Question

The Affordable Care Act is the expansion of socialized medicine beyond traditional Medicare and Medicaid. Should the United States adopt a universal health care policy like that of other industrialized nations?

Answer 1

Ans-

aims of the Affordable Care Act (ACA) were to increase health insurance coverage for those under age 65, improve the performance of the health care delivery system, and slow cost growth. Less recognized are the provisions of the law that seek to strengthen the Medicare program.

The ACA addresses gaps in Medicare preventive and prescription drug benefits. It initiates ambitious testing of new payment methods to improve the value of care received by beneficiaries and, indirectly, all Americans. And it substantially extends the solvency of the Medicare Health Insurance Trust Fund by slowing the growth of future Medicare outlays.

By moving Medicare away from fee-for-service payment and by holding health care providers accountable for both the quality and total cost of care, certain ACA reforms have the potential to reshape not just the Medicare program but the entire U.S. health care system. For example, the law’s creation of the Center for Medicare and Medicaid Innovation (CMMI) will enable Medicare to test innovative models of provider payment and service delivery and expand those that demonstrate promise to improve beneficiary outcomes and patient experiences of care or lower cost. The projects initiated by the CMMI are just now beginning to produce results; significant work remains to identify and spread successful payment innovations.

The ACA also makes important changes to the Medicare Advantage (MA) program, through which enrollees can choose to receive their Medicare benefits from private plans. Payment rates to MA plans are to be constrained until those plans are on a par with traditional Medicare, though financial rewards are available for plans achieving high performance ratings. These changes are intended to provide incentives for MA plans to improve quality and patients’ health care experiences and encourage beneficiaries to choose plans with higher quality and lower cost.

While these new policies strengthen Medicare, they were not intended to address some of the serious challenges facing Medicare in the future. Without additional changes, the retirement of the post–World War II generation will cause total Medicare outlays to outpace growth in the economy, claim an increasing share of the federal budget, and exceed the revenues currently dedicated to the Medicare program.

As currently configured, Medicare benefits do not adequately address the financial and health care needs of future beneficiaries—particularly the poorest and sickest among them. Traditional Medicare’s benefit design reflects the fragmented nature of health care delivery, with separate hospital, physician, and prescription drug benefits adding to the complexity, administrative cost, and difficulty of coordinating care. The predominantly fee-for-service provider payment system used by traditional Medicare, and by most MA plans, provides no incentive to eliminate duplicative or ineffective care, coordinate care, or substitute lower-cost care alternatives—and in effect penalizes providers who do so. This mismatch between benefits and needs will be an increasing source of concern as families struggle with out-of-pocket costs, serious health conditions, and inadequate options for caring for family members with physical and cognitive functional impairments.

While the ACA’s reforms hold significant potential to make Medicare more viable and successful in the future, Medicare’s long-term fiscal solvency, complexity, and gaps in coverage remain unaddressed. As millions of Americans age into Medicare, federal budgetary pressures will inevitably focus attention on more fundamental reform of the program

Universal health care is a system

that provides quality medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay. The sheer cost of providing quality health care makes universal health care a large expense for governments.Most universal health care is funded by general income taxes or payroll taxes.

The United States is the only one of the 33 developed countries that doesn’t have universal health care.2 But its health delivery system does have specific components, such as Medicare, Medicaid, and the Department of Veterans Affairs, that provide universal health care to specific populations.

Advantages

• Lowers overall health care costs: The government controls the prices through negotiation and regulation.
• Lowers administrative costs: Doctors only deal with one government agency. For example, U.S. doctors spend four times as much as Canadians dealing with insurance companies.
• Forces hospitals and doctors to provide the same standard of service at a low cost: In a competitive environment like the United States, health care providers must also focus on profit. They do this by offering the newest technology. They offer expensive services and pay doctors more. They try to compete by targeting the wealthy.
• Creates a healthier workforce: Studies show that preventive care reduces the need for expensive emergency room usage.Without access to preventive care, 46% of emergency room patients went because they had no other place to go.5 They used the emergency room as their primary care physician. This health care inequality is a big reason for the rising cost of medical care.
• Early childhood care prevents future social costs: These include crime, welfare dependency, and health issues. Health education teaches families how to make healthy lifestyle choices, preventing chronic diseases.
• Governments can impose regulations and taxes to guide the population toward healthier choices: Regulations make unhealthy choices, such as drugs, illegal. Sin taxes, such as those on cigarettes and alcohol, make them more expensive.

• Disadvantages

• Healthy people pay for others' medical care: Chronic diseases make up 90% of health care costs.The sickest 5% of the population create 50% of total health care costs, while the healthiest 50% only create 3% of costs.
• People have less financial incentive to stay healthy: Without a copay, people might overuse emergency rooms and doctors.
• There are long wait times for elective procedures: The government focuses on providing basic and emergency health care.
• Doctors may cut care to lower costs if they aren't well paid by cost-cutting governments: For example, doctors report Medicare payment cuts will force them to close many in-house blood testing labs.