American medicine is admired and respected by many in the world. The United States has the best hospitals with well-trained, highly skilled, and innovative doctors. It produces the lion’s share of the most significant advances in biomedical research (Sultz & Young, 2010, p.38). Ironically, the same country “has constructed a health-care system that is wasteful, inefficient, increasingly irrational – and unsustainably expensive” (Staff of the Washington Post, 2010. p.65).
The country spends a fortune on medical care, and yet it still lags behind other nations in several major categories that define a healthy country. The USA devotes about 17 percent of its GDP to health care, an amount that is far more than any other developed nation. Nonetheless, citizens do not receive the health care they need (Barr, 2011, p. 5). This is the flawed system that the Patient Protection and Affordable Care Act of 2010 seeks to overhaul.
The proposed health care cover
The legislation will cost nearly $1 trillion over its first 10 years, which seeks to pay for the taxes, industry fees, and spending cuts (Sultz & Young, 2010, p.357). It is the largest expansion to cover the social safety net in more than four decades, providing greater economic security to millions of poor and working-class families. Its impact will be felt in almost every aspect of the American health care system. Albeit for all its scope, the law is a relatively moderate and incremental document – evolutionary, not revolutionary. The aim of the ACA is not to substitute the existing system that is founded on private health insurance with a government-controlled system such as the Medicare system in Canada (Pipes, 2010, p.9). It will not do away or change the system of insurance provided by the employer as some options had proposed. It, however, seeks to expand the number of people covered and commence the work of cutting down expenditures by developing the existing system of private insurance (Nather, 2010, p.9).
Helping Americans get affordable and adequate health insurance stands as the aim of the ACA. The law will, if Congress’ budget analysts turn out to be right, lead to coverage for 32 million more people in the U.S., starting in 2014 (Nather, 2010. p13). The law does not quite strive for universal coverage but tries to make the biggest dent in the country’s uninsured population that the government has ever attempted in a single step. If the legislation works, 95 percent of U.S. citizens and other legal residents will have insurance within six years (Barr, 2011, p.323). The strategies of ACA are to cover those people unable to get or afford medical cover for their employer since the employer cannot afford it, or because it is too dear- or due to their unemployment status or even self-employment (Sultz & Young, 2010, p.278).
Provisions tackled in Affordable care Act
One of the important provisions tackled in the Affordable Care Act is the one that addresses the appropriate use of medical technology and other high-cost medical care. “ACA establishes a national Patient-Centered Outcomes Research Institute (PCORI). PCORMI is structured as an independent, non-profit organization” (Barr, 2011, p.68). It will have a nationally representative board of governors, a series of national advisory panels, and a staff of experienced researchers. With funds from ACA, PCORMI will either carry out or arrange to have conducted a sequence of research studies that compare existing alternatives for diagnosis or treatment (Nather, 2010, p. 124).
ACA is explicit in requiring that comparative effectiveness research provides recommendations for the optimal approach of care, but does not create mandates as to how specific conditions should be approached. Similarly, CER results are not to be used to determine insurance coverage or payment for differing approaches to care (Sultz & Young, 2010, p.326).
Another provision that is of interest concerns the expansion of primary care delivery. ACA shifts funding for graduate medical education away from programs that train specialists and redirects it to programs that train primary care physicians (Staff of the Washington Post, 2010, p.190). It also provides for new types of primary care training programs that are based in community settings rather than the traditional hospital setting.
These teaching health centers will represent collaborations between academic training centers and nonprofit, federally certified community clinics (Nather, 2010, p.147). ACA provides for increased payment for primary care services. Since 2011, the federal Medicare program has been providing a 10 percent bonus payment to primary care physicians who treat Medicare beneficiaries. As of 2013, primary care physicians who treat Medicaid patients will see their payment rate, historically substantially lower than Medicare rates, raised to the same rate as that paid by Medicare (Barr, 2011, p.324).
The Affordable Care Act provides increased federal funding for the National Health Service Corps and other programs that provide repayment of educational loans for primary care physicians practicing typically in rural areas and inner cities, which have documented medical manpower shortages (Pipes, 2010, p.50). The legislation also provides substantially increased support for a new model of organizing primary care: the patient-centered medical home (PCMH) (Sultz & Young, 2010, p.123).
The PCMH will involve a team of providers, including physicians, allied professionals such as nursed practitioners or physician’s assistants, as well as support personnel with a range of professional skills. This team approach will be supported by an electronic health record system that will enable providers to access the records of a patient’s health care and facilitate ongoing quality assessments of the care provided to patients (Nather, 2010, p.166).
Barr, D. (2011). Introduction to U.S policy health policy: The organization, financing and delivery of health care in America. New York, USA: JHU Press.
Nather, D. (2010). The new health care system: Everything you need to know. Washington DC, USA: St. Martin’s Press.
Pipes, S. (2010). The truth about Obamacare. New York, USA: Regnery Gateway.
The staff of the Washington Post. (2010). Landmark: The inside story of America’s new health care law and what it means for us all. Washington DC, USA: Public Affairs.
Sultz, H. A, & Young, K. M. (2010). Health care the USA. New York, USA: Jones & Bartlett.