US Healthcare Reform Initiatives

The United States is relatively unique in the world community for offering healthcare through a variety of employer-provided and government insurance systems. While most US citizens obtain healthcare via their employers, others have health insurance via a variety of government-provided programs such as Medicaid or Medicare. Still others purchase their insurance from health insurance companies themselves because they do not receive employer coverage and are unable to qualify for Medicaid. This suggests that cooperation between insurance companies, providers, and the government is necessary to improve delivery, reduce costs, and expand access to all patients.

One of the first presidents to attempt to orchestrate broad-sweeping healthcare reform, Bill Clinton, recently underlined the need to embark upon reform in a collective and unified effort. “The former president called on attendees to embrace evidence-based medicine as a means to bend healthcare\\'s cost curves and lauded Medicaid expansion as a means to keep health plan rate increases low” (Eastwood, 2015, par.3). Clinton’s stress upon evidence-based medicine underlines the need to structure coverage and treatments based upon proven research of what is most effective; too often, critics have stated, care is dispensed based more along the lines of what a patient’s insurance will cover rather than actual need. The Affordable Care Act (ACA) was instrumental in expanding Medicaid coverage in many states, although many individuals who do not obtain healthcare through their providers still find its insurance plans excessively costly. Subsidies are available but high-deductible plans on the ACA exchanges still make healthcare a struggle for many American families and even families who receive employer-provided insurance may have high copays and deductibles.

Granted, there is a constant tension within healthcare between the needs of patients and providers which can make cooperation difficult, namely the “difficulty of reconciling the public’s desire for low-cost, high-quality care with physicians’ desire for professional autonomy and control of health resources” as well as the “ideals of consumer-governed health care in the face of a marketplace that rewards volume over value” (Davis, 2009, par.4). In other words, physicians have an incentive to provide more care and patients with comprehensive health insurance are inclined to accept a doctor’s word about the need for a particular service. The explosion of health management organizations and rewarding physicians based upon meeting quality benchmarks and containing costs have been designed to counteract this fact but patients have often feared that rationing and denial of care to meet benchmarks will be the result.

Regardless, the government clearly has an important role to play in the development of healthcare to regulate both insurance companies and providers to ensure that patients have adequate access to safe, affordable care. Even nations which do not have single-payer healthcare systems still have substantially more national government intervention in their healthcare systems in comparison to the United States. For example, in Germany, where all citizens must have some sort of health insurance, Germans can select a plan from “competing, not-for-profit, nongovernmental health insurance funds” of their choice or “substitutive private health insurance” from employers (“What is the Role,” 2017, par.6). In France, private insurance plans and the healthcare system as a whole is heavily regulated on a national level, including both hospitals and care delivery (“What is the Role,” 2017). Even if the United States is unlikely to shift to a national healthcare system like Canada or the United Kingdom, more regulation is likely to be needed in the future to achieve universal access, contain costs, and create greater equity in coverage.

References
Davis, K. (2009). Cooperative health care: The way forward? The Commonwealth Fund.
Retrieved from: http://www.commonwealthfund.org/publications/blog/health- cooperatives-the-way-forward
Eastwood, B. (2013). AHIP: Bill Clinton calls for cooperative approach to healthcare reform.
Fierce Healthcare. Retrieved from: http://www.fiercehealthcare.com/payer/ahip-bill- clinton-calls-for-cooperative-approach-to-healthcare-reform
What is the role of government? (2017). The International Commonwealth Fund. Retrieved
from: http://international.commonwealthfund.org/features/government_role/