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Lisa Azevedo

Azevedo 2




9December 2016

QualityHealthcare in the US

Theresponsibility of any democratic and legitimate government is toprovide proper infrastructures, education, and more importantly,quality healthcare. As such, the citizens have the expectation thatthe government in place would execute these mandates. However,according to Kovner and Knickman (19), this is not always the caseas, despite attempts by the existing regimes to provide qualityhealthcare, they have fallen short of the citizens’ expectations.In the United States, the enactment of the Patient Protection andAffordable Care Act (PPACA) or simply the Affordable Care Act (ACA)commonly known as ‘Obamacare’ was viewed as the ultimate solutionto the healthcare concerns of the American population. However,Blumenthal, David and Sara (275) posit that this has not been thecase as the quality of healthcare is still very low while thegovernment expenditures in the health sector have been rising everyfinancial year. The citizens are forced to pay for services that donot match the expected quality. Additionally, despite the aim of ACAbeing to provide healthcare coverage to all Americans, it has failedto achieve that as close to 10% of the American population remainsuninsured (Blumenthal, David, and Sara, 276). As such, the mortalityrates are likely to increase and the quality of lives made deplorable(Kovner and Knickman, 20). Lack of competition in the provision ofhealth insurance cover has compromised on the quality of healthcare.As such, there is a need for the making of significant changes in thehealth sector with the aim of improving the quality of healthcare, asthe existing one is not only costly regarding the expenditure on theindustry but also ineffective and of low quality.

Despitethe high taxes that the American people have paid in the provision ofquality healthcare, the healthcare services offered have been veryineffective, and inefficient. The Department of Health and HumanServices recognizes that “improving quality healthcare entailssystemic and protracted actions to realize a metric progress inmedical services as well the health status of particular patientgroups.” The expectations of the American is that the hugebudgetary allocations to the healthcare sector would ensure that theservices that they receive are not only efficient but also of highquality. However, Kovner and Knickman (21) states that the quality oflife of the people has not been any better as the institutionsresponsible for fostering healthcare quality improvements have failedto accomplish their mandate. For instance, National Strategy forQuality Improvement in Health Care which is an organization funded bythe public Corfu has not initiated any notable quality improvementinitiatives in healthcare. The supporters of the ACA, mostly theDemocrats, argue that Obamacare has led to an increase in thehealthcare coverage for the poor and middle classes. This is entirelyaccurate, as, since the implementation of ACA, the coverage rateshave continued to increase. However, this does not mean thathealthcare quality has been improved. Although more Americans arebeing covered under the Medicare and Medicaid programs, the qualityof healthcare services that they receive do not match with thefinancial amounts that have been pumped in the healthcare sector.

Theconcept of healthcare quality has been politicized with the Democratsand Republicans failing to be objective about the matter. As such,Tom (1) states that the citizens have been trapped between thepolitics of the two parties. The Democrats are adamant that Obamacareis the way to go and that only a few things ought to be repealed inthe ACA so that it can be up to date with the changing healthcareconcerns (Kovner and Knickman, 22). They opine that the healthcarequality has improved since the implementation of the ACA. However,Republicans, on the other hand, are confident that the Act requires acomplete overhaul and replacement. In their view, the healthcaresituation in the country is a mess and has been that way since theACA was operationalized (Tom, 1). In the new proposal that waspresented to the Congress by the Speaker, the Republicans- who havenow control the Congress thanks to their majority numbers and theelection of Donald Trump, state that “Obamacare simply does notwork” (Blumenthal, David and Sara, 280). There is no bipartisanlook at the issues of the healthcare quality and what can be done toimprove it. Every political wing is pulling to its side while thecitizens continue to be curious and afraid of what will become oftheir health. Irrespective of the side of the political divide thatan individual is in, it is evident that the ACA requires severalimprovements, which will ensure that the quality of healthcare isimproved. However, this cannot be done by ignoring the benefits thathave been realized since the passage and implementation of ACA(Kovner and Knickman, 20). There is a need for a bipartisan look atthe healthcare concerns and adequate measures taken to ensure thatthe costs of healthcare match the quality.

Thehealthcare system in the US has been generalized, and individuals areassumed to have similar healthcare problems hence compromising on thequality of healthcare services offered to each patient. Specifically,Epstein, Ronald and Richard (100) state that patient-centered carehas been ignored under the ACA, which is the reason behind thelow-quality services that are offered to the Americans when theyvisit the healthcare facilities. The ACA has repeatedly used termssuch as “patient-centeredness, patient satisfaction, patientexperience of care, patient engagement, and shared decision-making”(Epstein, Ronald, and Richard, 101). However, this is not the caseconsidering that no freedom is given to the citizens to choose thecover that suits their healthcare needs. The Institute of Medicine(IOM) proposes that one of the aims of any 21st-century healthcaresystem is to provide a patient-centered healthcare. As such,according to Epstein et al. (1489), it is of importance that patientsare given the opportunity to purchase their healthcare covers thatwould be most suitable for their needs and which would ensure thatthey do not worry about paying more for any extra services that arenot included in their coverage. The classification of healthcareproblems and then generalizing them has been a big disappointment, asit has not helped in improving healthcare quality.

Americanshave been denied the right to choose their most suitable healthcarecovers, which has reduced competition in the provision of healthcarecovers and hence compromising healthcare quality. According to thepresident of Avalere, Dan Mendelson “Nearly 36 percent of exchangemarket rating regions may have only one participating insurancecarrier offering plans for the 2017 plan year and there may be somesub-region counties where no plans are available&quot (Schansberg,5). This underlies the problem that exists when there is nocompetition regarding the companies that offer healthcare coverage.Epstein et al. (1489) suggest that the exit of some big healthcareinsurance companies such as Aetna, Humana United, and Healthcare withonly a few companies remaining to be the ones solely responsible forthe provision of healthcare services has monopolized the insurancemarket. According to Schansberg (6), any market that lackscompetition is likely to be redundant and even offer products of lowquality. The health insurance sector is no exception as it has led todecreased concern for quality due to lack of competition, as thecitizens have to choose only between Medicare and Medicaid.Schansberg (6) adds that there are no public insurance exchanges,which would create a competitive environment, and eventually each ofthe insurance companies would better the quality of their services sothat they do not lose their customers. As such, competition inhealthcare coverage provision is critical but has been barred by theACA, which only requires citizens to take healthcare coverage fromMedicare and Medicaid and then private insurance.

Thecosts of healthcare in the US have not been cheap as this is hard tosay considering that the level of competition is very low.Contentions that the implementation of ACA has led to reduced costsof healthcare services and increased the number of people under theinsurance covers are overrated (Tom, 1). This is not easy to proveconsidering that the government spends a lot of money in thehealthcare sector. Specifically, the US government spent $3 trillionin 2014, which was a rise from the expenditure of the previous year(2013) by 5.3%. These amounts paid in 2014 constituted to 17.5% ofthe Gross National Product (GDP) (Kovner and Knickman, 19). Thesecosts were shared between Medicare, Medicaid, and other privatehealth insurances. Specifically, Medicare spent 20% of the totalnational health expenditure while Medicaid spends 16% and 33% wasspent on private health insurance (Kovner and Knickman, 20). The restwas spent in hospital expenses, physicians, and clinical services aswell as the purchase of prescribed drugs. Proponents of thisincreased expenditure state that it is justified because it has ledto increased healthcare coverage. However, they do not look at theservices offered Vis a Vis the cost of those services. Compromisingon the quality of healthcare is very dangerous considering that thehealth of the people affects their productivity and hence the economyof the country. As such, the costs of healthcare in the US have growndue to lack of competition as only a few companies offer healthcareinsurance.

Theabsence of the deployment of the current technology in the UShealthcare sector has been the reason as to why the quality ofhealthcare has not matched that of other countries such as Japan.Specifically, in the view of Squires (5), despite the high costs ofliving in Japan compared to the US, the country provides one of themost comprehensive health insurance covers in the world.Additionally, Squires (6) states that the Japanese governmentprovides comprehensive healthcare to all its citizens and the peopleare not required to acquire the healthcare covers or the employers topay for the covers of their employees. The citizens cater for 30 % ofthe total costs of insurance while the government pays for theremaining 70% (Squires, 8). Additionally, the costs of the coverageare very low regarding the premiums. Compared to the Japanesehealthcare coverage system, the US coverage is an embarrassment.Japan uses the state of art equipment for the treatment of diseasessuch as cancer as well as the screening of people to ensure that theyare free of some conditions. As such, the amounts that the citizenscontributes to their healthcare is justified because of the qualityhealthcare services offered. Strategists argue that it isinappropriate to compare Japan with the United States as the twocountries have a different number of people and different economies.However, Squires (10) argues that this is just a scapegoat that ismeant to justify the poor quality healthcare services in the US. Theuse of technology is healthcare is imperative for any country thatintended to improve the quality of healthcare services.

TheUnited States has made improvements on some of the quality measuresof healthcare such as mortality rates related to healthcare, and therates of secondary infections in healthcare facilities however, ithas worsened in improving the health-related quality of life.Specifically, Schansberg (5) posits that the healthy days of thecitizens, as well as the days in which the daily activities ofindividuals are interrupted by poor health, have been on the rise. Onsome health quality measures, some first world countries haveoutperformed the United States (Schansberg, 6). Specifically, thelife expectancy at birth of Canada is high than that of US.Additionally, the cost-related barriers to health access are morethan those of Japan are. According to the Kaiser Family FoundationAnalysis of OECD (2013), the US cannot boast of having the besthealthcare system in the world despite it having the largest economyin the world ahead of China. Arguments have been raised to the effectthat those who are not happy with the leadership of Obama havedownplayed the benefits of Obamacare. However, this cannot bejustified as the comparison of healthcare quality is done based onfigures as opposed to the regime in power. Additionally, having apolitical view on an issue as important as healthcare would be acolossal mistake.

Inconclusion, the provision of quality healthcare is one of theresponsibilities of any democratic and legitimately electedgovernment. The American citizens had an expectation that the passageof the Affordable Care Act was a guarantee to improved healthcareservices. However, this has not been the case despite the hugenational expenditures that have been directed at the healthcaresector. Although the ACA implementation has led to increased coveragethrough the Medicare and Medicaid programs, it has failed to improvethe quality of life of the people. The mortality rates of children atbirth are even lower than those of Canada are. Additionally, comparedto Japan, the US healthcare quality is very low. This is becauseinstead of focusing on the improvement of healthcare quality, the twomain parties: the Democrats and the Republicans are playing politicalgames with the issue of healthcare. The losers here are the citizenswho still have to pay taxes but get poor quality health services. Assuch, there is a need for the repealing of various sections of ACA sothat healthcare can be patient-centered and that the patients can begiven, the freedom to choose the healthcare insurance cover thatsuits their healthcare concerns. Additionally, the healthcareinsurance industry should be opened to competition instead of givinga few companies the responsibility of providing the insuranceservices. This way, the health care quality would improve due tocompetition.


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