Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by practitioners in allied health, dentistry, midwifery-obstetrics, medicine, nursing, optometry, pharmacy, psychology and other care providers. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as in public health.
In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others, planning occurs more centrally among governments or other coordinating bodies. In all cases, according to the World Health Organization (WHO), a well-functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained health facilities and logistics to deliver quality medicines and technologies.
Health care can contribute to a significant part of a country's economy. In 2011, the health care industry consumed an average of 9.3 percent of the GDP or US$ 3,322 (PPP-adjusted) per capita across the 34 members of OECD countries. The USA (17.7%, or US$ PPP 8,508), the Netherlands (11.9%, 5,099), France (11.6%, 4,118), Germany (11.3%, 4,495), Canada (11.2%, 5669), and Switzerland (11%, 5,634) were the top spenders, however life expectancy in total population at birth was highest in Switzerland (82.8 years), Japan and Italy (82.7), Spain and Iceland (82.4), France (82.2) and Australia (82.0), while OECD's average exceeds 80 years for the first time ever in 2011: 80.1 years, a gain of 10 years since 1970. The USA (78.7 years) ranges only on place 26 among the 34 OECD member countries, but has the highest costs by far. All OECD countries have achieved universal (or almost universal) health coverage, except Mexico and the USA.
Active debate about health care reform in the United States concerns questions of a right to health care, access, fairness, efficiency, cost, choice, value, and quality. Some have argued that the system does not deliver equivalent value for the money spent. According to a 2004 Institute of Medicine (IOM) report:
"The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population." A 2004 OECD report said: "With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990." The American Health Care Act of 2017 (H.R. 1628) often shortened to the AHCA, or nicknamed Trumpcare, is a United States Congress bill to partially repeal the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. Rejected Senate amendments would have renamed it the Better Care Reconciliation Act of 2017, Obamacare Repeal Reconciliation Act of 2017, or Health Care Freedom Act of 2017. |
The group's methodology has been criticized by economist John C. Goodman for not looking at cause of death or tracking insurance status changes over time, including the time of death. Further, a 2009 study by former Clinton policy adviser Richard Kronick found no increased mortality from being uninsured after certain risk factors were controlled for, and specifically criticized the methodology used by IOM
Access to health care varies across countries, groups, and individuals, largely influenced by social and economic conditions as well as the health policies in place. Countries and jurisdictions have different policies and plans in relation to the personal and population-based health care goals within their societies.
Health care systems are organizations established to meet the health needs of target populations. Their exact configuration varies between national and sub-national entities. Many tylpes of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programmes for the prevention of transmissible diseases.
They also include the services of professionals in residential and community settings in support of self care, home care, long-term care, assisted living, treatment for substance use disorders and other types of health and social care services. Community rehabilitation services can assist with mobility and independence after loss of limbs or loss of function. This can include prosthesis, orthotics or wheelchairs. Many countries, especially in the west are dealing with aging populations, and one of the priorities of the health care system is to help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day-to-day activities at home, transporting them to doctor's appointments, and many other activities that are so essential for their health and well-being. Although they provide home care for older adults in cooperation, family members and care workers may harbor diverging attitudes and values towards their joint efforts. This state of affairs presents a challenge for the design of ICT for home care. Health care quality assurance consists of the "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps." Private companies such as Grand Rounds also release quality information and offer services to employers and plans to map quality within their networks.
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The 2004 IOM report observed that "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States", while a 2009 Harvard study conducted by co-founders of Physicians for a National Health Program, a pro-single payer advocacy group, estimated that 44,800 excess deaths occurred annually due to lack of health insurance.
Health care is conventionally HB regarded as an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions. The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams. This includes professionals in medicine, psychology, physiotherapy, nursing, dentistry, midwifery (obstetrics) and allied health, plus many others such as public health practitioners, community health workers and assistive personnel, who systematically provide personal and population-based preventive, curative and rehabilitative care services. The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations' International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and "other human health activities".
The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates, or other allied health professions, e.g. in the field of optometry, hydrotherapy, medical massage, yoga therapy, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc. In addition, according to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, health care includes many categories of medical equipment, instruments and services as well as biotechnology, diagnostic laboratories and substances, and drug manufacturing and delivery. The US health care delivery system unevenly provides medical care of varying quality to its population. In a highly effective health care system, individuals would receive reliable care that meets their needs and is based on the best scientific knowledge available.
In order to monitor and evaluate system effectiveness, researchers and policy makers track system measures and trends over time. The US Department of Health and Human Services(HHS) populates a publicly available dashboard called, the Health System Measurement Project (healthmeasures.aspe.hhs.gov), to ensure a robust monitoring system. The dashboard captures the access, quality and cost of care; overall population health; and health system dynamics (e.g., workforce, innovation, health information technology). Included measures align with other system performance measuring activities including the HHS Strategic Plan, the Government Performance and Results Act, Healthy People 2020, and the National Strategies for Quality and Prevention. On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act by a narrow margin of 217–213, sending the bill to the Senate for deliberation. It was passed as a budget reconciliation bill that is part of the 2017 federal budget process; if this status is upheld by the Senate Parliamentarian, then no Senate filibuster will be permitted and passage of the bill in the Senate will require only a simple majority of votes. |
On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act by a narrow margin of 217–213, sending the bill to the Senate for deliberation. It was passed as a budget reconciliation bill that is part of the 2017 federal budget process; if this status is upheld by the Senate Parliamentarian, then no Senate filibuster will be permitted and passage of the bill in the Senate will require only a simple majority of votes. It would repeal the parts of the Affordable Care Act within the scope of the federal budget, including provisions contained within the Internal Revenue Code such as the "individual mandates" (in IRC § 205), employer mandates (in IRC § 206) and various taxes (IRC § 201 et. seq.), and also modifications to the federal Medicaid program (in Sections 111-116 and 121).
The nonpartisan Congressional Budget Office projects that the AHCA would increase the number of uninsured people by 23 million over 10 years, but would decrease the federal budget deficit by $119 billion over the same period (about 1%), mainly by cutting Medicaid coverage for lower income Americans. Both the House AHCA bill and Senate BCRA bill would cut taxes largely for wealthy Americans. If enacted, insurance premiums are projected to decrease for younger, healthier, and wealthier people, while older and poorer people would likely see their premiums increase.
Senate Republicans initially approached the AHCA with an unprecedented level of secrecy; a group of 13 Republican Senators drafted the Senate's substitute version in private, raising bipartisan concerns about a lack of transparency and about the all-male composition of the committee. On June 22, 2017, Republicans released the first discussion draft for an amendment to the bill, which would rename it to the Better Care Reconciliation Act of 2017. On July 25, 2017, although no amendment proposal had yet garnered majority support, Senate Republicans voted to advance the bill to the floor and begin formal consideration of amendments.
On July 28, 2017, the bill was returned to the calendar after the Senate rejected several amendments, including S.Amdt. 667, the "Skinny Repeal" package offered by Sen. Mitch McConnell, which failed on a 49–51 vote. Sens. John McCain, Susan Collins, and Lisa Murkowski were the only Republicans to vote against the measure.
On September 13, 2017, Senators Graham, Cassidy, Heller, and Johnson released a draft amendment to the bill that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states". However, it was not voted upon due to lack of support. On October 12, 2017, due to this failure of Congress to pass a repeal, President Donald Trump issued an Executive Order to Promote Healthcare Choice and Competition. A separate decision on the same day as this order resulted in no longer paying a key ACA healthcare subsidy, which the Congressional Budget Office warned would increase health insurance premiums on the ACA exchanges by as much as 20% and add nearly $200 billion to the budget deficit over a decade. Critics further described the executive order as another part of an ongoing strategy to sabotage the Affordable Care Act.
The first executive order signed by U.S. President Donald Trump, executed just hours after he was sworn into office on January 20, 2017, was Executive Order 13765, titled Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal. The order set out interim procedures in anticipation of repeal of the Patient Protection and Affordable Care Act (popularly known as the ACA, or Obamacare). The order came on Trump's campaign pledges to repeal the Patient Protection and Affordable Care Act, which Trump stated would take a long time, with a replacement possibly not being ready until 2018.
On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act of 2017 (ACHA) by a narrow margin of 217–213, sending the bill to the Senate for deliberation. It would repeal the parts of the Affordable Care Act within the scope of the federal budget, including provisions contained within the Internal Revenue Code such as the "individual mandates" (in IRC § 205), employer mandates (in IRC § 206) and various taxes (IRC § 201 et. seq.), and also modifications to the federal Medicaid program.
The nonpartisan Congressional Budget Office projected that the AHCA would increase the number of uninsured people by 23 million over 10 years, but would decrease the federal budget deficit by $119 billion over the same period (about 1%), mainly by cutting Medicaid coverage for lower income Americans. Both the House AHCA bill and Senate BCRA bill would cut taxes largely for wealthy Americans. Insurance premiums were projected to decrease for younger, healthier, and wealthier people, while older and poorer people would likely see their premiums increase.
Senate Republicans initially approached the AHCA with an unprecedented level of secrecy; a group of 13 Republican Senators drafted the Senate's substitute version in private, raising bipartisan concerns about a lack of transparency and about the all-male composition of the committee. On June 22, 2017, Republicans released the first discussion draft for an amendment to the bill. On July 25, 2017, although no amendment proposal had yet garnered majority support, Senate Republicans voted to advance the bill to the floor and begin formal consideration of amendments.
On July 28, 2017, the bill was returned to the calendar after the Senate rejected several amendments, including S.Amdt. 667, the "Skinny Repeal" package offered by Sen. Mitch McConnell, which failed on a 49–51 vote. Sens. John McCain, Susan Collins, and Lisa Murkowski were the only Republicans to vote against the measure. On September 13, 2017, Senators Graham, Cassidy, Heller, and Johnson released a draft amendment to the bill that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states". However, it was not voted upon due to lack of support. The deadline for Congressional Republicans to end the ACA as part of the Congressional budget reconciliation process (which would enable Senate Republicans to pass new legislation with 51 votes, rather than 60) then expired on September 30, 2017.
The nonpartisan Congressional Budget Office projects that the AHCA would increase the number of uninsured people by 23 million over 10 years, but would decrease the federal budget deficit by $119 billion over the same period (about 1%), mainly by cutting Medicaid coverage for lower income Americans. Both the House AHCA bill and Senate BCRA bill would cut taxes largely for wealthy Americans. If enacted, insurance premiums are projected to decrease for younger, healthier, and wealthier people, while older and poorer people would likely see their premiums increase.
Senate Republicans initially approached the AHCA with an unprecedented level of secrecy; a group of 13 Republican Senators drafted the Senate's substitute version in private, raising bipartisan concerns about a lack of transparency and about the all-male composition of the committee. On June 22, 2017, Republicans released the first discussion draft for an amendment to the bill, which would rename it to the Better Care Reconciliation Act of 2017. On July 25, 2017, although no amendment proposal had yet garnered majority support, Senate Republicans voted to advance the bill to the floor and begin formal consideration of amendments.
On July 28, 2017, the bill was returned to the calendar after the Senate rejected several amendments, including S.Amdt. 667, the "Skinny Repeal" package offered by Sen. Mitch McConnell, which failed on a 49–51 vote. Sens. John McCain, Susan Collins, and Lisa Murkowski were the only Republicans to vote against the measure.
On September 13, 2017, Senators Graham, Cassidy, Heller, and Johnson released a draft amendment to the bill that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states". However, it was not voted upon due to lack of support. On October 12, 2017, due to this failure of Congress to pass a repeal, President Donald Trump issued an Executive Order to Promote Healthcare Choice and Competition. A separate decision on the same day as this order resulted in no longer paying a key ACA healthcare subsidy, which the Congressional Budget Office warned would increase health insurance premiums on the ACA exchanges by as much as 20% and add nearly $200 billion to the budget deficit over a decade. Critics further described the executive order as another part of an ongoing strategy to sabotage the Affordable Care Act.
The first executive order signed by U.S. President Donald Trump, executed just hours after he was sworn into office on January 20, 2017, was Executive Order 13765, titled Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal. The order set out interim procedures in anticipation of repeal of the Patient Protection and Affordable Care Act (popularly known as the ACA, or Obamacare). The order came on Trump's campaign pledges to repeal the Patient Protection and Affordable Care Act, which Trump stated would take a long time, with a replacement possibly not being ready until 2018.
On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act of 2017 (ACHA) by a narrow margin of 217–213, sending the bill to the Senate for deliberation. It would repeal the parts of the Affordable Care Act within the scope of the federal budget, including provisions contained within the Internal Revenue Code such as the "individual mandates" (in IRC § 205), employer mandates (in IRC § 206) and various taxes (IRC § 201 et. seq.), and also modifications to the federal Medicaid program.
The nonpartisan Congressional Budget Office projected that the AHCA would increase the number of uninsured people by 23 million over 10 years, but would decrease the federal budget deficit by $119 billion over the same period (about 1%), mainly by cutting Medicaid coverage for lower income Americans. Both the House AHCA bill and Senate BCRA bill would cut taxes largely for wealthy Americans. Insurance premiums were projected to decrease for younger, healthier, and wealthier people, while older and poorer people would likely see their premiums increase.
Senate Republicans initially approached the AHCA with an unprecedented level of secrecy; a group of 13 Republican Senators drafted the Senate's substitute version in private, raising bipartisan concerns about a lack of transparency and about the all-male composition of the committee. On June 22, 2017, Republicans released the first discussion draft for an amendment to the bill. On July 25, 2017, although no amendment proposal had yet garnered majority support, Senate Republicans voted to advance the bill to the floor and begin formal consideration of amendments.
On July 28, 2017, the bill was returned to the calendar after the Senate rejected several amendments, including S.Amdt. 667, the "Skinny Repeal" package offered by Sen. Mitch McConnell, which failed on a 49–51 vote. Sens. John McCain, Susan Collins, and Lisa Murkowski were the only Republicans to vote against the measure. On September 13, 2017, Senators Graham, Cassidy, Heller, and Johnson released a draft amendment to the bill that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states". However, it was not voted upon due to lack of support. The deadline for Congressional Republicans to end the ACA as part of the Congressional budget reconciliation process (which would enable Senate Republicans to pass new legislation with 51 votes, rather than 60) then expired on September 30, 2017.
Following the failure of Congress to repeal the ACA through legislation, Trump issued the new order. Both supporters and critics asserted that the provisions of the order were intended to redefine the American health care market and effectively replace Obamacare with a new health care regime. Trump briefly forgot to sign the order before leaving the signing ceremony, but was ushered back to the table by Vice President Mike Pence to complete this step. Senator Rand Paul, who attended the signing, described the order as "the biggest free market reform of health care in a generation"
A separate decision on the same day commonly associated with the executive order resulted in no longer paying the cost sharing reduction (CSR) subsidies, which are payments to insurers to keep premiums down for low-income persons. The Congressional Budget Office reported in August 2017 that not making the CSR payments could increase health insurance premiums on the ACA exchanges by as much as 20% and add nearly $200 billion to the budget deficit over a decade. The deficit increase is because the premium tax credit subsidy (the largest Affordable Care Act subsidy) increases to offset increases in health insurance premium amounts, far outweighing savings from not paying the smaller CSR subsidy
Critics described the Executive Order as another part of an ongoing strategy to sabotage the ACA by enabling insurance companies to circumvent ACA mandates and sell insurance that does not cover mandated conditions, and excludes individuals with pre-existing conditions. Other elements alleged to be part of the sabotage strategy include denying funding not mandated by law for cost sharing reduction (CSR) subsidies, significantly reducing funding for enrollment advertising and support efforts, asserting that the ACA exchanges are in a "death spiral" (contrary to CBO conclusions), and conducting negative advertising campaigns, among other measures.]
For example, President Trump tweeted on October 13, 2017 that: "The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!". Journalist Ezra Klein wrote that: "Trump has long held the view that if he can inflict sufficient damage to the Affordable Care Act, Democrats will have no choice but to cut a deal — on Trump’s terms — to save it".
Journalist Sarah Kliff wrote that: "Trump announced last week he would stop making [CSR] payments. But let's be clear: That decision will cause the federal government to spend billions more subsidizing insurance companies, not less." That is because the savings from reducing CSR payments is less than increases in the insurance premium tax credits, which rise along with sizable (20%+) premium increases for 2018 caused by Trump's threats to the CSR payments during 2017. Kliff used the CBO estimate of $194 billion in higher budget deficits from stopping CSR payments as an estimate of the net impact over a decade.
Journalist David Leonhardt wrote on October 15, 2017: "Last week, the administration took several steps to deprive people of health insurance. In doing so, it has both a short-term goal (have the federal government do less to help vulnerable citizens) and a long-term goal (sabotage Obamacare, so that Congress can more easily repeal the law)". He continued: "When [the executive order] takes full effect, it will most likely allow a variety of cheap insurance plans that don’t cover many treatments. These plans will siphon healthy families from the normal markets, raising prices on the sick. It will work nicely for healthy families, until it doesn’t. If they get sick and want insurance that pays for their treatments, they will be out of luck".
According to The Economist, Trump’s plans "are likely to end up inflicting the most pain on self-employed, middle- to upper-income folk—in other words, on a Republican constituency
Senator Lamar Alexander and Senator Patty Murray reached a compromise to amend the Affordable Care Act to fund cost cost-sharing reductions. President Trump had stopped paying the cost sharing subsidies and the Congressional Budget Office estimated his action would cost $200 billion, cause insurance sold on the exchange to cost 20% more and cause one million people to lose insurance. The plan will also provide more flexibility for state waivers, allow a new "Copper Plan" or catastrophic coverage for all, allow interstate insurance compacts, and redirect consumer fees to states for outreach.
Although Trump initially expressed support for the compromise, he later reversed course by tweeting a dismissive tweet about it
A survey by Chapman University conducted shortly before the order was enacted found that a large proportion of the American public feared the effects of Trumpcare, with this being a greater source of fear than terrorism.
A separate decision on the same day commonly associated with the executive order resulted in no longer paying the cost sharing reduction (CSR) subsidies, which are payments to insurers to keep premiums down for low-income persons. The Congressional Budget Office reported in August 2017 that not making the CSR payments could increase health insurance premiums on the ACA exchanges by as much as 20% and add nearly $200 billion to the budget deficit over a decade. The deficit increase is because the premium tax credit subsidy (the largest Affordable Care Act subsidy) increases to offset increases in health insurance premium amounts, far outweighing savings from not paying the smaller CSR subsidy
Critics described the Executive Order as another part of an ongoing strategy to sabotage the ACA by enabling insurance companies to circumvent ACA mandates and sell insurance that does not cover mandated conditions, and excludes individuals with pre-existing conditions. Other elements alleged to be part of the sabotage strategy include denying funding not mandated by law for cost sharing reduction (CSR) subsidies, significantly reducing funding for enrollment advertising and support efforts, asserting that the ACA exchanges are in a "death spiral" (contrary to CBO conclusions), and conducting negative advertising campaigns, among other measures.]
For example, President Trump tweeted on October 13, 2017 that: "The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!". Journalist Ezra Klein wrote that: "Trump has long held the view that if he can inflict sufficient damage to the Affordable Care Act, Democrats will have no choice but to cut a deal — on Trump’s terms — to save it".
Journalist Sarah Kliff wrote that: "Trump announced last week he would stop making [CSR] payments. But let's be clear: That decision will cause the federal government to spend billions more subsidizing insurance companies, not less." That is because the savings from reducing CSR payments is less than increases in the insurance premium tax credits, which rise along with sizable (20%+) premium increases for 2018 caused by Trump's threats to the CSR payments during 2017. Kliff used the CBO estimate of $194 billion in higher budget deficits from stopping CSR payments as an estimate of the net impact over a decade.
Journalist David Leonhardt wrote on October 15, 2017: "Last week, the administration took several steps to deprive people of health insurance. In doing so, it has both a short-term goal (have the federal government do less to help vulnerable citizens) and a long-term goal (sabotage Obamacare, so that Congress can more easily repeal the law)". He continued: "When [the executive order] takes full effect, it will most likely allow a variety of cheap insurance plans that don’t cover many treatments. These plans will siphon healthy families from the normal markets, raising prices on the sick. It will work nicely for healthy families, until it doesn’t. If they get sick and want insurance that pays for their treatments, they will be out of luck".
According to The Economist, Trump’s plans "are likely to end up inflicting the most pain on self-employed, middle- to upper-income folk—in other words, on a Republican constituency
Senator Lamar Alexander and Senator Patty Murray reached a compromise to amend the Affordable Care Act to fund cost cost-sharing reductions. President Trump had stopped paying the cost sharing subsidies and the Congressional Budget Office estimated his action would cost $200 billion, cause insurance sold on the exchange to cost 20% more and cause one million people to lose insurance. The plan will also provide more flexibility for state waivers, allow a new "Copper Plan" or catastrophic coverage for all, allow interstate insurance compacts, and redirect consumer fees to states for outreach.
Although Trump initially expressed support for the compromise, he later reversed course by tweeting a dismissive tweet about it
A survey by Chapman University conducted shortly before the order was enacted found that a large proportion of the American public feared the effects of Trumpcare, with this being a greater source of fear than terrorism.
