Health Care Reform in the U.S.

Notable Harvard health economist, Dr. William Hsiao, when asked about health system reform said, “Before you can set up a health care system for any country, you have to know that country’s basic ethical values. The first question is: Do people in your country have a right to health care? If the people believe that medical care is a basic right, you design a system that means anybody who is sick can see a doctor. If a society considers medical care to be an economic commodity, then you set up a system that distributes health care based on the ability to pay. And then the poor, pretty much, are left out” [1] Dr. Hsiao has consulted many national governments on health system reform, including those of Taiwan, Colombia, China, and Sweden. He has also worked with the World Bank, UNICEF, and most recently worked with Vermont policymakers on designing a state health reform plan.

As Dr. Hsiao stated, undergoing serious health reform requires an evaluation of nation’s values. While the world’s richest countries have agreed that access to health care is a basic human right, the United States has answered the question, perhaps indirectly, by letting health care evolve into a market-based system that has left millions uninsured. Let’s be clear on how we define “access to health care”: it is not just being able to receive treatment at the ER in the case of an emergency. It is being able to go see a primary care or specialty care physician for follow-up visits. It is being able to acquire needed medicine or medical equipment – all of which that is reasonably affordable to the individual. The United States is the only country where its citizens have had to declare bankruptcy because of medical expenses.

President Obama’s ambitious health care reform will extend coverage to millions more individuals but fails in providing universal coverage.  Regardless of GOP politicians failing to enact Medicaid expansion, at least 30 million individuals are expected to remain uninsured after the law goes into full affect in 2016. The health care reform law includes an exemption from the individual mandate for low-income people who cannot find affordable coverage. These will likely be individuals who make too much to be eligible for Medicaid but not enough to afford coverage through the exchanges.

Health care reform in the United States has been a political calamity. Presidents Jimmy Carter and Bill Clinton both failed at passing any significant health care reforms. It should be noted President George W. Bush was successful at creating Medicare Part D – which expanded Medicare coverage to include prescription drugs. President Obama’s health care reform has been the most ambitious plan to be signed into law since Medicare in 1965.  Yet, it did not include a single payer plan and most importantly did not sufficiently enough address the growing number of uninsured.

[1] Reid, T. R. (2009). 12: The First Question. In The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (p. 215). New York: Penguin Press.


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