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Research Draft

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Healthcare Costs: Barriers to Affordability and Strategies for Ensuring

Equitable Access

Introduction

Affordable and quality healthcare continues to be an elusive dream in the United

States of America. With the technological core state-of-the-art to world-class medical

resources, many Americans stand enormous barriers to getting necessary health-

related care. Specifically driving this problem is the immensely soaring cost of

healthcare, driven by prescription drug prices that are uncontrolled through systemic

inefficiencies toward huge profits in healthcare-based businesses. These factors are

toxic to the most precarious individuals, leaving millions lacking access to health

insurance or chronically underinsured.

The present paper argues that unaffordability calls for government intervention

in regulating costs and streamlining systemic inefficiencies to make access equitable.

Such a policy would reduce financial burdens on patients and provide a healthier and

more productive society.

Thesis Statement:

High prescription drug prices, inefficiencies in healthcare delivery, and profit-driven

priorities drive the unaffordability of healthcare in the United States. Still,

government intervention through price regulation, administrative reform, and

investment in preventive care can ensure equitable and accessible healthcare for all.

The Burden of Prescription Drug Prices

One of the leading contributors to healthcare costs is the cost of prescription

drugs. In many cases of chronic conditions such as diabetes, cancer, and hypertension,

prescription medication often takes the lion's share of their medical expenditure. The
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United States has weak regulatory mechanisms for controlling drug prices, which is

why pharmaceutical companies set exorbitant prices freely. For example, the

lifesaving drug insulin has tripled in cost in the last decade and, therefore, has become

unaffordable to many patients.

Personal experience also underlines these high costs' ethical and moral

dilemmas. One of the patients I encountered in the clinical setting had to ration her

insulin because she could not afford the prescribed dosage. This not only

compromised her health but also led to repeated hospital visits, increasing the overall

expenditure on healthcare.

According to Shrank (2021), government-imposed price caps on lifesaving

medications would ensure affordability and prevent such dire outcomes. Increasing

competition for pharmaceuticals by allowing the importation of cheaper drugs could

further lower costs.

Systemic Inefficiencies in Healthcare Delivery Inefficiencies in the US.

Healthcare systems are among the leading contributors to its high costs.

Administrative costs alone account for nearly 25% of all spending on healthcare,

whereas countries with more streamlined systems spend as little as 10%. This is

because of the complexity of the billing process, the need for standardized EHRs, and

duplicative services. These inefficiencies in my professional life manifest as delays in

patient care and wasted resources. For example, one of the hospitals I have been

working for has regular billing disputes with insurance companies, taking necessary

time and resources away from patient care. Of course, to cure such inefficiencies,

standardized EHR systems and simplification in billing processes must be accepted.

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As the Commonwealth Fund has suggested, a single-payer or universal

healthcare model significantly lowers administrative costs, leaving much room for

potential savings in the US.

The Role of Profit-Driven Models

The profit motive in the US health system exacerbates inequities and raises costs.

Hospitals, insurance companies, and pharmaceutical firms put revenues ahead of

patient outcomes, further creating disparities in care (Baicker et al., 2023). For

example, elective procedures, often more lucrative, are performed before preventive

care, leaving people with low incomes underserved.

This profit-first approach creates ethical dilemmas for healthcare professionals,

who must balance organizational profitability with patient needs. Such a conflict leads

to moral distress and degrades the quality of care. This could be mitigated in a

government-regulated system prioritizing patient outcomes over profits. Healthcare

could be treated as a public good, not a market commodity, ensuring fair access to all

citizens.

Government Intervention as a Solution

Treating healthcare as a national security issue managed by the government may

address the cost and access problems. Any meaningful reform effort should entail the

price regulation of consultations, procedures, and essential medical devices. This

would even out the playing field and make lifesaving treatments accessible to all,

regardless of socio-economic status (Baicker et al., 2023). There are valuable lessons

to be learned from countries that have achieved universal health systems, such as

Canada and the United Kingdom. These countries achieve much lower per capita

healthcare spending but retain high-quality care. Using the same principles-such as

regulated pricing and universal coverage, can reduce disparities and improve
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population health in the US. Expanding Medicaid and introducing public options

could instantly insure millions of uninsured Americans.

Counterarguments and Rebuttals

Opponents of government intervention argue that price regulation c would

hamper innovation in the pharmaceutical industry, claiming that high drug prices are

necessary to fund research and development for new treatments. However, public

funding, particularly from the National Institutes of Health (NIH), drives much of the

innovation in groundbreaking medical research. The study suggests that price

regulation would not hinder innovation but redirect corporate spending toward

patient-centered outcomes (Baicker et al., 2023).

Another common criticism is that government-regulated systems only allow

rationing or access to care after long wait times. Critics often cite examples from

universal healthcare systems, where patients sometimes face delays for elective

procedures (Fisher et al., 2022). However, evidence from Germany's multi-payer

system demonstrates that efficient resource allocation can mitigate rationing while

ensuring timely care. The US can design a model that balances access and efficiency

by adopting best practices from these systems by adopting best practices from these

systems.

Recommendations for Equal Access to Health Care

To begin addressing these barriers to affordable care, many aspects need to be

brought into the equation:

1. Price Controls for Prescription Drugs: Legislation in the form of drug price

caps and facilitating competition within the pharmaceutical industry.

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2. Streamlining administrative processes: Standardization of systems that

support billing and electronic health records to reduce costs through lower overhead.

3. Expand Preventive Care: Invest in early detection and disease management

programs that reduce long-term costs.

4. Universal Coverage: This is achieved through expanding Medicaid and

public health insurance for all.

These measures, added to the movement toward a value-based healthcare model,

could revolutionize the US system into one centered on patient outcomes and equity

of access.

Conclusion

Unaffordability in the US health system is systemic and deeply rooted in

unregulated drug prices, inefficiencies, and profit-driven priorities. While cost

regulation, simplification of processes, and learning from successful global models

are essential for building a more equal and sustainable healthcare system, the United

States can be made more fair and sustainable. Addressing these challenges is a moral

imperative and an investment in the nation's future. A healthier population will

translate into a more productive human resource, reduce the economic burden, and

improve the quality of lifestyle for all.

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References

Baicker, K., Chandra, A., & Shepard, M. (2023). A Different Framework to Achieve

Universal Coverage in the US. JAMA Health Forum, 4(2), e230187.

[Link]

Fisher, M., Freeman, T., Mackean, T., Friel, S., & Baum, F. (2022). Universal health

coverage for health equity: From principle to practice; A response to the recent

commentaries. International Journal of Health Policy and

Management, 11(8). [Link]

Shrank, W. H. (2021). Health costs and financing: Challenges and strategies for a new

administration. Health Affairs, 40(2), 235–242.

[Link]