Health reform efforts in the United States
Previously, reform efforts in the United States have been characterized by failure. For instance, the Clinton health plan failed after the president and his advisers misconstrued managed competition (Brady & Kessler, 2010). Another reason denotes the fragmented and federated political system in the country, which grants considerable power to focused interest groups. According to Brady and Kessler (2010), the groups inhibit large-scale transformation like health reform despite being favored by a majority. Similarly, the interaction between voters’ preferences and congressional institutions affected care reform efforts in the 1990s. Rendering to Gridlock theory, voters’ penchants, and congressional establishments constrains policy formation (Brady & Kessler, 2010). Some measures were killed by veto or a filibuster. Similarly, while the Affordable Care Act (ACA) came to register success, the election of Donald Trump constrained its growth and implementation with the president echoing the promise to repeal and replace it (Hirsch et al., 2017).
ACA’s effort at national health reform was successful since efforts to repeal and replace were rhetorical and politically motivated, leading to their failure. Similarly, the senate composition prevents the republicans from successfully invoking a closure of a filibuster by the minority democratic party. This shields the ACA from any repeal through senate (Hirsch et al., 2017). However, it is vital to establish the underlying social, political and economic contexts that facilitated the passage of ACA. The social milieu advocated for the health promotion as a human right making it a responsibility of those in power to achieve it. On the other hand, the economic context involved guaranteeing care access to everyone, from birth through retirement which resonated well with the mainstream Americans. Major players like the insurance establishment supported it fully (Oberlander, 2010). Lastly, the political context was not favorable for repealing the ACA. The penchant to create deals with health-sector groups underscored a vital reason for success (Oberlander, 2010). The senate majority lacked the required votes to invoke such changes in the face of the democratic minorities (Hirsch et al., 2017). Similarly, since the calls to repeal it were rhetorical, they eventually failed. In my opinion, the functional elements of the ACA are those aimed at achieving universal insurance coverage. According to Obama (2016), these elements have registered considerable success. However, those concerned with improving the impartiality, quality, and affordability of health coverage necessitate improvement since mainstream Americans stull struggle with access and insurance.
References
Brady, D. W., & Kessler, D. P. (2010). Why is health reform so difficult?. Journal of health politics, policy and law, 35(2), 161–175. https://doi.org/10.1215/03616878-2009-048
Hirsch, J. A., Rosenkrantz, A. B., Nicola, G. N., Harvey, H. B., Duszak, R., Silva, E., … & Manchikanti, L. (2017). Contextualizing the first-round failure of the AHCA: down but not out. Journal of NeuroInterventional Surgery, 9(6), 595-600. http://dx.doi.org/10.1136/neurintsurg-2017-013136
Obama B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA, 316(5), 525–532. https://doi.org/10.1001/jama.2016.9797
Oberlander, J. (2010). Long time coming: why health reform finally passed. Health Affairs, 29(6), 1112-1116.