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Andre Thompson
HSMG 753.TW1 Sp.25
Individual Writing Assignment #1
2/12/2025

Before the ACA, what were the central attempts at health care reform in the United States?
Why did they fail?
Before the Affordable Care Act (ACA), several significant attempts at healthcare reform in
the United States had strong backing but ultimately failed due to various political and social
factors. According to (Donald Bar, 2023 x), the process of healthcare reform has a long
history going back as far as the 1930's starting:
1930s—National Health Care Plan: A national health care plan was considered part of
Social Security but dropped to ensure its passage. The fear of overreach and opposition
from various stakeholders contributed to its failure.
1940s - Truman's Proposal: President Harry Truman proposed a national health insurance
system. However, this proposal faced strong opposition from organized medicine and
was seen as a government takeover of health care, leading to its defeat.
1960s—Medicare and Medicaid: While Medicare and Medicaid provide healthcare
financing for the elderly and poor, they did not address the need for comprehensive
national reform, leaving many issues unresolved.
1970s - Comprehensive National Reform: Congress nearly adopted comprehensive
national reform in the 1970s, but the Watergate scandal shifted political priorities,
causing the reform efforts to stall.
1990s - Clinton Health Reform Proposals: President Bill Clinton's health reform
proposals aimed at comprehensive reform met defeat due to a robust national ad
campaign by the health insurance industry, which warned of a massive federal
bureaucracy. Additionally, a shift in congressional control from Democrats to
Republicans led to the abandonment of these proposals. (Barr, 2023)
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These failures were primarily due to deep political divisions, public confusion, and strong
opposition from interest groups, which created significant barriers to achieving lasting
healthcare reform.
What are the main features of the Affordable Care Act?
According to Barr (2023), the Affordable Care Act (ACA) introduced several key features
to reform the U.S. healthcare system. The ACA has several features, but a few mentioned
by Barr (2023) include Expansion of Health Insurance Coverage: The ACA aimed to
expand coverage to millions of uninsured Americans through state-based health insurance
exchanges and expanded Medicaid eligibility in participating states.
Consumer Protections: The ACA implemented protections against discrimination by
health insurance companies based on preexisting conditions, ensuring that individuals are
not denied coverage due to their health status.
Individual Mandate: The ACA initially included an individual mandate requiring most
Americans to have health insurance or pay a penalty, although the ACA eliminated that
version in 2019.
Employer Mandate: Large employers must provide health insurance to their employees or
face penalties, encouraging businesses to offer coverage.
Essential Health Benefits: The ACA established a set of essential health benefits that all
insurance plans must cover, including preventive services, maternity care, mental health
services, and prescription drugs.
Preventive Services: The law mandates that certain preventive services be provided
without cost-sharing, making it easier for individuals to access necessary care.
Medicaid Expansion: The ACA allowed states to expand Medicaid to cover individuals
with incomes up to 138% of the federal poverty level, significantly increasing access to
health care for low-income individuals.
Health Insurance Marketplaces: The ACA created health insurance marketplaces where
individuals and small businesses can compare and purchase insurance plans, often with
subsidies based on income.
Focus on Quality and Cost Control: The ACA introduced various initiatives to improve
the quality of care and control healthcare costs, including Accountable Care
Organizations (ACOs) and value-based payment models.
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Why have there been such strong positions (for and against) regarding the ACA?
The strong positions for and against the Affordable Care Act (ACA) take into account
several factors:
Political Polarization: The ACA has become highly politicized, with strong partisan
divides. Supporters view it as a necessary step toward expanding healthcare access, while
opponents see it as government overreach and infringing personal freedoms.
Impact on Health Care Costs: Proponents argue that the ACA helps control rising
healthcare costs and provides essential consumer protection. Critics contend that it has
increased premiums and out-of-pocket expenses for some individuals and businesses.
Philosophical Differences: The debate often reflects more profound philosophical beliefs
about the role of government in health care. Supporters advocate for a more inclusive,
government-influenced approach, while opponents prefer a market-driven system with
minimal government intervention.
Economic Concerns: Opponents of the ACA often cite concerns about its financial
impact, including potential job losses and increased taxes. Supporters argue that the ACA
can lead to a healthier workforce and lower long-term healthcare costs.
Public Opinion: Public opinion has fluctuated over time, with varying levels of support
and opposition based on the political climate, media coverage, and personal experiences
with the healthcare system. For instance, favorable opinions of the ACA increased after
its implementation, reflecting a growing acceptance of its benefits.
Media Influence: The media's portrayal of the ACA has influenced public perception,
with some outlets emphasizing negative aspects while others highlight its successes. This
media framing can shape the narratives surrounding the law.
Legal Challenges: The ACA has faced numerous legal challenges, which have fueled
ongoing debates about its constitutionality and implementation. These challenges have
kept the law in the public eye and contributed to the polarized views.
Overall, the firm positions regarding the ACA stem from a complex interplay of political,
economic, and social factors, reflecting broader healthcare debates in the United States.
What does it mean that the United States has a "market economy" in health care?
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A "market economy" in health care means that the provision and financing of health care
services fluctuate by supply and demand, similar to other goods and services in a free
market. Here are some key aspects of this concept (Barr, 2023):
Consumer Choice: Individuals can choose their healthcare providers and services based
on personal preferences and financial considerations.
Private Sector Dominance: A significant portion of health care services is provided by
private entities, including hospitals, clinics, and insurance companies, rather than being
predominantly government-run.
Price Competition: Healthcare services can vary based on competition among providers.
This competition can influence the quality and cost of care as providers strive to attract
patients.
Insurance Market: Health insurance operates where individuals and employers purchase
plans from various insurers. The availability and pricing of insurance plans can affect
access to care.
Access Based on Ability to Pay: In a market economy, an individual's ability to pay can
influence access to health care. Those without sufficient financial resources may face
barriers to obtaining necessary care.
Limited Government Role: The government's role in regulating and providing health care
is relatively limited compared to countries with more centralized health care systems.
Focus on Profit: The profit motive drives many healthcare providers and insurers, which
can lead to innovations and improvements in services but may also result in prioritizing
profit over patient care.
A market economy in health care emphasizes individual choice and competition, but it
can also lead to disparities in access and affordability, particularly for vulnerable
populations.
What are the strengths and weaknesses of a market economy for healthcare cost, access, and
quality?
The healthcare market economy presents strengths and weaknesses regarding cost,
access, and quality. Here is a breakdown: According to (Barr, 2023),
Consumer Choice: Individuals can choose their health care providers and services,
leading to better satisfaction and tailored care.
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Innovation and Efficiency: Competition among providers can drive innovation, leading to
advancements in medical technology and treatment options and improved efficiency in
service delivery.
Price Competition: In a competitive market, prices may decrease as providers seek to
attract patients, potentially making care more affordable for consumers.
Diverse Options: A market economy allows various healthcare plans and services,
catering to consumers' needs and preferences.
Quality Improvement: Providers may strive to improve quality to attract more patients,
which can lead to better health outcomes in some cases.
Weaknesses:
Access Disparities: Individuals without sufficient financial resources may face significant
barriers to accessing care, leading to inequities in health outcomes.
High Costs: The U.S. spends more on health care than any other country, and costs can
be prohibitively high for many, particularly those without insurance or high deductibles.
Profit Motive: The focus on profit can sometimes lead to prioritizing financial gain over
patient care, resulting in unnecessary treatments or services.
Complexity of Insurance: The variety of insurance plans can confuse consumers, making
it challenging to navigate coverage options and understand costs.
Quality Variability: The quality of care can vary significantly between providers and
regions, leading to inconsistent health outcomes and patient experiences.
In summary, while a market economy in health care can foster innovation and consumer
choice, it poses challenges regarding access, affordability, and quality of care. In my
opinion, we still have a long way to go, especially after this administration. There is no
way to understand how far we are being set back in the realm of healthcare. There are
already states taking people off of Medicaid in certain states.
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References

Barr, D. A., MD, PhD (2023). Introduction to US Health Policy The Organization, Financing,
and Delivery of Health Care in America (5th ed., pp. x, xi, 1, 14, 15, 48). Johns Hopkins
University Press.