This paper examines the structure and delivery of the United States health care system through several interconnected lenses. It begins by defining what a health care system encompasses, then analyzes how differing beliefs and values — particularly around personal freedom and the proper role of federal government — shape health policy debates such as those surrounding the Affordable Care Act. The paper then surveys the major delivery models in use in the United States, including managed care, governmental programs such as Medicare and Medicaid, and private indemnification insurance. Finally, it explains how these models function together as a hybrid system designed to address the diverse needs of American stakeholders.
Over the last several years, America's health care system has been undergoing a tremendous amount of change. At the heart of these transformations is the role of the federal government in regulating the delivery of various services. For some, this is troubling, as it may lead to a larger form of socialized medicine in which consumers have less choice and underlying quality decreases. Others believe that the government can protect consumers and negotiate lower prices for everyone. These contrasting views highlight how America's health care system is a combination of government and private entities working together.
To fully understand what is taking place requires examining: the definition of the health care system, the impact of beliefs and values, examples of models for health care delivery, and an explanation of how these areas are applied in the United States. Together, these different elements illustrate the way health care services are provided to stakeholders in America.
A health care system consists of all the different components that help deliver various products and services to consumers. These include: facilities, insurance companies, health care providers, doctors, nurses, suppliers, the government, nonprofit organizations, the general public, and manufacturers. The combination of these factors is designed to effectively deliver specific health solutions to consumers in a cost-efficient manner (Matcha, 2003, pp. 4–5).
Different beliefs and values have a significant impact on the health care system. In America, these ideas are rooted in personal freedom and differing views about the appropriate size of the federal government. As noted above, these views influence the intensity of policy debates and the kinds of programs that are enacted. A clear example can be seen with the Patient Protection and Affordable Care Act. As the law was going through congressional debate, many groups approached members of Congress in their home districts. Central to their arguments was the question of what role the federal government should play in health care and how that role connects to their core values. Proponents argued that the law was necessary to address the rising number of uninsured Americans and to curb abuses within the health care industry — a position rooted in the belief that the federal government should protect consumers and effectively regulate these markets ("A More Secure Future," 2012; "Health Care Reform and the Supreme Court," 2012).
Many opponents, on the other hand, felt that the law was a violation of personal freedom. They argued that expanding the size of the federal government and requiring everyone to purchase health care reduced efficiency, lowered productivity, and increased taxes. From this perspective, speaking out against such policies was a moral obligation ("A More Secure Future," 2012; "Health Care Reform and the Supreme Court," 2012).
These divergent views set the stage for the heated conflicts that occurred at many Congressional town hall meetings, where both sides expressed their opinions in an atmosphere of anger and animosity. This demonstrates how beliefs and values directly shape the kinds of health care programs that are introduced ("A More Secure Future," 2012; "Health Care Reform and the Supreme Court," 2012).
In this context, the federal government could theoretically have followed a model similar to Canada's single-payer system. However, given the strong opposition to that approach, the designers of the Affordable Care Act sought to limit direct federal involvement. This was accomplished by expanding existing state Medicare and Medicaid programs and providing states with block grants to deliver services to the general public. The implication of these competing beliefs is that any resulting program will attempt to incorporate the views of multiple stakeholders, producing a health care system that is a combination of private and governmental elements ("A More Secure Future," 2012; "Health Care Reform and the Supreme Court," 2012).
After the law was passed, various parties challenged its legality. The outcome of those legal challenges was expected to shape how the debate evolved — either moving toward greater acceptance of the program or renewing opposition if the law were declared unconstitutional. This dynamic fueled ongoing arguments about what type of health care system America should have ("A More Secure Future," 2012; "Health Care Reform and the Supreme Court," 2012).
Within the U.S. health care system there are several major delivery models. The most notable include managed care, governmental programs, and private insurance. Managed care is typically offered through large employers. The basic idea is that individuals pool their resources together in order to receive a lower rate. This model emphasizes controlling costs through primary care, requiring patients to obtain approval from their primary care physician before seeing a specialist. In addition, patients must generally stay within a designated network of health providers associated with the plan. These programs are operated by private insurance companies ("A Distinctive System of Health Care Delivery," 2010).
Governmental programs include Medicare and Medicaid. Medicare is available to individuals who reach the age of 65, while Medicaid serves those with lower incomes. Under these programs, the federal government negotiates reduced rates for the services patients receive. Patients are typically required to cover a portion of the costs in the form of deductibles or copayments. These programs are designed to provide the most vulnerable members of society — the elderly and the poor — with some form of health care coverage ("A Distinctive System of Health Care Delivery," 2010).
Private indemnification insurance is when an individual purchases health care coverage directly from an insurance company. This option is generally used by self-employed individuals and those who are not traditional employees, such as independent contractors. Like other forms of coverage, it requires the individual to pay a copay and meet a deductible each year for a defined set of services ("A Distinctive System of Health Care Delivery," 2010).
These different models demonstrate that the health care delivery system in America is built upon a combination of programs working in conjunction with one another. The result is a hybrid system designed to deliver specific services that are vital to various stakeholders ("A Distinctive System of Health Care Delivery," 2010).
These areas are designed to provide a total health care solution to the individual. This is accomplished through a combination of programs that address specific needs. For example, someone who is employed and receives health care coverage for their family may still be unable to afford the high cost of prescription drugs. Under Medicare and Medicaid, they may be eligible for a discount if they meet predetermined eligibility conditions. This is designed to address gaps in coverage that exist within a person's existing policies ("A Distinctive System of Health Care Delivery," 2010).
By not relying on a single delivery model, the U.S. system provides the public with a more comprehensive health care solution. Instead, the emphasis is on addressing needs through a combination of programs. As a result, the U.S. health care system functions as a hybrid of private and governmental models integrated into one ("A Distinctive System of Health Care Delivery," 2010).
Clearly, the U.S. health care system is shaped by the beliefs and values of different stakeholders. This is evident in the basic approach used to deliver health solutions to the general public — an emphasis on combining multiple models to address the concerns and needs of various individuals.
As a result, the system has become a mixture of programs designed to cover specific areas. In some cases, this involves a person utilizing services from both private insurance companies and governmental entities. In other situations, a single program may be sufficient. In either case, individuals retain the option to draw on these various programs to address their critical needs and to fill gaps in their existing coverage. This illustrates how the beliefs and values of stakeholders have directly influenced the kinds of programs that were developed. In many ways, the current approach represents a deliberate effort to create an agreeable solution that bridges competing visions of health care in America.
"Hybrid model addressing gaps in individual coverage"
Health Care Reform and the Supreme Court. (2012). NY Times. Retrieved from: http://topics.nytimes.com/top/reference/timestopics/organizations/s/supremecourt/affordablecareact/index.html
Matcha, D. (2003). Health Care Systems. Westport, CT: Praeger.
You’re 96% through this paper. Sign up to read the remaining 1 section.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.