The government plays a vital role in the regulation of the healthcare system in terms of control of costs, quality of services, accessibility, and laws governing various medical professions. In the United States, the government under different administrations has strived to create a quality healthcare system accessible and affordable to every resident in the nation. The healthcare policy in the U.S. has gone through a series of changes attributed to the prevailing economic and political system and the desire to make the sector better and beneficial to everyone (Engel, 2018). For example, Medicare and Medicaid program, Children’s health insurance program, and Affordable Health Care Act (ACA) that emphasized on making insurance premiums affordable and accessible to Americans (Callaghan & Jacobs, 2016). The principles stated in the health policy give the characteristics of the distribution of the resources to the public. The United States has one of the finest quality healthcare systems among developed nations. However, at the time people were pushing for reforms, the healthcare services were only available to a limited portion of the American population who could afford them. Apart from the healthcare services being expensive to the citizens, the federal government was spending a lot of resources in the healthcare sector than any other nation. Despite the high expenditure, the U.S. was still recording the high incidence of chronic conditions and infant mortality (Engel, 2018). The private health facilities and insurance companies played a major role in the high cost of medication. To address these problems, the federal government tried to strengthen and bring together the fragmented health policies. For example, the President Barrack Obama’s Affordable Care Act of 2010 addressed the issues of women and children, health insurance cover, strengthened Medicare, introduced Young Adult Coverage, and incorporated Medicaid and CHIP health insurance programs (Fuchs, 2018). The process involves introducing a bill to the House Committee, the Congress, and the Senate before the president approves it and signs it into law. The healthcare system touches almost every individual in the economic, social and political sector. The major stakeholders with a primary interest in healthcare policies are patients, healthcare providers, insurance firms, non-governmental organizations that fight for human rights and health, pharmaceutical firms, and employers. The government and its officials, such as the president and state governors play a central role of trying to regulate the various stakeholders to ensure none benefits at the expense of the other (Fuchs, 2018). Healthcare is a human right, and the government is supposed to set policies that strike a balance in the players that make up the healthcare sector. Most insurance companies are usually large corporations privately owned by locals or foreigners. The insurance companies offer health covers to patients. The premiums are charged based on the health of a patient and pre-existing conditions. Patients consider such considerations when determining premiums for patients unethical. As a result, some people end not buying the covers due to high premiums. The firms oppose almost every insurance program set by the government due to the low premiums expected to be charged, and the extent of services the covers should encompass (Dalen et al., 2015). For instance, private insurance firms are afraid of a Medicare program that covers all Americans because they might remain without clients. Pharmaceutical companies are tasked with the provision of health products such as medicines. The firms usually set prices for medicines based on many market forces such as the cost of other products, the demand for the products, and the supply of raw materials. The government regulates prices and quality of pharmaceutical products entering the market to protect patients’ safety and ensure affordability. The government subsidizes the prices or provides the medication for free. Just like insurance firms, the government sets policies that guide the entry of drug products into the market and the price ranges (Engel, 2018). The pharmaceutical firms work closely with insurance firms because most patients use their insurance covers to purchase medicines. Additionally, they work with healthcare providers who are the prescribers of their products. In the healthcare sector, caregivers play a vital role in healthcare policies. They are mandated to provide quality and adequate services to patients to ensure their full recovery. Apart from their professional regulatory bodies, healthcare providers work under policies that guide their behavior and actions at work and regulate their payment. For the patients, they have an obligation of living a healthy lifestyle and a right to access quality and affordable care (Fuchs, 2018). The policies set by the government aim at ensuring the patient has access to the medical services they deserve. The set policies ensure social standards or economic background of a patient do not hinder them from acquiring the services they desire.
Non-governmental organizations such as trade unions fight for the rights of the patients and push the government to set policies and programs that protect the citizens’ health and welfare. They also push employers to take insurance covers for their employees and ensure they are up to date and eligible to use in accessing medical services (Tricco et al., 2017). For instance, ACA imposes a fine to employers with fifty or more full-time employees who do not provide health coverage to approximately 95% of the employees. The United States federal government under the administration of President Bill Clinton and Barrack Obama made tremendous efforts in making health policies or strengthening the existing policies. President Clinton wanted a nation with healthy individuals who could drive the economy forward. In so doing, he lobbied and pushed for a revival of the Medicare program by introducing reforms that ensured the private sector does not take advantage of the political conflicts to mint money from innocent citizens. At the time of implementing the policy, the Senate was divided on the plan to strengthen the Medicare policy, and the private sector was unwilling to accept change (Tricco et al., 2017).
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President Obama is remembered for enacting the ACA policy that saw millions of Americans receiving care and accessing health insurance covers despite their economic background. During his campaign, Obama had promised people to transform the nation’s health system. The health industry supported the Obama reforms, including major interest groups led by Senator Ted Kennedy and a group lobbying for prescription drugs, PhRMA. Initially, all the Republicans and most of the Democrats were against ACA. The political mood was hostile, and most people were opposed to the policy citing government interference in the public sector and cost implications for the economy. The program was considered costly and unaffordable in the long run (Dalen et al., 2015). However, Obama managed to convince the Republicans, and a section of them helped in passing the policy in 2010. The insurance firms in the U.S. abandoned Obamacare, citing that it was unaffordable and could collapse their businesses. The policy emphasized expanding the Medicare program, which would put more Americans under insurance schemes funded by the government. Insurers felt such a move was pushing them out of business and the interested Republicans helped them to oppose most components of the policy that concern the insurance policies (Callaghan & Jacobs, 2016). As a result, the implementation process was delayed. It forced the team lobbying for the policy to make some changes to the policy. For instance, they revised the tax code and reduced health insurance coverage by dropping the preventive care coverage and remained with chronic conditions cover. Despite the challenges it met, Obamacare got enough support to be enacted, and the policy has changed the face of health in the U.S.
References
Callaghan, T., & Jacobs, L. R. (2016). Interest group conflict over Medicaid expansion: The surprising impact of public advocates. American journal of public health, 106 (2), 308-313.
Dalen, J. E., Waterbrook, K., & Alpert, J. S. (2015). Why do so many Americans oppose the Affordable Care Act? The American journal of medicine, 128 (8), 807-810.
Engel, J. (2018). Unaffordable: American Healthcare from Johnson to Trump. The University of Wisconsin Press.
Fuchs, V. R. (2018). How to make U.S. health care more equitable and less costly: Begin by replacing employment-based insurance. Jama, 320 (20), 2071-2072.
Tricco, A. C., Langlois, E. V., & Straus, S. E. (Eds.). (2017). Rapid reviews to strengthen health policy and systems: A practical guide. Geneva: World Health Organization.
