The provision of health care in the United States (U.S.) does not function as a logical and interconnected system network designed to work together in a coherent manner. Instead, it is devoid of any unity and remains poorly structured in terms of funding, insurance delivery, distribution and payment processes. In a system that is fundamentally fractured and in which the different system components fit together only loosely, there is little standardization. Since a central agency like government does not control the overall operation of such a program, replication issues, confusion, inadequacy, inconsistency, and waste occur. Lack of planning, direction and coordination across the system leads to a complex and inefficient system. Therefore, handling or regulating is almost impossible. The U.S. health care program is short of offering equal care to all Americans and unable to provide cost-effective programs (Shi & Singh, 2019).
The Affordable Care Act (ACA) changed the U.S. health care system significantly. The goals of the law were to reduce the number of people who were not covered, make coverage more affordable, and improve access to care. Since the introduction of the ACA, an estimated 20 million people have become newly insured, and by federal tax credits and Medicaid expansion, about 24 million people have gained access to subsidized or free treatment. Notwithstanding these milestones, from the start, the legislation has encountered strong political resistance. Repeated calls from both sides of the political spectrum have been made to repeal the law and replace it with new laws or amend the law to accomplish certain goals. Since it was passed in 2010, there has been a strong push to repeal the ACA (Rand Health Care). Matter of fact, President Trump signed an executive order on his first day of office in January 2017, essentially abolishing small portions of the ACA dealing with taxes and fees (Shi & Singh, 2019). The American Health Care Act (AHCA) is an alternative to the Affordable Care Act, with modifications passed by the Senate in May 2017. The AHCA is making significant changes to the ACA, although it is not formally repealed (Rand Health Care). Congressional dysfunction and growing deep partisan divisions are becoming increasingly dim and one wonders whether this political gridlock will continue to be the new norm. The political impasse and the challenge of passing laws will only affect the needs of the American people.
Proposed Changes to a Highly Partisan Congress
A site of tremendous resentment and tension has become what was once considered a respected division of the federal government. The public approval of Congress now hovers just over 10%, a huge drop from just under 20 years ago to almost 50%. Increasing bipartisan partnerships and creating better conditions for legislative deliberation, negotiation and compromise is necessary in order to change a system that has become increasingly dysfunctional (Hewlett Foundation, 2016). A democracy that works well has become almost non-existent. There are a number of important issues that concern American voters. Health care and accessibility, efficiency, expense and reduction of health inequalities are at the top of the list.
A well-functioning government requires some degree of openness, responsiveness, and tolerance from both parties to pass good laws on behalf of the American people's needs. In debating health policy proposals, initiatives that provide effective solutions to strengthen the U.S. health care system are highly partisan, with little or no likelihood of passing. In regards to health care, most Americans want to see a bipartisanship Congress who are willing cooperate through compromise. With the amount of rancor in place at the moment, it won't be bipartisan for all members of Congress. Nonetheless, those who can be bipartisan will need to lead the way in proposing health care reform measures that would enhance all Americans’ health coverage. A suggestion would be to begin with items that can be agreed upon, to maintain successful provisions and to change the ACA's controversial provisions. Bipartisan members of Congress need to collaborate and propose legislation with reasonably high levels of support from both parties. This would most likely have to begin at the middle of the ideological spectrum of ideologies with moderate members of Congress.
This writer also agrees with the suggestion of building new bipartisan partnerships is the belief that bringing together members of Congress and staff from opposing political parties for educational, informational, and social events would result in more interaction, better working relationships, and eventually more successful legislation. An example of this is the Rodel Fellowships in Public Leadership program of the Aspen Institute which selects 24 Rodel fellows each year. These fellowships are evenly split between Republicans and Democrats who have demonstrated the ability to collaborate across political and ideological lines for a two-year leadership development program (Hewlett Foundation, 2016). These proposed changes to a highly partisan Congress could possibly help members of Congress work together to pass meaningful health care legislation.
Currently, there are over 700 health care policy legislative proposals in Congress addressing the health care system at large (Evans & Fleming, 2019). Examples of these include legislative proposals which address high costs of health care, prescription drugs, insurance premiums, strengthening the ACA, Medicare and Medicaid reforms, hospital price transparency and competition, age band rating, telehealth services, long-term care services, to name a few (GovTrack, 2019). These are issues that affect every American. Unfortunately, few of these bills have bipartisan support necessary for them to be enacted in Congress (Evans & Fleming, 2019).
- Evans, M.L. & Fleming, K. (July 7, 2019). 5 Key Healthcare Issues Pending in Congress: New Rules that Could Change How You Get Healthcare. Retrieved on December 30, 2019 from https://www.forbes.com/sites/allbusiness/2019/07/07/5-key-healthcare-issues- pending-in-congress-new rules-that-could-change-how-you-get- healthcare/#767be56b1ed9
- GovTrack.us (2019). Bills and Resolutions. Retrieved from https://www.govtrack.us/congress/bills/
- Rand Health Care (n.d.). The Future of U.S. Health Care: Replace or Revise the Affordable Care Act? Rand Health Care. Retrieved on December 30, 2019 from https://www.rand.org/health-care/key-topics/health-policy/in-depth.html
- Shi, L., & Singh, D.A. (2019). Delivering Health care in America: A Systems Approach (7th ed). Sudbury, MA: Jones and Bartlett.
- William and Flora Hewlett Foundation (October 13, 2016). In a polarized era, efforts to boost bipartisanship in Congress. Retrieved on December 30, 2919 from https://hewlett.org/making-bipartisanship-stick-in-congress/