Accountable-Care Organizations—ACOs are care providers that follow the philosophy salaried care with emphasis on results, as opposed to fee-for-service pay ments to physicians, will lead not only to lower medical costs, but higher quality of care. These organizations pay physicians salaries competitive with incomes earned in a fee-for-service setting. Examples of ACOs include Bassett Healthcare, Kaiser Perman ente, the Mayo Clinic, the Veterans Admin istration, and the Cleveland Clinic. These salaried hospitals and clinics also often use electronic medical records in order to better achieve integrated, collaborative care.

Affordability Credits—this sliding scale form of subsidies reduces both the premium costs as well as the individual’s annual spending for health coverage. Fami lies and individuals with incomes up to four times the poverty level are guaranteed af fordable coverage if part of the Health In surance Exchange and not eligible for Med icaid. This is potentially the most expensive part of the current plan. However, the plan has this expense offset by savings—as well as some increased taxing—as to not exac erbate the federal deficit. Although these credits would do much for the healthcare of the country, their opposition is overwhelm ingly stronger than the opposite to Bush’s 2001 tax cut. The tax cut was bi-partisan-supported, even as it indebted the nation more than this one trillion in ten years; in fact, the tax cut set us back $1.35 trillion in only one year.

Defensive Medicine—physicians prac tice “defensive medicine” when they take unnecessary measures (such as unneces sary specialist referrals, excessive medicine prescriptions, or superfluous tests), in order to defend themselves from legal claims or charges. Fear of litigation takes prece dence over acting in the best interest of the patient’s health, because the malpractice lawsuits can be so financially devastating for a physician or clinic. The result is over-spending and inflated costs for care for ev eryone. President Obama has expressed openness to what he calls medical liability reforms—a responsible way to help avoid this expensive upshot of American law and society—as part of the current health care reform plan.

End-of-Life Services Counseling—(aka “Death Panels,” as coined by Sarah Palin) this optional choice for full disclo sure of risk and consultation on the hospice services is an attempt at giving patients a say in their care and situation. With this in clusion of more transparency of information and decision-making, aggressive and often inhumane attempts at maintaining ‘life’ for extra weeks/months in some patients with out personal choice could thus be avoided. Although it would allow for better moral as well as economical choices, the idea has been dropped from any official legislation given the mid-August outcry over falsi fied and dramatized rumors. An admirable alternative—for those still touched by this attempted and failed policy—is the individ ual’s creation of a “living will”.

Fee-for-Service—in this reimburse ment system, a physician is paid for quantity of services and care provided as opposed to for the quality of care. The model encour ages the overprovision of medical services and specialized physicians. It also leads to perverse incentives for doctors to do and recommend more than is essential. As pa tients are bounced from doctor to doctor without much coordination of care or pa tient records, the result is piecemeal—and often poorer—care. Without any incentive to check such needless spending, the sys tem leads to paying more money for wors ened care. For a full run-down on “Fee-for-Service,” see Daniel Leifer’s article.

Health Insurance Cooperatives— Like with a credit union, these nonprofit con sumer entities would allow member pa tients to have a stake in the spending and care decisions but would circumvent gov ernment regulations or involvement—and thus should ideally serve to lower the over all cost of the health care. These nongov ernment networks, however, would need grants issued by the government (current proposals value the grants at $6 billion for all states combined) to start providing healthcare in this group-oriented and group-managed fashion. The choice to join such system would be available through the state through the Health Insurance Exchange, as an option outside the circle of profit-seek ing companies. The Co-op system has been presented as an alternative to the public option, but it may not be as easily imple mentable on the national level.

Health Insurance Exchange— An or ganization which offers consumers a better way of choosing a health insurance provid er. It gathers insurance options along with their prices and benefit levels and allows individuals, families, and employers to pur chase in a regulated and informed fashion with consumer protections. However, those who currently have a plan can continue for ward with what they have.

Independent Medicare Advisory Coun cil—In draft legislation sent out in mid-July by the Obama Administration, this council would report to the president and set payment policies for Medicare twice an nually; Congress could block the policies within a month. The five council members would be doctors or medical policy experts, and thus theoretically in a good position to suggest acceptable pay-rates for doctors, nurses, medical suppliers, and more. How ever, the irksome aspect of the proposal for many moderate and conservative Congress men is its obvious transfer of power-of-the-purse—away from Congress and towards the executive branch. This shift could be a good thing in the long-run, helping to make health reform more sustainable financially and less riddled with special interest and politics (as is the simple congressional ad visory panel established twelve years ago, MedPAC). The Act establishes this panel to start making recommendations after 2014, allowing the panel time to develop under standing and competence in the field of federal health policy. And as an additional check on long-term healthcare spending, the Act requires that Medicare expenditures do not exceed the previous year.

Mandates—
1) On individuals: Americans would be required, or mandated, to purchase some form of insurance regardless of the fact that they may be currently healthy—rather than signing up only when they need care.
2) On employers: also called “Play or Pay,” all but the smallest businesses partici pate in a two-choice system: the employer can choose either to provide employees with basic health insurance or otherwise pay a fee—which would go into an insur ance pool for government allocation. This allocation would then go into subsidies or affordability credits—helping to make in surance more affordable for all socio-eco nomic groups in America. Furthermore, employer mandates put all companies on a level playing field so that those reducing benefits to employees do not gain a market advantage.

Medicaid—as a large part of the 1965 Social Security Act, this program is funded by the federal government as well as states. It is intended for low-income fami lies and individuals, as well as those with certain disabilities. In addition to being partially funded by states (and sometimes even counties), the state governments man age and administer the program; as a result, many states even use their own name for it (such as California’s Medi-Cal).

Medicare —slightly separate from the rest of the Social Security Act of 1965, Medicare is a federally-funded health insur ance program. It is for people aged 65 and older, or who meet other specified criteria such as if one is entitled to receive Social Security or railroad retirement benefits. The program has two major parts: Part A provides basic cost protection for the par ticipants, whereas Part B of the program is voluntary and is medical insurance financed from federal funds and also from partici pants’ premiums. The public option would build off of this plan, and would not add or increase federal powers, but rather change the specifications for entitled enrollees.

Public Option—Different from the single-payer system, the public option is only one of many insurance options within the health insurance exchange. It is built off Medicare, but is in place mainly to compete with private insurers to help hold down costs. This cost-saving aspect is the basis of much of the insurance lobbyists and Republican’s opposition to reform, as it will bring absolute profits down. While for-profit private insurers will indeed need to work harder to compete, a plan with this public option will hold down insurance pre miums for all Americans—including those not participating in the public option.

Single-Payer System—Also known as the “Canadian Plan,” or “Socialized Medi cine,” the system is designed such that all medical services are paid by a ‘single’ gov ernment reimbursement agency. In a single-payer system, individuals choose their doc tors and other health care providers, but the providers bill the one over-arching govern ment agency for the services. It is not being heavily considered currently in America, due to being viewed as “un-American.” So although it covers everyone, and saves on bureaucractic costs , the idea is not currently politically feasible. However, single-payer is practiced in American on a semi-federal (and also individual state) scale through Medicare and Medicaid.

Social Security—often abbreviate “SS,” is a government program that pro vides economic assistance benefits for those who qualify. Generally, the term is used to refer to one major part of the program—the “Old-Age, Survivors, and Disability Insur ance” (“OASDI”). Through payroll taxes, this portion of the social insurance program covers those who are disabled, in retire ment, and survivors of a death in the fam ily such as children or a widow/er. Social Security also includes Unemployment ben efits, SCHIP (funding for children’s health), Medicaid, Medicare, and other facets of general welfare protection. The program is progressive in that it grants supplemental benefits for impoverished citizens. Howev er, SS gathers funding from only the lower-most (approximately $100,000) portion of everyone’s payroll tax which regressively makes poorer people pay a higher percent age of their wages.