For many years, the American healthcare system has faced many challenges including non-traditional entrance into the market; the growth of technology, which includes the Internet of things and artificial intelligence (AI); and private equity investment in healthcare. Most importantly are the problems that surround private health insurance and lack of insurance (Kruse et al. 38). Uninsured people are more likely than those with insurance to postpone health care or forgo it altogether. The consequences can be severe, particularly when preventable conditions or chronic diseases go undetected. The most critical problem facing the American healthcare system is the lack of affordable insurance, which the president and Congress could address by implementing a universal healthcare plan,
In the United States, healthcare is a massive business. The United States spends much more per person on health care than other developed countries. In 2010, the average expenditure was $2.6 billion, which was the largest per capita figure worldwide. By 2018, this figure rose to almost $5 trillion annually. Unlike these industrial nations, the United States largely relies on the direct-fee system where patients pay directly for the services of doctors and hospitals. People over 65 are covered by Medicare, while those below age 65 pay for their medical expenditures though private health insurance, their employer’s plan, Medicaid, or self-insurance.
In the United States, approximately 29 percent of the population is covered by public insurance. Public health insurance plans are plans provided by the government for low-income individuals or families, the elderly, and other individuals that qualify for special subsidies. The primary public health programs in the U.S. are Medicare, Medicaid, and CHIP (Children’s Health Insurance Program). However, these programs are not enough to ensure a healthy outcome for every citizen of the United States. Another solution is needed for the rising cost of healthcare and access to affordable care. (Bourgois et al. 299).
Among the many solutions proposed to solve the problem of uninsured Americans, two solutions compete actively against each other: mandated insurance and universal healthcare. The first solution, which was addressed by the Affordable Care Act (ACA) passed in 2010, included an individual mandate requiring all Americans to purchase health insurance or face a penalty. In addition, employers with 50 or more full-time employees (or the equivalent in part-time employees) were required to provide health insurance to 95 percent of their full-time employees or pay a penalty to the IRS.
Small businesses were not required to offer group health insurance and had several options for compliantly providing health benefits to their employees. In 2019, the ACA’s individual mandate was eliminated by the Trump administration, but not being required by federal law to have health insurance coverage doesn’t mean that people don’t need it. However, many Americans are unemployed or underemployed without access to affordable insurance. The cost of going without health insurance can be substantial when a person needs expensive medical care and doesn’t have the money to pay for it from savings.
Another solution to cover the uninsured is universal coverage through national insurance. Universal health care is a system that provides quality medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay and funds it through general income taxes or payroll taxes and controls the price of medication and medical services through negotiation and regulation.
Universal healthcare eliminates the administrative costs of dealing with different private health insurers. Although universal healthcare often has long wait times for elective procedures, it provides coverage for vulnerable populations, which include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with other chronic health conditions, including severe mental illness. (Anderson 363).
The United States is the only OECD (Convention on the Organisation for Economic Co-operation and Development) nation which does not have universal health care either in practice or by constitutional right. Over 130 countries have a right to health care in their national constitutions. Many European countries with a universal right to health care, such as France, Germany, Italy, and the United Kingdom, have a lower Gross Domestic Product (GDP) per capita than the United States, yet they provide a right to health care for all their citizens. (OECD, 2019).
Accessible, affordable and high-quality health care is part of the American promise guaranteed by the U.S. Constitution. Single-payer health-care (in which the government pays for universal coverage, typically through taxes) helps keep costs down for two reasons: (1) the government can regulate and negotiate the price of drugs and medical services, and (2) it eliminates the need for a vast private health-insurance bureaucracy.. This method is the most suitable approach to ensure that all Americans have health insurance.
The different levels of government play important roles in handling the problems facing healthcare. The federal government has played a major role in healthcare from the establishment of Medicare and Medicaid in 1965 ensuring access to insurance coverage for a large portion of the U.S. population to multiple pieces of legislation that protect individuals under employer-sponsored health insurance and expanded federal healthcare programs under the ACA. States are responsible for marinating public hospitals, ambulance services, public dental care, community health services, and mental health care, while local governments play a role in the delivery of community health and preventive health programs, such as immunization and the regulation of food standards..
All three branches of government; the legislative, executive, and judicial; influence health care decisions. The legislative branch determines which services or programs the government will pay for and for which members of society. Many of these decisions impact the most vulnerable members of the population. For example, on October 17, 2019, the State of Arizona notified the Centers for Medicare and Medicaid Services (CMS) that it will delay the implementation of the planned Medicare work requirement and other program changes. The judicial branch of government is responsible for interpreting laws related to healthcare.
For example, in 2012, the Supreme Court upheld a decision affirming the government’s power to require that Americans have health insurance or pay a financial penalty. However, the justices also ruled that states may opt out of the law’s significant expansion of the Medicaid health care program without losing all of their federal Medicaid funds. In many ways, the executive branch of government is in the best position to gather and organize all the evidence, data, and reasoning necessary for the formulation of sound health policies. However, it has frequently failed to follow sound scientific recommendations. For example, President Reagan barely acknowledged the work of the President’s Commission on AIDS.
Currently, 40 percent of the workforce are either self-employed or in multiple part-time jobs so affordable group coverage through an employer is no longer an option. Too many Americans cannot afford adequate individual coverage on their own. In 2020, a new president and Congress could address the problem of our broken healthcare system and the steadily declining financial access to affordable healthcare by leading the charge for universal healthcare.
- Anderson, Barbara A. ‘Facing the Nursing Workforce Shortage: Policies and Initiatives to Promote a Resilient Healthcare System.’ Caring for the Vulnerable (2019): 363.
- Bourgois, Philippe, et al. ‘Structural vulnerability: operationalizing the concept to address health disparities in clinical care.’ Academic medicine: journal of the Association of American Medical Colleges 92.3 (2017): 299.
- Health Markets. “Healthcare Reform News Updates.” https://www.healthmarkets.com/resources/ health-insurance/trumpcare-news-updates/ (Accessed, October 24, 2019)
- Kruse, Clemens Scott, et al. ‘Challenges and opportunities of big data in health care: a systematic review.’ JMIR medical informatics 4.4 (2016): e38.
- Organisation for Economic Co-Operation and Development (OECD), “1. Gross Domestic Product (GDP): GDP Per Head, US$, Current Prices, Current PPPs,” stats.oecd.org (Accessed October 21, 2019)