History of health care reform in the United States
Encyclopedia
The issue of health insurance reform in the United States has been the subject of political debate since the early part of the 20th century. Recent reforms remains an active political issue. Alternative reform proposals were offered by both of the two major candidates in the 2008 presidential election
.
, which would have established asylums for the indigent insane, as well as the blind, deaf, and dumb, via federal land grants to the states. This bill was proposed by activist Dorothea Dix
, which passed both houses of congress, but was vetoed by president Franklin Pierce
. Pierce argued that the federal government should not commit itself to social welfare, which he believed was properly the responsibility of the states.
Pierce's veto was seen as a landmark in social welfare legislation in the United States, the veto establishing federal non-participation in social welfare for over 70 years, until the New Deal
legislation of the 1930s, in the context of the Great Depression
.
, who had the support of progressive
health care reformers in the 1912 election but was defeated. During the Great Depression
in 1933, Franklin D. Roosevelt
asked Isidore Falk and Edgar Sydenstricter to help draft provisions to Roosevelt's pending Social Security
legislation to include publicly funded health care programs. These reforms were attacked by the American Medical Association
as well as state and local affiliates of the AMA as "compulsory health insurance." Roosevelt ended up removing the health care provisions from the bill in 1935. Fear of organized medicine's opposition to universal health care
became standard for decades after the 1930s.
Following the second world war, President Harry Truman called for universal health care as a part of his Fair Deal
in 1949 but strong opposition stopped that part of the Fair Deal. However, in 1946 the National Mental Health Act
was passed, as was the Hospital Survey and Construction Act, or Hill-Burton Act
.
The Medicare
program was established by legislation signed into law on July 30, 1965, by President Lyndon B. Johnson. Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are either age 65 and over, or who meet other special criteria.
In his 1974 State of the Union address
, President Richard M. Nixon called for comprehensive health insurance. On February 6, 1974, he introduced the Comprehensive Health Insurance Act. Nixon's plan would have mandated employers to purchase health insurance for their employees, and provided a federal health plan, similar to Medicaid, that any American could join by paying on a sliding scale based on income. The New York Daily News wrote that Ted Kennedy
rejected the universal health coverage plan offered by Nixon because it wasn't everything he wanted it to be. Kennedy later realized it was a missed opportunity to make major progress toward his goal.
Former President Jimmy Carter wrote in 1982 that Kennedy’s disagreements with Carter's proposed approach thwarted Carter’s efforts to provide a comprehensive health-care system for the country.
The Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA) amended the Employee Retirement Income Security Act
of 1974 (ERISA) to give some employees the ability to continue health insurance
coverage after leaving employment.
headed up by First Lady Hillary Clinton; however, the 1993 Clinton health care plan was not enacted into law. The Health Insurance Portability and Accountability Act
of 1996 (HIPAA) made it easier for workers to keep health insurance coverage when they change jobs or lose a job, and also provided national standards for protecting personal health information.
The "Health Security Express" was a bus tour that started the end of July 1994. It involved supporters of President Clinton's national health care reform. Several buses leaving from different points in the United States, such as Portland, Oregon, and Boston, Mass crossed the country and stopped in many cities along their way to their final destination at the White House in Washington, DC on August 3, 1994. During these stops, each of the bus riders would talk about their personal experiences, health care disasters and why they felt it was important for all Americans to have health insurance. When the Health Security Express bus tour ended, all of the riders were greeted by President Clinton and the First Lady on the White House South lawn for a rally on Wednesday, August 3, 1994 which was broadcast all over the world by many international networks including C-SPAN.
and the American Hospital Association
(AHA) on a "strange bedfellows" proposal intended to seek common ground in expanding coverage for the uninsured.
In 2001, a Patients' Bill of Rights
was debated in Congress, which would have provided patients with an explicit list of rights concerning their health care. This initiative was essentially taking some of ideas found in the Consumers' Bill of Rights
and applying it to the field of health care. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the health care industry. Standardizing the nature of health care institutions in this manner proved rather provocative. In fact, many interest groups, including the American Medical Association
(AMA) and the pharmaceutical industry came out vehemently against the congressional bill. Basically, providing emergency medical care to anyone, regardless of health insurance status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the biggest stumbling blocks for this bill. As a result of this intense opposition, the Patients' Bill of Rights
initiative eventually failed to pass Congress
in 2002.
As president, Bush
signed into law the Medicare Prescription Drug, Improvement, and Modernization Act
which included a prescription drug plan for elderly and disabled Americans.
During the 2004 presidential election
, both the George Bush
and John Kerry
campaigns offered health care proposals. Bush's proposals for expanding health care coverage were more modest than those advanced by Senator Kerry. Several estimates were made comparing the cost and impact of the Bush and Kerry proposals. While the estimates varied, they all indicated that the increase in coverage and the funding requirements of the Bush plan would both be lower than those of the more comprehensive Kerry plan.
In 2006 the HIAA's successor organization, America's Health Insurance Plans (AHIP), issued another set of reform proposals.
In January 2007 Rep. John Conyers
, Jr. (D-MI) has introduced The United States National Health Care Act (HR 676) in the House of Representatives
. As of October 2008, HR 676 has 93 co-sponsors. Also in January 2007, Senator Ron Wyden introduced the Healthy Americans Act
(S. 334) in the Senate
. As of October 2008, S. 334 had 17 cosponsors.
Also in 2007, AHIP issued a proposal for guaranteeing access to coverage in the individual health insurance market and a proposal for improving the quality and safety of the U.S. health care system.
"Economic Survey of the United States 2008: Health Care Reform" by the Organisation for Economic Co-operation and Development
, published in December 2008, said that:
In December 2008, the Institute for America's Future together with the chairman of the Ways and Means Health Subcommittee Pete Stark launched a proposal from Jacob Hacker who is co-director of the U.C. Berkeley School of Law Center on Health that in essence said that the government should offer a public health insurance plan
to compete on a level playing field with private insurance plans. This was said to be the basis of the Obama/Biden plan. The argument is based on three basic arguments. Firstly public plans success at managing cost control (Medicare medical spending rose 4.6% p.a. compared 7.3% for private health insurance on a like-for-like basis in the 10 years from 1997–2006). Secondly public insurance has better payment and quality-improvement methods based on its large databases, new payment approaches, and care-coordination strategies. Thirdly it can set a standard against which private plans must compete which would help unite the public around the principle of broadly shared risk while building greater confidence in government over the long term.
Also in December 2008, America's Health Insurance Plans (AHIP) announced a set of proposals which included setting a national goal to reduce the projected growth in health care spending by 30%. AHIP said that if this goal were achieved, it would result in cumulative five-year savings of $500 billion. Among the proposals was the establishment of an independent comparative effectiveness entity that compares and evaluates the benefits, risks, and incremental costs of new drugs, devices, and biologics. An earlier "Technical Memo" published by AHIP in June 2008 had estimated that a package of reforms involving comparative effectiveness research, health information technology (HIT), medical liability reform, "pay-for-performance" and disease management and prevention could reduce U.S. national health expenditures "by as much as 9 percent by the year 2025, compared with current baseline trends."
John McCain
's proposals focused on open-market competition rather than government funding. At the heart of his plan were tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan."
Barack Obama
called for universal health care
. His health care plan called for the creation of a National Health Insurance Exchange
that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.
The Philadelphia Inquirer
reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance." The Des Moines Register characterized the plans similarly.
A poll released in early November, 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.
On May 5, 2009, US Senate Finance Committee held hearings on Health care reform. On the panel of the "invited stakeholder", no supporter of the Single-payer health care
system was invited. The panel featured Republican senators
and industry panelists who argued against any kind of expanded health care coverage. The preclusion of the single payer option from the discussion caused significant protest by doctors in the audience.
There is one bill currently before Congress but others are expected to be presented soon. A merged single bill is the likely outcome. The Affordable Health Choices Act is currently before the House of Representatives and the main sticking points at the markup stage of the bill have been in two areas; should the government provide a public insurance plan option to compete head to head with the private insurance sector, and secondly should comparative effectiveness research be used to contain costs met by the public providers of health care. Some Republicans have expressed opposition to the public insurance option believing that the government will not compete fairly with the private insurers. Republicans have also expressed opposition to the use of comparative effectiveness research to limit coverage in any public sector plan (including any public insurance scheme or any existing government scheme such as Medicare), which they regard as rationing by the back door. Democrats have claimed that the bill will not do this but are reluctant to introduce a clause that will prevent, arguing that it would limit the right of the DHHS to prevent payments for services that clearly do not work. America's Health Insurance Plans, the umbrella organization of the private health insurance providers in the United States has recently urged the use of CER to cut costs by restricting access to ineffective treatments and cost/benefit ineffective ones. Republican amendments to the bill would not prevent the private insurance sectors from citing CER to restrict coverage and apply rationing of their funds, a situation which would create a competition imbalance between the public and private sector insurers. A proposed but not yet enacted short bill with the same effect is the Republican sponsored Patients Act 2009
.
On June 15, 2009, the U.S. Congressional Budget Office
(CBO) issued a preliminary analysis of the major provisions of the Affordable Health Choices Act. The CBO estimated the ten-year cost to the federal government of the major insurance-related provisions of the bill at approximately $1.0 trillion. Over the same ten-year period from 2010 to 2019, the CBO estimated that the bill would reduce the number of uninsured Americans by approximately 16 million. At about the same time, the Associated Press
reported that the CBO had given Congressional officials an estimate of $1.6 trillion for the cost of a companion measure being developed by the Senate Finance Committee. In response to these estimates, the Senate Finance Committee delayed action on its bill and began work on reducing the cost of the proposal to $1.0 trillion, and the debate over the Affordable Health Choices act became more acrimonious. Congressional Democrats were surprised by the magnitude of the estimates, and the uncertainty created by the estimates has increased the confidence of Republicans who are critical of the Obama Administration's approach to health care.
However, in a June New York Times
editorial, economist Paul Krugman
argued that despite these estimates universal health coverage is still affordable. "The fundamental fact is that we can afford universal health insurance--even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."
In contrast to earlier advocacy of a publicly-funded health care
program, in August 2009 Obama administration officials announced they would support a health insurance cooperative
in response to deep political unrest amongst Congressional Republicans and amongst citizens in town hall meetings held across America. However, in a June 2009 NBC News
/Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance."
During the summer of 2009, members of the "Tea Party" protested against proposed health care reforms. Former insurance PR
executive Wendell Potter
of the Center for Media and Democracy
- whose funding comes from groups such as the Tides Foundation- argue that the hyperbole generated by this phenomenon is a form of corporate astroturfing
, which he says that he used to write for CIGNA
. Opponents of more government involvement, such as Phil Kerpen of Americans for Prosperity
- whose funding comes mainly from the Koch Industries
corporation counter-argue that those corporations oppose a public-plan
, but some try to push for government actions that will unfairly benefit them, like employer mandates
forcing private companies to buy health insurance. Journalist Ben Smith
has referred to mid-2009 as "The Summer of Astroturf" given the organizing and coordinating efforts made by various groups on both pro- and anti-reform sides.
, Massachusetts
and Connecticut
, with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet
plan to provide quality, affordable health care to state residents. The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked primary-care physicians who were already in short supply in Massachusetts. Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health care providers using what is generally characterized as a charity care
scheme; New Jersey
is perhaps the best example of a state that employs the latter strategy.
Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California
in 1994, Massachusetts
in 2000, and Oregon
in 2002. The state legislature of California has twice passed SB 840, The Health Care for All Californians Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger
(R) vetoed the bill, once in 2006 and again in 2008.
The percentage of residents that are uninsured varies from state to state. Texas
has the highest percentage of residents without health insurance at 24%. New Mexico
has the second highest percentage of uninsured at 22%.
States play a variety of roles in the health care system including purchasers of health care and regulators of providers and health plans, which give them multiple opportunities to try to improve how it functions. While states are actively working to improve the system in a variety of ways, there remains room for them to do more.
One municipality, San Francisco, California
, has established a program to provide health care to all uninsured residents (Healthy San Francisco
).
In July 2009, Connecticut
passed into law a plan called SustiNet
, with the goal of achieving health-care coverage of 98% of its residents by 2014. The SustiNet law establishes a nine-member board to recommend to the legislature, by January 1, 2011, the details of and implementation process for a self-insured health care plan called SustiNet. The recommendations must address (1) the phased-in offering of the SustiNet plan to state employees and retirees, HUSKY A and B beneficiaries, people without employer-sponsored insurance (ESI) or with unaffordable ESI, small and large employers, and others; (2) establishing an entity that can contract with insurers and health care providers, set reimbursement rates, develop medical homes for patients, and encourage the use of health information technology; (3) a model benefits package; and (4) public outreach and ways to identify uninsured citizens. The board must establish committees to make recommendations to it about health information technology, medical homes, clinical care and safety guidelines, and preventive care and improved health outcomes. The act also establishes an independent information clearinghouse to inform employers, consumers, and the public about SustiNet and private health care plans and creates task forces to address obesity, tobacco usage, and health care workforce issues. The effective date of the SustiNet law was July 1, 2009 for most provisions.
United States presidential election, 2008
The United States presidential election of 2008 was the 56th quadrennial presidential election. It was held on November 4, 2008. Democrat Barack Obama, then the junior United States Senator from Illinois, defeated Republican John McCain, the senior U.S. Senator from Arizona. Obama received 365...
.
19th century
One of the earliest health care proposals at the federal level was the 1854 Bill for the Benefit of the Indigent InsaneBill for the Benefit of the Indigent Insane
The Bill for the Benefit of the Indigent Insane was proposed legislation that would have established asylums for the indigent insane, and also blind, deaf, and dumb, via federal land grants to the...
, which would have established asylums for the indigent insane, as well as the blind, deaf, and dumb, via federal land grants to the states. This bill was proposed by activist Dorothea Dix
Dorothea Dix
Dorothea Lynde Dix was an American activist on behalf of the indigent insane who, through a vigorous program of lobbying state legislatures and the United States Congress, created the first generation of American mental asylums...
, which passed both houses of congress, but was vetoed by president Franklin Pierce
Franklin Pierce
Franklin Pierce was the 14th President of the United States and is the only President from New Hampshire. Pierce was a Democrat and a "doughface" who served in the U.S. House of Representatives and the Senate. Pierce took part in the Mexican-American War and became a brigadier general in the Army...
. Pierce argued that the federal government should not commit itself to social welfare, which he believed was properly the responsibility of the states.
Pierce's veto was seen as a landmark in social welfare legislation in the United States, the veto establishing federal non-participation in social welfare for over 70 years, until the New Deal
New Deal
The New Deal was a series of economic programs implemented in the United States between 1933 and 1936. They were passed by the U.S. Congress during the first term of President Franklin D. Roosevelt. The programs were Roosevelt's responses to the Great Depression, and focused on what historians call...
legislation of the 1930s, in the context of the Great Depression
Great Depression
The Great Depression was a severe worldwide economic depression in the decade preceding World War II. The timing of the Great Depression varied across nations, but in most countries it started in about 1929 and lasted until the late 1930s or early 1940s...
.
First plans
U.S. efforts to achieve universal coverage began with Theodore RooseveltTheodore Roosevelt
Theodore "Teddy" Roosevelt was the 26th President of the United States . He is noted for his exuberant personality, range of interests and achievements, and his leadership of the Progressive Movement, as well as his "cowboy" persona and robust masculinity...
, who had the support of progressive
Progressivism in the United States
Progressivism in the United States is a broadly based reform movement that reached its height early in the 20th century and is generally considered to be middle class and reformist in nature. It arose as a response to the vast changes brought by modernization, such as the growth of large...
health care reformers in the 1912 election but was defeated. During the Great Depression
Great Depression
The Great Depression was a severe worldwide economic depression in the decade preceding World War II. The timing of the Great Depression varied across nations, but in most countries it started in about 1929 and lasted until the late 1930s or early 1940s...
in 1933, Franklin D. Roosevelt
Franklin D. Roosevelt
Franklin Delano Roosevelt , also known by his initials, FDR, was the 32nd President of the United States and a central figure in world events during the mid-20th century, leading the United States during a time of worldwide economic crisis and world war...
asked Isidore Falk and Edgar Sydenstricter to help draft provisions to Roosevelt's pending Social Security
Social Security (United States)
In the United States, Social Security refers to the federal Old-Age, Survivors, and Disability Insurance program.The original Social Security Act and the current version of the Act, as amended encompass several social welfare and social insurance programs...
legislation to include publicly funded health care programs. These reforms were attacked by the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
as well as state and local affiliates of the AMA as "compulsory health insurance." Roosevelt ended up removing the health care provisions from the bill in 1935. Fear of organized medicine's opposition to universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
became standard for decades after the 1930s.
Following the second world war, President Harry Truman called for universal health care as a part of his Fair Deal
Fair Deal
The Fair Deal was the term given to an ambitious set of proposals put forward by United States President Harry S. Truman to the United States Congress in his January 1949 State of the Union address. The term, however, has also been used to describe the domestic reform agenda of the Truman...
in 1949 but strong opposition stopped that part of the Fair Deal. However, in 1946 the National Mental Health Act
National Mental Health Act
On July 3, 1946, Harry Truman signed the National Mental Health Act, which called for the establishment of a National Institute of Mental Health. The first meeting of the National Advisory Mental Health Council was held on August 15...
was passed, as was the Hospital Survey and Construction Act, or Hill-Burton Act
Hill-Burton Act
The Hospital Survey and Construction Act is a U.S. federal law passed in 1946, during the 79th United States Congress...
.
The Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
program was established by legislation signed into law on July 30, 1965, by President Lyndon B. Johnson. Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are either age 65 and over, or who meet other special criteria.
In his 1974 State of the Union address
State of the Union Address
The State of the Union is an annual address presented by the President of the United States to the United States Congress. The address not only reports on the condition of the nation but also allows the president to outline his legislative agenda and his national priorities.The practice arises...
, President Richard M. Nixon called for comprehensive health insurance. On February 6, 1974, he introduced the Comprehensive Health Insurance Act. Nixon's plan would have mandated employers to purchase health insurance for their employees, and provided a federal health plan, similar to Medicaid, that any American could join by paying on a sliding scale based on income. The New York Daily News wrote that Ted Kennedy
Ted Kennedy
Edward Moore "Ted" Kennedy was a United States Senator from Massachusetts and a member of the Democratic Party. Serving almost 47 years, he was the second most senior member of the Senate when he died and is the fourth-longest-serving senator in United States history...
rejected the universal health coverage plan offered by Nixon because it wasn't everything he wanted it to be. Kennedy later realized it was a missed opportunity to make major progress toward his goal.
Former President Jimmy Carter wrote in 1982 that Kennedy’s disagreements with Carter's proposed approach thwarted Carter’s efforts to provide a comprehensive health-care system for the country.
The Consolidated Omnibus Budget Reconciliation Act of 1985
Consolidated Omnibus Budget Reconciliation Act of 1985
The Consolidated Omnibus Budget Reconciliation Act of 1985 is a law passed by the U.S. Congress on a reconciliation basis and signed by President Reagan that, among other things, mandates an insurance program giving some employees the ability to continue health insurance coverage after leaving...
(COBRA) amended the Employee Retirement Income Security Act
Employee Retirement Income Security Act
The Employee Retirement Income Security Act of 1974 is an American federal statute that establishes minimum standards for pension plans in private industry and provides for extensive rules on the federal income tax effects of transactions associated with employee benefit plans...
of 1974 (ERISA) to give some employees the ability to continue health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
coverage after leaving employment.
Clinton initiative
Health care reform was a major concern of the Bill Clinton administrationPresidency of Bill Clinton
The United States Presidency of Bill Clinton, also known as the Clinton Administration, was the executive branch of the federal government of the United States from January 20, 1993 to January 20, 2001. Clinton was the first Democratic president since Franklin D. Roosevelt to win a second full term...
headed up by First Lady Hillary Clinton; however, the 1993 Clinton health care plan was not enacted into law. The Health Insurance Portability and Accountability Act
Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act of 1996 was enacted by the U.S. Congress and signed by President Bill Clinton in 1996. It was originally sponsored by Sen. Edward Kennedy and Sen. Nancy Kassebaum . Title I of HIPAA protects health insurance coverage for workers and their...
of 1996 (HIPAA) made it easier for workers to keep health insurance coverage when they change jobs or lose a job, and also provided national standards for protecting personal health information.
The "Health Security Express" was a bus tour that started the end of July 1994. It involved supporters of President Clinton's national health care reform. Several buses leaving from different points in the United States, such as Portland, Oregon, and Boston, Mass crossed the country and stopped in many cities along their way to their final destination at the White House in Washington, DC on August 3, 1994. During these stops, each of the bus riders would talk about their personal experiences, health care disasters and why they felt it was important for all Americans to have health insurance. When the Health Security Express bus tour ended, all of the riders were greeted by President Clinton and the First Lady on the White House South lawn for a rally on Wednesday, August 3, 1994 which was broadcast all over the world by many international networks including C-SPAN.
Bush era debates
In 2000 the Health Insurance Association of America (HIAA) partnered with Families USAFamilies USA
Families USA is an American non-profit consumer health-care advocacy organization. It was co-founded by attorney Ronald Pollack, its current executive director, and Philippe Villers, the organization's current President....
and the American Hospital Association
American Hospital Association
The American Hospital Association is an organization that promotes the quality provision of health care by hospitals and health care networks through such efforts as promoting effective public policy and providing information related to health care and health administration to health care...
(AHA) on a "strange bedfellows" proposal intended to seek common ground in expanding coverage for the uninsured.
In 2001, a Patients' Bill of Rights
U.S. Patients' Bill of Rights
A Patient's Bill of Rights is a statement of the rights to which patients are entitled as recipients of medical care. Typically, a statement articulates the positive rights which doctors and hospitals ought to provide patients, thereby providing information, offering fair treatment, and granting...
was debated in Congress, which would have provided patients with an explicit list of rights concerning their health care. This initiative was essentially taking some of ideas found in the Consumers' Bill of Rights
Consumer Bill of Rights
Before the mid-twentieth century, consumers were without rights with regard to their interaction with products and commercial producers. Consumers had little ground on which to defend themselves against faulty or defective products, or against misleading or deceptive advertising methods.By the...
and applying it to the field of health care. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the health care industry. Standardizing the nature of health care institutions in this manner proved rather provocative. In fact, many interest groups, including the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
(AMA) and the pharmaceutical industry came out vehemently against the congressional bill. Basically, providing emergency medical care to anyone, regardless of health insurance status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the biggest stumbling blocks for this bill. As a result of this intense opposition, the Patients' Bill of Rights
U.S. Patients' Bill of Rights
A Patient's Bill of Rights is a statement of the rights to which patients are entitled as recipients of medical care. Typically, a statement articulates the positive rights which doctors and hospitals ought to provide patients, thereby providing information, offering fair treatment, and granting...
initiative eventually failed to pass Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
in 2002.
As president, Bush
George W. Bush
George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....
signed into law the Medicare Prescription Drug, Improvement, and Modernization Act
Medicare Prescription Drug, Improvement, and Modernization Act
The Medicare Prescription Drug, Improvement, and Modernization Act is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.The MMA was signed by President George W...
which included a prescription drug plan for elderly and disabled Americans.
During the 2004 presidential election
United States presidential election, 2004
The United States presidential election of 2004 was the United States' 55th quadrennial presidential election. It was held on Tuesday, November 2, 2004. Republican Party candidate and incumbent President George W. Bush defeated Democratic Party candidate John Kerry, the then-junior U.S. Senator...
, both the George Bush
George W. Bush presidential campaign, 2004
This article is about the presidential campaign of George W. Bush, the former President of the United States and winner of the 2004 Presidential Election. See George W. Bush for a detailed biography and information about his full presidency, and George W. Bush presidential campaign, 2000 for a...
and John Kerry
John Kerry presidential campaign, 2004
The Presidential Campaign of John Kerry, U.S. Senator from Massachusetts and the nominee of the Democratic Party challenged Republican incumbent President George W. Bush in the U.S. presidential election on November 2, 2004. Ultimately, Kerry conceded defeat in the race in a telephone call to Bush...
campaigns offered health care proposals. Bush's proposals for expanding health care coverage were more modest than those advanced by Senator Kerry. Several estimates were made comparing the cost and impact of the Bush and Kerry proposals. While the estimates varied, they all indicated that the increase in coverage and the funding requirements of the Bush plan would both be lower than those of the more comprehensive Kerry plan.
In 2006 the HIAA's successor organization, America's Health Insurance Plans (AHIP), issued another set of reform proposals.
In January 2007 Rep. John Conyers
John Conyers
John Conyers, Jr. is the U.S. Representative for , serving since 1965 . He is a member of the Democratic Party...
, Jr. (D-MI) has introduced The United States National Health Care Act (HR 676) in the House of Representatives
United States House of Representatives
The United States House of Representatives is one of the two Houses of the United States Congress, the bicameral legislature which also includes the Senate.The composition and powers of the House are established in Article One of the Constitution...
. As of October 2008, HR 676 has 93 co-sponsors. Also in January 2007, Senator Ron Wyden introduced the Healthy Americans Act
Healthy Americans Act
The Healthy Americans Act , also known as the Wyden-Bennett Act, is a Senate bill that proposes to improve health care in the United States by transitioning away from how currently employers typically purchase their employees' health insurance for them, to having individuals purchase their own...
(S. 334) in the Senate
United States Senate
The United States Senate is the upper house of the bicameral legislature of the United States, and together with the United States House of Representatives comprises the United States Congress. The composition and powers of the Senate are established in Article One of the U.S. Constitution. Each...
. As of October 2008, S. 334 had 17 cosponsors.
Also in 2007, AHIP issued a proposal for guaranteeing access to coverage in the individual health insurance market and a proposal for improving the quality and safety of the U.S. health care system.
"Economic Survey of the United States 2008: Health Care Reform" by the Organisation for Economic Co-operation and Development
Organisation for Economic Co-operation and Development
The Organisation for Economic Co-operation and Development is an international economic organisation of 34 countries founded in 1961 to stimulate economic progress and world trade...
, published in December 2008, said that:
- Tax benefits of employer-based insurances should be abolished.
- The resulting tax revenues should be used to subsidize the purchase of insurance by individuals.
- These subsidies, "which could take many forms, such as direct subsidies or refundable tax credits, would improve the current situation in at least two ways: they would reach those who do not now receive the benefit of the tax exclusion; and they would encourage more cost-conscious purchase of health insurance plans and health care services as, in contrast to the uncapped tax exclusion, such subsidies would reduce the incentive to purchase health plans with little cost sharing."
In December 2008, the Institute for America's Future together with the chairman of the Ways and Means Health Subcommittee Pete Stark launched a proposal from Jacob Hacker who is co-director of the U.C. Berkeley School of Law Center on Health that in essence said that the government should offer a public health insurance plan
Public health insurance option
The public health insurance option is a proposed government-run health insurance agency which competes with other health insurance companies. It is not the same as Publicly-funded health care. Called the public insurance option or public option, for short, it was a proposed health insurance plan...
to compete on a level playing field with private insurance plans. This was said to be the basis of the Obama/Biden plan. The argument is based on three basic arguments. Firstly public plans success at managing cost control (Medicare medical spending rose 4.6% p.a. compared 7.3% for private health insurance on a like-for-like basis in the 10 years from 1997–2006). Secondly public insurance has better payment and quality-improvement methods based on its large databases, new payment approaches, and care-coordination strategies. Thirdly it can set a standard against which private plans must compete which would help unite the public around the principle of broadly shared risk while building greater confidence in government over the long term.
Also in December 2008, America's Health Insurance Plans (AHIP) announced a set of proposals which included setting a national goal to reduce the projected growth in health care spending by 30%. AHIP said that if this goal were achieved, it would result in cumulative five-year savings of $500 billion. Among the proposals was the establishment of an independent comparative effectiveness entity that compares and evaluates the benefits, risks, and incremental costs of new drugs, devices, and biologics. An earlier "Technical Memo" published by AHIP in June 2008 had estimated that a package of reforms involving comparative effectiveness research, health information technology (HIT), medical liability reform, "pay-for-performance" and disease management and prevention could reduce U.S. national health expenditures "by as much as 9 percent by the year 2025, compared with current baseline trends."
Debate in the 2008 presidential election
Both of the major party presidential candidates offered positions on health care.John McCain
John McCain
John Sidney McCain III is the senior United States Senator from Arizona. He was the Republican nominee for president in the 2008 United States election....
's proposals focused on open-market competition rather than government funding. At the heart of his plan were tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan."
Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
called for universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
. His health care plan called for the creation of a National Health Insurance Exchange
Health insurance exchange
A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance that is eligible for Federal subsidies...
that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.
The Philadelphia Inquirer
The Philadelphia Inquirer
The Philadelphia Inquirer is a morning daily newspaper that serves the Philadelphia, Pennsylvania, metropolitan area of the United States. The newspaper was founded by John R. Walker and John Norvell in June 1829 as The Pennsylvania Inquirer and is the third-oldest surviving daily newspaper in the...
reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance." The Des Moines Register characterized the plans similarly.
A poll released in early November, 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.
2009 reform debate
In March 2009 AHIP proposed a set of reforms intended to address waste and unsustainable growth in the current health care market. These reforms included:- An individual insurance mandate with a financial penalty as a quid pro quo for guaranteed issue
- Updates to the Medicare physician fee schedule;
- Setting standards and expectations for safety and quality of diagnostics;
- Promoting care coordination and patient-centered care by designating a "medical homeMedical homeThe medical home, also known as the patient-centered medical home , is defined as "a health care setting that facilitates partnerships between individual patients, and their personal providers, and when appropriate, the patient’s family". It is "an approach to providing comprehensive primary care...
" that would replace fragmented care with a coordinated approach to care. Physicians would receive a periodic payment for a set of defined services, such as care coordination that integrates all treatment received by a patient throughout an illness or an acute event. This would promote ongoing comprehensive care management, optimizes patients’ health status and assist patients in navigating the health care system - Linking payment to quality, adherence to guidelines, achieving better clinical outcomes, giving better patient experience and lowering the total cost of care.
- Bundled paymentBundled paymentBundled payment, also known as episode-based payment, episode payment, episode-of-care payment, case rate, evidence-based case rate, global bundled payment, global payment, package pricing, or packaged pricing, is defined as the reimbursement of health care providers "on the basis of expected...
s (instead of individual billing) for the management of chronic conditions in which providers would have shared accountability and responsibility for the management of chronic conditions such as coronary artery disease, diabetes, chronic obstructive pulmonary disease and asthma, and similarly - A fixed rate all-inclusive average payment for acute care episodes which tend to follow a pattern (even though some acute care episodes may cost more or less than this).
On May 5, 2009, US Senate Finance Committee held hearings on Health care reform. On the panel of the "invited stakeholder", no supporter of the Single-payer health care
Single-payer health care
Single-payer health care is medical care funded from a single insurance pool, run by the state. Under a single-payer system, universal health care for an entire population can be financed from a pool to which many parties employees, employers, and the state have contributed...
system was invited. The panel featured Republican senators
Republican Party (United States)
The Republican Party is one of the two major contemporary political parties in the United States, along with the Democratic Party. Founded by anti-slavery expansion activists in 1854, it is often called the GOP . The party's platform generally reflects American conservatism in the U.S...
and industry panelists who argued against any kind of expanded health care coverage. The preclusion of the single payer option from the discussion caused significant protest by doctors in the audience.
There is one bill currently before Congress but others are expected to be presented soon. A merged single bill is the likely outcome. The Affordable Health Choices Act is currently before the House of Representatives and the main sticking points at the markup stage of the bill have been in two areas; should the government provide a public insurance plan option to compete head to head with the private insurance sector, and secondly should comparative effectiveness research be used to contain costs met by the public providers of health care. Some Republicans have expressed opposition to the public insurance option believing that the government will not compete fairly with the private insurers. Republicans have also expressed opposition to the use of comparative effectiveness research to limit coverage in any public sector plan (including any public insurance scheme or any existing government scheme such as Medicare), which they regard as rationing by the back door. Democrats have claimed that the bill will not do this but are reluctant to introduce a clause that will prevent, arguing that it would limit the right of the DHHS to prevent payments for services that clearly do not work. America's Health Insurance Plans, the umbrella organization of the private health insurance providers in the United States has recently urged the use of CER to cut costs by restricting access to ineffective treatments and cost/benefit ineffective ones. Republican amendments to the bill would not prevent the private insurance sectors from citing CER to restrict coverage and apply rationing of their funds, a situation which would create a competition imbalance between the public and private sector insurers. A proposed but not yet enacted short bill with the same effect is the Republican sponsored Patients Act 2009
Patients Act 2009
The Patients Act 2009 is a bill set before the United States Congress in June 2009 which has been proposed by Senators Kyl and McConnell...
.
On June 15, 2009, the U.S. Congressional Budget Office
Congressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
(CBO) issued a preliminary analysis of the major provisions of the Affordable Health Choices Act. The CBO estimated the ten-year cost to the federal government of the major insurance-related provisions of the bill at approximately $1.0 trillion. Over the same ten-year period from 2010 to 2019, the CBO estimated that the bill would reduce the number of uninsured Americans by approximately 16 million. At about the same time, the Associated Press
Associated Press
The Associated Press is an American news agency. The AP is a cooperative owned by its contributing newspapers, radio and television stations in the United States, which both contribute stories to the AP and use material written by its staff journalists...
reported that the CBO had given Congressional officials an estimate of $1.6 trillion for the cost of a companion measure being developed by the Senate Finance Committee. In response to these estimates, the Senate Finance Committee delayed action on its bill and began work on reducing the cost of the proposal to $1.0 trillion, and the debate over the Affordable Health Choices act became more acrimonious. Congressional Democrats were surprised by the magnitude of the estimates, and the uncertainty created by the estimates has increased the confidence of Republicans who are critical of the Obama Administration's approach to health care.
However, in a June New York Times
The New York Times
The New York Times is an American daily newspaper founded and continuously published in New York City since 1851. The New York Times has won 106 Pulitzer Prizes, the most of any news organization...
editorial, economist Paul Krugman
Paul Krugman
Paul Robin Krugman is an American economist, professor of Economics and International Affairs at the Woodrow Wilson School of Public and International Affairs at Princeton University, Centenary Professor at the London School of Economics, and an op-ed columnist for The New York Times...
argued that despite these estimates universal health coverage is still affordable. "The fundamental fact is that we can afford universal health insurance--even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."
In contrast to earlier advocacy of a publicly-funded health care
Publicly-funded health care
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
program, in August 2009 Obama administration officials announced they would support a health insurance cooperative
Health insurance cooperative
A health insurance cooperative is a cooperative entity that has the goal of providing health insurance and is also owned by the people that the organization insures...
in response to deep political unrest amongst Congressional Republicans and amongst citizens in town hall meetings held across America. However, in a June 2009 NBC News
NBC News
NBC News is the news division of American television network NBC. It first started broadcasting in February 21, 1940. NBC Nightly News has aired from Studio 3B, located on floors 3 of the NBC Studios is the headquarters of the GE Building forms the centerpiece of 30th Rockefeller Center it is...
/Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance."
During the summer of 2009, members of the "Tea Party" protested against proposed health care reforms. Former insurance PR
Public relations
Public relations is the actions of a corporation, store, government, individual, etc., in promoting goodwill between itself and the public, the community, employees, customers, etc....
executive Wendell Potter
Wendell Potter
Wendell Potter is former Vice President of corporate communications at CIGNA, one of the United States' largest health insurance companies. In June 2009, he testified against the HMO industry in the U.S. Senate as a whistleblower....
of the Center for Media and Democracy
Center for Media and Democracy
The Center for Media and Democracy is a non-profit investigative reporting group. The CMD gives analysis and opinion on policies such as the economy, environment and national security...
- whose funding comes from groups such as the Tides Foundation- argue that the hyperbole generated by this phenomenon is a form of corporate astroturfing
Astroturfing
Astroturfing is a form of advocacy in support of a political, organizational, or corporate agenda, designed to give the appearance of a "grassroots" movement. The goal of such campaigns is to disguise the efforts of a political and/or commercial entity as an independent public reaction to some...
, which he says that he used to write for CIGNA
CIGNA
Cigna , headquartered in Bloomfield, Connecticut, is a global health services company, owing to its expanding international footprint and the fact that it provides administrative services only to approximately 80 percent of its clients...
. Opponents of more government involvement, such as Phil Kerpen of Americans for Prosperity
Americans for Prosperity
Americans for Prosperity is a Washington, D.C.–based political advocacy group. According to their literature, they promote economic policy that supports business, and restrains regulation by government...
- whose funding comes mainly from the Koch Industries
Koch Industries
Koch Industries, Inc. , is an American private energy conglomerate based in Wichita, Kansas, with subsidiaries involved in manufacturing, trading and investments. Koch also owns Invista, Georgia-Pacific, Flint Hills Resources, Koch Pipeline, Koch Fertilizer, Koch Minerals and Matador Cattle Company...
corporation counter-argue that those corporations oppose a public-plan
Publicly-funded health care
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
, but some try to push for government actions that will unfairly benefit them, like employer mandates
Health insurance mandate
A health insurance mandate is either an employer or individual mandate to obtain private health insurance, instead of a National Health Service or National Health Insurance.-United States:...
forcing private companies to buy health insurance. Journalist Ben Smith
Ben Smith (journalist)
Ben Smith is an American political journalist and blogger for the news outlet Politico, which was frequently cited during the 2008 presidential election. He formerly wrote for the Wall Street Journal Europe, the New York Sun, the New York Observer and wrote a political column for the New York Daily...
has referred to mid-2009 as "The Summer of Astroturf" given the organizing and coordinating efforts made by various groups on both pro- and anti-reform sides.
State and city reform efforts
A few states have taken serious steps toward universal health care coverage, most notably MinnesotaMinnesota
Minnesota is a U.S. state located in the Midwestern United States. The twelfth largest state of the U.S., it is the twenty-first most populous, with 5.3 million residents. Minnesota was carved out of the eastern half of the Minnesota Territory and admitted to the Union as the thirty-second state...
, Massachusetts
Massachusetts
The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010...
and Connecticut
Connecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
, with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet
SustiNet
SustiNet is a Connecticut health care plan passed into law in July, 2009. Its goal is to provide affordable health care coverage to 98% of Connecticut residents by 2014.-Provisions of the legislation:...
plan to provide quality, affordable health care to state residents. The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked primary-care physicians who were already in short supply in Massachusetts. Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health care providers using what is generally characterized as a charity care
Charity care
In the United States, charity care is health care provided for free or at reduced prices to low income patients. The percentage of doctors providing charity care dropped from 76% in 1996-97 to 68% in 2004-2005. Potential reasons for the decline include changes in physician practice patterns and...
scheme; New Jersey
New Jersey
New Jersey is a state in the Northeastern and Middle Atlantic regions of the United States. , its population was 8,791,894. It is bordered on the north and east by the state of New York, on the southeast and south by the Atlantic Ocean, on the west by Pennsylvania and on the southwest by Delaware...
is perhaps the best example of a state that employs the latter strategy.
Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
in 1994, Massachusetts
Massachusetts
The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010...
in 2000, and Oregon
Oregon
Oregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...
in 2002. The state legislature of California has twice passed SB 840, The Health Care for All Californians Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger
Arnold Schwarzenegger
Arnold Alois Schwarzenegger is an Austrian-American former professional bodybuilder, actor, businessman, investor, and politician. Schwarzenegger served as the 38th Governor of California from 2003 until 2011....
(R) vetoed the bill, once in 2006 and again in 2008.
The percentage of residents that are uninsured varies from state to state. Texas
Texas
Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...
has the highest percentage of residents without health insurance at 24%. New Mexico
New Mexico
New Mexico is a state located in the southwest and western regions of the United States. New Mexico is also usually considered one of the Mountain States. With a population density of 16 per square mile, New Mexico is the sixth-most sparsely inhabited U.S...
has the second highest percentage of uninsured at 22%.
States play a variety of roles in the health care system including purchasers of health care and regulators of providers and health plans, which give them multiple opportunities to try to improve how it functions. While states are actively working to improve the system in a variety of ways, there remains room for them to do more.
One municipality, San Francisco, California
San Francisco, California
San Francisco , officially the City and County of San Francisco, is the financial, cultural, and transportation center of the San Francisco Bay Area, a region of 7.15 million people which includes San Jose and Oakland...
, has established a program to provide health care to all uninsured residents (Healthy San Francisco
Healthy San Francisco
Healthy San Francisco is a program to subsidize medical care for certain uninsured residents of San Francisco. The program's stated objective is to bring universal health care to the city, but eligibility and services are limited, and the program website states that insurance "is always a better...
).
In July 2009, Connecticut
Connecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
passed into law a plan called SustiNet
SustiNet
SustiNet is a Connecticut health care plan passed into law in July, 2009. Its goal is to provide affordable health care coverage to 98% of Connecticut residents by 2014.-Provisions of the legislation:...
, with the goal of achieving health-care coverage of 98% of its residents by 2014. The SustiNet law establishes a nine-member board to recommend to the legislature, by January 1, 2011, the details of and implementation process for a self-insured health care plan called SustiNet. The recommendations must address (1) the phased-in offering of the SustiNet plan to state employees and retirees, HUSKY A and B beneficiaries, people without employer-sponsored insurance (ESI) or with unaffordable ESI, small and large employers, and others; (2) establishing an entity that can contract with insurers and health care providers, set reimbursement rates, develop medical homes for patients, and encourage the use of health information technology; (3) a model benefits package; and (4) public outreach and ways to identify uninsured citizens. The board must establish committees to make recommendations to it about health information technology, medical homes, clinical care and safety guidelines, and preventive care and improved health outcomes. The act also establishes an independent information clearinghouse to inform employers, consumers, and the public about SustiNet and private health care plans and creates task forces to address obesity, tobacco usage, and health care workforce issues. The effective date of the SustiNet law was July 1, 2009 for most provisions.
See also
- Health care reform in the United StatesHealth care reform in the United StatesHealth care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
- Health economicsHealth economicsHealth economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care...
- Health insurance exchangeHealth insurance exchangeA health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance that is eligible for Federal subsidies...
- Health insurance in the United StatesHealth insurance in the United StatesThe term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government...
- Health policy analysis
- Health care politicsHealth care politicsHealth policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific health care goals within a society." According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines...
- List of healthcare reform advocacy groups in the United States
- National health insuranceNational health insuranceNational health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law. It may be administered by the public sector, the private sector, or a combination of both...
- United States National Health Care Act