US Public Healthcare Policy

The healthcare public policy has been a topic that has circled presidential debates and everyday conversations for centuries. I believe more so in the latest presidential election than ever before. Today, we face the effects of a pandemic, where many people without access to basic healthcare faced increased medical debt or death. In the first presidential debate, President Trump stated that private insurance was the best way to fund the medical expenses for US citizens, while current President-Elect Biden sided with a growing number of people seeking a universal healthcare policy reform. But, what does all of this mean? Why is it so important for Americans to have access to healthcare? In this essay we will discover why the policy was created, how it has changed, and how it can be improved moving forward.

During the early twentieth century, a group of organized reformers known as the American Association of Labor Legislation (AALL) proposed a model health care bill in 1915. (Miller) The model stated comprehensive health insurance coverage for many Americans who were working class or poor. The stated a structure of employees paying 40% of the coverage, while employers and the state covered 20% each. At first glance, this model was destined to succeed, however it faced failure when the American Medical Association (AMA), American Federation of Labor and commercial insurers influenced denied support for the bill. When America entered into World War I in 1917, the proposed bill was marked to a close as the bill as health care opponents associated the bill with German socialism.

A healthcare reform bill was once again brought to light as American stepped into a deep depression in the 1930's. As many Americans lost their jobs, homes and legacies, their health declined as well. President Roosevelt elected a Committee on Economic Security to study economic insecurities- including unemployment insurance, public employment and relief, old age security and medical care. When the research was proposed to Roosevelt, it included a national healthcare plan. However, AMA doctors raised concern that a national plan would lose money or their right to self government and the proposal was not included in the Social Security Bill being passed in Congress.

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In 1946, President Harry S. Truman noticed the growing need for health and medical insurance following World War II and introduced the Hill Burton Act to congress. (Newton) The bill authorized loans and grants for communities to improve their local healthcare facilities. The goal in mind was to add 4.5 beds per 1,000 people in the community. However, the many holes in the bill lead to many Americans not truly receiving the medical care they needed. Since the communities had to provide economic stability in order to receive funds through the bill, the communities truly suffering from lack of proper care did not receive the help they needed. The law was revised and edited in 1975 when it became the Title XVI of the Public Health Service Act and provided more than $12 billion toward improved medical facilities over it's 20 year period.

Although the creation of Medicare, specialized health coverage for seniors, was first introduced in 1965, Ronald Reagon expanded the policy in 1988 with the Medicare Catastrophic Coverage Act. (Modern Healthcare) The plan introduced a new way to administer healthcare, along with long term and prescription drug coverage that was said to pay for itself through high premiums and extra income tax on the users. However, seniors utilizing the coverage soon became frustrated with the high payments, causing such a revolt it led to an appeal of the bill barely a year later. It was not until 1993 when Bill Clinton attempted to launch another healthcare bill, stating that all Americans need to be covered either through their employer or their government offered benefits. This bill was shot down by insurance lobbyists shortly after it's arrival, stating that it was too complex and the government was taking too much control over healthcare.

Today, the Affordable Care Act (commonly called Obamacare) is the law of the land. This act was first introduced in 2010 by President Barack Obama, it was able to drastically reduce the number of people without coverage to below 10% and stood against many appeals from the legislative office. (Alic) The Trump administration fought hard to overrule Obamacare; So much so that during the healthcare reform discussion of the presidential debate against Biden, he stated he "would like to terminate Obamacare, and come up with a brand new, beautiful healthcare." (Kapur) However, with little to no plan in place, he was unsuccessful during his presidency. Current President Elect Joe Biden is planning on transforming the current plan to "Biden Care" by expanding Medicaid options for Americans with private insurance and increasing federal subsidies lowering the costs of premiums.

One thing that catches my eye of the possible "Biden Care" is the projected budget of $750 billion. Healthcare is funded through three main sources of revenue: private insurance companies, government insurance programs, and out-of-pocket funds by the individual. (Merck Manuals) Private insurance is typically purchased by corporations for their employees as a benefit, however in most cases the total cost of the insurance premium is not fully covered by the employer. Government insurance programs such as Medicare or Medicaid have strict qualifications and are mainly used for people unable to be covered by private insurance companies. Lastly, roughly 17% of Americans are paying out of pocket for their medical bills. This is stating they are without health coverage, and are needing to use anywhere from savings accounts to credit cards to cover any medical conditions that may arise. There are programs such as flexible spending accounts or health savings accounts that are offered through employers as a way to help employees put aside funds for unknown medical bills.

I believe we can all agree that our current healthcare policy needs a change. However, we cannot blindly go about an attempt. We must have strategy and follow through. According to the AAFP website, they believe in a four way model to best make healthcare available to all Americans. This model includes: Population- Based payment, Fee-for Service Payment, Performance- Based Incentive Payment, and Primary Care Global Payment. ("Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States") Which piece of the model introduces a way that healthcare can be paid for without breaking the bank of Americans. Such as the Performance- Based Incentive Payment is based on the quality and cost of the care, with a percentage of the other three pieces of the model paid respectfully overtime. This model could lead to a breakthrough of Americans choosing the type of medical coverage they need and them being able to pay for the coverage without breaking their bank.

Works Cited

Alic, Margaret, PhD. "Affordable Care Act." The Gale Encyclopedia of Nursing and Allied Health, edited by Jacqueline L. Longe, 4th ed., vol. 1, Gale, 2018, pp. 88-93. Gale Health and Wellness, link.gale.com/apps/doc/CX3662600035/HWRC?u=txshracd2531&sid=HWRC&xid=8e4f0248.

Accessed 8 Jan. 2021.

"Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States." AAFP​ ​, 2019, www.aafp.org/about/policies/all/health-care-for-all.html.

Kapur, Sahil. "Trump Says Obamacare Must Die. Biden Says He'll Make It into

'Bidencare.'" NBC News​ ​, 23 Oct. 2020, www.nbcnews.com/politics/2020-election/trump-says-obamacare-must-die-biden-says-he-ll-mak e-n1244454.

Merck Manuals. "Overview of Health Care Financing." Merck Manuals Consumer​ Version​, 2020, www.merckmanuals.com/home/fundamentals/financial-issues-in-health-care/overview-of-health -care-financing.

Miller, Debra A. "The Debate About Health Care Reform." Health Care, Lucent Books,

2011, pp. 27-42. Hot Topics. Gale Health and Wellness, link.gale.com/apps/doc/CX1968400008/HWRC?u=txshracd2531&sid=HWRC&xid=3276d5d8.

Accessed 8 Jan. 2021.

Newton, David E., EdD. "Hill-Burton Act." The Gale Encyclopedia of Public Health, edited by Brigham Narins, 2nd ed., vol. 1, Gale, 2020, pp. 533-535. Gale Health and Wellness, link.gale.com/apps/doc/CX7947900146/HWRC?u=txshracd2531&sid=HWRC&xid=cca3ffd7.

Accessed 8 Jan. 2021.

"Reagan: Changed Medicare." Modern Healthcare, vol. 36, no. 31, 7 Aug. 2006, p. 50. Gale Health and Wellness, link.gale.com/apps/doc/A149362785/HWRC?u=txshracd2531&sid=HWRC&xid=82f1225b.

Accessed 8 Jan. 2021.