Despite the progress of the ACA, more work needs to be done. We need to continue to make sure that all Americans can afford physician visits and prescription drugs; that they are not stuck with skyrocketing insurance premiums; and that their health care is coordinated. We also need to ensure that safety net funding remains in place for the residual uninsured.
In the 1960s, a movement to reform health policy began. The number of women entering medical school increased dramatically; hospitals and physicians were beginning to organize into groups such as Blue Cross and General Motors; and the federal government began imposing cost controls on hospitals. At this time, national health expenditures accounted for 4.5 percent of GDP.
The 1980s saw more significant changes in healthcare policy. The Mental Health Parity Act was passed, requiring that insurance companies treat mental illness on the same basis as physical illness. The Medicare program moved away from paying for each service and started using diagnostic related groups to pay for hospital services. The government also moved to expand Medicaid to cover infants and children up to 100 percent of poverty and established a national health insurance exchange to allow individuals to shop for plans.
A major goal of healthcare reform is to take the nation back toward health promotion, tackling problems that are known to cause long term ill health such as smoking and obesity. The NHS in England, for example, is moving towards this new paradigm and focusing on prevention of disease rather than treating it once the disease has developed. This includes the addition of chlorine and fluoride to community water supplies, iodine in salt, and folic acid in flour.