Healthcare policy experts and pundits have discussed the role of government in healthcare and
how the federal government’s reach has expanded over the years, perhaps most exponentially
with the passage of the Affordable Care Act of 2010 (ACA). The appropriateness of government’s
expanded role has been mightily debated with strongly held opinions from both sides of the
political aisle. “Still, the government, with extensive programs and market influence, is likely to
play a major role in achieving better quality and value in health care and in the success or failure
of lasting healthcare reform (Straube, 2013).” Straube (2013) noted that studies have researched
the role government can play in the management of healthcare costs and have presented several
arguments and, although views on the value and appropriateness of government involvement
may differ, there is consensus that government is a major stakeholder in combating rising
healthcare costs. The National Prevention, Health Promotion and Public Health Council
established under Title IV of the ACA issued a report in 2011 titled, “National Prevention
Strategy” outlining a vision of a medical community that worked “together to improve the health
and quality of life for individuals, families, and communities by moving the nation from a focus on
sickness and disease to one based on prevention and wellness” which outlined four strategic
directions: building safe community environments, expanding preventative services, empowering
people to make healthy choices, and eliminating health disparities (Straube, 2013). The report
also detailed specific actions to which the federal government would commit along with
evidence-based actions that stakeholders could implement to complement federal activities
(Straube, 2013).
The Centers for Medicare and Medicaid (CMS), as the largest payer for healthcare services in the
country, has the capability to aggregate large volumes of data from across the nation and
leverage the data to develop evidence-based recommendations for interventions that incentivize
quality improvement and accountability, and elimination of waste in the system. With centralized
data resources information can be used to set benchmarks and targets for improvement, and
monitor progress toward goals, both nationally and locally (Straube, 2013). Additionally, data can
be used to support and drive value-based purchasing decisions, pay-for-performance incentives,
shared-savings programs, accountable care organizations and medical homes, as well as penalties
for failure to meet goals or achieve targets (Straube, 2013). Using results from comparative-
effectiveness research and cost-effective analysis, CMS can balance promotion of technology
innovation with avoidance of wasteful/unnecessary technology, treatments, pharmaceuticals,
devices and medical services (Straube, 2013).
Whether federal efforts to improve efficiency in the healthcare system will succeed remains an
unanswered question. Healthcare costs continue to rise, and the U.S. continues to spend more on
healthcare as a share of the economy than any other advanced nation. Perhaps the best role that
the federal government can play is a data aggregator. In our federal republic, the states might
play a larger role in reducing the rate of spending increase over time; however, to do so they
must change the behaviors of payers, providers and consumers in their borders by improving
competition using policy strategies around anti-trust regulation to combat market consolidation
which often leads to an increase in prices (Chernew, Cutler, & Shah, 2021). Chernew, Culter and
Shah (2021) reported that states may pursue a variety of strategies to control spending growth,
ranging from promoting competition, reducing prices through regulation, and designing
incentives to reduce utilization of low-value care to more holistic approaches like broad payment
reform. Meaningful policy action to control spending and increase efficiency in the health system
is more likely to occur at the state and local level where community organizations cooperate to
achieve common goals, and where local health system improvements can benefit from public and
philanthropic investments (Klein, Hostetter, & McCarthy, 2017). State and local health policy
makers can play a central role in supporting those efforts (Chernew, Cutler, & Shah, 2021).
References
Barry Straube, M. (2013, January 1). A role for government - an observation on federal healthcare
efforts in prevention. The American Journal of Preventative Medicine, 44(1, Supplement
1), S39-S42. doi:https://doi.org/10.1016/j.amepre.2012.09.009
Chernew, M., Cutler, D., & Shah, S. (2021, August 18). Reducing heath care spending: what tools
can states leverage? Retrieved May 5, 2022, from The Commonwealth Fund:
https://www.commonwealthfund.org/publications/fund-reports/2021/aug/reducing-
health-care-spending-what-tools-can-states-leverage
Klein, S., Hostetter, M., & McCarthy, D. (2017, September 26). All heatlh care is local, revisited:
what does it take to improve? Retrieved May 5, 2022, from The Commonwealth Fund:
https://www.commonwealthfund.org/publications/other-publication/2017/sep/all-
health-care-local-revisited-what-does-it-take-improve
