Healthcare is one of the major industries today in the United States, and its significance has never been more than what it is today and predictably will be in the future. We have come a long way from living in the dark ages of medical advancement to having the ability to treat the diseases that were once thought to be death sentences. People have trusted the healthcare system for years, and though it has not been a perfect system, it has survived thus far with all of its trials and tribulations.
The two practice types are hospital-based practice and private medical practice. In a discussion of the current healthcare system and the Affordable Care Act (ACA) changes, a distinction between the two types of medical practices must be made, and the impact of ACA must be evaluated on these two entities independently. However, before digging any deeper, it is imperative to understand some political history of modern medicine and how we came to have the current healthcare system.
Before the 19th century, there was no medical licensing system by a governing body or any professional board. A doctor would receive his medical training primarily via apprenticeships and mainly worked in their communities. Mid 19th century brought about the formation of the AMA or American Medical Association. Members of this association had to pay a certain fee to become eligible to pass judgment on the competence of other physicians’. By the year 1900, licensing boards were formed in all states, and they were generally tolerant of all kinds of medical practices such as homeopathy, herbal medicine, midwifery, surgery, and so on.
Next came the Flexner Report in 1909. Abraham Flexner visited 69 medical schools in 90 days to gather data about medical education standards around the country. The report was published in 1910. Some felt that it was an unfair and biased report since the underwriters were the AMA, the Carnegie Foundation, and the Rockefeller General Education Board.
Nevertheless, this report now laid down the foundation for the current American healthcare system. The report replaced the apprenticeship style with preferred institutions accredited by the AMA and other officiating organizations.
Most of these institutions were big money-holding institutions, which made the less known institutions suffer, and as a result, the smaller institutions eventually closed down. The lesser-known institutions were predominantly filled with African Americans and Women, which resulted in a white male-dominated healthcare society. The rural communities suffered because now that spirit of medicine was floating in a sea of debt brought about by attending these large institutions, and serving the community from which these doctors came was not the most financially apt thing to do.
Fast forward to 1928, penicillin was discovered by Alexander Fleming, which changed the course of history and gave humans the ability to treat infections that were once known to be fatal. Many other advances in pharmacology were made, but there was no authority to test these drugs and verify their safety for human consumption.
In 1950, a tragedy occurred in Europe with a drug called Thalidomide. This drug was given to pregnant women to treat nausea in the first trimester, resulting in severe congenital disabilities. The babies of the mothers who were given the drug were born with missing limbs or malformed limbs. This brought about a change in the policy in the United States, and in 1962, United States Congress passed the Kefauver Harris Amendment, which required pre-market approval of drugs.
The following significant change came in 1965 when president Harry S. Truman signed Medicare into law, which gave Social Security recipients access to affordable healthcare. This coverage expanded later on and is now accepted by most healthcare providers. More recently, in 2010, the Affordable Care Act was implemented in which healthcare expanded to millions of Americans who previously were unable to afford healthcare.
Private health insurance is also a considerable part of the healthcare system. While TRICARE, Veterans Health Administrations, Indian Health Service, Medicare, and Medicaid provide the public options for healthcare, the rest of the public has to depend on the privately sold health insurance.
Before the Affordable Care Act (ACA), the practice of medicine did not have much governmental intervention except programs like Medicaid, Medicare, and CHIP. The private sector was primarily responsible for the health insurance needs of families, groups, and individuals. They set the terms of the agreement and specific rules and regulations for different insurance policies. They were able to dictate the types of benefits covered in a particular insurance plan. Furthermore, the insurance companies had the authority to drop any individual from their health insurance plan if they thought that a specific individual or a group was becoming too expensive to keep on the plan.
Furthermore, insurance would cherry-pick the individuals they want to take on as their clients. This translated into more healthy patients without any pre-existing medical conditions obtaining health insurance, and the ones who had a pre-existing condition were not able to obtain insurance, or they were able to obtain insurance but at extremely high premiums. Such an approach of the insurance companies left many individuals out of the healthcare system because they did not qualify for government aid, and when they turned to the private sector, they were faced with high premiums that they could not afford.
Being uninsured further became a compounding problem for an American citizen’s general health because an alarmingly increasing number of Americans did not have any primary care physician who would take care of their healthcare needs. Physicians’ were also faced with deciding whether to take on patients without insurance or opt-out of such practice. Since taking patients without insurance was not a financially sound decision, they turned down patients who did not have adequate insurance coverage.
These changes in the insurance policies and strictly for-profit organizations led to an Emergency room care culture. The patients who did not have any primary care physicians started going to the Emergency Room for their healthcare needs, and the waiting room lines grew significantly. The hospitals cannot turn down any patients who come to the Emergency Room, so the hospital must treat them irrespective of their insurance status.
Once the patient has been treated, the patient is billed in a fee-for-service manner. The ambulance ride, medication, equipment usage, doctor’s time, nightly charges for staying at the hospital, and multiple diagnostic tests are covered under this. Such visits become rather costly, and the patients can not afford to pay this enormous bill. Hospitals lose a great deal of money and continue to lose money even today because of these practices. Even though the hospitals do get reimbursed for a certain amount every year by the government for such expenses, however, these reimbursements are minuscule compared to the money that is spent diagnosing and treating these patients, and so the hospitals have to absorb these costs. In poverty-stricken areas of the United States, many hospitals have declared bankruptcy due to this ever-increasing problem.
Private health insurance is a big business in the United States. These companies have policies that are incredibly complicated and very hard for the ordinary person to understand completely. The Affordable Care Act was an effort to address these issues and many others that the healthcare industry faces today.
