(Note from me: you have already help with the main part of the assignment. The part that I want you to work on now is to help me responds to two post from to different colleagues. I have attached their post so read it and give a respond to their post. Just a page or less will be fine as long as it meets the discussion)

· During a break at work, you and a colleague are discussing health policy issues (because—(a) you always take your breaks on time; and (b) you and your colleagues are always discussing health policy during your breaks). 😁
· Your colleague says to you:
· “Okay, so for as long as I can remember, health reform proposals have focused on what’s ‘realistic’ and on the need to make compromises. The Affordable Care Act has accomplished some good things, but millions of people are still uninsured. And the ACA is constantly under attack; now the Supreme Court might invalidate it altogether. Maybe being “realistic” was a mistake—progress is so slow, and we might end up with nothing at all. We should just push for a single-payer plan, like Medicare For All.”
· Do you agree or disagree? How would you respond?

Initial Post Due: Wednesday by

Responses Due: Sunday by
· Respond to at least (2) of your colleague’s postings over the course of the week to continue the dialogue. 


The Patient Protection and Affordable Care Act (ACA), which was signed into law back in 2010 has faced some legal challenges since its implementation. However, at this point it seems highly unlikely that the Supreme Court will invalidate the ACA. It has survived multiple lawsuits and many legislative and executive attempts to repeal or reduce its impact. According to the Center on Budget and Policy Priorities, “The Supreme Court Ruled in June 2021 that the challengers to the Affordable Care Act (ACA) lacked standing, effectively throwing out the lawsuit argued by 18 Republican state attorneys general and the Trump administration” (ACA, 2021). While the ACA is an imperfect system, shutting it down at this point would cause a great deal of harm to many people who are currently insured. According to the Urban Institute, “Striking down the ACA would have increased the number of uninsured people by 21 million, or 69 percent” (Blumberg, 2020). The Urban Institute also argues that eliminating the law would end the Medicaid expansions, and terminate other important protections that the law provides such as preventing limits on coverage, and the coverage of young adults on parents’ plans until age 26 as well as many other benefits provided by the ACA (Blumberg, 2020). 
     Since the ACA is unlikely to be overturned it seems that reversing course and pushing for a single-payer plan may cause more damage than benefit at this point. While there is still a need for more health care reform in the United States the issue is very complex. There is also much perplexity in what a single-payer system constitutes. Some people confuse the idea of single-payer and universal coverage which are not really the same thing to my understanding. Universal health coverage just means every person has individual health coverage, this can be from a government system or private health insurance system. While the single-payer system typically refers to a government being responsible for paying for health care claims generally out of tax revenues. Today in the United States there is a combination of single payer coverage like Medicaid, and people being covered by employer plans or market plans like the ACA but universal coverage is not achieved. In Canada universal coverage for basic health exists and it is a single-payer system, but according to Montgomery in Verywellhealth, “Two-thirds of Canadians purchase supplemental private coverage for dental, vision, and prescription drugs because the government-run plan doesn’t provide those benefits”(Montgomery, 2021). To me neither situation seems ideal for the citizens. Examining the systems in countries who claim to have universal coverage for their citizens and have a combination of single payer and private health insurers may be a better example for us to follow. 
     I know many people believe we already have the single payer system in place in the United States via Medicare. Medicare for All is frequently touted as a single-payer plan, but the current “Medicare program itself is not a single-payer plan, It is a multi-payer program that includes a government run plan, enrollee premiums, and an array of private insurance options, and significant beneficiary cost-sharing requirements” (Blumberg, 2019). In the United Kingdom (U.K.) citizens have universal coverage with a single-payer system. “Since the government owns most of the hospitals and employs the medical providers. Funding for the U.K. National Health service (NHS) comes from tax revenue. Residents can purchase private health insurance if they want. It can be used for elective procedures in private hospitals or to gain faster access to care without the waiting period that might otherwise be imposed” (Montgomery, 2021).  Since it appears that in the U.K. there is a multitiered system that benefits the wealthier citizens it doesn’t seem all that appealing to me. I really think the solution to our healthcare delivery system in the United States is very complex and needs a solution that covers the diverse needs of its citizens and not a one size fits all plan. 

ACA survives legal challenge, protecting coverage for tens of millions. Center on Budget and Policy Priorities. (2021).  
Blumberg, L. J., & Holahan, J. (2019). The Pros and cons of single-payer health plans. Urban Institute.  
Blumberg, L. J., Simpson, M., Buettgens, M., Banthin, J., & Holahan, J. (2020). The potential effects of a Supreme Court decision to overturn the Affordable Care Act: Updated estimates. Urban Institute.  
Montgomery, K. (2021). Difference between universal coverage and a single-payer system. Verywell Health.  


I honestly am not sure how I would respond, due to the fact that I do not know the ins and outs of health policies and how to pass a bill as larg as the one needed for this. However, America does need to do better to help its citizens afford healthcare. I feel like because our healthcare system is just a big business anyways, having one source of insurance like “Medicare For All” would just end up a dictatorship or completely do a one-eighty and make us a completely socialist society. The Affordable Care Act provided us with a great foundation in my opinion, but it just kind of failed us in the end. In reality, this dream will probably never happen. An article I read basically sums it up by saying, “With health care costs at 18% of the gross domestic product and the number of uninsured persons once again increasing, finding a policy approach that insures more individuals while attenuating projected increases in health care spending remains a goal that has been elusive for more than 5 decades of US policy making”().
Schulman KA, Milstein A. The Implications of “Medicare for All” for US Hospitals. JAMA. 2019;321(17):1661–1662. doi:10.1001/jama.2019.3134