Healthcare Reform in the United States: Difficult Road

Author(s):  
G. Zeveleva

The article focuses on a healthcare reform, one of the pillars of Barack Obama’s presidency. The author argues that the reform was driven by social considerations, and the goal was to make the American healthcare system more just by implementing universal mandatory health insurance. The author analyses how implementation of Obama’s reform has turned into an arduous process, and why the enactment of some of its regulations were postponed. The article examines why some of the new regulations have already begun to function, while others are due to begin in 2018 and 2020. In 2014 the reform entered its critical phase, as its most controversial element on mandatory health insurance for all Americans came into effect. Failure to comply is met with the fine, while citizens with low incomes can rely on state support. Opponents of the reform are still undertaking efforts to eliminate the universal health insurance requirement. The author comes to the conclusion that despite the challenges Obama has already made the pages of history as the president who succeeded in implementing universal health insurance. One of his greatest achievements has been the triumph over many of the healthcare reform’s opponents as he wrote the reform into law in the spring of 2010. All previous attempts to reform the national system had been met with failure due to conservative resistance. The controversy around this topic stems from many Americans’ understanding of fundamental values. The central point of debate is not about the American healthcare system, but rather about what kind of country the United States of America will be in the 21st Century. Democrats believe that the reform will make the country more just, while their opponents fear that the USA will turn into a welfare state with less freedom and more control of federal authority.

1992 ◽  
Vol 18 (1-2) ◽  
pp. 1-13 ◽  
Author(s):  
Daniel Callahan

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.


2015 ◽  
Vol 55 (3-4) ◽  
pp. 413-447 ◽  
Author(s):  
Aasim I. Padela

This paper compares the discursive frames utilised by several national American Muslim organisations to craft an “Islamic” argument for healthcare reform via an expansion of health insurance coverage in the United States with Islamic ethico-legal opinions (fatwas) of U.S.-based jurists regarding the permissibility of purchasing health insurance. I analyse the differing ways in which these producers of “Islamic bioethics” material ground their arguments and draw on vocabulary from other discourses. The paper closes by reflecting upon the socio-political undercurrents that may contribute to the differences and disconnections between the ways in which these bioethics stakeholders produce their outputs and by arguing that further developing the field of Islamic bioethics will require concerted multidisciplinary engagements that clarify the distinctive nature of Islamic norms.



2018 ◽  
Vol 48 (3) ◽  
pp. 568-585 ◽  
Author(s):  
Ashley Fox ◽  
Roland Poirier

Described as “universal prepayment,” the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. Policy debates about single-payer or national health insurance in the United States and abroad have relied heavily on Canada’s system as an ideal-typical single-payer system but have not systematically examined health system performance indicators across different universal coverage models. Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.


2018 ◽  
Vol 6 (3) ◽  
pp. 190-204
Author(s):  
John Hoornbeek ◽  
Bethany Lanese ◽  
Mutlaq Albugmi ◽  
Joshua Filla

The Affordable Care Act (ACA) was subjected to repeated repeal and replace efforts in the United States Congress in 2017. Attempts to repeal and replace the law failed, but penalties for not complying with its mandate that individuals purchase health insurance were removed in tax legislation passed late in the year and administrative actions taken by President Trump yielded additional concerns about the stability of the law’s reform approach and the expanded health insurance access that it created. This article explores public advocacy efforts by key interest groups from three major policy sectors—health providers, the insurance industry, and the business community—that had served as an “axis of opposition” to past American healthcare reform efforts. It identifies resource and incentive policy feedback effects that appear likely to influence these groups due to design features of the ACA and assesses whether patterns of advocacy efforts in 2017 are consistent with what might be expected if these design features had their predicted effects. Our assessment reveals patterns of interest group advocacy that are consistent with what might be expected to arise from resource and incentive based policy feedback effects, and interest group political dynamics that differ from what was in place prior to passage of the ACA. It also reveals advocacy patterns that are not well explained by resource and incentive based policy feedback effects, and—in so doing—yields insights that are relevant to the design of policy reforms and future research.


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