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Title: Politics and Healthcare System in US

Thesis: The healthcare delivery system in the US has undergone noticeable gradual improvements from the financing sector, insurance sector, delivery and quality sector even though many politicians politicize the gaps in healthcare for their own benefits with the pretense of initiating reforms to the sector.

I. Introduction

A. Politics started intervening in the healthcare sector between the years 1930 and 1960. Comment by James A Love: Were politics not involved in healthcare prior to the 1930s and 1960s? Be prepared to cite this assertion. What changed in the 1930s?

B. Thesis: The healthcare delivery system in the US has undergone noticeable gradual improvements from the financing sector, insurance sector, delivery and quality sector even though many politicians politicize the gaps in healthcare for their own benefits with the pretense of initiating reforms to the sector. Comment by James A Love: This claim will need citing for support. Comment by James A Love: This claim will need to supported with specific citations.

II. Background Comment by James A Love: The ‘background’ is appropriate here. It is essentially your ‘literature review’. I think you can use either section title, but you should include multiple citations of articles that discuss “politics in healthcare” spanning history.

A. The aim is to discuss the association between politics and healthcare and to try and find out the roles politics has played in reforming the healthcare sector.

III. Formation of acts to offer medical security Comment by James A Love: Section III, IV, and V seem like they should be the major subsections within section II.

A. Formation of social security act of 1935

a. Provide unemployment compensation Comment by James A Love:

b. Provide old-age pensions

c. Other benefits

1. Provision of federal funds for hospital construction

B. Kerr-mills act of 1960

a. Federal matching payments

b. Elderly disabled and poor

IV. The election of some prominent leaders in the US

A. Kennedy, 1961

a. Kennedy kept the issue of elderly healthcare needs alive

B. Lyndon Johnson 1963

a. Initiated the Great Society’s War on Poverty Program

b. Medicare

C. Nixon

a. He signed various acts to extend community mental health centers

b. National Health Insurance Partnership Act

1. Family Health Insurance Plan

i. Offers health insurance to low income families

2. National Health Insurance Standards Act

i. Developing Health Maintenance Organizations

D. Jimmy carter

a. Supported national health insurance program

E. Clinton

a. He made changes in health insurance coverage

b. Introduced National Health Reform

F. Harris Wofford

a. He formed democratic debates

b. He insisted on health insurance

G. Barrack Obama

a. Introduced the Affordable Care Act

1. The purpose is creating more tax revenue

2. Condemning citizens to vote for their health care services

V. Introduction of the managed care plan

A. A way of containing health care costs

· [INCLUDE FINDINGS, ANALYSIS, DISCUSSION SECTIONS HERE] Comment by James A Love: After you give a solid review, you will need some additional sections to add in your “new” contributions to the existing literature. Basically, try to find some meaning from all of the research your studied to support your thesis. This is typically in the “findings” section. You may need to revise your thesis if research indicates something else. That is okay. It is part of iteration process of making your paper better. Then, a separate “discussion” section, will include your interpretation of the findings. These sections are the important contributions that make this paper more than simply a review paper. You can choose to make the paper a “literature review” paper, but you will need to have many citations and still synthesize some meaning from the review in a “findings” and “discussion” sections.

VI. Conclusion Comment by James A Love: The conclusion will end up being a summary of what all you did in the previous sections.

Liberals and conservative are in constant conflicts and their differences is the main cause of the failures and successes in the health care sector

Abstract

It should be noted that the U.S health care delivery system is constantly undergoing transformation through new legislation or improvement and amendments of the existing legislations. Some of the most common areas that are often improved concern the financing sector, insurance sector, delivery sector and quality sector. New laws are often introduced in these sectors with the purpose of ensuring that the resultant health care is of high quality and that it is cheaper and accessible to many. Affordability is another crucial component of health care delivery system. The four basic functional components of the U.S. health care delivery system include financing, insurance, delivery and quality would be discussed.

The paper will explore and analyze the association between the politics and the health care reforms in the United States. The analysis will try to find out the role of politics in the key healthcare reforms such as Medicare, Medicaid, Managed care and even the most current act called Affordable Care Act. The paper will demonstrate that politicians have been using gaps in the healthcare system to campaign for their consideration for being elected as Congress or senators. It will also demonstrate that some politicians such as Clinton plan to initiate reforms to suit their political interest. The paper will conclude by indicating how the politics and politicians manipulate the health care reform as their campaign strategies of winning voters.

Politics and healthcare system in USA

A closer look at the health care reform in United States reveals that any reform is politically orchestrated. In fact it is as if one of the campaign strategies of most of the politicians is to come up with a reform that can improve cost of care, quality of care and access to care. A closer look at the history of the United States reveals that politics started intervening in health care between 1930s and 1960s (Patel & Rushefsky, 1999). During this time, there was depression, unemployment insurance and hence the government was in pressure to provide cheaper if not free medical care or reimbursement for its cost (Patel & Rushefsky, 1999).

In 1935, the Social Security Act of 1935 was formed to provide for unemployment compensation, old-age pensions and other benefits (Patel & Rushefsky, 1999). It should be noted that the political party in leadership had to be careful on how it handles the issue of health care lest it lose the confidence in people. Before the idea of insurance was introduced, the American Medical Association was strongly opposing it.

On the other hand, the politicians and the ruling political government had to force it happen because that was the only option in which politicians could help its citizens and possibly get reelected. After World War II, the Truman administration initiated the expansion of hospitals, increased support for public health and federal aid for medical research and education. This was reinforced by the passage of Hill-Burton Act in 1946, which provided federal funds to subsidize construction of hospitals in areas of bed shortages.

In 1960, Kerr-Mills Act, which is also known as Medical Assistance Act was passed by Congress. This provided federal matching payments to states and allowed the state to include medically needy or vulnerable groups such as the elderly, the disabled and the poor. However, the act failed to offer significant relief for the substantial portion of the elderly population. This is because it was found that only one percent of the nation’s elderly received help under the program. The program was curtailed by stringent eligibility rules and high administrative costs of state government. The issue therefore remained on political agenda.

When Kennedy became president in 1961, one of his political agenda was to increase access to health care for millions of Americans. However, it is indicated that Kennedy won a narrow victory and was not in a position to push for a universal insurance program. This is because he had a Congress that was not very amenable to his legislative proposals. Kennedy’s key achievement is that he was able to keep the issue of healthcare needs of elderly alive and on political agenda.

However, his assassination in 1963 left the task of carrying on the fight for Medicare to Lyndon Johnson, who adopted most of Kennedy’s unfinished legislative proposals. He also initiated the Great Society’s War on Poverty program (Patel, Rushefsky & McFarlane, 2005). It should be noted that after civil rights, Medicare was second in priority with the Johnson administration.

Johnson recognizes Medicare as crucial part of his fight on poverty. As a result, he won a landslide victory, which enabled him carry out his political agendas successfully (Patel, Rushefsky & McFarlane, 2005). It is also important that during that time, the Democrats won major victories in congressional elections. This means that the administration had enough votes in the House and the Senate for the passage of its health care proposals.

When Nixon took the leadership, he proposed moderate changes in the health care programs (Patel, Rushefsky & McFarlane, 2005). He signed into law various acts meant to extend community mental health centers, migrant health centers and programs designed to support training of health care personnel (Patel, Rushefsky & McFarlane, 2005). It should be noted that Nixon was interested in vying for the president in 1972 again. He felt compelled to respond to Kennedy’s political challenge (Patel, Rushefsky & McFarlane, 2005).

Nixon proposed the National Health Insurance Partnership Act. This comprises of the Family Health Insurance Plan, which is federally financed to offer health insurance for all low-income families. The second component of this act is the National Health Insurance Standards Act. This act is financed by private funds. Its goal is to set standards for employer health insurance and expected coverage of employees.

Another one of Nixon’s proposal was to provide federal funds for the development of health maintenance organizations (HMO) (Patel, Rushefsky & McFarlane, 2005). In this system, enrollees are allowed to pay a fixed fee in advance, and in return, received a comprehensive set of health care services. Such organizations promote competition with traditional health care delivery system. This is because they create incentives for shifting health services utilization from more costly impatient services such as hospitals and skilled nursing facilities to less costly outpatient services such as visits to doctor’s offices (Patel, Rushefsky & McFarlane, 2005).

Jimmy Carter, on the other hand, pledged his support for a comprehensive national health insurance program (Morone & Belkin, 1994). This was a response to his opponent, who was also seeking the Democratic Party’s nomination. However, when he finally assumes the office in 1977, he could not meet his pledges because he was hindered by financial constraints (Morone & Belkin, 1994).

Roosevelt administration did not want to jeopardize the enactment of Social Security Act. The 1980’s political leadership; which was under the leadership of Reagan and Bush healthcare system targeted mostly on the cost of health care (Morone & Belkin, 1994). They use such to influence voters. Ironically, during that time, the key reforms that were expected especially by various experts and policy makers’ concerned access to care and quality of care delivered. However, because of the political influence, a number of legislation meant to cut the cost of health care was passed (Morone & Belkin, 1994). In fact it is during this period that the legislations related to the Medicare and Medicaid programs were implemented. They both focus on how to control rising health care costs. The impact of this was positive because it is indicated that there was a reduction in health care costs in 1990s (Shi & Singh, 2010).

When Clinton was elected as the present, the politics targeted at ensuring access to health care insurance and health care services. The Clinton administration really pushed for this. The poll that was conducted in 1992 reveals that most of American was in favor or reforming the health care system. George Bush announced new health care initiatives. He proposed a series of reforms. Under the proposal, the self-employed were to receive a tax deduction equal to the size of the premiums and that small business would receive tax inducement.

A closer look at Bush initiative reveals that it was in response to the coming presidential election and was a way of assuring Bill Clinton that he would offer a plan for comprehensive reform of the U.S. healthcare system. The Bush government and Clinton later endorsed managed care. The Clinton’s administration was doing this as one of his pledges he made during election. It is apparent that during the campaign of 1990s, the Clinton was convicted that health care was an issue which could allow him go back to the White House for a Democrat. During this time, the political analysts were certain that health care was an aspect that could define a presidency (Jacobs & Skocpol, 2012). In fact it has been established that it is during the Clinton’s time when the United States experienced a push for major health care reform. It was during this time when the health care reform began to take shape seriously.

There are a number of politically motivated reforms that took place during the Clinton’s time (Jacobs & Skocpol, 2012). The first reform that is as a result of the political motivation is the changes in health insurance coverage. Health insurance coverage was one way of increasing the access to health care services in the United States. Politicians were looking at every possible way in which they can improve the healthcare system in the United. For example, after the initiation of private insurance, the problem of lack of healthcare of lack of health insurance coverage became a problem of special groups such as the aged, the poor, and more recently, the unemployed (Jacobs & Skocpol, 2012).

A closer analysis of the health care system and reforms in the United States reveals that the exact time when the healthcare reform was politicized is in 1990s. It is during this time that most of the trends such as the rising numbers of Americans without health insurance and the rising fears of the middle class about not having health insurance. The change started in 1991, when Harris Wofford aired a television commercial during the campaign that argued “if every criminal in America has the right to a lawyer, then I think every working individuals or citizens have the right to see a doctor when they are ill.

Using this as campaign strategy, Harris managed to defeat his opponent. It is envisaged that it was during this time that the Democratic Party started realizing that access to health care was an issue on the minds of the public (Jacobs & Skocpol, 2012). In fact during the following Democratic debates, health insurance was one of the issues that were given a lot of weight. The different candidate from the different states started developing well-thought and comprehensive proposals related to health reform (Jacobs & Skocpol, 2012). For example, history shows that Senator Robert Kerry introduced a comprehensive plan in mid-1991. Kerry proposed a government-financed and government-run plan. However, other Democratic competitors and contenders adopted less comprehensive reforms positions.

Paul Tsongas, for example pushed an approach which later became publicly identified as the Jackson Hole Plan. This plan was partly contributed by Paul Ellywood. It resembles the managed care (Jacobs & Skocpol, 2012). It was proposed that managed competition envisioned a health care system that relied largely on market forces of supply and demand. It was during this time that an agreement was made that it is better if employers can pay a portion of their workers’ coverages, but not necessarily pay the whole insurance amount (Jacobs & Skocpol, 2012).

Another major significant reform took place when Clinton became president. It is shown that President Clinton initiated a reform led by the President’s Task Force on National Health Reform. The goal of the reform was to make health care reform legislation that could be submitted to Congress within 100 days (In Selker & In Wasser, 2014).

The Task force was headed by Clinton’s wife. Clinton, according to analysts, wanted to tackle the entire issue of health care reform. He wanted a comprehensive proposal from the task force (In Selker & In Wasser, 2014). The idea that Clinton chooses his wife to head the task force is an indication of political intentions. It is also shown that the way the commission was created and the secrecy around its actions leave a lot of questions related to the task force and the Clinton’s administration (In Selker & In Wasser, 2014).

Medicare is another health care program that has some political elements. It was initiated during the Clinton’s administration. It should be noted that Medicare is a very crucial reform as far as health care is concerned (In Mason, In Leavitt, & In Chaffee, 2014). This is because it currently serves more than 39 million people, who get insurance and health care through Medicare (In Selker & In Wasser, 2014).

Although Medicare is meant to reduce the cost of health care, there is evidence that the Medicare costs have been growing even faster than general health care costs since it was formed. This is attributable to the increase in the share of population over 65 years. It was agreed that the only way of reducing the Medicare cost is to control the rate of growth in costs per beneficiary (Faguet, 2013). It was also proposed that the cost reduction can only be accomplished by a fundamental restructuring of incentives for beneficiaries, and also adoption of fee-for-service Medicare (In Selker & In Wasser, 2014). Two key proposals were thus made. The first proposal is Breaux-Frist proposal. This comprises of the Bi-Partisan Commission’s plan and President Clinton’s plan.

Managed care plan is also envisaged to have some political association. This plan was developed as a way of containing the costs in 1970s and 1980w. This was the time when the health care costs increased rapidly.

The last form of healthcare reform is the Affordable Care Act, which was recently passed under the Obama administration (Pratt, 2012). A closer look at the act reveals that it is a political document. It is not a healthcare document (Pratt, 2012). In fact the main reason why the Act was initiated is to create more tax revenue to support a bigger government, and to create a large voting block dependent on government for their healthcare services (Pratt, 2012). It is apparent that the public dependency related to the act provides politicians enormous political power (Pratt, 2012).

Depoliticizing the healthcare system can result in poor quality reforms. This is because the politicians compete based on how best they can improve the health care. However, care should be taken to analyze any given policy before it is amended because some policies such as Affordable Care Act may appear good superficially, but is not actually good.

Solution to the problem

As indicated in the foregoing discussion and analysis, it is clear that the development of healthcare system is not always for the interests of the people, but just a way of getting votes. Such approach is always not good because it means that the politicians are just to impress the voters. Let us consider the healthcare system during Kennedy’s era.

As indicated earlier, when Kennedy became president in 1961, one of his political agenda was to increase access to health care for millions of Americans. However, it is indicated that Kennedy won a narrow victory and was not in a position to push for a universal insurance program. This is because he had a Congress that was not very amenable to his legislative proposals. This clearly indicates that politics may not always deliver good thing because it requires that the issue of proposal goes through the Congress. This means that even if the proposal is good and the Congress is divided on whether to adopt or not, such proposal may fail. This means that it is high time to have independent body responsible for proposal and amendment of healthcare system.

Another problem related to politicizing of healthcare system is that some bills passed are appealing at the superficial level, yet in reality, they are costly to the citizens. A good example is the Affordable Care Act, which was proposed by President Barrack Obama. When one looks at this act, it appears that it is indeed affordable. However, the truth is that the act is controversial and highly political. Ezekiel Emanuel, who is a professor of medical ethics and health policy at the University of Pennsylvania, refers it as a signature piece of legislation for President Obama’s first term, and also a ball and chain for his second. Principally, the act’s main aim is on providing more Americans with access to affordable health insurance, improving the quality of health care and health insurance, regulating the health insurance industry and reducing health care spending.

The research reveals that ACA is a political document. It is not a healthcare document (Pratt, 2012). In fact the main reason why the Act was initiated is to create more tax revenue to support a bigger government, and to create a large voting block dependent on government for their healthcare services (Pratt, 2012). The citizens or rather voters may be happy that their healthcare services are taken care of, yet in reality, they are the one taking care of them.

A solution to this problem is that the trusted bodies such as Supreme Court should always be ready to defend the citizens by providing right interpretation of the Acts passed. This means that there is need of independent, neutral and accountable body that can help interpret the bill before it is passed as a law. Such bodies will enable the citizens/ voters make a sound decision based on pro and cons of the bill. This is because most politicians are very cunning such that they can easily coerced the voters into believing that a given bill is right

Conclusion

It should be noted from the foregoing discussion that failure or success to provide universal health insurance coverage can be attributed to fundamental political ideological differences between liberals and conservatives. The two are in conflict about the role of the public and private sector in health care. It is apparent that one of the factors that determine whether a given candidate would become president is the nature and the role of the health care act he or she initiates.

References

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Faguet, G. B. (2013). The Affordable Care Act: A missed opportunity, a better way forward. New York: Algora Pub.

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In Mason, D. J., In Leavitt, J. K., & In Chaffee, M. W. (2014). Policy & politics in nursing and health care.

In Selker, H. P., & In Wasser, J. S. (2014). The Affordable Care Act as a National Experiment: Health Policy Innovations and Lessons.

Jacobs, L. R., & Skocpol, T. (2012). Health care reform and American politics: What everyone needs to know. New York: Oxford University Press.

Morone, J. A., & Belkin, G. S. (1994). The politics of health care reform: Lessons from the past, prospects for the future. Durham: Duke University Press.

Patel, K., & Rushefsky, M. E. (1999). Health care politics and policy in America. Armonk, NY [u.a.: M.E. Sharpe.

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Patel, K., Rushefsky, M. E., & McFarlane, D. R. (2005). The politics of public health in the United States. Armonk, N.Y: M.E. Sharpe.

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Pratt, L. L. (2012). Let's fix medicare, replace medicaid, and repealthe affordable care act: Here is why and how. Bloomington, Ind: AuthorHouse. Top of Form

Shi, L., & Singh, D. A. (2010). Essentials of the U.S. health care system.

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