NURS 8100 Health Care Reform

NURS 8100 Health Care Reform

NURS 8100 Health Care Reform

Feature of the Health Care System

One feature of the US health care system is that it is the most expensive healthcare in the world with results that would not agree with the cost. It is interesting to see that the US healthcare system has tried to evolve over the years and in that evolving has actually increased the cost of healthcare (Bodenheimer&Grumbach, 2020). Competition has fueled the improvement of healthcare, but at the cost of raising healthcare costs for the individual. There are other countries that have better health care systems in place, for a fraction of the cost. It would be interesting to investigate the actual cost of care and how much insurance companies gain compared to their actual payout. There is much that could be improved in the US health care system. It could be possible that the monetary issues prevent there from being major reform to the system because companies make such a large sum of money that they do not want things to change. As the US health care system has tried to change and become seemingly more affordable through the use of policy changes there has been an increase in the amount of money that they government pays, which is actually paid by US citizens through taxes (Bodenheimer&Grumbach, 2020). It seems that whenever the US health care system is taking one step forward it is also taking two steps back.

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Challenges

The Affordable Care Act (ACA) did provide more individuals with health care coverage. This has improved

NURS 8100 Health Care Reform
NURS 8100 Health Care Reform

the health of many individuals. One condition of the ACA is that it protects individuals with preexisting conditions from insurance companies denying care based on their condition (Healthcare.gov, n.d.). This is a great benefit for many individuals, but it comes at a cost for the insurance companies. This mandatory coverage causes insurance companies to then have to try to balance out coverage for those individuals that are ill versus those individuals who are healthy which can end up costing those individuals that are healthy to pay for others in their groups (Bodenheimer&Grumbach, 2020). This causes insurances to have to base their premiums on an experience rating versus a community rating which potentially provides unfair coverage to individuals (Bodenhemier&Grumbach, 2020). This seemingly minor change from the ACA has a ripple effect in the way that insurance companies need to charge for care and how they will determine premiums for individuals. The ACA in general is an example of how the policy making process is in the United States. Making or changing policy in the United States is a very slow, very incremental process which makes it hard to change or add policies (Walden University, LLC, 2011). The ACA was a worked on for a long time and because of the changes that were made many companies had to adjust accordingly. Health reform in the United States is difficult because there are so many entities that want to make sure that they are not being left out or hurt in decisions or policies that are being made and so they will stall or stonewall different policies if they feel that it does not benefit them. When there are policy changes then there are adjustments that need to be made and sometimes that effects so many different things that the changes end up being a negative instead of a positive, such as individuals who have to pay too much for the ACA healthcare and therefore opt out and are fined for that decision (Bodenheim &Grumbach, 2020).

References

Bodenheimer, T., & Grumbach, K. (2020).  Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.

HealthCare.gov. (n.d.) Understanding the Affordable Care Act. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html

Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: The policy process. Baltimore: Author.

 

Response

This is an exceptional work on health care reform. I concur with you that cost of care is an important feature of health care system that has great influence on the health policy and reforms.  Other than the cost, the other important feature of the US health care system is politics. Politics play a crucial role in the health care affairs, particularly health policy and reforms (Tuohy, 2018). The health care reform discussion in the US has been a political issue centered on reduction of cost, funding, increasing medical coverage, insurance reform, government involvement, and philosophy of its provision.  Health care reforms have been highly contentious among law makers (Haeder, 2020). For instance, President Obama enacted the Patient Protection and Affordable Care Act (PPACA) to increase health coverage to all Americans.  However, the Trump administration consistently made efforts to repeal the ACA and adopt alternative policy called repeal and replace approach.  This effort to repeal the ACA has been a controversial political topic among the Democrats and Republicans in the Congress (Michener, 2020).

References

Haeder, S. F. (2020). Political science and US health policy in the era of the affordable care act. Policy Studies Journal, 48, S14-S32. https://doi.org/10.1111/psj.12385

Michener, J. (2020). Race, politics, and the affordable care act. Journal of Health Politics, Policy and Law, 45(4), 547-566. https://doi.org/10.1215/03616878-8255481

Tuohy, C. H. (2018). Remaking policy: scale, pace, and political strategy in Health care reform (Vol. 54). University of Toronto Press.