1. The Obama Health Plan: Hit or Miss on Addressing the Real Issues of the U.S. Healthcare System
Ryan McReynolds
November 27, 2013

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Withmany of the more radical aspectsof the PatientProtectionandAffordableCare Actfinally
rollingout, Americans anxiouslywaittosee whathealthcare inthe UnitedStateswill looklike once all
the “bugs” inthe systemare workedout.Before Obamacare waspassedin2010, the UnitedStates
struggledtofinda solutiontothe glaringflaws of anunsustainable model of health care delivery.
Despite spendingmore onper-capitahealth care coststhanany othernationinthe world,the United
Statesexperiencedsomewhatpoorhealthoutcomesincomparisontoothernationsandstill left
millionsof citizens withoutaccesstoadequate care. (Niles,161) Withoutthe establishmentof aformal
infrastructure forhealthcare delivery uptothat point,the UnitedStateshadmanagedissuesthatarose
inhealthcare as theycame along,typicallythroughthe additionof policy andregulationsonto existing
law.Onlyaimingtosolve the immediateissuesandneverthe problemswithinthe systemitself, health
care inthe UnitedStatesbecame increasinglyentangled inconflictinglaws,opportunisticbehavior,and
rampant inefficiency.
Healthcare isunlike anyotherindustry,anditisfor thisreasonthat itshouldnotbe approached
as such. Virtuallyeveryhumanbeingisindemandforhealth care servicesatsome pointintheirlife,and
oftentimesthatresultsinavirtuallyinelasticdemand forhealthcare service. Thisphenomenon
compoundedwiththe scarcityof the supplyside makesallocatingresourceseffectivelyverydifficult. In
the UnitedStates,the general publiciswildlyundereducatedonhealthylivinghabits, whichinturn
increasesthe overall needforhealth care services. (Niles,171) Large gaps inthe knowledge of the
healthcare servicesbetweenthe patientandprovidercombinedwith anunfocusedpaymentsystem
give rise toopportunisticbehavior onthe providerside. (Goldsteen, 141) Additionally,the personal
nature of an individual’shealthstatusmakessharinginformationbetween differenthealthcare
professionalsextremelydifficult,affectingoutcomesanddrivingpricesup. (Niles,204) Lastly,laws
requiringhealth care facilitiestoprovide charitycare force providerstocharge more for those whocan

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pay. This isby no meansanexhaustive listof the flawsinthe health care deliverysystem,but itprovides
insightasto the root of the biggerissues.
Althoughthere isno“quickfix”to the healthcare crisisin the UnitedStates,changingthe
infrastructure andfocusingon several specificcore valuesmayhelpcreate amore sustainable and
collaborative model of health care delivery.These core valuesincludeeducation, information
technology,andinfrastructure.Byfocusingonthe advancementof information technology,improving
basichealtheducation,andrefocusingthe infrastructure of the health care deliverysystemtothe
people andnottreatment,the UnitedStateswouldexperience lowerper-capitahealthexpenditures,
improvedpatientoutcomes,andincreasedefficiency.
The U.S. boasts some of the most advancedmedical technologyinthe world,butthe
informationtechnologysurroundinghealth care isstrikinglymediocre. Manyprovidersare still inthe
processof switching patientrecordsinthe formof paperfilestoelectronicmedicalrecords,andthere is
little informationtransfereffortsbetween unaffiliatedproviders.(Goldsteen, 199) This isnot because of
a lack of technology orinabilitybecauseof law—itisdue tothe lack of incentivestocollaborate.
Additionally,electronicmedical records canbe pooledanonymouslytoprovide “bigdata”onhealth
trends,outcomes,andeffectivenessof certaintypesof care. (Siegel,393)Thistype of datacollection
wouldreveal awealthof knowledge aboutthe effectivenessof the health care systemandaboutpublic
healthingeneral.Continuedinnovationof the informationtechnology side of healthcare isvital tothe
continuedimprovementof quality,butincentivesneedtobe createdforthose innovationstotake
place.
There is alsoa needtoimprove the overall healtheducationof the Americanpublic. The
general population’slevel of educationonhealthand costof care isterrible,andthe state of public
healthisdirectlyreflective of that.(Goldsteen, 171) Many Americanshave noideahow to live ahealthy
lifestyle orunderstandhowtheirhabitsaffecttheirhealth.Effortstoimprove educationonhealthand

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the costs associatedwithit are veryimportantto the preventionof many“lifestyle diseases”thathave
arisenthatcost the UnitedStates enormous amountsof money. Currently,thereislittleincentive to
create an effective healtheducationsystembecause the incentive istotreat people,notkeepthem
healthy. (Goldsteen,7) Likewise,educationremainsunderutilizedbecause thereisnodirectincentiveto
become educated—aphenomenonknownasmoral hazard. (Goldsteen,141)
In additiontothe improvementsneededfor informationtechnology andpublichealtheducation
isthe needtocompletely reformthe infrastructureof health care.Creatingincentivesforcertain
desiredbehaviorsisthe bestwayto influence peopletoact intheirownbestinterest withouttaking
away anyof theirfreedoms.Consumersshould be incentedtostayhealthy, providersshouldbe
incentedtokeeppeoplehealthy,andinsurersshouldbe incentedtoprovide insurance (thathasatleast
some minimumcomprehensivecoverage)tomore people.Theseare three verybasicfunctionsthatall
workcollaboratively,yetindependently towardstheirown specificgoals.If the infrastructure of health
care were tofocus onthese incentives,thenmarket factorswouldequilibrate the systemandthe need
for continuedadditionstolawwouldvirtuallydisappear.
Overall,the ObamaHealthPlanseemstobe well-equippedtoimprove the areasof information
technology,education,andinfrastructure.Three specificfeatureseitherdirectlyorindirectlyaddress
the shortcomingsinthose areas:the creationof the healthinsurance exchange,the establishmentof an
innovationcenterwithinthe CentersforMedicare andMedicaidServices, andthe investmentinthe
infrastructure fora high-performance healthsystem. (Goldsteen,p.259) In theorythese three features
have great potential forpositive outcomes,buttheywill have tobe allocatedenoughresourcestocarry
out theirrespectiveintenttodoso. Whetherornot thiswill be the case witheach of these featureswill
onlybe determinedwithtime.
The creationof the healthinsurance exchangedirectlyaddressesthe educationvoidwhile
simultaneously bolsteringthe use of informationtechnology initscreationof awebsite.The purpose of

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the exchange isto“efficientlypool risk,loweradministrativecosts,andprovide eligibleindividualsand
small businessesachoice of affordable healthplans.” (Goldsteen,259) Call centersanda comprehensive
website will educate people onwhattheirbesthealthplanoptionsare andwhatthat healthplancosts.
It fallsshortinthe accessibilitytoindividualswithoutaphone orcomputingdevice,butitdoesprovide
some sort of initiativetoconnectthe systeminsome way and provide uniformitywithinformation
technology.If successful,the exchange mayprove tobe the frameworkforsharinginformationinthe
healthcare industry.
The innovationcenterscreatedwithinthe CentersforMedicare andMedicaidServicesdirectly
targetsthe needto change infrastructure withinhealth care throughthe creationof incentives.Its
purpose isto “rapidlytestandspreadeffectivepaymentmethodsthatrewardqualityof care…[where]
additional paymentandsystemreformprovisionsencourage accountabilityforpatientoutcomesand
use of medical resources,andprovideincentivesforproductivityimprovement.” (Goldsteen,260) If
providersare rewardedforhighqualitycare andare subsequently heldaccountablefordoingso,better
outcomeswill be the focus of providers insteadof the volume of patientsandservicestheyare able to
provide.Thoughthisinitiativedoesnotincludethe ideaof creatingincentivesfordifferentbehaviors on
the parts of consumersandinsurance companies, itlaysthe groundworkfora culture change inhealth
care.
The investmentininfrastructuredirectlyaddressesthe shortcomingsininformationtechnology
and the needfora more appropriatelyfocusedinfrastructure while more indirectlyaddressinghealth
education. Focusingoninfrastructure reformation,thisfeature of the plan intendstobolsterthe use of
“publiclyreportedinformationonquality,cost,andperformance of providersandinsurers;…modern
informationtechnologyinmedical care andhealthinsurance;andnational strategiesandpolicieson
disease prevention,publichealth,quality,safety,andthe healthcare workforce.” (Goldsteen,260) Using
informationtechnologytopubliclyreportthe performance of providersandinsurerseducatespeopleon

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the cost of care,incentsproviderstokeepcostslow andqualityof care high,and incentsinsurersto
keeppriceslowaswell.The national strategiesforincreasingthe amountof attentiononpublichealth
and preventionmay alsoindirectlyencourage effortstoimprove healtheducationamongstthe public,
as theytypically gohand-in-hand.
There isno tellingif the ObamaHealthPlanwill solve all of America’sproblemswithhealthcare,
but if radical reformwasnot made soon,the UnitedStateswouldbe ina full-blowncrisisbefore too
long. Evenif it failstofix all problems,itisundoubtedlyastepinthe right direction.Byfocusingonthe
areas of education,informationtechnology,andinfrastructure astheyrelate tohealthcare inthe
UnitedStates,Obamacare will atthe veryleasthelpchange the culture of health care inthe United
Statesfor the betterbyrevealingthe needforachange infocus. As Americanscontinue towaitoutthe
storm of policyimplementation overthe nextdecade orso,the onlycertaintyisthat healthcare
deliverywill lookdramatically differentthanitdidbefore the PatientProtectionandAffordableCare Act
was signedin2010. Onlythencan the Obama HealthPlanbe deemedasuccessorfailure.

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Works Cited
Goldstein,RaymondL.,andKarenGoldsteen. Jonas'Introduction to theU.S.Health Care System.7thed.
NewYork:Springer,2012. N. pag.Print.
Niles,NancyJ. Basicsof the U.S.Health CareSystem.Sudbury,MA:Jonesand BartlettPublishers,2011.
N.pag. Print.
Siegel,Bruce."REALData CollectionEssential forCare of VulnerablePopulations." Journalof Healthcare
Management58.6(2013): 392-95. Print.