The healthcare reform debate in the United States has been a political issue focusing upon increasing medical coverage, decreasing costs, insurance reform, and the philosophy of its provision, funding, and government involvement.
Details
During the presidency of Barack Obama, who campaigned heavily on accomplishing health care reform, the Patient Protection and Affordable Care Act (PPACA) was enacted in March 2010.
In the next administration, President Trump said the healthcare system should work based on free market principles. He endorsed a seven-point plan for healthcare reform: repeal Obamacare reduce barriers to the interstate sale of health insurance institute a full tax deduction for insurance premium payments for individuals make Health Saving Accounts inheritable require price transparency block-grant Medicaid to the states allow for more overseas drug providers through lowered regulatory barriers
He also suggested that enforcing immigration laws could reduce healthcare costs.
The Trump administration made efforts to repeal the ACA and replace it with a different healthcare policy (known as a "repeal and replace" approach), but it never succeeded in doing so through Congress. Next, the administration joined a lawsuit seeking to overturn the ACA, and the Supreme Court agreed at the beginning of March 2020 that it would hear the case. Under normal scheduling, the case would be heard in the fall of 2020 and decided in the spring of 2021. However, as the Supreme Court subsequently went on hiatus in response to the coronavirus pandemic, it is unclear when the case will be heard.
Cost debate
U.S. healthcare costs were approximately $3.2 trillion or nearly $10,000 per person on average in 2015. Major categories of expense include hospital care (32%), physician and clinical services (20%), and prescription drugs (10%). U.S. costs in 2016 were substantially higher than other OECD countries, at 17.2% GDP versus 12.4% GDP for the next most expensive country (Switzerland). For scale, a 5% GDP difference represents about $1 trillion or $3,000 per person. Some of the many reasons cited for the cost differential with other countries include: Higher administrative costs of a private system with multiple payment processes; higher costs for the same products and services; more expensive volume/mix of services with higher usage of more expensive specialists; aggressive treatment of very sick elderly versus palliative care; less use of government intervention in pricing; and higher income levels driving greater demand for healthcare. Healthcare costs are a fundamental driver of health insurance costs, which leads to coverage affordability challenges for millions of families. There is ongoing debate whether the current law (ACA/Obamacare) and the Republican alternatives (AHCA and BCRA) do enough to address the cost challenge.
In 2009, the U.S. had the highest health care costs relative to the size of the economy (GDP) in the world, with an estimated 50.2 million citizens (approximately 16% of the September 2011 estimated population of 312 million) without insurance coverage. Some critics of reform counter that almost four out of ten of these uninsured come from a household with over $50,000 income per year, and thus might be uninsured voluntarily, or opting to pay for health care services on a "pay-as-you-go" basis. Further, an estimated 77 million Baby Boomers are reaching retirement age, which combined with significant annual increases in healthcare costs per person will place enormous budgetary strain on U.S. state and federal governments. Maintaining the long-term fiscal health of the U.S. federal government is significantly dependent on healthcare costs being controlled.
Quality of care
There is significant debate regarding the quality of the U.S. healthcare system relative to those of other countries. Physicians for a National Health Program, a political advocacy group, has claimed that a free market solution to healthcare provides a lower quality of care, with higher mortality rates, than publicly funded systems. The quality of health maintenance organizations and managed care have also been criticized by this same group.