While the Obama administration's Patient Protection and Affordable Care Act (ACA) has expanded health care coverage for millions of Americans, it has fallen short in offering universal health care to all. In Health Care as a Right of Citizenship, Gunnar Almgren argues that the ACA's primary significance is not in its expansion of health care entitlements but in its affirming by an act of Congress the idea that comprehensive health care must be available to all as a right of citizenship. The mainstream American public now views access to affordable health care for all citizens as a crucial function of just and effective governance—and any proposed alternative to the ACA must be reconciled with that expectation. This ambitious book examines how the American healthcare system must be further reformed to bring it closer in line with the ideals of modern democracy, as well as how the ACA may change in the coming years.
The contentious passage of the Affordable Care Act in 2010 highlighted the incredible complexity and controversy surrounding health care in the United States. While the U.S. federal government does not provide universal health care, it has an extremely wide reach when it comes to the health of its citizenry.
How can countries chart their own course toward universal health coverage? Like many ambitious global goals, universal health coverage (UHC) remains an aspiration for many countries. The World Health Organization estimates that half the world's population lacks access to basic health services.
Health insurance characteristics shift at age 65 as most people become eligible for Medicare. We measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on. weekdays and weekends. The age profiles of admissions and comorbidities for these patients are smooth at age 65, suggesting that the severity of illness is similar on either side of the Medicare threshold. In contrast, the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities, implying that patients over 65 receive more services. We estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group. The mortality gap persists for at least 9 months after admission.