The Underwriting of American Healthcare: One Hundred Years of Reform and the Need for a New Paradigm
Notice bibliographique
Résumé
In 2009, healthcare costs in the United States totaled $2.5 trillion dollars and constituted more than 17% of GDP. 1 , 2 Healthcare inflation has trended higher than general CPI for more than twenty years and this pattern is expected to escalate. The U.S. currently has the most expensive healthcare system in the world both in terms of absolute dollars and per capita spending. The underwriting for these costs however, is highly fragmented and currently leaves 47 million Americans to either cover the full costs themselves or forego treatment. 3 Recent enactment of healthcare reform via the Patient Protection and Affordability Act and the Health Care and Education Reconciliation Act promises to expand insurance coverage as well as redress systemic shortcomings in the delivery and financing of healthcare. However, there is considerable debate as to what will really be accomplished by this latest reform attempt as well as considerable opposition its promulgation. The current debate over healthcare reform is a continuation of a conflict that arose more than one hundred years ago when powerful business, political and medical interest groups allied themselves against changes to the status quo. In 2010, it is simply “déjà vu all over again”.*\nThis paper will present the salient features of the current healthcare model in the U.S. It details the elements making up the three segments of the model and the factors that led to their entrenchment. The paper will also trace the evolutionary reformation of healthcare and the forces that have shaped the model we have today. It will highlight the process surrounding the passage of the latest reform measure as well as specific requirements and protections being introduced by it. *Quote attributed to Yogi Berra\nAs other countries have faced the same issues with respect to the role of government in ensuring the health and welfare of its citizens, a comparative review of the healthcare financing and delivery models in Great Britain, Germany, France and Canada will be presented. The paper will further examine the governance structures in these countries versus those in the U.S. to gain insight as to why the U.S. has lagged behind its democratic peers in implementing healthcare reform.\nLastly, this paper will seek to reframe the current U.S. debate over healthcare reform from one centered on underwriting principles to one centered on national values.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».