What action should be taken to reduce the cost and improve the quality of U.S.

health
care? How are the national and state governments implementing the 2! Health "are
law?
#y $ovonne %iang
According to new data, rising medical bills are expected to push 1.7 million
American households into bankruptcy this yearmaking health expenses the
single biggest cause of such filings, outpacing bankruptcies due to credit-card
bills or unpaid mortgages. &hese rising costs have eroded the financial stability of all
'mericans on their families( businesses( and the entire economy. Een haing health
insurance doesn!t shield Americans against financial hardships. "or example,
nearly 1# million adults with year-round health insurance coerage will still
accumulate medical bills they can!t pay off this year. $ealth care issue is so
personal, so painful, and so oerwhelming, yet many people try not to face it.
%efore soling the health care problem, we need to understand what our health
system is. &nlike other countries, the U.S. health care system maintains many separate
models for separate classes of people. When it comes to treating veterans( we)re like
#ritain or "uba. *or 'mericans over the age of +, on -edicare( we)re like "anada. *or
working 'mericans who get insurance on the .ob( we)re like /ermany. *or the !, percent
of the population who have no health insurance( the United States is like "ambodia or
rural 0ndia( with access to a doctor available if you can pay the bill out1of1pocket at the
time of treatment or if you)re sick enough to be admitted to the emergency ward at the
public hospital.
While United States has elements of all fragmented health care systems( other countries
on the planet have settled on .ust one model for everybody. "or instance, here are fie
capitalist democracies' details listed below. (he report shows that uniersal
insurance models are much simpler than the U.S. system2 and they are fairer
and cheaper( too.

UNITED KINGDOM
3ercentage of /ross 4omestic 3roduct 5/436 spent on health care7 8.9
'verage family premium7 :one2 funded by ta;ation.
"o1payments7 :one for most services2 some co1pays for dental care( eyeglasses and ,
percent of prescriptions. <oung people and the elderly are e;empt from all drug co1pays.
What is it? &he #ritish system is =sociali>ed medicine= because the government both
provides and pays for health care. #ritons pay ta;es for health care( and the government1
run :ational Health Service 5:HS6 distributes those funds to health care providers.
Hospital doctors are paid salaries. /eneral practitioners 5/3s6( who run private practices(
are paid based on the number of patients they see. ' small number of specialists work
outside the :HS and see private1pay patients.
How does it work? #ecause the system is funded through ta;es( administrative costs are
low2 there are no bills to collect or claims to review. 3atients have a =medical home= in
their /3( who also serves as a gatekeeper to the rest of the system2 patients must see their
/3 before going to a specialist. /3s( who are paid e;tra for keeping their patients healthy(
are instrumental in preventive care( an area in which #ritain is a world leader.
What are the concerns? &he stereotype of sociali>ed medicine 11 long waits and limited
choice 11 still has some truth. 0n response( the #ritish government has instituted reforms
to help make care more competitive and give patients more choice. Hospitals now
compete for :HS funds distributed by local 3rimary "are &rusts( and starting in 'pril
28 patients are able to choose where they want to be treated for many procedures
JAPAN
3ercentage of /43 spent on health care7 8
'verage family premium7 ?28 per month( with employers paying more than half.
"o1payments7 9 percent of the cost of a procedure( but the total amount paid in a month
is capped according to income.
What is it? $apan uses a =social insurance= system in which all citi>ens are required to
have health insurance( either through their work or purchased from a nonprofit(
community1based plan. &hose who can)t afford the premiums receive public assistance.
-ost health insurance is private2 doctors and almost all hospitals are in the private sector.
How does it work? $apan boasts some of the best health statistics in the world( no doubt
due in part to the $apanese diet and lifestyle. Unlike the U.@.( there are no gatekeepers2
the $apanese can go to any specialist when and as often as they like. Avery two years the
-inistry of Health negotiates with physicians to set the price for every procedure. &his
helps keeps costs down.
What are the concerns? 0n fact( $apan has been so successful at keeping costs down that
$apan now spends too little on health care2 half of the hospitals in $apan are operating in
the red. Having no gatekeepers means there)s no check on how often the $apanese use
health care( and patients may lack a medical home.
GERMANY

3ercentage of /43 spent on health care7 !.B
'verage family premium7 ?B, per month2 premiums are pegged to patients) income.
"o1payments7 ! euros 5?!,6 every three months2 some patients( like pregnant women(
are e;empt.
What is it? /ermany( like $apan( uses a social insurance model. 0n fact( /ermany is the
birthplace of social insurance( which dates back to "hancellor Ctto von #ismarck. #ut
unlike the $apanese( who get insurance from work or are assigned to a community fund(
/ermans are free to buy their insurance from one of more than 2 private( nonprofit
=sickness funds.= 's in $apan( the poor receive public assistance to pay their premiums.
How does it work? Sickness funds are nonprofit and cannot deny coverage based on
pree;isting conditions2 they compete with each other for members( and fund managers
are paid based on the si>e of their enrollments. %ike $apan( /ermany is a single1payment
system( but instead of the government negotiating the prices( the sickness funds bargain
with doctors as a group. /ermans can go straight to a specialist without first seeing a
gatekeeper doctor( but they may pay a higher co1pay if they do.
What are the concerns? &he single1payment system leaves some /erman doctors feeling
underpaid. ' family doctor in /ermany makes about two1thirds as much as he or she
would in 'merica. 5&hen again( /erman doctors pay much less for malpractice insurance(
and many attend medical school for free.6 /ermany also lets the richest ! percent opt
out of the sickness funds in favor of U.S.1style for1profit insurance. &hese patients are
generally seen more quickly by doctors( because the for1profit insurers pay doctors more
than the sickness funds.
TAIWAN
3ercentage /43 spent on health care7 +.9
'verage family premium7 ?+, per year for a family for four.
"o1payments7 2 percent of the cost of drugs( up to ?+.,2 up to ?B for outpatient care2
?!.8 for dental and traditional "hinese medicine. &here are e;emptions for ma.or
diseases( childbirth( preventive services( and for the poor( veterans( and children.
What is it? &aiwan adopted a =:ational Health 0nsurance= model in !DD, after studying
other countries) systems. %ike $apan and /ermany( all citi>ens must have insurance( but
there is only one( government1run insurer. Working people pay premiums split with their
employers2 others pay flat rates with government help2 and some groups( like the poor
and veterans( are fully subsidi>ed. &he resulting system is similar to "anada)s 11 and the
U.S. -edicare program.
How does it work? &aiwan)s new health system e;tended insurance to the E percent of
the population that lacked it while actually decreasing the growth of health care spending.
&he &aiwanese can see any doctor without a referral. Avery citi>en has a smart card(
which is used to store his or her medical history and bill the national insurer. &he system
also helps public health officials monitor standards and effect policy changes nationwide.
&hanks to this use of technology and the country)s single insurer( &aiwan)s health care
system has the lowest administrative costs in the world.
What are the concerns? %ike $apan( &aiwan)s system is not taking in enough money to
cover the medical care it provides. &he problem is compounded by politics( because it is
up to &aiwan)s parliament to approve an increase in insurance premiums( which it has
only done once since the program was enacted.
SWITZERLAND
3ercentage of /43 spent on health care7 !!.+
'verage monthly family premium7 ?B,( paid entirely by consumers2 there are
government subsidies for low1income citi>ens.
"o1payments7 ! percent of the cost of services( up to ?E2 per year.
What is it? &he Swiss system is social insurance like in $apan and /ermany( voted in by a
national referendum in !DDE. Swit>erland didn)t have far to go to achieve universal
coverage2 D, percent of the population already had voluntary insurance when the law was
passed. 'll citi>ens are required to have coverage2 those not covered were automatically
assigned to a company. &he government provides assistance to those who can)t afford the
premiums.
How does it work? &he Swiss e;ample shows that universal coverage is possible( even in
a highly capitalist nation with powerful insurance and pharmaceutical industries.
0nsurance companies are not allowed to make a profit on basic care and are prohibited
from cherry1picking only young and healthy applicants. &hey can make money on
supplemental insurance( however. 's in /ermany( the insurers negotiate with providers to
set standard prices for services( but drug prices are set by the government.
What are the concerns? &he Swiss system is the second most e;pensive in the world 11
but it)s still far cheaper than U.S. health care. 4rug prices are still slightly higher than in
other Auropean nations( and even then the discounts may be subsidi>ed by the more
e;pensive U.S. market( where some Swiss drug companies make one1third of their
profits. 0n general( the Swiss do not have gatekeeper doctors( although some insurance
plans require them or give a discount to consumers who use them.
:o doubt that 'mericans need a broad( long1term ramification for our health care system.
0n 2!( landmark reform was passed through two federal statutes( the 3atient 3rotection
and 'ffordable "are 'ct 533'"'6( signed -arch 29( 2!. %ecause )bama!s party did not
hae a filibuster-proof ma*ority in the +enate, the law was amended by the $ealth ,are and
Education -econciliation Act of .#1# using the reconciliation process in which debate in the
+enate is limited and the filibuster is therefore not permitted.
and the Health "are and Aducation Feconciliation 'ct of 2!( which amended the
33'"' and became law on -arch 9( 2!. &he 'ct( designed to lower healthcare costs
and increase access to healthcare( offers advantages and disadvantages.
PROS
0ncreased coverage. &hirty1two million 'mericans who would not have been covered
by health insurance either now have coverage or will get the coverage they need
starting in 2!E. &his includes7
o 9.! million 'mericans ages !D through 2, who may be added to their parentsG
plans. -any of these youth are working but still cannot afford to pay for
health benefits.
o 3atients with pre1e;isting conditions who will no longer be able to be denied
coverage by insurance companies. 3lus( insurance companies will no longer
be able to drop plan members once they get sick.
o 0n general( people who can)t afford health insurance. &he *ederal government
will pay states to add this group to the stateGs -edicaid program.
Feduced healthcare costs. 'ccording to the "ongressional #udget Cffice5"#C6( the
cost of healthcare could be reduced. Since the 'ct makes sure D, percent of citi>ens
have health insurance( preventative healthcare will be more accessible. &he newly
insured will no longer have to wait until their ailments become so e;treme that they
are forced to visit the hospital emergency room( a more costly care avenue.
Feduced budget gaps. &he "ongressional #udget Cffice 5"#C6 estimates that
the 33'"' will reduce the national budget deficit by ?!E9 billion by 2!D because of
the 'ctGs associated ta;es and fees. 0n addition( the "#C believes that the -edicare
=donut hole= gap in coverage will be eliminated by 22.
Higher ta;es( lower deductions. 'mericans who don)t pay for insurance and don)t
qualify for -edicaid will be assessed a ta; of ?D, 5or ! percent of income( whichever
is higher6 in 2!E. &he ta; will increase substantially to ?92, 5or 2 percent of income6
in 2!,( and ?+D, 5or 2., percent of income6 in 2!+. 0ndividuals with annual
incomes above ?2( and couples with incomes above ?2,( will pay higher
ta;es to help cover costs of the program. 'nd( in 2!E( families can only deduct
medical e;penses that e;ceed! percent of income( rather than todayGs B., percent of
income.
CONS
Shortage of healthcare professionals. ' new study by the :ational -onitor predicts
that the implementation of the 33'"'( coupled with the nationGs aging population(
could lead to a shortage of ,2( primary care physicians by 22,. &his could leave
millions of 'mericans without access to healthcare. &he study also noted that office
visits to primary care physicians will likely increase from E+2 million to ,+,
million by 22,( further straining the system.
Higher drug costs. 3harmaceutical companies will pay an e;tra ?8E.8 billion in fees
over the ne;t ten years to pay for closing the =donut hole= in -edicare. &his could
raise drug costs if they pass these fees on to consumers.
&he legislation remains controversial( with some states challenging it in federal court and
opposition from some voters. 0n $une 2!2( in a ,HE decision( the U.S. Supreme "ourt
found the law to be constitutional. However( the law continues to face legal challenges.
*ortunately( "alifornia was the first state in the nation to enact legislation under the
'ffordable "are 'ct. A;changes are created to develop an organi>ed marketplace where
legal residents of "alifornia can buy health coverage that cannot be denied or canceled if
you are sick or have pre1e;isting health conditions.
's of 2!E( about 2.+ million "alifornians will qualify for federal financial assistance
and an additional 2.B million who do not qualify for assistance will benefit from
guaranteed coverage through e;changes or from an insurance company in the individual
market. 'n estimated 2.9 million "alifornia residents will enroll in a health plan through
e;changes by 2!B.
'll health plans purchased through e;changes must cover a range of services called
Assential Health #enefits. &hese include services like doctor visits( hospitali>ation(
emergency care( maternity care( pediatrics( prescriptions( medical tests( mental health
care and others. 3lans must cover preventive care services like mammograms and
colonoscopies with no out1of1pocket cost to consumers. 'll newly sold health plans(
whether offered by e;change or in the private marketplace( will be required to meet these
basic requirements
http7IIwiki.answers.comIJIWhyKareKFepublicansKagainstKhealthcareKreformKasKoutlinedKbyKCbama
Why are Republicans against healthcare reform as outlined by Obama?
'nswer7
1. POWER/ 0t is about limiting the power and control of the goernment oer the people.
-epublicans fear that control oer healthcare choices is *ust the beginning to control oer
citi1ens! lies.
.. IDEOLOGY: -epublicans are center2conseratie and 3emocrats are center2liberals.
(hey disagree with each other. (he conseraties ideology is the goernment should hae
less control oer citi1ens! lies. (hey also strongly beliee a person!s success and
adancement is attributed solely to dedication and hard work. 0n other words, if you don!t
work, you shouldn!t eat. (hat is why it is ery difficult for a republican to feel obligated to pay
more taxes for health insurance for someone who they feel has a bad work ethic or who
wants to oer eat, smoke and chose not to be healthy.
4. TAXATION FOR WEALTHY: 5ost -epublicans do not want higher taxes for the
wealthy6 those making more than 7.8#,### per year, as they will be the ones paying for most
goernment spending...e.g the heathcare bill.
-epublicans also state that it is the wealthy that create *obs by inesting and that if their
taxes are raised, there will be less inesting and *ob creation. 9hile this thinking is not
incorrect in of itself, :#; - <#; of *ob creation comes from small businesses, not large
corporations. 0f the goernment wanted to gie tax breaks to stimulate *ob creation, the
breaks should go to small businesses and startups.
Also, the upper class spends 78 cents for eery dollar they earn =and sae .8 cents>, while
the lower class spends ?8 cents for eery dollar they earn =and sae 8 cents>. +o if tax
breaks are giing to stimulate the economy, the theory is that it should go to the poor, since
they are more likely to spend it. (he reason being is that they need to for necessities.
4. FEAR OF SOCIALIZED MEDICINE: -epublicans beliee the healthcare system in
America needs reform, but feel the best solution is not to hand it oer to the goernment.
Although the )bama plan is not sociali1ed medicine, it appears in time employers will dump
their employees into an @exchange2public option@ and most people will eentually be enrolled
in the one payer system. Aong Aines, 3eath panels, deciding what medicine you should get
etc...
5. BUDGET DEFICIT: -epublicans beliee the American goernment is nearly bankrupt.
Although )bama and the ,%) has stated the health care bill will reduce goernment
expenses. (here may be a moderate risk it does not and the goernment may hae to take
on more debt. (he deficit is already high. As our goernment has had to borrow money from
other countries such as ,hina, which must be paid back with added interest.
6. FOUNDING PRINCIPLES: America, was founded on the principles of absolute
minimalist goernment, both economically and socially, and was intended to be run as
capitalistically as possible. -epublicans beliee our ,onstitution strictly forbids the federal
goernment!s interference into our personal and economic decisions, including healthcare.
LL "alifornia LL
http7IIwww.healthe;change.ca.govI3agesI4efault.asp;
&he vision of the "alifornia Health #enefit A;change is to improve the health of all
"alifornians by assuring their access to affordable( high quality care. &he mission of the
"alifornia Health #enefit A;change is to increase the number of insured "alifornians(
improve health care quality( lower costs( and reduce health disparities through an
innovative( competitive marketplace that empowers consumers to choose the health plan
and providers that give them the best value.
http7IIwww.coveredca.comI34*sIAnglishI"overedK"aliforniaK'boutKfactKsheetKAnglish
.pdf
&he new law created a number of ways to help reduce the cost of insurance and
encourage uninsured people to get covered. &he federal law is important to "alifornians
because it provides financial assistance to help individuals and small business pay for
health insurance. &he law also requires that most people over the age of !8 have health
insurance or pay a penalty starting in 2!E. 0f you already have affordable health
insurance( you donGt need to take any action( unless your health coverage status changes.
&o help those without health insurance get covered( the 'ffordable "are 'ct also requires
that the states either set up their own marketplace to offer health insurance or have one
set up by the federal government. &hese marketplaces will provide an accessible place
where you can compare health plans and buy health insurance that works best for you(
your family and your budget. "alifornia chose to set up its own marketplace M
"overed "alifornia M as your doorway to health coverage.
%y law, your coerage can!t be dropped or denied een if you hae a pre-existing
medical condition or get sick.
/etting "alifornia covered
.
LLLLLL left over LLLLLL
When 0 go to the store and offer my least money to get one of their best products in line(
what do 0 get? &he answer is obvious H 0 may be called Ncra>y and 0 will not have my
favorite toy in my pocket. Strangely enough( in terms of Health "are( when 0 show my
intention to pay only the least portion out of my pocket but entitle to the highest quality
in health care( what do 0 get? -ost people will side up with me and think that is what our
government supposed to offer its citi>ens. #ut government "ost versus quality is like
liberty versus security( 0 believe that everyone should pay their fair share to access
desirable health care.
'merican 7 Cbamacare
http7IIwww.pbs.orgIwgbhIpagesIfrontlineIsickaroundtheworldIcountriesImodels.html
%y law, your coerage can!t be dropped or denied een if you hae a pre-existing
medical condition or get sick.
(PPACA) will have broad, long-term ramifcations for Americans. The Act, designed to lower
healthcare costs and increase access to healthcare, ofers advantages and disadvantages.
http7IIwww.supplementalhealthcare.comIblogI2!2Ipatient1protection1and1affordable1
care1act1snapshot1pros1and1cons
Theres no dobt that the Patient Protection and Afordable Care Act of !"#" (PPACA) will have
broad, long-term ramifcations for Americans. The Act, designed to lower healthcare costs and
increase access to healthcare, ofers advantages and disadvantages.
$ere are some of the %e& 'otential ('ros) and (cons) for &o to consider.
PROS
Incr!"# c$%r!&. Thirt&-two million Americans who wold not have been covered b&
health insrance either now have coverage or will get the coverage the& need starting in !"#*.
This incldes+
o '.( )*++*$n A)r*c!n" !&" (, -.r$/&. 05 who ma& be added to their
'arents 'lans. ,an& of these &oth are wor%ing bt still cannot aford to 'a& for health
benefts.
o P!-*n-" 1*-. 2r34*"-*n& c$n#*-*$n" who will no longer be able to be
denied coverage b& insrance com'anies. Pls, insrance com'anies will no longer be able to
dro' 'lan members once the& get sic%.
o In &nr!+5 2$2+ 1.$ c!n6- !7$r# .!+-. *n"/r!nc. The -ederal
government will 'a& states to add this gro' to the states ,edicaid 'rogram.
R#/c# .!+-.c!r c$"-". According to the C$n&r""*$n!+ B/#&- O8c(C./), the cost
of healthcare cold be redced. 0ince the Act ma%es sre 12 'ercent of citi3ens have health
insrance, preventative healthcare will be more accessible. The newl& insred will no longer
have to wait ntil their ailments become so e4treme that the& are forced to visit the hos'ital
emergenc& room, a more costl& care avene.
R#/c# 9/#&- &!2". The Congressional .dget /5ce (C./) estimates that
the PPACA will redce the national bdget defcit b& 6#*7 billion b& !"#1 becase of the Acts
associated ta4es and fees. 8n addition, the CBO believes that the ,edicare 9dont hole9 ga' in
coverage will be eliminated b& !"!".
H*&.r -!4"5 +$1r ##/c-*$n". Americans who don:t 'a& for insrance and don:t
;alif& for ,edicaid will be assessed a ta4 of 612 (or # 'ercent of income, whichever is higher)
in !"#*. The ta4 will increase sbstantiall& to 67!2 (or ! 'ercent of income) in !"#2, and 6<12
(or !.2 'ercent of income) in !"#<. 8ndividals with annal incomes above 6!"",""" and
co'les with incomes above 6!2",""" will 'a& higher ta4es to hel' cover costs of the 'rogram.
And, in !"#*, families can onl& dedct medical e4'enses that e4ceed10 percent of
income, rather than toda&s 7.5 percent of income. -or details, see+ W.!- O9!)!c!r M!n"
:$r T!4".
For may of the same reasons they failed before: interest group influence (code words for
class), ideological differences, anti-communism, anti-socialism, fragmentation of public
policy, the entrepreneurial character of American medicine, a tradition of American
voluntarism, removing the middle class from the coalition of advocates for change through
the alternative of Blue Cross private insurance plans, and the association of public programs
with charity, dependence, personal failure and the almshouses of years gone by
For the ne!t several years, not much happened in terms of national health insurance
initiatives "he nation focussed more on unions as a vehicle for health insurance,
http7IIwww.politico.comIpdfI33-!!KfinalKfactKsheetK,1!1D.pdf
*or years( rising health care costs have been a burden on families( businesses( and the
entire economy. Since 2( health insurance premiums have almost doubled and health
care premiums have grown three times faster than wages. &hese rising costs have eroded
the financial stability of all 'mericans as families have had to pay more for insurance
coverage2 have been e;posed to a greater risk of personal bankruptcy as deductibles and
co1payments increase2 and have seen their actual benefits decrease as employers search
for ways to rein in escalating health care costs. 's families and businesses have struggled
with these rising costs( states have also been forced to cut back on investments in areas
that are critical to long1term prosperity such as higher education and infrastructure.
Cverall( health care is consuming an ever increasing amount of our nationGs resources7 at
the current rate( health care will eat up more than 2 percent of /43 in 2!8. Feforming
health care is the key to restoring financial stability for 'merican families and businesses
and for securing our fiscal future.
the road to health care reform H a reform that will ease the burden of spiraling costs for
our families( free our businesses from these yearly burdensome cost increases( and put
our nation on a fiscally sustainable path.
http7IIwww.pnhp.orgIfactsIa1brief1history1universal1health1care1efforts1in1the1us
A Brief History: Ui!ers"# He"#t$ %"re Efforts i t$e US
("ranscribed from a tal# given by $aren % &almer '&(, '% in %an Francisco at the %pring,
)*** &+(& meeting)
%ome ,uropean countries started with compulsory sic#ness insurance, one of the first
systems, for wor#ers beginning in -ermany in )../0 other countries including Austria,
(ungary, +orway, Britain, 1ussia, and the +etherlands followed all the way through )*)2
3ther ,uropean countries, including %weden in ).*), 4enmar# in ).*2, France in )*)5, and
%wit6erland in )*)2, subsidi6ed the mutual benefit societies that wor#ers formed among
themselves %o for a very long time, other countries have had some form of universal health
care or at least the beginnings of it "he primary reason for the emergence of these programs
in ,urope was income stabili6ation and protection against the wage loss of sic#ness rather
than payment for medical e!penses, which came later &rograms were not universal to start
with and were originally conceived as a means of maintaining incomes and buying political
allegiance of the wor#ers
7n a seeming parado!, the British and -erman systems were developed by the more
conservative governments in power, specifically as a defense to counter e!pansion of the
socialist and labor parties "hey used insurance against the cost of sic#ness as a way of
8turning benevolence to power9
:hat was the ;% doing during this period of the late ).55<s to )*)2= "he government too#
no actions to subsidi6e voluntary funds or ma#e sic# insurance compulsory0 essentially the
federal government left matters to the states and states left them to private and voluntary
programs "he ;% did have some voluntary funds that provided for their members in the case
of sic#ness or death, but there were no legislative or public programs during the late )*th or
early 25th century
Finally there is always hope for fle!ibility and change
3ne Canadian lesson > the movement toward universal health care in Canada started in )*)?
(depending on when you start counting), and too# until )*?2 for passage of both hospital and
doctor care in a single province 7t too# another decade for the rest of the country to catch on
"hat is about @5 years all together 7t wasn<t li#e we sat down over afternoon tea and
crumpets and said please pass the health care bill so we can sign it and get on with the day
everything is in flu! and open to renegotiation
http7IIen.wikipedia.orgIwikiIHealthKcareKreformKinKtheKUnitedKStatesO3atientK3rotectio
nKandK'ffordableK"areK'ct
$ere is a summary of reform achieements at the national leel in the &nited +tates. "or failed
efforts, +tate based efforts, natie tribes serices and more details generally, see the main
article $istory of health care reform in the &nited +tates.

(he Social Security Amendments of 1965 - $uly 9( !D+,( Bresident Ayndon Cohnson
signed it into law as part of his /reat Society %egislation (he legislation created two
programs/ 5edicare and 5edicaid initially proiding federal health insurance for the elderly
=oer :8> and for poor families. (he 5edicare coered both hospital and general medical
insurance for senior citi1ens paid for by a "ederal employment tax oer the working life of the
retiree, and 5edicaid permitted the "ederal goernment to partially fund a program for the
poor, with the program managed and co-financed by the indiidual states.

1985 (he ,onsolidated )mnibus %udget -econciliation Act of 1?<8 =,)%-A> amended
the Employee -etirement 0ncome +ecurity Act of 1?7D =E-0+A> to gie some employees the
ability to continue health insurance coerage after leaing employment.
E7F

199 (he +tate ,hildren!s $ealth 0nsurance Brogram, or +,$0B, was established by the
federal goernment in 1??7 to proide health insurance to children in families at or below
.## percent of the federal poerty line.
E<F
!"1" (he Batient Brotection and Affordable ,are Act is enacted by Bresident %arack
)bama, proiding for the purchased introduction oer four years of a comprehensie system
of mandated health insurance with reforms designed to eliminate @some of the worst
practices of the insurance companies@ pre-condition screening and premium loadings,
policy rescinds on technicalities when illness seems imminent, annual and lifetime coerage
caps. 0t also sets a minimum ratio of direct health care spending to premium income, and
creates price competition bolstered by the creation of three standard insurance coerage
leels to enable like-for-like comparisons by consumers, and a web-based health insurance
exchange where consumers can compare prices and purchase plans. (he system preseres
priate insurance and priate health care proiders and proides more subsidies to enable
the poor to buy insurance.
After campaigning on the promise of health care reform, Bresident )bama gae a speech in
5arch .#1# at a rally in Bennsylania explaining the necessity of health insurance reform and
calling on ,ongress to hold a final up or down ote on reform.
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(he result of his efforts was
the Batient Brotection and Affordable ,are Act. %ecause )bama!s party did not hae a filibuster-
proof ma*ority in the +enate, the law was amended by the $ealth ,are and Education
-econciliation Act of .#1# using the reconciliation process in which debate in the +enate is
limited and the filibuster is therefore not permitted.
(he legislation remains controersial,
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with some states challenging it in federal court
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and
opposition from some oters.
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0n Cune .#1., in a 8GD decision, the &.+. +upreme ,ourt found
the law to be constitutional.
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$oweer, the law continues to face legal challenges.
#ealth care in the $nited States is proided by many distinct organi1ations. $ealth
care facilities are largely owned and operated by priate businesses. $ealth insurance for public
sector employees is primarily proided by the goernment. :#-:8; of healthcare proision and
spending comes from programs such as 5edicare,5edicaid, (-0,A-E, the ,hildren!s $ealth
0nsurance Brogram, and the Heterans $ealth Administration. 5ost of the population under :8 is
insured by their or a family member!s employer, some buy health insurance on their own, and the
remainder are uninsured.
http7IIen.wikipedia.orgIwikiIHealthKcareKreformKdebateKinKtheKUnitedKStates
(here is significant debate regarding the Iuality of the &.+. healthcare system relatie to those of
other countries. Bhysicians for a Jational $ealth Brogram, a political adocacy group, has
claimed that a free market solution to health care proides a lower Iuality of care, with higher
mortality rates, than publicly funded systems.
According to a .### study of the 9orld $ealth )rgani1ation, publicly funded systems of industrial
nations spend less on health care, both as a percentage of their K3B and per capita, and en*oy
superior population-based health care outcomes.
&he new law created a number of ways to help reduce the cost of insurance and
encourage uninsured people to get covered. &he federal law is important to "alifornians
because it provides financial assistance to help individuals and small business pay for
health insurance. &he law also requires that most people over the age of !8 have health
insurance or pay a penalty starting in 2!E. 0f you already have affordable health
insurance( you donGt need to take any action( unless your health coverage status changes.
&o help those without health insurance get covered( the 'ffordable "are 'ct also requires
that the states either set up their own marketplace to offer health insurance or have one
set up by the federal government. &hese marketplaces will provide an accessible place
where you can compare health plans and buy health insurance that works best for you(
your family and your budget. "alifornia chose to set up its own marketplace M
"overed "alifornia M as your doorway to health coverage.
&orei' (o)tries
http7IIwww.pbs.orgIwgbhIpagesIfrontlineIsickaroundtheworldIcountriesI
fi!e ("*it"#ist +e,o(r"(ies "+ $o- t$ey +o it