International Journal of Arts Humanities and Social Sciences Studies

Volume 7 Issue 10 ǁ October 2022

ISSN: 2582-1601
www.ijahss.com

Healthcare Reform in America

Sherryl W. Johnson, Ph.D.
Albany State University , School of Business
504 College Drive , Albany, Ga. 31705

Sherryl.Johnson@asurams.edu

Dr. Sherryl W. Johnson currently serves as a Professor in the School of Business at Albany State University.
She teaches in the Management: Healthcare Administration Program and in the Master of Business
Administration Program – Healthcare Concentration. She attended graduate school at Emory University
(MPH) and Clark-Atlanta University (MSW, Ph.D.). Her publications span a variety of healthcare promotion
topics. She holds membership in various professional and community organizations.

Abstract: This article provides a historical account of the United States Healthcare System – including its
benefits and limitations. Also provided are the responses of fifteen multi-disciplinary health professionals from
a variety of health care settings on the current health care crisis. In this age of healthcare reform, solutions are
proposed to improve the healthcare system in the United States of America.

Key Words: Health, Uninsured, Healthcare, Insurance, Health Reform, Affordable Care

I. Introduction
Governmental politics and recent presidential elections have propelled healthcare reform to the top of the
nation’s domestic policy priorities. According to the American Medical Association (1995-2022), health care
spending accounted for about 19.7 percent of the U.S. gross domestic product in 2020 compared to 17.6 in 2019.
Health spending in the U.S. increased by 9.7% in 2020 to $4.1 trillion or $12,530 per capita.

In terms of spending, the U.S. spends more on health care per capita than most industrialized countries. The
World Population Review estimated that the U.S. spent more on its health care costs than any other
industrialized country in 2021 (World Population Review 2022). Even so, healthcare outcomes were not
noticeably different from other developed countries that spent less. The U.S. spends 40% more on healthcare
than any other country in the world – largely due to drug costs and administrative fees. With health costs so
high in the U.S., health insurance is no longer a mere commodity but an essential necessity. According to the
Centers for Disease Control - National Center for Health Statistics, there were 29.6 million (11%) Americans
under age 65 without any health insurance. Uninsured individuals 18-64 represented 13.5% of the population in
2021 (Centers for Disease Control, National Center for Health Statistics, 2022).

With these statistics on the forefront of health care, the questions arise - Whether health care is a right or a
privilege? And What healthcare reforms are needed in America? In 1974, Victor Fuch wrote that - While social
reformers tell us that “health is a right,” the realization of the “right” is always less than complete because some
of the resources that could be used for health are allocated for other purposes. Thus, politicians, health
professionals and the general citizenry of the U.S. continue to ask the question, “Is healthcare a right?" We
must ask “What problems are we currently facing that limit access to health care and how can they be
resolved?” Finally, “What reallocations and systemic changes are necessary to assure that health care is a right?”

This article presents the viewpoints of selected health professionals in a southern U.S. state on these
fundamental health care questions. Their insights from first-hand, day to day knowledge should prove to be both
insightful and useful.

International Journal of Arts Humanities and Social Sciences Studies V7● I 10 ● 20

Healthcare Reform in America

II. Review of Literature

Historically, many measures in both the government and private sector have been taken to promote health care
among the citizens of the U.S. According to the Health Insurance Institute, the nation’s first health insurance
company began in 1847 for the protection of rail and steamboat workers. Anderson, 1975 further revealed that
in 1916 and 1918, attempts were made by 16 state legislatures to establish some form of compulsory health
insurance, as a mechanism to help families pay for health services. However, the movement was stalled due to
lack of support from other health related industries.

Insurance as we know it today began in 1929 for Dallas school teachers. This insurance plan eventually evolved
into Blue Cross plans (for hospital care), and later became Blue Cross and Blue Shield (to provide for outpatient
care). Many other commercial health plans such as Aetna, Prudential and Cigna have also developed (Raffel
and Barsukiewicz, 2002). In 2007, 99 percent of companies with 200 workers or more provided health
insurance to their employees, according to the Kaiser Family Foundation and Health Research and Educational
Trust (HRET) Survey of Health Benefits (Collins, 2007).

In addition to private health plans, Title XVIII Medicare and Title XIX, Medicaid were enacted in 1967 to
provide health services for the indigent, elderly and disabled – via the modification of the Social Security
Legislation. Since that time numerous other health care plans have been approved such as SCHIP (State
Children’s Health Insurance Program) for children and the Medicare Part C to provide prescription coverage for
the elderly.

After a lengthy series of legislative events, led by President Obama, the House of Representatives passed the
Health Care Reform Bill. In March 2010, the health care reform bill that President Obama officially titled the
Affordable Care Act, became a part of the law (Alpin, 2010). Various aspects of the act took effect relative to
children staying on their parents’ health plans until age 26; coverage for certain pre-existing conditions,
reducing insurance cancellation / lifetime caps, providing preventive care and emergency room care (Alpin,
2010).

Since it was enacted, the Affordable Health Care Act has helped about 20 million people get health insurance
with increased benefits and lower costs to consumers and adding quality to the healthcare system – despite the
individual mandate repeal in 2019 (American Public Health Association, 2021).

Yes, in principle, it appears that we want to increase access, quality and the affordability of health care – but
barriers to accomplishing these goals still remain. A few of the many culprits include the high prices of
premiums and deductibles and the link between employment and insurance. Part-time workers and those under
contract are often excluded as premier candidates for health insurance (NCHI, 2004). The healthcare
marketplace offers an alternative for part-time and unemployed workers (Healthcareplans.com 2022). Even so,
universal governmental coverage without premiums is lacking.

Historical polls, showed that public and opinion leaders viewed the need to expand health care as the most
critical domestic policy challenge facing the nation (Collins, 2007). Poll results also showed that the majority
of Americans (61%) believe that paying for health insurance should be a shared responsibility by individuals,
employers and government (Collins, 2007). Many movements have been underway recently opposing and
supporting healthcare reform. Some “tea-partyers” have organized movements across the country in opposition
to “Obamacare.”

Additionally, another author suggested that physicians, nurses and other medical professions were in the best
position to collaborate with patients on health care decisions – without being at the mercy of insurance
companies’ profit driven decisions (Kucinich, 2007). Other suggested resolutions have included making health
care affordable, increasing access to quality health care, making health care portable (despite job mobility or life
occurrences) and slowing the rate of health care spending (Romney, 2007).

Kucinich, 2007, also advocated for fundamental changes in the current health care system. In order to make
fundamental changes, the major players in the health care system must be considered: (1) patients and
customers; (2) providers of services; (3) suppliers of services and goods, including pharmaceuticals; (4)
insurance intermediaries, including Medicare and Medicaid; and (6) government - as regulator, planner,
financier for research and training (Williams and Torrens, 2008).

International Journal of Arts Humanities and Social Sciences Studies V7● I 10 ● 21

Healthcare Reform in America

While the U.S. health system needs significant reform, it is still known as the best quality health care system in
the world (Romney, 2007). To make needed reform, and assure the right to health care, health providers may
be among the best “front-line” professionals to propose changes and solutions to the crises we face in the
delivery of health care in the United States.

III. Methods
Semi structured interviews were conducted with over a dozen health providers in southern and northern Georgia
cities – in their health care facilities. All of the providers were involved in direct patient care or the
administration of patient care services. The health providers included health service owners, physicians, nurses,
office managers, a health educator and a health analyst. The major interview questions requested the insights of
the health professionals on health care / insurance problems and related solutions to the problems identified.
The responses from the providers were placed in tabular form for review and summarization.

IV. Results
Results of the semi-structured interviews yielded fifteen responses from a wide variety of health providers on
the U. S. health care crisis. A summary of the responses are presented in Tables Ia and Ib.

Generally, speaking, all of the health providers identified health problems commonly associated with the “three-
legged stool” – cost, access and quality. The cost issues seemed to have the greatest frequency in occurrence
and were directly related to the other issues. Solutions were suggested by the health providers - including
universal access / coverage, National Health Insurance, governmental intervention, reconfiguration of premiums
and deductibles, direct pay vs. third party pay and other incentives for preventive health practices (See Tables Ia
and Ib).

Table Ia -Health Care Providers’ Identification of Health Problems and Related Solutions

Health Provider–Work Site Sources of Problems Related Solutions

CNA - Assisted Living -Cost of health care; medical -Universal access and coverage
Facility insurance premiums are sky -Health care should be a right;
rocketing not a privilege
-Many employees not eligible for
medical benefits
-Employer plans too expensive
-Demand for insurance increasing
-Elderly population living longer
Nurse Tech – Hospital -Limitations on Peach Health -Continuation of Peach Health
Care funding Care funding
Chiropractor – Private -Insurance profit vs. patient health -Everyone should have some type
Practice primary focus of health insurance.
-Rising cost of visiting a provider -Workshops on various issues,
-Unemployed / self-employed do e.g. health insurance for those
not always know where to find with low incomes
quality insurance at a fair price
Family Nurse Practitioner – -Disparities in health care – -Government programs for the
Health Clinic especially for the uninsured poor
-Underinsured with Preferred -Governmental intervention; less
Provider Organizations that allow spending on war
selected coverage -More programs from which the
uninsured may choose
-Preventive medicine to keep
different diseases from occurring
– e.g. healthy diet and exercise
Health Office Manager – -Insurance is too expensive -There should not be premiums
Hospital -Health care costs are too and deductibles.
expensive -There are Medicare plans that do
-Low income families cannot not require premiums and
afford health care and make deductibles – but one or the
decisions on whether to get other.
International Journal of Arts Humanities and Social Sciences Studies V7● I 10 ● 22
Healthcare Reform in America

treatment or not Why can’t insurance companies

do the same?
Senior Medical Secretary – -Health insurance is not patient -Eliminate cumbersome aspects
Hospital friendly- too much “red tape” of insurance coverage and
-For needed care, some insurance approval for procedures.
companies have to be called
repeatedly (by the physicians) to
verify claims
-Insurance verification approval
sometimes falls on the patient
R.N. – Health Clinic -Insurance is too high and many -Follow recommended health
people are unable to afford any guidelines form experts.
policy. -People should be more proactive
-People do not practice preventive about their health – get
self-care. screenings, eat healthy and drink
water.
-The government should offer
lower premium policies (for all) –
especially for the less fortunate.
-Lower premiums should be
offered through jobs.
-(Affordable) healthcare should -Pass legislation for universal
RN – Health Center be for everyone – not just for health care (for all)
those who work. -Include health care as a national
-Mis-prioritization of the priority vs. war (national
country’s needs security) only
-Reassess the need for and role of
technology in promoting health
care

Table Ib -Health Care Providers’ Identification of Health Problems and Related Solutions

Health Provider–Work Site Sources of Problems Related Solutions

RN – Hospital -Insurance does not meet the -Insurance companies should
patients’ basic or major needs. cover more services for less
-Some insurance companies give money – so that basic needs can
minimum coverage, and leave the be met.
patients with more than half of the
costs for their visits.
-Many major surgeries are not
covered and leave the patient to go
untreated or pay out of pocket.
General Surgeon – Private -Problems stem from the profit -National Health Insurance
Practice motive of insurance companies and
hospitals – along with annual
increases in premiums.
-Unaffordable health insurance and
hospital services
-Fee increases for new equipment
purchases in health facilities yearly
LPN – Outpatient Clinic -Failed national policies on -Affordable health care by the
economics and healthcare government (for all)
-“Free-loading” – the shift in the cost -Continuation of the Medicare
of employee health care coverage to and Medicaid programs for the
tax payers and responsible citizens elderly and mentally challenged
-Critical choices – basic living -Discount insurance based on
expenses such as rent compete with income level and allow choices
health insurance premiums on amount of coverage
--Dropped benefits by employees -Have direct pay for insurance vs.
International Journal of Arts Humanities and Social Sciences Studies V7● I 10 ● 23
Healthcare Reform in America

leads to emergency room care and third party

increases for tax payers. -Insurance incentives for
preventive health practices – such
as being a non-smoker
Certified Nurse Midwife – -Limited service availability and - Governmental review of health
Private Practice affordability for low- or no-income care to determine what works and
individuals what doesn’t
-Public services should include
all.
Health Educator – Public -People with limited education often -Write elected officials to support
Health Clinic take jobs without insurance. expanded health care access.
-Implement universal health care.
Home Health Care Director -Employment is no longer a -Laws to make health care
– Owner Home Health guarantee of health coverage. affordable
Care Service -Part-time and contract workers may -The government should be
be ineligible for employer insurance. removed from decisions on health
-Some people cannot afford insurance and allow doctors to
insurance. approve patient’s insurance.
-Too many factors in pre-qualifying
for insurance
-Too few insurance companies from
which to choose – thus, limiting
market competition
-Too much paper work
Health Management -Expense of health insurance -Hospital carefulness is needed in
Analyst- Hospital -Affordability for unemployed or low providing care for those who
income families cannot afford it.
-High premiums for employers -Promotion of primary care
services to minimize unnecessary
care

V. Discussion / Conclusion
Problems and solutions for the current health care system identified by the health providers were quite similar to
those identified in the literature. One author suggested one “real” solution to the health care crisis as the
removal of the “for-profit” element from the health care equation (Kucinich, 2007). Other less radical
suggestions included such measures as shared responsibility in funding (Collins, 2007).

Allowing health providers to make more health care decisions relative to funding / reimbursement (Kucinich,
2007); establish federal incentives to deregulate and reform state markets; enhance savings accounts and provide
full deductibility of qualified medical expenses and the reformation of Medicaid were also suggested in the
literature (Romney, 2007). Additionally, the administration of President Obama has led reforms to increase
access to health insurance. Even so, national healthcare remains a common recommendation by health
professionals. Many of the suggested solutions have considered cost-saving measures, more care management
and prevention (Woolhandler and Himmestein, 2007).

Both preventive and chronic disease management models consist of coordinated sets of health care interventions
and communications amenable to self-care management (Long, Perry, Pelletier, Lehman, 2006). Mathematical
and business models have also been suggested to explore price control and regulation relative to the delivery of
health care and pharmaceuticals.

Obviously, the health care crisis is much too complex to be effectively resolved in one study – especially in
consideration of escalating administrative costs and pharmaceutical prices, the increase in specialization among
providers, the increase in technological advances, the aging of the population, the increase in chronic diseases,
health consumerism and open-ended spending in health care.

Despite the approach selected based on feedback from professionals and citizens, alike, the era in which we
live presents a golden opportunity to revisit our health care stance in America. It is also a time when we can
critically review appropriate alternatives and determine resolutions to our dilemma. The ultimate question
International Journal of Arts Humanities and Social Sciences Studies V7● I 10 ● 24
Healthcare Reform in America

remains “What additional steps will be embraced to move towards health care as a right vs. a privilege - for all
of the citizens of our great nation?”

References
[1]. American Medical Association. 1995-2022. Retrieved October 6, 2022 from
https://www.ama-assn.org/about/research/trends-health-care-spending
[2]. American Public Health Association. 2021. Health Reform. Retrieved October 6, 2022
from https://www.apha.org/topics-and-issues/health-reform
[3]. Anderson, O. 1975. Blue Cross since 1929: Accountability and public trust. Cambridge: Ballinger.
[4]. Aplin, L. 2010, Sept. Healthcare reform bill: The true effect on small business. The US
Financial Report. Retrieved September 23, 2010, from
http://www.usfinancialpost.com/healthcare-rform-bill-the-true-effet-....
[5]. Centers for Disease Control – National Center for Health Statistics. 2022. Health
Insurance Coverage: Early Release of Estimates From the National Health Interview Survey,
2021. Retrieved October 6, 2022 from https://www.cdc.gov/nchs/fastats/health-insurance.htm
[6]. Collins, S. 2007, December. Employer-based health insurance: past, present and future.
Healthcare Financial Management, 34-37.
[7]. Fuch, V. 1974. Who shall live? Health, economics, and social choice. New York: Basic Books.
[8]. Growth in U.S. health care spending slows: but out of pocket continue to rise, annual government
report shows. 2007. Health Day. Retrieved February 21, 2007, from
http://www.nlm.nih.gov/medlineplus/news/fullstory_43636.html
[9]. Healthcareplans.com. 2022. 10 of the most popular Obamacare questions answered.
Retrieved October 6, 2022 from https://www.healthplans.com/Obamacare- FAQ.html
[10]. Kucinich, D. 2007, November. Get rid of for-profits. Healthcare can no longer be a commodity for
sale to those who can afford it. Modern Healthcare, 37 (47), pp. 19-20.
[11]. Long, D. A, Perry, T., Pelletier, K., Lehman,G. 2006. Disease Management, 9 (3), 176-181.
[12]. National Coalition on Health Care. 2004. Health insurance coverage. Retrieved February 2007, from
www.nchc.org/facts/cost.shtml
[13]. National Coalition on Health Insurance (NCHI) Coverage. 2004. Retrieved February 2007, from
www.nchc.org.facts/coverage.shtml
[14]. Raffel, M. and Barsukiewicz, C. 2002. The U.S. Health System: Origins and Functions. Albany:
Delmar – Thomson Publishing.
[15]. Romney, M. 2007, November. A federalist approach. Modern Healthcare, 37 (47), pp. 24 – 25.
[16]. Williams, S. and Torrens, P. 2008. Introduction to Health Services, 7 th edition. Clifton Park:
Thomson Delmar Learning.
[17]. Woolhandler, S. and Himmestein, D. 2007, November. Care is complicated. Modern Healthcare,
37 (47), pp. 32 – 33.
[18]. World Population Review. 2022. Healthcare costs by country 2022. Retrieved October
6, 2022 from https://worldpopulationreview.com/country-rankings/health-care-costs-by-country

International Journal of Arts Humanities and Social Sciences Studies V7● I 10 ● 25