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Although adults under age 65 typically receive health insurance as an employment benefit, not all are so fortunate.Most small businesses, many medium-sized firms, and even some large firms do not offer health insurance to their employees.This essay, written for readers unfamiliar with the details of American health law and policy, portrays the essential features of the battle for health reform in the United States and of the law that survived the battle: the Patient Protection and Affordable Care Act (PPACA). The political and legal conflicts leading up to and following PPACA’s enactment are described.
In the early months of his presidency, Obama made overtures to congressional Republicans in an effort to reach agreement on the outlines of a bipartisan consensus health reform program. Former Republican vice-presidential candidate Sarah Palin characterized the reform proposals as creating government “death panels” to determine whose life is worth saving and whose should be sacrificed to save money.
At town hall meetings across the country, “tea party” activists denounced health reform as a government scheme for “socialized medicine.” The health reform debate took on larger overtones symbolic of what some have called a “culture war” between proponents of different visions of America’s future.
Cost-control success cannot be predicted with confidence. What is less well known is which segments of the population lack coverage, and how the high-cost care that does reach the public results in many respects in mediocre health outcomes.
Myths about American health care are pervasive, and factual correctives are needed.
These incentives are heightened by the fear of lawsuits – an exaggerated fear, perhaps, since the number of paid malpractice claims per active physician has been declining steadily for the past twenty years. health insurance costs higher than costs in nations with universal coverage is our private health insurance companies’ practice of medical underwriting and risk selection.
Still, professional impulses to do everything possible for the patient, united to considerations of litigation avoidance and financial gain, create intractable upward pressures on expenditures. In the absence of rules requiring health insurers to accept all applicants, companies seeking to avoid high-risk customers have devoted considerable resources to investigating and screening applicants’ past health records, a practice that both is costly and results in denials of insurance to those most in need. But in terms of providing good health care to the nation as a whole, the U. falls far behind other advanced nations, and even behind some much poorer nations.In the author’s view, for advanced, specialized treatments at selected hospitals, the U. For what Americans pay for their health care, too often they fail to get their money’s worth.And the unceasing growth of health care costs is unsustainable.Private health insurers’ premiums for individuals are notoriously costly, beyond the budgets of many working families.As a result, 67% of the uninsured are members of families with at least one full-time worker.The percentage of total health care expenditures spent on administration and insurance in the U. (7.7% in 2006) is almost double that reported in Canada (4.1%), and more than triple the level in Japan (2.3%).The Institute of Medicine, a prestigious research entity, estimated that almost one-third of U. health care spending goes to waste on billing and excess administrative costs, duplicative x-rays and other diagnostic tests, and unnecessary or ill-advised procedures.This essay portrays the essential features of that story and of the law that survived the battle: the Patient Protection and Affordable Care Act (PPACA). The political and legal conflicts leading up to and following PPACA’s enactment are described.The major features of the law are explained, and the issues remaining to be addressed are set out.Perhaps the most important structural reason contributing to America’s excessive health care costs is that the amount of payment providers receive for their services depends chiefly on quantity, not quality.Since physicians control most health care purchasing decisions, and they are not constrained in most health care settings by cost considerations, incentives for excessive diagnostic procedures are built into the system.