The United States Health System in Transition

Abstract

—After six years of an intensely polarized legislative and implementation process, the United States has achieved significant national health reform. Though much implementation work remains, the essential reform structure stands and is increasingly immune from repeal by its opponents. The Affordable Care Act (ACA) is the first law ever in US history to attempt comprehensive health reform by simultaneously addressing access, quality, and cost control. Regarding access, the ACA is on target to cover about half the US uninsured population by 2017, or 92% of all citizens and authorized immigrants, though offering no meaningful lessons to all other advanced nations that have already created universal health insurance systems. Regarding quality improvement and cost control, the ACA's numerous initiatives will offer increasingly valuable evidence and insights to other advanced nations struggling to develop greater efficiency, quality, and effectiveness in their medical care systems. The US is moving quickly and unevenly to transform its health care financing model away from fee-for-service and toward a capitated-accountable-global payment structure that rewards quality and efficiency over volume. As the political storm over “Obamacare” subsides, policy makers will increasingly focus on making continuous policy improvements to this historic law.