medical interventions such as surgery and prescribed medications (all of which carry risks to patients but increase income for the medical care industry) and disrespect other activities such as encouraging behavioral changes such as modifying dietary habits and quitting smoking, or follow-up on a determined regime that could have better outcomes for patients with lower costs. The current cost-for-service system also rewards poor hospitals for poor service. Some have noted that the best hospitals have lower rates of acceptance than others, which benefit patients, but some of the worst hospitals have a poor recall rate for patients but are rewarded with a cost-for-service system.
CMS projects are examining the possibility of rewarding healthcare providers through a process known as "bundled payments" whereby local doctors and hospitals in a region will be paid no for services but on capitation-related systems. Areas with the best results will get more. This system, it says, makes medical practitioners more concerned to focus on activities that deliver real health benefits at lower costs to the system by eliminating the crimes embedded in the fee-for-service system.
Although intended as a model for health care funded by CMS, if the project is successful, it is estimated that the model can be followed by the commercial health insurance industry as well.
Trump administrations
Donald Trump was elected President on a platform that includes a pledge to "uproot and replace" the Patient Protection and Affordable Care Act (usually called the Affordable Care Act or Obamacare). To that end he supports the proposed American Health Care Act (AHCA), developed by the House of Representatives. The government has suggested that the AHCA is only part of the reform effort. Other proposals include enabling interstate competition in the health insurance market.
See also
- Health care reform
- Health care reform proposed during the Obama administration
- Health care system Ã, § International comparison
- Health Economics
- Health policy
- List of health care reform advocacy groups in the United States
- McCarran-Ferguson Act
- Medicare Sustainable Growth Rate
References
Further reading
- Christensen, Clayton Hwang, Jason, Grossman, Jerome, Innovator Recipes , McGraw Hill, 2009. ISBNÃ, 978-0-07-159208-6.
- Terry L. Leap, Phantom Billing, False Recipes, and High Medical Expenses: Health Care Fraud and What to Do About It (Cornell University Press, 2011).
- Mahar, Maggie, Money-Based Medicine: The Real Reasons of Much Health Care Costs , HarperCollins, 2006. ISBNÃ, 978-0-06-076533-0
- Starr, Paul, American Drug Social Transformation , Books, 1982. ISBNÃ, 0-465-07934-2
- Reid, T. R. (2009). The Healing of America: A Global Search for Better, Cheaper and More Fair Health Care . Penguin Books. ISBN: 978-1-59420-234-6.
External links
- Health reform in the United States in Curlie (based on DMOZ)
Source of the article : Wikipedia
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