Health care is one of the most ideologically divisive issues in the country, with wide ranging implications affecting not only the health care industry (providers, employees, beneficiary industries) itself, but the average Americans in general, as well as the government (both at local and federal level), along with the national economy, owing to its sheer size.
This very complex subject unfortunately has been reduced to two chief fundamentals, namely, the mechanics of cost and the scope of coverage.
There are two major schools of thoughts dominating the mainstream thought process when it comes to the American health care system.
The First School of Thought
The first school of thought (primarily in the conservative sphere) believes that the federal government's involvement in health care should be similar to every other sector of the economy - minimal. The healthcare industry should be left to its own devices, and allowed to achieve a point of maximum efficiency through a system of trial and error based on our own unique blend of free market economics- the very same organic process that successfully propelled the American economy to become the largest in the world. The health care industry must learn to navigate itself through the vicissitudes of the open market, without the comfort of a federal safety net blunting its competitiveness and natural ability to evolve. Case to the point: this process of trial and error has already exposed the impracticability and harmful effects of a federal or state mandate on health care economics, which almost always result in insurance firms building additional cost into their premiums.
The Second School of Thought
The second school of thought (primarily within the liberal sphere), on the other hand, believe that health care is not a business. It is the fundamental right of every member of our society to have access to health care. By subjectively abdicating the responsibility of managing the national health care, and handing the task to the fragmented, uncoordinated and capitalistic private enterprises, we are risking the health and well-being of millions of Americans. Private firms, by its very nature, are chiefly answerable to their shareholders, and thus, will attempt to minimize its business risks and increase its return of investments by excluding the weakest and least commercially viable members of the society from health care coverage. The aged, the poor, the chronically ill and the high risk demographics will inevitably be left in the sideline as insurance companies and private healthcare providers pursue their overarching strategic goals. Furthermore, the United States is one of the last remaining developed country that has yet to implement a universal healthcare system. This is despite the fact that the United States spends more on health care per capita ($8,937) than any other developed countries. 29 of the top 31 developed countries in the world has a universal health care system (twelve single payer, nine two tier, and eight insurance mandate).
H.R. 3590 Patient Protection And Affordable Care Act (PPACA)
The exponentially accelerating cost of health care has been a major source of concern for successive American administrations since the Nixon presidency.
23 March, 2010: Barack Obama signs PPACA
In fact, there have been numerous health care proposals flying around the Capitol over the last four decades; nonetheless, there have been only incremental reforms and tweaks enacted thus far.
However, on March 23, 2010, President Barack Obama's controversial H.R. 3590 Patient Protection and Affordable Care Act (Full Text), referred to by many as Obamacare, was signed into law. It is the most transformative piece of legislation passed by Congress since the enactment of the Medicare Legislation of 1965.
Mandate for businesses (exception applies) and individuals to have an approved level of health insurance, enforceable by penalties
A federal subsidy program to pay, either in part or full, the health insurance of 34 million uninsured American to comply with item 1.
Prohibition for insurance providers to deny coverage based on preexisting conditions, a move which is expected to extend coverage to an additional 20% to 66% of the U.S. adult population, approximately 36 to 122 million Americans (Source: Government Accountability Office, Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million, March 27, 2012)
A range of regulatory changes related to the Patient Centered Outcomes Research Institute (PCORI) and the Independent Payment Advisory Board (IPAB), including discounts on physicians reimbursement claims
Health insurance exchanges
Expanded access to Medicaid
Staggered rollout began on June 12, 2010, and will run until 2018.
The creation of mandates for businesses and individuals, as well as the introduction of a range of new regulations, expands the federal government's role in health care into unhealthy levels and encroaches on the personal liberty of individuals
The creation of a federalized subsidy system, through a mixture of health insurance exchanges and Medicaid expansion to enable uninsured Americans to comply with the federal health mandate
Penalizing healthier and younger insurance policy holders with higher premiums to subsidize uninsured Americans
No real efforts to tackle the spiraling cost of health care
Questionable figures used to calculate the PPACA's actual cost, with some claiming that it will actually increase health care costs by a significant margin
The coverage is not universal, and as many as 20 million Americans are expected to remain uninsured upon the plan's full enactment