Volume 6, Issue 1, March 2020, Page: 24-30
Healthcare Reform in the U.S. Must Be Driven by Policy and Data, Not Politics and Ideology
Teresa Waters, Department of Health Management & Policy, University of Kentucky College of Public Health, Lexington, Kentucky, United States
Michael Karpf, Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, United States
Received: Feb. 21, 2020;       Accepted: Mar. 9, 2020;       Published: Mar. 31, 2020
DOI: 10.11648/j.jfmhc.20200601.15      View  99      Downloads  61
Background U.S. healthcare spending will reach 20% of GDP by 2026. Despite this spending, almost 14% of our under-65 population still lacks health insurance and out-of-pocket healthcare spending is high. To date, much of the healthcare reform debate has focused on who pays—the government, employers or individuals. Objective To review current healthcare reform issues and evidence. Method We address the questions of how much we pay, how we pay and what we receive for the money as a potential foundation for constructive dialogue. Results U.S. healthcare spending continues to exceed that of other countries, without offering universal coverage. Notwithstanding coverage expansions implemented under the Affordable Care Act, uninsurance rates have been rising. Rapid growth of high deductible plans has also significantly increased rates of underinsurance. There is very little evidence that specific policies or interventions employed to date will significantly reduce cost, especially under a fee for service system, where volume makes up for cuts. Global risk payments hold the greatest promise for real cost containment because they can drive true delivery system reform. Conclusion Meaningful, long-term healthcare reform cannot be successful until comprehensive, evidence-based policies that address healthcare costs are fully embraced and implemented.
Healthcare Reform, Healthcare Cost, U.S. Healthcare System, Access and Coverage
To cite this article
Teresa Waters, Michael Karpf, Healthcare Reform in the U.S. Must Be Driven by Policy and Data, Not Politics and Ideology, Journal of Family Medicine and Health Care. Vol. 6, No. 1, 2020, pp. 24-30. doi: 10.11648/j.jfmhc.20200601.15
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sisko AM, Keehan SP, Poisal JA, Cuckler GA, Smith SD, Madison AJ, et al. National Health Expenditure Projections, 2018–27: Economic And Demographic Trends Drive Spending And Enrollment Growth. Health Affairs. 2019; 38 (3): 491-501.
Witters D. U.S. Uninsured Rate Rises to Four-Year High Washington DC: Gallup; 2019 [Available from: https://news.gallup.com/poll/246134/uninsured-rate-rises-four-year-high.aspx.
Medicaid's Share of State Budgets. Medicaid and CHIP Payment and Access Commission; 2019.
What are tax expenditures and how are they structured. The Tax Policy Center’s Briefing Book a citizen’s guide to the fascinating (though often complex) elements of the federal tax system: Tax Policy Center; 2019.
OECD Data: Health [Internet]. 2020 [cited 01/15/2020]. Available from: http://www.oecd.org/health/.
Bradley EH, Elkins BR, Herrin J, Elbel B. Health and social services expenditures: associations with health outcomes. BMJ Qual saf. 2011; 20 (10): 826-31.
Claxton G, Rae M, Long M, Damico A, Whitmore H. The Kaiser Family Foundation Employer Health Benefits 2018 Annual Survey. 3 October 2018. 2018.
Chappell B, Dwyer C. Amazon, Berkshire Hathaway and JPMorgan Chase Launch New Health Care Company [Internet]: National Public Radio; 2018 January 30, 2018. Podcast.
National Health Expenditure Data Baltimore, MD: Centers for Medicare & Medicaid Services; 2018 [updated April 17, 2018. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html.
Health UDo, Human Services %J Washington DUDoH, Services H. The poverty guidelines updated periodically in the Federal Register. 2015; 42.
Hamel L, Norton M, Pollitz K, Levitt L, Claxton G, Brodie MJKFF. The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey. 2016.
Anderson GF, Reinhardt UE, Hussey PS, Petrosyan V. It's The Prices, Stupid: Why The United States Is So Different From Other Countries. Health Affairs. 2003; 22 (3): 89-105.
Kamal R, Cox C. How do healthcare prices and use in the U.S. compare to other countries: Kaiser Family Foundation; 2018.
Buntin MJ, Escarcé JJ, Goldman D, Kan H, Laugesen MJ, Shekelle P. Increased Medicare expenditures for physicians' services: what are the causes? INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2004 Feb; 41 (1): 83-94.
Schumock GT, Stubbings J, Hoffman JM, Wiest MD, Suda KJ, Rim MH, Tadrous M, Tichy EM, Cuellar S, Clark JS, Matusiak LM. National trends in prescription drug expenditures and projections for 2019. American Journal of Health-System Pharmacy. 2019 Aug 1; 76 (15): 1105-21.
Sarnak DO, Squires D, Kuzmak G, Bishop S. Paying for Prescription Drugs Around the World: Why is the U.S. an Outlier? Issue Brief (Commonw Fund). 2017; 2017: 1-14.
Casalino LP, Nicholson S, Gans DN, Hammons T, Morra D, Karrison T, et al. What Does It Cost Physician Practices To Interact With Health Insurance Plans? A new way of looking at administrative costs—one key point of comparison in debating public and private health reform approaches. Health Affairs 2009; 28 (Suppl1): w533-w43.
Himmelstein DU, Jun M, Busse R, Chevreul K, Geissler A, Jeurissen P, et al. A comparison of hospital administrative costs in eight nations: U.S. costs exceed all others by far. Health Affairs 2014; 33 (9): 1586-94.
Woolhandler S, Himmelstein DUJAoim. Single-payer reform: the only way to fulfill the president's pledge of more coverage, better benefits, and lower costs. Annals of Internal Medicine 2017; 166 (8): 587-8.
Health Cost Containment and Efficiencies. Denver, Colorado; 2010.
Association. NHA-F. The Challenge of Health Care Fraud. 2013 [Available from: https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx.
Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. New England Journal of Medicine. 1991; 324 (6): 370-6.
Danzon PM, Lillard LA. Settlement out of Court: The Disposition of Medical Malpractice Claims. The Journal of Legal Studies 1983; 12 (2): 345-77.
Gostin L. A Public Health Approach to Reducing ErrorMedical Malpractice as a Barrier. JAMA. 2000; 283 (13): 1742-3.
Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment. JAMA. 2005; 293 (21): 2609-17.
Waters TM, Budetti PP, Claxton G, Lundy JP. Impact of state tort reforms on physician malpractice payments. Health Affairs. 2007; 26 (2): 500-9.
The Lewin Group. Medicaid Managed Care Cost Savings—A Synthesis of 24 Studies. 2004.
Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. Changes in Health Care Spending and Quality 4 Years into Global Payment. New England Journal of Medicine. 2014; 371 (18): 1704-14.
“Implementing MACRA, " Health Affairs Health Policy Brief, 2017.
Araujo M. Understanding Minimum Car Insurance Requirements State-By-State List of Minimum Car Insurance Requirements: The Balance; 2019 [Available from: https://www.thebalance.com/understanding-minimum-car-insurance-requirements-2645473.
Claxton G, Rae M, Damico A, Young G, McDermott D, Whitmore H. Health Benefits In 2019: Premiums Inch Higher, Employers Respond To Federal Policy. Health Affairs. 2019; 38 (10): 1752-61.
Brook RH, Ware JE, Rogers WH, Keeler EB, Davies AR, Donald CA, et al. Does Free Care Improve Adults' Health? New England Journal of Medicine. 1983; 309 (23): 1426-34.
Austin JM, Jha AK, Romano PS, Singer SJ, Vogus TJ, Wachter RM, et al. National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Affairs. 2015; 34 (3): 423-30.
Blumberg L, Holahan J, Karpman M, Elmendorf C. Characteristics of the Remaining Uninsured: An Update. The Urban Institute; 2018 July.
Enthoven AC. The History and Principles of Managed Competition. Health affairs. 1993; 12 (suppl 1): 24-48.
Browse journals by subject