20.4 Comparative health and medicine  (Page 2/10)

Why are so many people uninsured or underinsured? Skyrocketing health care costs are part of the issue. Many people cannot afford private health insurance, but their income level is not low enough to meet eligibility standards for government supported insurance. Further, even for those who are eligible for Medicaid, the program is less than perfect. Many physicians refuse to accept Medicaid patients, citing low payments and extensive paperwork (Washington University Center for Health Policy N.d.).

Health care in the United States is a complex issue, and it will only get more so with the continued enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. This Act, sometimes called “ObamaCare” for its most noted advocate, President Barack Obama, represents large-scale federal reform of the United States’ health care system. Most of the provisions of the Act will take effect by 2014, but some were effective immediately on passage. The PPACA aims to address some of the biggest flaws of the current health care system. It expands eligibility to programs like Medicaid and CHIP, helps guarantee insurance coverage for people with pre-existing conditions, and establishes regulations to make sure that the premium funds collected by insurers and care providers go directly to medical care. It also includes an individual mandate    , which requires everyone to have insurance coverage by 2014 or pay a penalty. A series of provisions, including significant subsidies, are intended to address the discrepancies in income that are currently contributing to high rates of uninsurance and underinsurance.

The PPACA has been incredibly contentious. Private insurance companies have been among the strongest opponents of the law. But many Americans are also concerned that the PPACA will actually result in their medical bills increasing. In particular, some people oppose the individual mandate on the grounds that the federal government should not require them to have health care. A coalition of 26 states and the National Federation of Independent Businesses brought suit against the federal government, citing a violation of state sovereignty and concerns about costs of administering the program.

Health care elsewhere

Clearly, health care in the United States has some areas for improvement. But how does it compare to health care in other countries? Many Americans are fond of saying that this country has the best health care in the world, and while it is true that the United States has a higher quality of care available than many peripheral or semi-peripheral nations, it is not necessarily the “best in the world.” In a report on how American health care compares to that of other countries, researchers found that the United States does “relatively well in some areas—such as cancer care—and less well in others—such as mortality from conditions amenable to prevention and treatment” (Docteur and Berenson 2009).