Current Managed Care Health Policy Issue Art Essay


Health reforms refers to a policy that a government intends to take in order to address issues pertaining to the delivery of health service to the populace. The United States is characterized by a mixture of both public and private sector providers of healthcare where 159 million Americans have enrolled in a health insurance scheme that is employer sponsored; 49 million get their coverage through Medicaid while 45 million get coverage through Medicare. A whooping 46 million Americans have no health insurance at all. Medicare and Medicaid are health schemes sponsored by the US government. Medicaid provides medical cover for low income Americans, the elderly and people with disabilities. Each state undertakes the scheme on its own under federal guidelines. It has enrollment of over 49 million at any one time. Medicare is an entitlement for people who are 65 years and above and has 45 million Americans enrolled in it. It's the largest health care payer in the US with the cost reaching $440 billion in 2007. The cost of health insurance has been climbing steadily over the years, in 2007 it was 16% of the GDP ($2.2 trillion) and it's estimated that it will rise to 20% in 2017 and 25% in 2025. This is a high cost as compared to other developed countries that spend less.

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The issue has been about weather one has a basic right to health care, who should have access to the health care and under what circumstance. The quality, cost and sustainability of the programme in relation to the budget. Questions have been raised regarding the role of government in the health economy. The united states is currently undergoing debate on the recently passed comprehensive health reform legislation The Obama administration believes the bill will reduce the cost of health to business and governments in the long run, invest in prevention and wellness, provide an affordable quality heath care, shield families from the effect of a bread winner changing a job, being retrenched or bankruptcy thus losing their health insurance cover. It also guarantees choice of health plans and doctor and ends barriers to coverage for those citizens with pre existing medical conditions.


1n the early 1900s, the American Medical Association was reconstituted as A national body of state and local association, becoming a powerful body. Membership soured to 70,000 in 1910- more than half the physicians in the country. In reaction, the Americana association of labor (AALL) organized its first conference on social insurance in 1910. Subsequent reformers begin to advocate for health insurance but there effort was undermined by the world war one. 1920s came with the reformers emphasis on the impact of the cost of medical care instead of wages to corporate balance sheet Vis a Vis the lost labor due to diseases. The period saw the socio-cultural perspective on the profession change due to the increase in income and prestige of physicians as the non-urban health facilities became inadequate. The depression of 1930s resulted in the governments focus shifting to pension and unemployment benefits making the social security act to be passed minus health insurance.

Roosevelt tried to push for health insurance but his effort was derailed by internal rangles over government priorities as Blue cross company begun to offer private insurance health cover in a number of states. Come 1940s and prepaid group health care is initiated. World War Two effected wage and price control being imposed on employers making them to offer health benefits so as to attract employees. President Roosevelt requests congress for an economic bill of rights that includes medical care and his successor Truman proposes a single system that will include all Americans through a national health program but these plans are thwarted as a communist ploy by congress and denounced by the American health association (AMA).

In 1950s the national health care expenditure was 4.5% of the GNP and America now had two system of health coverage- private for the rich and welfare for the poor with federal responsibility. The price of hospital bed double as attention shifted to the war in Korea. In 1960s those outside the two schemes increasingly faced difficulties in getting insurance cover. The shortage of physicians made the federal government to increase medical health teaching institution as the number of doctors in private practice increased to 69%. The number of insurance companies selling cover increased and they adopted the high cost medicine. President Lyndon Johnson signed Medicare and Medicaid into law in 1970s, President Nixon endorsed the prepaid group health insurance scheme as health maintenance organization with federal support amid a massive increase in the cost of health care, generating a crisis leading to his plan for a national health insurance to be rejected by liberals and labor unions.

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The next decade saw a general shift towards privatization and corporatization of healthcare. Under Reagan, Medicare changed policy to payment by diagnosis rather than by treatment prompting private organizations to follow suit amid complains by them that the convectional free-for-service payment method to doctors is being exploited leading to the adoption of capitation method of payment. With the end of cold war, federal health care reform bill fails to pass in congress amid increase in cost of health care. But the expansion of managed care stabilizes the costs as the number of Americans with no health care rose to 44 million (16%) of the nation. In the 21st centaury health care cost is on the rise again. Medicare is viewed as unsustainable in the long run while the employer based system is being seen as unsustainable due to changing demographics. These prompted the Obama administration to bring the health reform bill to congress that was passed on Monday 22nd march and was signed to law on 23rd march.


The signing of the health reform legislation into law (The patient protection and affordable care act) has been received with mixed feelings making Americans to be divided along party lines during the one year that the debate took. Democrats state that the large number of un insured Americans is a burden to the state and society as a whole indirectly and the passage of the health reforms bill will counter this. The republicans who oppose the bill on the other hand state that the bill infringes on their personal freedom and that the government should address the issue by moving closer to the people. To them different ways to lower the cost could be adopted other than what the bill proposes. To some like Kate Randall in her article “the new York times and the Obama health plan” see the bill as having nothing in common with what has been doing the circle in the pro legislation newspapers like the New York Times. The beneficiaries indeed are the privileged section of the ruling class who will benefit from the cost cutting measures and the gutting of the health care for the ordinary Americans. Critics argue the new bill will reduce government spending and lower the quality of health care and services while increasing the profit of the health insurance companies.

The social security and Medicare was wrestled from the ruling elites by the efforts of the workers but the Obama legislation is being imposed by the ruling elites with little people's effort. Randall sites the Time's praise of the law as a moral obligation of the state, as a fallacy because the bill has nothing in common with universal health care for 23 million people will be left uninsured by 2019. That the legislation will reign in on insurance bad practices will only be achieved when all Americans buy their coverage in order to spread the cost evenly funneling billions of dollars to the insurance companies, for them to fund their own reforms. With the expurgation of the Health Insurance Rate Authority there is no guarantee that insures will not charge high fees. The Obama legislation will impose an excise levy on high cost premiums in 2018 to drive employers and their workers from the highest cost insurance policies i.e. workers benefit will be cut and their out of pocket insurance will increase - a strong cost control measure to the insurance companies. The law proposes the Independent payment advisory board that will have powers to control costs, services and Medicare regulations. Whose decisions can only be overruled by super majority in congress?

The law also forces millions of well off Americans who can fend for their health bill into buying insurance cover. Of particular interest is the rebounding of US stocks following the passage of the bill driven up by the insurance related stocks? But other skeptics like Sherryl Gay Stolberg and Robert Pear in their article titled “Obama Signs Health Care Overhaul Bill, With a Flourish” Published in the New York times dated 23rd march , paint the bill in positive picture. The patient protection and affordable care act signed by president Obama on Tuesday 23rd march 2010 is a reflection of the effort that generations of Americans have put in order to reaffirm their aspirations despite the republicans who were opposed to the bill seeing the day as a no celebration day as they filed suits in various states contending the measures in the new law as unconstitutional. The bill indeed was a big deal for president Obama.


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Given that the measure is now law, its prudent for the republicans to tone down their opposition to the law and seek ways by which they can collaborate with the democrats so as to pass the subsequent legislation that relate to the law. The patient protection and affordable care act is a step in the right direction but it doesn't cover the illegal immigrants and undocumented Americans hence it is near universal.


Sheryl G S& Robert P(2010). Obama signs Health Care Overhaul Bill, With a Flourish.

Retrieved: March 23rd 2010.


Kate R (2010).The New York Times and the Obama health care plan.

Retrieved: 24th March 2010.


Ian P & Lyndon K, (1993) Health Reforms a second opinion. Wellington, Health action


Chris H (1994). Health Care for an aging population. New York,SUNY Press.