Providers, Prescriptions and Patients: Methodology for U.S. Health Care Reform

Abstract

Abstract

Health care reform should be considered equal parts moral and economic issues. The United States spends more on health care than any other nation in the world ($2.6 trillion annually), yet the U.S. has some of the worst health outcomes of developed nations.^1,2 Although health care spending comprises over one-sixth of the economy (17.9% of GDP), over fifty million U.S. citizens live without health insurance. The U.S. needs to use finances more efficaciously not only to enhance quality of care and patient outcomes, but to avoid a looming economic crisis.³ Recently, the Congressional Budget Office reported that if Medicare cost inflation exceeds overall economic growth by 2.5%, the top marginal tax rates in 2050 will approach 92%.^3,4

The Patient Protection and Affordable Care Act (ACA) addresses problems associated with cost, coverage and quality by introducing: the Individual Mandate, Accountable Care Organizations (ACOs), Bundled Payments for Care Improvement (BPCI) Initiative, Patient-Centered Outcomes Research Institute (PCORI), and many more pilot programs that act as vehicles of site-specific reform. However, underlying health care problems still remain that must be resolved to facilitate the ACA reforms. These daunting issues include, but are certainly not limited to: the shortage of physicians, ACO practitioner liability, weaknesses of the Individual Mandate, the remaining uninsured and the outmoded practices of the U.S. Food and Drug Administration (FDA). The goal of this paper is to address these problems and propose strategic reforms that will either augment or exist concomitantly with the ACA.