The Flawed System of American Health: The High Costs of Healthcare and Health Insurance

Introduction

• American healthcare costs are high and have complex origins.
• The American Medical Association initially opposed state-sponsored insurance.
• Medicare and Medicaid were introduced by President Lyndon B. Johnson.
• The Patient Protection and Affordable Care Act (ACA), or Obamacare, was introduced to address healthcare affordability and coverage.
• A solution proposed is a Department of Healthcare to regulate and organize the system.

California v. Texas Case

• In 2012, the ACA's mandate for health insurance was upheld by the Supreme Court.
• In 2017, the mandate penalty was removed, leading to lawsuits questioning its constitutionality.
• The Supreme Court ruled there was no standing to challenge the mandate.

Historical Framework of American Healthcare

Early Healthcare

• The American Medical Association (AMA) was founded in 1846 and reorganized in 1901.
• Early 20th century saw medical advancements and the beginning of insurance-type programs.
• Early commercial health insurance was uncommon and mostly provided locally or by labor unions.

The Great Depression

• The focus shifted from health insurance to programs like Social Security during the New Deal.
• AMA opposed health insurance but later accepted voluntary insurance.
• The Blue Cross and Blue Shield programs were created in the 1930s.

1950s to 1970s

• Hospital care costs doubled in the 1950s due to new medical practices.
• Medicare and Medicaid were introduced in 1965.
• Patient rights movements led to increased malpractice cases and defensive medicine.
• Focus shifted from prevention to treatment, increasing healthcare costs.

1990s to Early 2000s

• Chronic diseases became a significant focus, consuming 70% of healthcare spending.
• The rise of the internet and digitization impacted healthcare, including patient records.
• Direct-to-consumer pharmaceutical advertising increased.

The Affordable Care Act (ACA)

Overview

• Signed into law by President Obama in 2010 to expand coverage and patient rights.
• Key changes included insurance marketplaces, expanded Medicaid, and mandated insurance.

Impact

• By 2015, 22.8 million Americans were newly insured.
• Reduced uninsured rates by 40%.

Controversy

• Republicans and some Democrats opposed the ACA.
• Insurance plan cancellations and tax changes were major criticisms.
• Many states did not set up their own insurance exchanges or expand Medicaid.

Current Issues and Proposed Solutions

• High healthcare costs and uninsured rates persist.
• Proposed solution: Department of Healthcare to centralize and regulate the system.
• Centralization could reduce duplication of resources and regulate pricing.
• Insurance marketplaces and Medicaid expansion are part of the solution.

Conclusion

• America's healthcare issue is complex and requires a balanced approach.
• Government inaction and aggressive solutions like the ACA have limitations.
• Centralization and gradual reform may offer a path forward.