Introduction to the U.S. health care delivery system

U.S. Health Care System

2010 saw the passage of the landmark Patient Protection and Affordable Care Act, the most striking transformation to the health care landscape since Medicare's enactment in 1965. The bill focuses on two critical issues facing the overall U.S. health care system: cost and coverage. Because the U.S. health model is not defined by a single payer or "socialized medicine"; the delivery system has created a significant lacuna in coverage and access for individuals primarily based on income and affluence. Further, the cost of care and coverage has outpaced national income growth over the last decades. "The U.S. is projected to spend over $2.5 trillion on health care in 2009, or $8,160 per U.S. resident, accounting for 17.6% of GDP. In 1970, U.S. health care spending was about $75 billion, or $356 per resident, and accounted for 7.2% of GDP" (Kaiser Family Foundation. March 2009. P. 1). The Affordable Care Act provides a template for redirection of the current delivery mechanism driven by "the middleman -- the insurance/managed care industry" (McCanne, D. & MacDonald, D.C. 2000. P. 5), with "emphasis on insurance expansion, benefit standards, and limits on costs for those with lower incomes" (Schoen, C. Osborn, R. Squires, D. Doty, M. Pierson, R. & Applebaum, S.P. 2)

U.S. Health Care Problems

A common phrase that is trumpeted by entrenched interests in the health care industry is that the U.S. has the finest health care in the world, yet a mountain of statistics proves otherwise. "The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance" (World Health Organization.org. 2000. P. 1) according to the World Health Organization. This ranking reflects core problems of the delivery model which has left some 49.9 million uninsured in 2010 (U.S. Census Bureau.gov. 2010. P. 27), leaves "one third of U.S. adults without recommended care, and one fifth of U.S. adults having major problems paying medical bills" (Schoen, C. Osborn, R. Squires, D. Doty, M. Pierson, R. & Applebaum, S.P. 2). A point that does resonate however is that income is the ultimate "Mendoza Line" for individuals receiving health services. "The uninsured rate was higher among people with lower incomes and lower among people with higher incomes" (U.S. Census Bureau.gov. 2010. P. 27). As a result the proclivity for individuals without insurance coverage is to ignore the necessary care, mainly preventative, which could dramatically impact the long run cost curve downward on health service affordability.

Access and Cost