• Andrew Rupp

Time for Change: American Health Care and its Profit-Driven Policies

Updated: Mar 23, 2021

Regarding American health care, there clearly is need for fundamental, systematic change, sure. Recent trends in American health care and its current state are distressing, and it is my hope to spread awareness and share insights into this sector. I also feel, moreover, perhaps even subconsciously, I undertook this work to shake off my listlessness for American politics. This being a result of watching the nation be ran by one of the most selfish regimes in history. Though it seems unlikely that much improvement will occur any time soon, this is due to the mere continuation of the corporately-minded policies which got us here in the first place and... okay, enough of my views, and on with the data.

There has been clear evidence that corporations have been at the helm of American policy making decisions (Gilens and Page, 2014), while citizens endure ongoing inequalities, all the while barely able to cover small emergency costs; that is, without going into debt (Pichee, 2017). Policy makers should be able to recognize something is wrong, as a third of the donations on GoFundMe is being donated for those trying to pay their medical bills (Cerullo, 2019). One. Third… clearly, something isn’t working.


Broad Overview

According to national surveys, health care has been branded the most important matter in terms of governmental authority (Aitalieva and Park, 2018). The topic has been, and likely always will be, a top concern for any national government; that is, if it is a government hoping to promote public well-being. The past decades have shown steadily rising levels of inequality in many areas, as many know, health care being one of them. These inequalities have, in turn, resulted in higher disparities in health care costs, measures of longevity, and other health care inequalities (Bor, Cohen and Galea, 2017).

Since the mid-1990’s, different solutions have been implemented yet health care costs continue to rise. Furthermore, one problem often overlooked is the complications which can arise when given too many options; people become confused at the complexities and find it difficult in making an educated decision. Anyone living in America knows the complexity of the health care system, and has likely experienced the stress and confusion when considering their health care options and eligibilities (Hisnanick and Coddington, 1994).



Background

Significant Historical and Contemporary Dynamics

American health care has long been a matter of controversy. Since Trump took office, Americans felt apprehensive of their futures as there have been ongoing scandals, lawsuits, and bickering between politicians (Pew Research Center for the People and the Press, 2015). It is not only the fault of Trump, but also of politicians and policy makers, as they have been unable or unwilling to work together and compromise in making sensible solutions in the area of health care (Diamond, 2019). This incapacity to work together not only effects levels of trust in their government, but also women’s health and equality (The Lancet, 2016) and other measures of mental health (Pickett and Wilkinson, 2015). There is also the unnerving unwillingness of politicians to observe what other nation’s policies are, which could be of use for ameliorating current American issues (Diamond, 2019).

Another alarming statistic shows the overwhelming powerlessness of the average citizen in comparison to elites and organized interest groups (Gilens and Page, 2014). According to Gilens and Page (2014), Americans have a near-zero percent chance to get Congress to pass legislation when compared to elites; and this is after controlling for organized interest groups. It is of course the average citizen who works to help fund these very same programs which were not made in their interest. American Health and Human Services (HHS) must remember the importance that Americans place on the government’s responsibility for providing citizens with health care (Aitalieva and Park, 2018) as well as the low levels of trust in the government due to politicians not listening to the public’s wishes (Rockers, Kruk and Laugesen, 2012).

Since its inception in 1980, the HHS has been responsible for many aspects of American health. In 2019, its massive budget of $1.216 billion was responsible for funding numerous programs, including: health research, Medicaid (which serves low-income people of any age), Medicare (which serves those 65 years and older), substance prevention, and many others (HHS.gov, 2017). Medicare and Medicaid combined accounted for a whopping 86% of this budget (HHS.gov, 2018). The ACA was passed in 2010, yet a significant drawback to it was the obligation for a citizen to have health insurance (Anderson, 2019). If one was uninsured, then they may face fines after completing their taxes.

From the age of 26 and onwards, I was not eligible to be insured under my parent’s health coverage, and had to find my own health care provider. Being forced to find health insurance was and still is not an easy endeavor, as there are no shortages of available health coverages to pick from; all containing many pages of fine print to hassle over. When considering Obamacare, I quickly realized I would not be able to afford even the most basic coverage, that is, unless most of my earnings were spent solely on health care. My two part time jobs gave me no benefits, even though I was working 40-hour work weeks (sometimes more). I was not alone in this position, as many friends also could not afford to be insured. By chance, a friend told me of an exceptionally cheap agency that was charging almost nothing for coverage. I was satisfied only because I was able to dodge penalties. However, paying close to nothing for health care is exactly what your health care agency provides…close to nothing. There is a strange irony in being fined for not being able to afford something designed to be for the greater good.

One thing the ACA set out to achieve was allowing for more Americans to have health coverage, which it did. This number has since decreased after Trump won the 2016 presidential election (Anderson, 2019). Though there exist many health care options for consumers, many of the better ones are only available to the wealthy. Private health care costs are beyond what many Americans can afford, not to mention the surprise costs that can occur for treatments of heart attacks, mastectomies, maternity and new born care, mental health care, and surgeries (Pollitz et al., 2019).


Trends, Debates and Why this Issue Matters

The USA spends more than any other nation by a great deal on health care (Stats.oecd.org, 2020). This does not mean, however, that the USA ranks highest in measurements of health for its citizens. The USA ranks mediocre to poor in a number of measurements, including: life expectancy at birth, infant mortality, unmanaged asthma, unmanaged diabetes, safety during childbirth, and heart attack mortality (Anon, 2019). These alarming statistics show no sign of improving; this as well as the widespread inability for many to afford decent health care.

Other negative trends have been publicized, as:


· 27.5 million people (8.5 percent of citizens) were uninsured in 2018, which had increased from 25.6 million people (7.9 percent) in 2017.

· Those who had health insurance for some or all of 2018 was 91.5 percent, which decreased from 92.1 percent in 2017.

· Private health insurance (67.3 percent) became more widespread in 2018 than public coverage (34.4 percent) while employer-based coverage remained the most common, which insured 55.1 percent of citizens.

· The amount of people insured by Medicaid decreased while rates for Medicare coverage increased.

· The rate of uninsured children increased from 0.6 percent in 2017 to 5.5 percent in 2018 (Berchick, Barnett and Upton, 2019).


There exist numerous markers indicating a need for change in the health care system, some of which include:


· “(…) Annual deductibles over $5,000 have become common, together with rising co-payments, coinsurance, surprise bills, and other out of-pocket expenses

· The combined annual cost of insurance and care now exceeds $25,000 for typical families of four

· Medical bankruptcies still affect more than one million people each year, despite most having had insurance before their illness or accident

· A one-year cost of cancer drugs often exceeds $200,000, and many patients have to choose between forgoing treatment and bankruptcy

· (…) The nation’s primary care shortage continues to get worse

· (…) Fragmentation and depersonalization of care are now the norm, with continuity of care difficult to attain

· Jails now house 10 times more mentally ill people than state mental hospitals; only 4 in 10 jails offer them psychiatric medications

· (…) Medical errors account for about 250,000 deaths each year

· Cross-national studies by the Commonwealth Fund have shown for years that the United States performs at or near the bottom among 11 advanced countries in access, efficiency, equity, and quality of health care” (Geyman, 2018).


Recent research has revealed some of the negative effects for those who do not have health insurance; of which has been increasing (Anderson, 2019). These outcomes include: reduced health care access, less access to preventative care, less access to receiving regular check-ups, and causing people to delay seeking care until the situation becomes absolutely necessary (Groman, 2004). The rising rates of uninsured citizens could largely be due to the escalating corporatization of the health care industry (Geyman 2018). Coupled with this is the declining number of employers who provide their employees with health care coverage, placing the large share of cost on the employee; which can potentially lead to cancellation of health care coverage altogether due to an inability to afford it (Groman, 2004).


Pre-existing Policies and Practice

The USA has always had a strong individualistic attitude, believing in freedom of choice, democracy, and that if one works hard enough, they can rise on the socioeconomic ladder (Diamond, 2019). Times of old are changing, and they are changing quickly as technology has grown leaps and bounds in a matter of decades. Although the advancements in technology has greatly enriched the health sector, the resulting automation of many jobs could prove to be a source of worry for many (Burrus, 2014). The disappearance of job markets could lead to higher unemployment rates, which could lead to poorer health as well as lower rates of those insured (Patel et al., 2018). This new age problem must be taken seriously to prevent large populations of people suffering from physical and/or mental health issues.

Earlier, there was listed some of the aims of the Patient Protection and Affordable Care Act (ACA) or “Obamacare”, which was passed in 2010. This bill was the American government’s first and only attempt at providing citizens universal health coverage. Other objectives were to:


· “Make health coverage on the individual market more affordable

· Included shopping options to improve coverage selection

· Put coverage standards in place to prevent insurers from discriminating against applicants based on an individual’s pre-existing medical conditions or their gender

· Providing a list of improved plan benefits

· Provisions designed to reduce Medicare spending, drive down costs and improve coverage for Medicare beneficiaries” (Anderson, 2019).


Since Trump won presidency many Republicans, especially those of the far-right, voiced their hopes of repealing the ACA; although those within the party have been unable to agree on precise terms (Flannigan, 2017). The main dispute for Republicans is that Obamacare forced people to be insured, even if they were already healthy individuals (Flannigan, 2017).

With Republicans wishing to overhaul Obamacare, Trump’s administration recently introduced the American Health Care Act of 2017 (the AHCA). This hastily thrown together, 132-page bill has not yet been fully voted in by the US Senate, although it has been voted on a total of 45 times; which is mainly due to its containing requirements that are unrelated to the national budget (GovTrack.us, 2017). According to Congress’s official website, the bill contained many amendments, namely to:


· Eliminate spending to the ACA

· Lower the poverty line for families to meet thresholds of eligibility (making it more problematic for those in need of Medicaid)

· Reduce Federal Medical Assistance Percentage (FMAP) for home and community-based services and supports with the plan to eliminate the FMAP in the year 2020

· To eliminate, in 2018, the state’s option of extending Medicaid to non-elderly adults who were at the prior poverty threshold

· State assessments of determining the eligibility of those who are on Medicaid every six months

· Allow states to enforce an employment requirement for them participants to receive Medicaid

· Using a formula to place spending caps for each state which would have limited Medicaid funding beginning in the year 2020

· Reduce funding to medical funds

· Reduce, for one year, the funding to family planning providers such as the Planned Parenthood Federation of America (United States Congress, 2017)


There was no surprise that many were vexed with the government’s plan to halt funds to family planning providers. What was interesting, however, was that even though Republicans wished the ACA to be repealed for the passing of the AHCA, more conservative members of the Republican party opposed the voting on it as they felt the AHCA did not go to the necessary lengths so as to fully rescind the ACA (GovTrack.us, 2017). The situation seemed less of an actual political debate over an important issue, but rather a squabbling match between parties over past disagreements, as Representative John Conyers Jr. went on to say:


“I’m as happy as anyone with the way the Republicans’ plan to wreck our healthcare system crashed and burned last week. And President Donald Trump is right: Republicans lost because Democrats beat them. We beat them because we were organized, we were unified and we were backed by unprecedented grassroots energy.


“(…) For two weeks, I’ve watched (…) righteous outrage that it would lead to 24 million Americans losing their insurance. But that same CBO score says that 28 million Americans will still be without insurance even under the Affordable Care Act. I’m impressed that the ACA has expanded Medicaid eligibility in states that have adopted it and more than 20 million previously uninsured now have insurance, but universal healthcare it is not.” (Conyers Jr., 2017).


The AHCA has not been surrendered, however, but with support for the ACA recently reaching its highest levels ever (Fingerhut, 2017) as well as strong opposition to the AHCA (even among Republican voters) (Reid, 2017), it does not seem likely that the AHCA will be voted for implementation any time soon.


Possible Avenues for Repair

So, what’s to be done? Here I expand on possible changes which could be made, stating the potential advantages and disadvantages of each option. To start with, however, the HHS needs to forget the corporate business model and take a conscientious examination of the current state of American health care. A team of researchers, scientists, and academics should be assembled to review the existing data so as to advise policy makers and explain contemporary findings. After assessing surveys and evidence-based materials, potential solutions may be proposed and discussed with Congress.

Once a feasible option has been agreed upon, discussions of how best to implement the policy must be performed, with realistic deadlines made. Before hastily implementing the policy nation-wide, as was the case with Obamacare, slightly varied healthcare policies might be tested in different states to see which policy best benefits the nation.


1. Make the necessary amendments to the ACA

Advantages

The ACA has been in effect for over 10 years. Instead of creating an entirely new plan, why not just fix the current system that has shown improvements in some areas? Why implement an unwanted, hastily drawn up bill that has been consistently voted against since its nascence? Examining the AHCA, the number of cons vastly outnumber the pros, and for years it has remained unclear if the bill was merely created due to the Trump administration’s grudge against former-President Barack Obama and the bills his administration passed (Simmons-Duffin, 2019).


Disadvantages

Taking the necessary steps to revise the ACA may not be a fruitful endeavor, as the future of the ACA remains unclear due to:


· The lack of capacity for the ACA to gain support due to policy flaws

· Republican intervention to do anything they can to destabilize the ACA, including:

o Withholding payments to insurers

o Decreasing the amount of advertising for the ACA

o Decreasing open-enrolment times

o And allowing ACA marketplaces access to plans with lower value and which cover only a narrow scope of benefits

· Although public support of the ACA reached its highest level in 2017, its popularity has continued to fluctuate

· Even those in the Democratic party may not wish to proceed in revising the ACA. Senator Bernie Sanders, if he had been elected, announced he would have pushed for something more on the line of universal health coverage for Americans (much to the chagrin of the Republican party) (Béland, Rocco and Waddan, 2018).


Further Points

The ACA was passed with hopes of enriching preventative care outcomes, coordination between doctors, nurses, hospitals and health care providers (Rice et al., 2014). There should be checks on whether disagreeing parties, such as the Republicans, continue their attempts to sabotage the bill as well. This would be so that the ACA can have the best chance for success.


2. Drastically decrease the level of corporate power in the health care industry

Advantages

Since the 1970’s, the USA has seen increasing rates of both measures of inequality and of corporate authority in the health care sector (Gaffney, 2015). Though correlation does not always equal causation, this option is important for the HHS to scrutinize due to the public wishing the government to be more authoritative on the matter (Rockers, Kruk and Laugesen, 2012). It is agreed that after the 1970’s, American hospital systems applied more of a financial accounting approach to health services with commercial accounting practices becoming more evident (Flesher and Pridgen, 2015). It does not seem probable that these systematic shifts have aided those who are in need of health care services.

Moreover, corporate power has increased not only within the health sector but also strongly influencing policy making decisions by Congress (Gilens and Page, 2014). Income equality, which has been rampant for decades, is inherent with the rise in corporate power and has recently been shown to increase negative health outcomes; namely:


· Life expectancy

· Obesity rates, for children as well

· Poor reports of health

· Infant mortality

· Mental health (depression and chronic stress)

· Low birthweight

· Shorter height

· AIDS (Wilkinson and Pickett, 2009)


The rise in corporate power is thought to have helped create the current “cost crisis” in health care, causing prices to inflate and productivity to decline (Gaffney, 2015). Cost crisis indeed, as despite its huge health care expenditure, the USA currently ranks lowest compared with all other democratic countries in measures of infant mortality, life expectancy, and maternal mortality (Diamond, 2019).


Disadvantages

For this option to occur the American government must enforce stronger antitrust laws to prevent the further creation of super-corporations and monopolies. To end health care privatization, the government would need to make further restrictions to re-socialize health care, which would likely take years. Passing and/or enforcing laws to restrict corporate power could prove to be a drawn-out, unpleasant process where those in need of services are left waiting.


3. Provide American citizens universal health care

Advantages

The number of uninsured Americans as well as the current cost of health care cannot, and should not, be overlooked. A public system of universal health care would mitigate rates of those who are insured while at the same time limiting the power and influence from private corporations (Jones and Kantarjian, 2019). The HHS must listen to the people, which are expressing their hopes of the government doing its duty to oversee the coverage of all citizens (Rice et al., 2018). With current, low levels of public trust in government, this option seems prudent (Pew Research Center for the People and the Press, 2015). If implemented efficiently, American tax money would help all citizens have access to effective health coverage, benefitting all classes of society.


Disadvantages

Tax rates would need to be able to cover the program, and some may not wish to spend more on taxes to be used for those among different in-groups. Providing universal health care may be more difficult than it seems, as many feel weary of America becoming a socialist nation (Pew Research Center for the People and the Press, 2019). Moreover, implementation of this option could be difficult, as hospitals and providers must have a clear idea of how this new system would work while at the same time keeping lines of communication open. This option is the most ambitious of the three, so there would need to be large-scale, cooperative effort to be sure that this option is done for the good of all and in the most efficient way.

Final Remarks

Will Biden and co. make the changes needed in promoting American well-being? We shall see. It is obvious that this issue is a complex one and needs a different approach than what has already been done, or, worse, doing nothing and allowing the momentum of inequality to continue.





References and Further Reading

Aitalieva, N. and Park, S. (2018). Political Trust, Ideology, and Public Support in the United States for Government Spending on Health Care. International Journal of Public Administration, 42(9), pp.776-785.


Anderson, S. (2019). Obamacare: the Affordable Care Act. [online] Available at: https://www.healthinsurance.org/obamacare/ [Accessed 5 Feb. 2020].


Anon, (2019). International Ranking — Health Outcomes. [online] Available at: https://www.pgpf.org/chart-archive/0011_health-outcomes [Accessed 5 Feb. 2020].


Béland, D., Rocco, P. and Waddan, A. (2018). Obamacare in the Trump Era: Where are we Now, and Where are we Going?. The Political Quarterly, 89(4), pp.687-694.


Berchick, E., Barnett, J. and Upton, R. (2019). Health Insurance Coverage in the United States: 2018. [online] United States Census Bureau. Available at: https://www.census.gov/library/publications/2019/demo/p60-267.html [Accessed 9 Feb. 2020].


Bor, J., Cohen, G. and Galea, S. (2017). Population health in an era of rising income inequality: USA, 1980–2015. The Lancet, 389(10077), pp.1475-1490.


Burrus, D. (2014). Is the US Workforce Prepared to Thrive in the Past or in the Future?. E-Learning and Digital Media, 11(4), pp.314-322.


Cerullo, M. (2019). Their twins’ medical costs total $750,000 — each. They and thousands of others are counting on GoFundMe. [online] www.cbsnews.com. Available at: https://www.cbsnews.com/news/crushed-by-medical-bills-many-americans-go-online-to-beg-for-help/?ftag=CNM-00-10aag7e [Accessed 22 Mar. 2021].


Diamond, J. (2019). Upheaval: Turning Points for Nations in Crisis. [S.I.]: Little, Brown and Company.


Fingerhut, H. (2017). Support for 2010 health care law reaches new high. [online] Pew Research Center. Available at: https://www.pewresearch.org/fact-tank/2017/02/23/support-for-2010-health-care-law-reaches-new-high/ [Accessed 11 Feb. 2020].


Flannigan, J. (2017). Universal Health in United States. [online] Healthline. Available at: https://www.healthline.com/health-news/why-doesnt-the-us-have-universal-healthcare#1 [Accessed 9 Feb. 2020].


Flesher, D. and Pridgen, A. (2015). The development of hospital financial accounting in the USA. Accounting History Review, 25(3), pp.201-217.


Gaffney, A. (2015). The Neoliberal Turn in American Health Care. International Journal of Health Services, 45(1), pp.33-52.


Geyman, J. (2018). Crisis in U.S. Health Care: Corporate Power Still Blocks Reform. International Journal of Health Services, 48(1), pp.5-27.


Gilens, M. and Page, B. (2014). Testing Theories of American Politics: Elites, Interest Groups, and Average Citizens. Perspectives on Politics, 12(3), pp.564-581.


GovTrack.us. (2020). Summary of H.R. 1628: American Health Care Act of 2017 - GovTrack.us. [online] Available at: https://www.govtrack.us/congress/bills/115/hr1628/summary [Accessed 11 Feb. 2020].


Groman, R. (2004). The Cost of Lack of Health Insurance - A White Paper of the American College of Physicians. Health and Public Policy Committee of the American College of Physicians.


HHS.gov, (2017). HHS Historical Highlights. [online] Available at: https://www.hhs.gov/about/historical-highlights/index.html [Accessed 5 Feb. 2020].


HHS.gov, (2018). HHS Budget in Brief. [online] Available at: https://www.hhs.gov/sites/default/files/fy-2019-budget-in-brief.pdf [Accessed 5 Feb. 2020].


Hisnanick, J. and Coddington, D. (1994). Measuring human betterment through avoidable mortality: a case for universal health care in the USA. Health Policy, 34(1), pp.9-19.


Jones, G. and Kantarjian, H. (2019). The many roads to universal health care in the USA. The Lancet Oncology, 20(10), pp.e601-e605.


Patel, P., Devaraj, S., Hicks, M. and Wornell, E. (2018). County-level job automation risk and health: Evidence from the United States. Social Science & Medicine, 202, pp.54-60.


Pew Research Center for the People and the Press. (2015). Trust in government: 1958-2015. [online] Available at: https://www.people-press.org/2015/11/23/1-trust-in-government-1958-2015/ [Accessed 10 Nov. 2019].


Pew Research Center for the People and the Press. (2019). Americans’ Views of ‘Socialism’ and ‘Capitalism’ In Their Own Words. [online] Available at: https://www.people-press.org/2019/10/07/in-their-own-words-behind-americans-views-of-socialism-and-capitalism/ [Accessed 13 Feb. 2020].


Pichee, A. (2017). A $500 surprise expense would put most Americans into debt. [online] CBS News. Available at: https://www.cbsnews.com/news/most-americans-cant-afford-a-500-emergency-expense/ [Accessed 13 Feb. 2020].


Pickett, K. and Wilkinson, R. (2015). Income inequality and health: A causal review. Social Science & Medicine, 128, pp.316-326.


Pollitz, K., Rae, M., Cox, C. and Kurani, N. (2019). Surprise bills vary by diagnosis and type of admission - Peterson-Kaiser Health System Tracker. [online] Peterson-Kaiser Health System Tracker. Available at: https://www.healthsystemtracker.org/brief/surprise-bills-vary-by-diagnosis-and-type-of-admission/ [Accessed 6 Feb. 2020].


Reid, J. (2017). Opposition to AHCA Has Doubled Among GOP Voters Since April - Morning Consult. [online] Morning Consult. Available at: https://morningconsult.com/2017/06/21/opposition-ahca-doubled-among-gop-voters-since-april/ [Accessed 11 Feb. 2020].


Rice, T., Unruh, L., Rosenau, P., Barnes, A., Saltman, R. and van Ginneken, E. (2014). Challenges facing the United States of America in implementing universal coverage. Bulletin of the World Health Organization, 92(12), pp.894-902.


Rice, T., Unruh, L., van Ginneken, E., Rosenau, P. and Barnes, A. (2018). Universal coverage reforms in the USA: From Obamacare through Trump. Health Policy, 122(7), pp.698-702.


Rockers, P., Kruk, M. and Laugesen, M. (2012). Perceptions of the Health System and Public Trust in Government in Low- and Middle-Income Countries: Evidence from the World Health Surveys. Journal of Health Politics, Policy and Law, 37(3), pp.405-437.


Simmons-Duffin, S. (2019). Trump Is Trying Hard To Thwart Obamacare. How's That Going?. [online] Npr.org. Available at: https://www.npr.org/sections/health-shots/2019/10/14/768731628/trump-is-trying-hard-to-thwart-obamacare-hows-that-going [Accessed 12 Feb. 2020].


Stats.oecd.org. (2020). Health expenditure and financing. [online] Available at: https://stats.oecd.org/Index.aspx?DataSetCode=SHA [Accessed 22 Jan. 2020].


The Lancet (2016). Unfinished business: women's health inequality in the USA. The Lancet, 388(10047), p.842.


United States Congress (2017). H.R.1628 - American Health Care Act of 2017. US Congress, https://www.congress.gov/bill/115th-congress/house-bill/1628.

Wilkinson, R. and Pickett, K. (2009). The Spirit Level. London: Allen Lane, pp.73-102.


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