There are four main reasons:
(a) Standardized management of diagnostic and treatment procedures. In order to standardize medical services, the American Medical Association issued a five-digit "Current Practice Specific Code" (CPT
CODE), which covers all treatment, diagnosis, and surgical procedures. The code is the basis for determining whether a doctor's treatment is reasonable and for charging fees. At the same time, with reference to the World Health Organization's International Classification of Diseases (ICD) system, the U.S. Department of Health (DOH) has developed a reference payment system for medical
services called the Diagnostic Relevant Groups (DRGs), which pay the same fee for all hospitals treating similar cases. [1]
(ii) Separate organizational structures. Physicians are usually not employed by hospitals, but rather have agreements with hospitals through physician team organization models, physician-hospital cooperative organizations, and so on. The hospital's internal diagnostic imaging, pathology, physical therapy and other specialized diagnostic departments are also contracted by the doctor and independent fees. The lack of collaboration in the entire medical process is one of the reasons for the high cost of medical care. [1]
(3) Government pricing affects the market. Medicare, administered by the Centers for Medicare and Medicaid Services under the jurisdiction of the U.S. Department of Health, is the largest
single payer in the nation's healthcare industry. The U.S. Department of Health projects that $119.5 billion will be spent on health care in 2009 by public **** funds, which together account for 47.4 percent of the nation's total health care expenditures. Regardless of how much healthcare providers ask for, the government only
pays for healthcare at predetermined rates, and insurance companies pay for healthcare up and down in reference to the government payment system. [1]
(d) Insurance companies control treatment procedures. Apart from the government, insurance companies bear most of the medical expenses. Insurance companies control the treatment process
from both the patient and the doctor, with the ultimate goal of compressing medical costs and making a profit. Insurance companies will give policyholders a list of primary care doctors who will be responsible for their health care schedules, and they can only seek specialty care if they are referred by one of the doctors on the list
, or else the insurance company may refuse to pay the premiums. In a way, the primary care doctor becomes the gatekeeper to the insurer's coffers. At the same time, insurers will scrutinize whether the primary care doctor refers patients he or she can
treat to specialists, requiring doctors to follow practice guidelines and even assigning patients to a nurse practitioner who can coordinate care for the chronically ill.
The healthcare industry is one of the most important industries in the U.S. According to the U.S. Department of Health projections, the U.S. spent $2509.5 billion, or about 17.6 percent of the U.S. GDP, on healthcare in 2009, and by 2018
the U.S. will spend $4,353.2 billion, or 20.3 percent of the GDP, on healthcare. Huge health care spending involves huge distribution of benefits and social and moral issues, and government spending has a
pivotal role in health care spending, the health care reform bill has also become the focus of attention of the current U.S. public.
Take a look at the reform process of the U.S. health insurance system:
In 1912, Theodore Roosevelt, the 26th President of the United States, put forward the idea of "establishing a system of universal health care" in his campaign for re-election, which was the first time that the issue appeared. [
The idea of universal health care was raised again during the administration of Franklin D. Roosevelt, the 32nd president of the United States, between 1933 and 1945. [2]
The Truman administration, between 1945 and 1953, attempted to continue his predecessor's vision of universal health care reform. [2]
Universal health care was brought up again during the administration of Richard Nixon, the 37th President of the United States, between 1969 and 1974. As some politicians realized that their vested interests would be affected by the reform, they fought back, causing the program to fail. [2]
Clinton made a huge effort to reform health care during his administration in the 1990s. He launched a health care reform package from 1993 to 1994 and appointed first lady Hillary as the head of health care reform. However this plan to create a national health care system was quickly opposed by powerful interest groups made up of wealthy health insurance companies and business organizations, while wealthy doctors and hospitals played the same role in various state legislative sessions, ultimately killing Hillary's health care reform plan. [2]
On the occasion of the 2008 U.S. election, Barack Obama, who was a presidential contender, pointed out that he would try to provide a suitable health plan for the people who did not have health insurance, and to construct a truly universal health care. This plan would have resulted in an unprecedented expansion of government power. [2]
From 1945, when President Harry S. Truman first proposed a universal health care program, to Obama's administration pushing for reform, it has been a long period of more than 60 years, which shows the difficulty of health care reform in the United States
. The United States is the only one of the developed countries did not realize the universal health care coverage of the country, while the medical cost is the world's most expensive. Data show that the U.S. government invests up to 2 trillion U.S.
dollars a year in health care, but nearly 50 million people do not have health insurance. And Americans with commercial health insurance often face monopoly insurance giants that refuse to pay for coverage through "bullying" clauses. The core of Obama's health care reform program
is to provide Americans with "affordable" health insurance, targeting mainly low- and middle-income people, Obama advocates expanding the scope of health insurance coverage, more than 30 million Americans do not enjoy health insurance into the scope of health care reform. [3]
Since taking office on January 20, 2009, Obama has been pushing for health care reform. Due to the divergent views of various interest groups in the United States, Obama's health care reform journey has been exceptionally difficult. [4]
On March 5, 2009, Obama held a conference on health care reform at the White House, saying in a televised speech that he was determined to launch a plan for a comprehensive reform of the U.S. health care system within the year, as growing health care spending has threatened the quality of life of the American people and the fundamental basis of the U.S. economy. [4-6]
On June 15, 2009, Obama warned doctors that the U.S. health care system was a ticking time bomb, urging them to support his own reforms, including a public **** insurance plan, which many doctors are skeptical of, Reuters reported. [7]
On June 17, 2009, the U.S. House of Representatives and Senate began formal discussions of health care reform proposals. [4]
On July 8, 2009, the U.S. government and representatives of U.S. hospitals reached an important agreement on health care reform. Under the agreement, hospitals will give up a total of $155 billion in government grants and subsidies over the next several years to offset some of the expenses of the health care reform package. At the same time, hospitals will be able to get some benefits from the health care reform program.
On August 14, 2009, Obama went to the western state of Montana to explain to the people, but could not resist relenting his anger at the U.S. media, accusing them of giving too much attention to the people's protests against health care reform. [8]
On September 9, 2009, Obama stated the three main goals of health care reform in a joint session of both chambers of Congress: to provide better coverage for those who already have insurance; to provide viable choices for those who are uninsured; and to mitigate the growth in spending that health care has brought to families, businesses, and governments. [4]
Obama renews his efforts during a meeting with representatives of the American Nurses Association in the Executive Mansion of the White House in Washington, D.C., Sept. 10, 2009
Meeting with representatives of the American Nurses Association/Xinhua News Agency photo
Promoting reforms in the health care system and expanding health insurance coverage. [9]
Thousands of Americans gathered on the National Mall in Washington, D.C., capital of the United States on Sept. 12, 2009, to stage a massive demonstration to protest President Barack Obama's proposed health care reform plan as well as a number of other policies, and to demand that the Democrat-controlled Congress commit to effectively controlling government spending. The demonstrators were mainly composed of members of the U.S. "Tea Party". Members of the organization set out from California earlier in September and rallied in more than 30 cities across the country against the government's "high spending, high taxes and interference in American families and businesses."
Senate Finance Committee passes health care bill/Xinhua News Agency photo
(2 photos)
The group's last stop was in Washington, D.C., to meet with Democrat-controlled Congress to discuss the health care reform plan and other policies. They made their last stop in the capital, Washington, D.C., to join a number of other conservative organizations for this largest rally against Obamacare reform. [10]
On October 13, 2009, the Senate Finance Committee passed the health care reform bill. This was one of the more eclectic positions of the five versions of the bill in Congress, and was basically in line with the principles of health care reform established by Obama. [4]
[12]
U.S. House of Representatives Speaker Nancy Pelosi (D) holds a news conference on Capitol Hill in Washington, D.C., on October 29, 2009.
Pelosi holds a news conference AFP/AFP photo
Announcing the introduction of a unified version of the health care reform bill, which includes the controversial creation of a public **** insurance agency. [4]
On November 7, 2009, the House of Representatives passed the health care reform bill by a vote of 220 in favor and 215 against. The centerpiece of the bill was the creation of a federally regulated health insurance marketplace, and the government would set up public *** insurance agencies to sell health insurance. [4]
On December 19, 2009, U.S. Democrats secured the support of the 60th U.S. Senator for the health care reform bill, the minimum number of votes needed for the bill to be passed by the Senate of Congress. Democrats hoped to facilitate passage of the Senate version of the health care reform bill in time for Christmas; many **** and GOPers vowed to continue to block it. [13]
On the early morning of December 24, 2009, the Senate voted to pass the health care reform bill. The centerpiece of the bill was the creation of a federally regulated health insurance marketplace, and the government would set up
public*** insurance agencies to sell health insurance. For the first time, the bill explicitly states that nearly all Americans should have health insurance by 2014. Unable to get unanimous approval from Senate Democrats, the most talked-about part of the bill,
"state-run health insurance," was deleted from the original version of the bill. Since then, the two chambers have begun negotiating a consensus version of the bill. However, due to serious differences, the process of harmonizing the text of the bill has reached a deadlock. [4]
On February 22, 2010, Obama personally launched the first detailed White House version of the health care reform program. The proposal was based on the Senate version of the bill, while adopting some of the recommendations of the **** and the party, but still did not get the approval of the **** and the party legislators. [4]
On February 25, 2010, Obama hosted a bipartisan health care reform summit to negotiate around controlling health care costs, reforming the health insurance marketplace, cutting the government's budget deficit, and expanding health care coverage, but the two parties failed to reach a compromise. [4]
On March 3, 2010, Obama unveiled a revised final version of his health care reform plan and called on Congress to schedule a vote on the health care reform bill in the coming weeks. [4]
On March 12 and 18, 2010, Obama postponed two visits to Australia and Indonesia in order to oversee the process of voting on the House health care bill. [4]
On March 15, 2010, Obama visited Strongsville, Ohio, and gave a speech in a last-ditch effort to push for health insurance reform. He called on congressional Democrats to "show courage" and pass a health care bill as soon as possible. [14]
On March 18, 2010, the Congressional Budget Office released its budget assessment of the final version of the health care reform bill.
On March 18, House Speaker Nancy Pelosi met with the media on the health care reform bill
The conditions were set for the House to vote on the bill. [4]
On the same day, Democratic leaders in the U.S. House of Representatives unveiled the final version of the health insurance reform bill. The final version of the health care reform bill consists of two parts, the health care reform bill passed by the Senate in December 2009 and a "budget reconciliation" bill that Democrats aim to amend parts of the Senate bill. [4]
The bill is expected to cost $940 billion over the first 10 years after it takes effect, and is expected to reduce the U.S. government's budget deficit by $138 billion. [15]
Signed/Xinhua for photo
(2 photos)
On March 21, 2010, the House of Representatives approved the $940 billion total, the largest U.S. health insurance reform bill in decades, by a vote of 219 to 212, with all the **** and GOP lawmakers and 34 Democratic lawmakers
voting against it. The House then voted 220 to 211 to approve Budget Reconciliation, a rider that tweaks the Senate bill and is expected to go to the Senate this week, completing the second step in a two-step process for health care reform legislation. The bill is expected to be submitted to the Senate for consideration this week. President Barack Obama then spoke at the White House in Washington, D.C., on the House's vote to pass the health care reform bill. At this point, the final version of the health care reform bill has been passed in the House of Representatives. [16]
This marks significant progress in the health insurance reform that Obama has pushed with all his might since coming to power, paving the way for the United States to realize universal coverage of health insurance. [4]
The Congressional Budget Office says the bill will make health insurance available to 32 million Americans who previously did not have it, thus making it available to nearly all Americans and reaching 95 percent coverage by 2019, up from 83 percent in 2010. The Congressional Budget Office also estimated that the federal budget deficit would be reduced by $143 billion over 10 years as a result. [17]
On March 23, 2010, President Barack Obama signed the health insurance reform bill at the White House. The goal of comprehensive health care reform, which U.S. Democrats have been working on for years, will finally be realized.
It can be said that, after a century of process, the U.S. health care system from the establishment, and now the enactment of the new health care bill, successive U.S. presidents are credited for their efforts. It is also quite difficult to spend $940 billion on the 15 percent of poor people under the U.S. democratic system.
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