Understanding the Issues of Healthcare Reform

The Healthcare.gov website.
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Most Americans understand that the healthcare system doesn't work efficiently or effectively, but few understand the scope of the problems involved. This guideline can help you understand what the problems are, and the questions that must be answered in order to fix the system.

Passage and implementation of the Affordable Care Act of 2010 (ACA) addressed many of these issues. But many remain unresolved and they continue to be debated as modifications are proposed and considered. Healthcare reform didn't end with the ACA, it is an ongoing process.

Most of us equate "health care reform" with "universal healthcare." In fact, not only are they NOT the same thing, health care reform is actually comprised of at least a dozen components, and universal healthcare is not even one of them. Universal healthcare is one of the answers to one of the questions (see "Coverage" below), albeit the question regarded by many people to be the most controversial.

There is a four-step process to understanding healthcare reform and its associated issues.

Understand the Problems That Led to the Passage of the Affordable Care Act of 2010

Understanding the problems that led to the creation of the bill will help you better understand what each specific protection means and why they exist.

Understand the Concept of Healthcare Rationing

What most of us don't understand is that the bigger picture questions of coverage are all about cost and rationing. The more people and the more services paid for, the more we will all be affected by rationing. Please take a few moments to understand the concept of rationing, then move on to the overall discussion of healthcare reform below.

Understand the Ripple Effect Each Decision Has on the Others

The many aspects of healthcare reform are related to every other aspect. Decisions about coverage will affect cost and payment, which will also affect patient safety and tort reform. Decisions about electronic medical records will affect privacy issues, and so forth. Further, the problems of the uninsured affect far more than our wallets. This is the reason healthcare reform is such a difficult puzzle to solve.

Grasp the Big Picture of Healthcare Reform Issues

Here are the questions involved in the overall topic of healthcare reform. Their order does not necessarily indicate their level of importance in the larger picture. You can learn more about each by following the links provided.

  • Coverage:
    • Should all Americans be guaranteed access to basic health and medical care? Should the child of an unskilled hourly worker have access to the same care options as the CEO of a large corporation, or a U.S. Congress member or a retired union member? Should there be differences in the care available from state to state? Included in the questions about coverage are these issues:
      • Who should be covered?
    • What are the differences between universal healthcare, single-payer healthcare, and socialized medicine?
    • Pre-existing Conditions: denial of health insurance for those who already have a medical problem
    • Denial of Care: what medical tests, treatments, and services should be, or should not be, paid for?
    • Types of services that should be covered (mental health? dental or vision?)
    • Primary care and the shortage of primary care physicians
    • Preventive care issues such as stop smoking campaigns, or overcoming childhood obesity problems
    • Portability of Care: with an employer-based system such as exists today, workers sometimes find they cannot move or change jobs without fear of losing their insurance
  • Payment Systems and Costs:
    • Prior to the passage of the Affordable Care Act of 2010, there were an estimated 47 million people in the United States that had no payment system for their health care. There were an additional estimated 25 million under-insured, meaning, 72 million people were at risk of losing their financial foundation should their medical care cost more than 10 percent of their income. This is mostly based on the concepts of private vs public, or regulation of private insurance. Only one of the answers is "universal healthcare."
    • Included in the questions about payment systems and costs are these issues:
      • What aspects of healthcare should be paid for by individuals, employers or the government?
    • including Health Savings Accounts
    • Cost transparency: currently patients have little idea of what healthcare really costs, which is considered to be one of the reasons healthcare in the United States is so expensive.
    • Billing Fraud and Overcharging for Services: this takes place in both government payment systems and private
    • Costs of drugs and devices: Patients in the United States pay more for drugs and medical devices than patients anywhere else in the world
    • Payments to doctors by pharmaceutical companies and medical device companies
    • Ownership of equipment and facilities
    • Use of technology
  • Patient Safety:
    • As each of the above-listed challenges has become more difficult for professionals, facilities, and patients to cope with, patients are more at risk of further problems as they access the system. Patients die or are further debilitated by the very system that is supposed to help them heal or be cured. Healthcare reform needs to improve the system to reduce the numbers of medical errors and deaths. Included in the questions about patient safety are these issues:
      • Transparency in error reporting
    • Tort reform: should patients be allowed to sue when mistakes are made? should there be caps on the amount they can sue for?
    • FDA oversight: which has missed the mark in protecting Americans on too many occasions in the past several years
  • Health Information Technology:
    • Using our traditional paper-based record keeping system impacts not only the cost of care but the quality of care as well. What problems can be solved during reform by the use of electronic medical records?
  • Medical Research, including Stem Cell Research:
    • In recent years, government funding for medical research has been cut dramatically, leaving major questions about the quality of privately funded research by pharmaceutical and device makers.

    2010 Patient Protection and Affordable Care Act (ACA)

    The first sweeping changes to the laws that govern health and medical care in the United States were signed into law by President Barack Obama on March 23, 2010. Many, but not all, aspects of reform listed above were addressed and will be phased in over a five-year period. They will continue to be the source of debate since the bill was modified in the coming years.

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