The core values St. Leo’s represents is applicable to the debate surrounding the ACA. St. Leo represents and firmly believes in community and integrity. The ACA is reportedly designed to provide for the welfare of the community, meaning Americans at large. The issue surrounding the ACA is that many say the provisions lack integrity due to various different reasons. Regardless of these issues, integrity is often defined as doing the right thing, even when no one is watching. World leaders and policy makers have a responsibility to maintain integrity to benefit the communities in which they live, whether it is a small community or it is the global community, it is everyone’s responsibility to leave it a better place. I am grateful I have the opportunity to study at a university that will help me prepare to influence the lives of other people for the better. I believe that policy decisions are very tricky to discuss because all legislature is designed to make someone else better off and to protect them; the debate is always around what is morally right and wrong and how people are affected. It is possible to produce a piece of legislation that is morally wrong but provides for the greater good. By utilizing the principle of respect, people can have open and honest debates about what the best way forward is, what is morally right, and what can provide for the common good of the community. It is important to note this because it helps demonstrate that the core values of St. Leo are very important in all fields and professions, even politics. It also shows that these core values can reach a large audience and better the lives of many people.
The Affordable Care Act, otherwise known as the ACA, caused a landmark shift in the way that the American government interacted with the healthcare system. Previously, the government provided healthcare funding through Medicare and Medicaid funding. These programs provided funds for the poor, disabled, and the elderly to receive adequate healthcare. These programs did not adequately address the issue of the rising cost of healthcare in the US, important as these rising costs forced the government to provide more funding to make ends meet. The ACA was meant to address this by spreading the cost to all tax-paying citizens by leveraging a tax on citizens who did not purchase health insurance through government set up marketplaces. The US government continued to provide subsidies to low-income families to help them pay for the cost of the product. In addition, the ACA mandated that companies provide insurance to their full-time employees when the company employs fifty or more people. Since its inception there has been considerable debate about the detriments and benefits of the ACA in regards to raising the standard of living for citizens, it is unlikely that the ACA will continue to exist in its present form.
The stakeholders involved in the ACA involve the purchasers of the insurance, or customers; other stakeholders are the pharmaceutical companies, doctors/healthcare providers, the insurance companies, and the US government. Each group has a very different role to play in providing quality care. According to the ACA, the government has the ability to set up online insurance marketplaces that consumers can use to find the best insurance policy for their children. In addition, the government has the responsibility for funding the subsidies provided to low-income families. The US government does this by increasing taxes to distribute the costs. The consumer picks the product that they want on the marketplace by utilizing the competitive pricing on the marketplace. The pharmaceutical companies have received increased business by the increase in insurance coverage, and this has affected the pricing of the companies and the resulting insurance premium costs. Doctors and healthcare providers have received increased business as a result of the higher coverage levels, and insurance providers have to increase their services to cover the costs associated with higher levels of business. Thus, the ACA has affected numerous different groups that play an important factor in the healthcare industry.
The ACA was heavy politicized because of the fact that the policy affected all Americans; history has shown us that various welfare programs that can affect such a large group of people often enable more people to participate in politics (Zhang, 2012). The ACA was no different, and America saw increased political participation as a result. The two main political parties took opposing sides in the debate. Democrats claimed that government mandated insurance would increase the standard of living for all Americans by spreading the cost among tax payers. Republicans claimed that the ACA was unconstitutional because it forces consumers to purchase a product and imposing a tax if that product is not bought. Admittedly, some of the opposition resorted to fear mongering, like Alaska governor Sarah Palin, who claimed that Obama was setting up death panels to decide who would receive coverage and who would not (Gitterman & Scott, 2011).
The biggest controversy surrounding the ACA is the fact that every citizen must buy health insurance. Republicans consider this unconstitutional because of the tax levied on those who do not purchase the product. This has been called by many a “tax on breathing”, and is the primary reason it is viewed as unconstitutional. The Supreme Court decided that the ACA was only constitutional because it was levied as a tax, causing further discrepancies in the political system. The continued decision on the part of the US Supreme Court to uphold the ACA in very narrow numbers (often 5-4 decisions) has led many on the opposition to claim that cases surrounding the ACA are cases of judicial activism rather than an actual interpretation of the US Constitution.
Complicating the way the ACA is viewed is the fact that sizable numbers of senior citizens believe that the ACA will decrease Medicare funding (Gitterman & Scott, 2011). The provisions of the bill actually increase the Medicare Trust Fund, which demonstrates that there is an information gap occurring. The plan actually allows Medicare receivers to switch to private insurance plans rather than receive money from the government. This, along with the rest of the programs features, is designed to put the quality of care on the service providers and not the government and insurance providers (Davis, Guterman, & Bandeali, 2015).
The ACA also allows for states to increase their Medicaid funding, though a 2012 ruling by the Supreme Court allows these states to opt out of the program. These states have a very low insured rate for the low-income in their constituency. This means a lot of people remain uninsured, which is a hotbed of debate. The American left claims that this is a travesty, but the American right does not believe in the provisions and expansion of the ACA regardless, so there is a disconnect between the two groups as neither side appears to understand the arguments of the other side.
Republicans will likely to continue to fight to remove the ACA from the law books, and every conservative candidate running for national office has vowed to fight to remove it. As Republicans currently hold the majority in both houses of Congress, it is looking like it will be possible to for this political party to achieve their goals. Democrats continue to support the ACA as the most efficient solution to the healthcare mess that permeates the American system. However, the Republicans do have a source of support for their position: data. Healthcare costs have only risen since the inception of the ACA, which is a reflection of what they increased demand for health insurance has done to the pricing. Millions of Americans were promised that they would be able to keep their current health insurers at the same rate that they had before the passage of the ACA; unfortunately for many, the Obama administration was unable to keep this promise due to most basic economic theories that govern how industries and markets work.
The Obama administration and many other professionals claimed that this price change was bound to happen as the dramatic increase in consumer demand would directly cause a reciprocal shift in the actual prices. Thus, the promises the ACA made at the outset of the program were not able to be kept, and this has provided significant fuel for the opposition to expand upon and exploit. The more moderate Republicans have relied on addressing this issue and the fact of rising healthcare costs as suitable reasons for why the ACA should not remain the law.
The ACA directly allows for higher pharmaceutical costs as well. This plays on the relationship pharmaceuticals have already established with health care providers, as the corruption that is rampant in the healthcare fields is slowly becoming more well-known. The monopolistic competition the small number of pharmaceutical companies have over the American market allow them to price gouge at will; in addition, there are many doctors who have been apprehended testing patients for diseases they do not have because it generates more money for the doctor and insurance typically covers the cost. This has enabled pharmaceutical companies to raise their prices and insurance premiums are artificially raised because of monopolistic competition and doctors overcharging insurance companies. The ACA has only provided a means for these companies to continue to do so by mandating US citizens purchase health insurance.
The ACA is reducing competition on the healthcare market because big insurers are able to artificially lower their prices to force out smaller competitors (Newkirk, 2016). In addition, premiums have risen dramatically because younger people are not enrolling in the program in significant numbers to spread out the cost of the program. There are also a high number of short-term insurance options that are not meant to provide long-term care, and that is affecting youth enrollment. Because the market is not competitive in the long-run and the American youth is not enrolling in the program, seniors and the disabled serve to lose a lot on the ACA market.
In some higher risk insurance plans, up to twenty percent of insured consumers have failed to pay the first premium on their respective plans (Newkirk, 2016). This has led to considerable turmoil on the market, and it implies that the ACA is not as affordable as it would seem. This is being reduced as time goes on and the program settles into a consistent pattern, but it is very possible that the high prices that are a result of constant shifts on the market will continue due to the fact that less than twenty million Americans are enrolled in the program; future shifts can be expected as more and more Americans are drawn into the ACA. These issues have provided the right in American politics with a strong argument.
The American left wing often cites the increased number of insured Americans as the best reason to support the ACA. Indeed, the ACA has increased the amount of insured Americans receiving access to better healthcare. In addition, the ACA prevents insurance providers from denying service to people with preexisting conditions coverage, which often happened before the ACA’s passage. Some Democrats believe that the ACA has not gone far enough to ensure Americans are receiving coverage at a fair price. Many are unsatisfied with the ACA and believe America should switch to a single-payer healthcare system.
Under a single-payer healthcare system, everyone is taxed but receives healthcare coverage through the government, which pays a third party to provide healthcare. Single-payer healthcare systems are the norm in Europe, and the system is considered socialistic in nature. These countries also have a significantly lower cost of healthcare, often under half the cost of American coverage. However, it is important to note that a single-payer system would not solve the problem of the high cost of healthcare in America. The cost of American healthcare is not a result of the ACA and the sheer number of people in the market, though this does influence it. The cost of healthcare is a complex function of the high cost of education (doctors paying student loans), the expensive nature of the services provided in America, and the cost of living in certain areas. Medicine costs significantly more in America, increasing the cost substantially. A single-payer healthcare system would not solve this fact. Only ending the monopolistic pricing by increasing competition in the pharmaceutical industry. This can be performed by creating new businesses, or by allowing free trade between the United States and other countries with a comparative advantage in medicine products, like Denmark and Canada.
The ACA did significantly alter the way the disabled received care because insurance providers were prevented from discriminating against them by denying service. However, the ACA does not stop insurance providers from using price discrimination to raise the premiums of the consumers. Thus, disabled citizens will still be charged a higher premium, and the US government is expected to foot the bill. Under a single-payer healthcare system, this price-discrimination would not exist. People pay into the system based on their income and not their policy. In addition, everyone would receive full coverage. Therefore, to address price discrimination, the US government could switch to a single-payer healthcare system. Alternatively, the government could remove the ACA and expand Medicaid/Medicare in order to better provide coverage for this consumer group. This way, the government is not forcing citizens to purchase a product, which is keeping with the concept of integrity (a significant portion of Congress holds shares in healthcare industries). By removing the ACA and increasing Medicaid/Medicare funding, the Americans can save in the long run. However, the youth are unlikely to purchase health insurance which means premiums will be higher than they would be otherwise.
The problem with a single-payer healthcare system is that it does nothing for preventing moral hazard. Moral hazard refers to a situation where people put themselves in harm’s way because they have no stake in the game, referring to the fact that they do not have to suffer any negative financial pitfalls because they choose to go to the doctor. Those who serve in the US military receive complete medical coverage as a result of the American government’s efforts to incentivize service and to make the service more efficient by protecting its troops; however, this free service has had very serious detrimental effects. In order to make an appointment on an on-base provider, it can take several weeks to be treated. Naturally, this is because it is free and people have no financial loss to offset going to the doctor. Thus, the single-payer healthcare could very well result in the same phenomena in America. The ACA insurance policies still involve a copay, and so would just expanding Medicaid and Medicare. This establishes a significant drawback to single-payer health care.
The biggest question policy makers must determine is the role of the government. Is it the government’s job to provide for the basic external necessities, like providing a military to protect against foreign invasion, or should the government actively work to better the lives of its citizens? Is it moral to take money from richer Americas and use it to provide for those with lesser incomes? At this time, I believe the answer is no, though it will benefit the community as a whole. Thus, while single-payer healthcare would probably provide a significantly higher standard of living for Americans, it may not be the moral choice for America to make due to fact that funding it requires taking money from wealthier Americans. Some believe the wealthier Americans have a moral obligation to pay more; this point is n important
A moral option does exist for Americans to pursue. The ACA was originally designed to reduce the cost of healthcare in America, but it has only provided Americans with an alternate means to pay for it through spreading the cost of it among all Americans through forcing them onto the American market. This has not reduced the cost of healthcare in the least. Rather, the American government should remove the ACA and expand Medicaid/Medicare coverage. As the original need for the ACA has not been met, an alternate should be found. The government needs to open free trade agreements with other nations to pressure American pharmaceutical companies to lower their price for life saving medicine. This will mean American companies do not make as large a profit as they used to, but the savings will better the standard of living for all citizens. Healthcare is also very high because of the excessive administration costs associated with figuring out payments between the many different insurers, etc (Epstein, 2015). The government and businesses can reduce the administrative costs by negotiating as a third party between healthcare providers and patients, as is done in other single-payer countries. By simply reducing the sheer expense of healthcare costs, the US will not need to change its healthcare laws, or force consumers to buy a product.
There have been a few minor external threats to the US healthcare system. These include the Ebola scare and the current issue with the Zika virus. These two diseases have caused American officials to review the system’s capacity to treat a large scale epidemic that the world has faced before. Nations did not have adequate healthcare systems to address the Spanish Flu epidemic. If a major epidemic were to strike the US as the Zika virus is poised to do, the US healthcare system as it currently stands would be unable to protect low-income families from the ravages of a serious disease. Other than the potential of an international epidemic that has always been a significant worry, there are no serious external threats to the way the US handles its healthcare.
There are several technologies that are changing the face of healthcare in America. The Scripps Institute is developing sensors that patients can wear that will track whether or not its wearer is experiencing a heart attack or not (Morrissey, 2015). The XPrize Foundation is holding a competition to find a more timely and efficient method of diagnosing patients in an effort to save money for healthcare providers. 3-D printing is also transforming healthcare because it enables doctors to reproduce simulations of a specific patient and enact a specific procedure before ever performing it on a patient. 3-D printing is also being used to create artificial limbs such as ears to replace lost appendages, which is a remarkable advancement. Another very important technology in development is the use of nanotechnology in artificial limbs; biomedical engineers from North Carolina State University are developing germ fighting nanotechnology to fight against infectious diseases that could afflict patients who receive prosthetics. This and the other technological advancements reflect the serious developments that are occurring in the medical field, but it also demonstrates how healthcare costs are rising, as these developments cost money.
Thus, there are considerable threats to the ACA that will depend on the political situation in America. Americas would be better served if the cost of healthcare in the country was severely reduced and Medicaid and Medicare were expanded on rather than the country switch to a single-payer healthcare system. However, either option is preferable to the situation that the ACA has left America in. Both sides in American politics believe they occupy the moral high ground. Once both sides come together and open an honest dialogue, the America legislators can draft a bill that will alleviate the financial burden of healthcare while providing quality services to the community.
References:
Epstein, L. (2015). 6 reasons healthcare is so expensive in the U.S. In Investopedia. Retrieved from http://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp
Davis, K., Guterman, S., & Bandeali, F. (2015, June 9). The affordable care act and medicare. Retrieved August 30, 2016, from http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare-affordable-care-act
Gitterman, D. P., & Scott, J. C. (2011). “Obama lies, grandma dies”: The uncertain politics of medicare and the patient protection and affordable care act. Journal of Health Politics, Policy and Law, 36(3), 555–563. doi:10.1215/03616878-1271252
Morrissey, J. (2015, April 14). The medical technologies that are changing health care. Retrieved August 31, 2016, from HHH Mag, http://www.hhnmag.com/articles/3580-the-medical-technologies-that-are-changing-health-care
Newkirk, V. R. (2016, June 15). The less affordable care act? The Atlantic. Retrieved from http://www.theatlantic.com/politics/archive/2016/06/obamacare-exchanges-premium-increases/486674/
Zhang, B. B. (2012). Affordable care act: What we don’t talk about when we talk about politics. Retrieved August 30, 2016, from Yale, http://isps.yale.edu/node/21451#.V8XLOZgrKM8
