Tattaunawar sake fasalin kiwon lafiya a Amurka

Muhawarar gyaran kiwon lafiya a Amurka ta kasance batun siyasa da ya mayar da hankali kan ƙara yawan inshorar lafiya, rage farashi, gyaran inshora, da kuma falsafar samar da shi, kuɗaɗen shiga, da kuma shigar gwamnati.

## Cikakkun bayanai
A lokacin shugabancin Barack Obama, wanda ya yi kamfe sosai kan cimma sauye-sauye a fannin kiwon lafiya, an zartar da Dokar Kare Marasa Lafiya da Kulawa Mai Sauƙi (PPACA) a watan Maris na 2010.

A gwamnatin 2016, Shugaba Donald Trump ya ce a lokacin zaɓen cewa tsarin kiwon lafiya ya kamata ya yi aiki bisa ƙa'idodin kasuwa mai 'yanci. Ya amince da wani shiri mai matakai bakwai don gyaran kiwon lafiya:

* soke Obamacare
* rage shingayen sayar da inshorar lafiya tsakanin jihohi
* kafa cikakken ragin haraji don biyan kuɗin inshora ga daidaikun mutane
* A sa Asusun Ajiye Lafiya ya zama abin gado
* buƙatar bayyana farashi
* tallafin Medicaid ga jihohi
* ba da damar ƙarin masu samar da magunguna na ƙasashen waje ta hanyar rage shingen dokoki

Ya kuma ba da shawarar cewa aiwatar da dokokin shige da fice na iya rage farashin kula da lafiya. [1]

Gwamnatin Trump ta yi ƙoƙarin soke ACA da maye gurbinta da wata manufar kiwon lafiya daban (wanda aka sani da hanyar "sokewa da maye gurbin" ), amma ba ta taɓa yin nasarar yin hakan ta hanyar Majalisa ba. [1] Na gaba, gwamnatin ta shiga ƙarar da ke neman soke ACA, kuma Kotun Koli ta amince a farkon Maris 2020 cewa za ta saurari ƙarar. A ƙarƙashin jadawalin da aka saba, za a saurari ƙarar a kaka ta 2020 kuma a yanke hukunci a bazara ta 2021. Duk da haka, yayin da Kotun Koli ta dakatar da shari'ar daga baya saboda annobar cutar coronavirus, ba a san lokacin da za a saurari ƙarar ba. [2]

## Muhawarar farashi

Kudaden kula da lafiya na Amurka sun kai kimanin dala tiriliyan 3.2 ko kusan dala 10,000 ga kowane mutum a matsakaicin shekarar 2015. Manyan nau'ikan kuɗaɗen sun haɗa da kula da asibiti (32%), ayyukan likita da na asibiti (20%), da magungunan da aka rubuta (10%). [1] Kudaden Amurka a shekarar 2016 sun fi na sauran ƙasashen OECD yawa, a kashi 17.2% na GDP idan aka kwatanta da kashi 12.4% na GDP ga ƙasa mafi tsada (Switzerland). [2] Dangane da sikelin, bambancin GDP na kashi 5% yana wakiltar kusan dala tiriliyan 1 ko dala 3,000 ga kowane mutum. Wasu daga cikin dalilan da aka ambata na bambancin farashi da sauran ƙasashe sun haɗa da: Babban kuɗaɗen gudanarwa na tsarin mai zaman kansa tare da hanyoyin biyan kuɗi da yawa; ƙarin farashi don samfura da ayyuka iri ɗaya; ƙarin girma/haɗen ayyuka tare da yawan amfani da ƙwararrun ƙwararru masu tsada; tsananin kulawa ga tsofaffi marasa lafiya da kulawa mai sauƙi; ƙarancin amfani da sa hannun gwamnati a farashi; da kuma matakan samun kuɗi mafi girma da ke haifar da ƙarin buƙatar kiwon lafiya. [undefined] [3] [4] Kuɗaɗen kula da lafiya sune babban abin da ke haifar da kuɗaɗen inshorar lafiya, wanda ke haifar da ƙalubalen araha ga miliyoyin iyalai. Akwai muhawara a yanzu ko dokar da ke akwai (ACA/Obamacare) da madadin 'yan Republican (AHCA da BCRA) sun yi isasshen aiki don magance ƙalubalen kuɗaɗen. [5]

A shekarar 2009, Amurka ce ke da mafi yawan kuɗaɗen kula da lafiya idan aka kwatanta da girman tattalin arzikin duniya (GDP), inda aka kiyasta cewa 'yan ƙasa miliyan 50.2 (kimanin kashi 16% na yawan jama'a miliyan 312 da aka kiyasta a watan Satumba na 2011) ba su da inshora. Wasu masu suka kan garambawul sun yi iƙirarin cewa kusan huɗu cikin goma daga cikin waɗannan marasa inshora sun fito ne daga gida mai kuɗin shiga sama da dala 50,000 a kowace shekara, don haka za a iya ba su inshora da son rai, ko kuma su zaɓi biyan kuɗin kula da lafiya bisa tsarin "biya-da-ku-tafi". [undefined] Bugu da ƙari, an kiyasta cewa jarirai miliyan 77 na jarirai suna isa shekarun ritaya, wanda tare da ƙaruwar kuɗin kula da lafiya na shekara-shekara ga kowane mutum zai sanya babban matsin lamba a kasafin kuɗi ga gwamnatocin jihohi da na tarayya na Amurka. [1] Kula da lafiyar kuɗin gwamnatin tarayya ta Amurka na dogon lokaci ya dogara sosai kan yadda ake sarrafa kuɗin kula da lafiya. [2]

## Ingancin kulawa
Akwai muhawara mai zurfi game da ingancin tsarin kiwon lafiya na Amurka idan aka kwatanta da na wasu ƙasashe. Likitoci na Shirin Lafiya na Ƙasa, wata ƙungiyar fafutukar siyasa, sun yi iƙirarin cewa mafita ta kasuwa ga harkokin kiwon lafiya tana ba da ƙarancin ingancin kulawa, tare da yawan mace-mace mafi girma, fiye da tsarin da gwamnati ke ba da kuɗaɗen gudanarwa. [1] Wannan ƙungiyar ta kuma yi suka ga ingancin ƙungiyoyin kula da lafiya da kuma kulawar da ake gudanarwa . [2]

A cewar wani rahoto na 2015 daga Asusun Commonwealth, kodayake Amurka tana biyan kusan ninki biyu na kuɗin da ake biya ga kowace mutum don kula da lafiya kamar sauran ƙasashe masu arziki waɗanda ke da tsarin kula da lafiya na duniya baki ɗaya, sakamakon marasa lafiya ya fi muni. Amurka tana da mafi ƙarancin tsawon rai gabaɗaya kuma adadin mace-macen jarirai shine mafi girma kuma a wasu lokuta ya ninka sau biyu idan aka kwatanta da sauran ƙasashen Ƙungiyar Haɗin Kan Tattalin Arziki da Ci Gaba (OECD). [1] Haka kuma an nuna a cikin wannan rahoton bayanai da ke nuna cewa duk da cewa Amurkawa suna da ɗaya daga cikin mafi ƙarancin kashi na masu shan taba a kowace rana, suna da mafi girman adadin mace-mace ga cututtukan zuciya, ƙimar kiba mai yawa da ƙarin yankewar jiki saboda ciwon suga. Sauran batutuwan da suka shafi lafiya da aka nuna sune cewa Amurkawa sama da shekaru 65 suna da mafi yawan kashi na yawan jama'a tare da cututtuka biyu ko fiye na yau da kullun da mafi ƙarancin kashi na wannan rukunin shekaru. [ ana buƙatar ambato ]

A cewar wani bincike da aka yi a shekarar 2000 kan Hukumar Lafiya ta Duniya (WHO), tsarin da kasashen masana'antu ke bayarwa a bainar jama'a yana kashe kuɗi kaɗan kan kiwon lafiya, duka a matsayin kashi na GDP da kuma kowane mutum, kuma yana jin daɗin sakamako mafi kyau na kula da lafiya bisa ga yawan jama'a. [undefined] Duk da haka, mai sharhi mai ra'ayin mazan jiya David Gratzer da Cibiyar Cato, wata ƙungiyar masu ra'ayin 'yanci, sun soki hanyar kwatantawa ta WHO da nuna son kai; binciken WHO ya nuna ƙasashe da samun kulawar lafiya masu zaman kansu ko waɗanda ke biyan kuɗi da kuma kimanta ƙasashe ta hanyar kwatantawa da aikin kiwon lafiya da ake tsammani, maimakon kwatanta ingancin kulawa da kyau. [2] [1]

Wasu masu binciken lafiya sun ce binciken gamsuwar marasa lafiya hanya ce mara kyau ta kimanta kulawar lafiya. Masu bincike a Kamfanin RAND da Ma'aikatar Harkokin Tsoffin Sojoji sun nemi tsofaffi marasa lafiya 236 a cikin tsare-tsaren kulawa daban-daban guda biyu da su kimanta kulawarsu, sannan su duba kulawa a cikin bayanan likita, kamar yadda aka ruwaito a cikin Annals of Internal Medicine . Babu wata alaƙa. "Matsakaicin marasa lafiya na kula da lafiya yana da sauƙin samu da bayar da rahoto, amma ba sa auna ingancin fasaha na kula da lafiya daidai," in ji John T. Chang, UCLA, babban marubucin. [undefined] [1] [2]

Akwai asarar lafiya sakamakon rashin isasshen inshorar lafiya. Wani bincike da Harvard ta gudanar a shekarar 2009 wanda aka buga a mujallar American Journal of Public Health ya gano cewa fiye da mace-mace 44,800 ne suka wuce gona da iri a kowace shekara a Amurka saboda rashin inshorar lafiya. [undefined] [1] A takaice dai, an kiyasta cewa jimillar adadin mutanen da ke mutuwa a Amurka, ko wadanda aka yi musu inshora ko wadanda ba su da inshora, wadanda suka mutu saboda rashin kulawar lafiya, an kiyasta cewa sun kai kusan 100,000 a kowace shekara. [2]

Wani kasidar da aka buga a shekarar 2007 daga The BMJ ta Steffie Woolhandler da David Himmelstein sun yi jayayya sosai cewa tsarin kula da lafiya na Amurka ya samar da kulawa mai ƙarancin inganci a farashi mai tsada, kuma sun ƙara da cewa: "Rashin ingancin kula da lafiya na Amurka ya samo asali ne kai tsaye daga dogaro da hanyoyin kasuwa da kamfanonin da ke neman riba kuma ya kamata ya gargaɗi sauran ƙasashe daga wannan hanyar." [1]

## Farashi da inganci

Amurka tana kashe mafi girman kaso na GDP ɗinta akan kiwon lafiya (19%) fiye da kowace ƙasa a duniya, banda Gabashin Timor (Timor-Leste).  Adadin ma'aikata da ke ba da inshorar lafiya yana raguwa. Kuɗaɗen inshorar lafiya da ma'aikata ke biya suna ƙaruwa da sauri: tun daga 2001, kuɗin inshorar iyali ya ƙaru da kashi 78%, yayin da albashi ya ƙaru da kashi 19% kuma farashin ya ƙaru da kashi 17%, a cewar wani bincike da Gidauniyar Kaiser Family ta yi a 2007. 

Inshorar masu zaman kansu a Amurka ta bambanta sosai a fannin inshora; wani bincike da Asusun Commonwealth ya gudanar wanda aka buga a cikin Harkokin Lafiya ya kiyasta cewa manya miliyan 16 na Amurka ba su da inshorar da ta dace a shekarar 2003. Waɗanda ba su da inshorar sun fi waɗanda ke da inshorar da ta dace da su daina kula da lafiya, su ba da rahoton matsalolin kuɗi saboda kuɗin likita, kuma su fuskanci gibin inshora ga abubuwa kamar magungunan da likita ya rubuta. Binciken ya gano cewa rashin inshora yana shafar waɗanda ke da ƙarancin kuɗi. – Kashi 73% na waɗanda ba su da inshorar da ta dace a cikin binciken sun sami kuɗin shiga na shekara-shekara ƙasa da kashi 200% na matakin talauci na tarayya. [1]

Duk da haka, wani bincike da Gidauniyar Kaiser Family ta buga a shekarar 2008 ya gano cewa tsarin da aka saba da shi na ƙungiyar masu ba da sabis na babban ma'aikaci (PPO) a shekarar 2007 ya fi karimci fiye da Medicare ko kuma Tsarin Tsarin Fa'idodin Lafiya na Ma'aikata na Tarayya . [1] Wani abin da ke nuna sakamakon rashin daidaiton tsarin kula da lafiya na Amurkawa shine wani bincike da aka yi a Harkokin Lafiya wanda ya kammala da cewa rabin fatarar da aka samu ta mutum ya shafi kuɗaɗen likita, [2] kodayake wasu majiyoyi sun musanta hakan. [3]

Masu goyon bayan gyare-gyaren kiwon lafiya da suka shafi faɗaɗa shigar gwamnati don cimma burin kiwon lafiya na duniya baki ɗaya suna jayayya cewa buƙatar samar da riba ga masu zuba jari a cikin tsarin kiwon lafiya na kasuwa mai 'yanci, da ƙarin kashe kuɗi na gudanarwa, yana haifar da hauhawar farashi, wanda ke haifar da tanadi mai tsada. [1]

A cewar masanin tattalin arziki kuma tsohon Sakataren Kwadago na Amurka, Robert Reich, "babban zaɓi na ƙasa, na jama'a " ne kawai zai iya tilasta wa kamfanonin inshora su yi aiki tare, su raba bayanai, da kuma rage farashi. " Ƙungiyoyin inshora da aka warwatse, waɗanda aka ware a cikin gida," ƙanana ne da ba za su iya yin hakan ba kuma an "tsara su don su gaza" ta hanyar ƙungiyoyi masu kuɗi da ke adawa da gyaran lafiyar 'yan Democrat. [undefined] [1]

### Tasiri ga yawan amfanin tattalin arzikin Amurka
A ranar 1 ga Maris, 2010, attajirin nan Warren Buffett ya ce yawan kuɗaɗen da kamfanonin Amurka ke kashewa wajen kula da lafiyar ma'aikatansu ya sanya su cikin matsala. Ya kwatanta kusan kashi 17% na GDP da Amurka ke kashewa kan kula da lafiya da kashi 9% na GDP da yawancin sauran ƙasashen duniya ke kashewa, ya lura cewa Amurka tana da ƙarancin likitoci da ma'aikatan jinya a kowane mutum, kuma ya ce, "irin wannan kuɗin, idan aka kwatanta da sauran ƙasashen duniya, kamar tsutsar da ke ci a jikin tattalin arzikinmu ne." [1]

### Zargin sharar gida
A watan Disamba na 2011, mai barin gado na Cibiyar Ayyukan Medicare & Medicaid, Dr. Donald Berwick, ya yi ikirarin cewa kashi 20% zuwa 30% na kashe kuɗin kula da lafiya ɓarna ne. Ya lissafa dalilai guda biyar da ke haifar da ɓarna: (1) yawan shan marasa lafiya, (2) gazawar daidaita kulawa, (3) sarkakiyar gudanarwa ta tsarin, (4) ƙa'idodi masu nauyi da (5) zamba. [1]

## Ra'ayoyi don gyara

A lokacin wani jawabi na watan Yunin 2009, Shugaba Barack Obama ya bayyana dabarunsa na yin garambawul. Ya ambaci adana bayanai ta hanyar lantarki, hana cututtuka masu tsada, rage kiba, sake mai da hankali kan abubuwan da likitoci ke bayarwa daga yawan kulawa zuwa inganci, haɗa kuɗaɗen magani maimakon takamaiman ayyuka, gano da kuma isar da magunguna mafi inganci, da kuma rage magungunan kariya. [1]

Shugaba Obama ya ƙara bayyana shirinsa a cikin jawabinsa na watan Satumba na 2009 ga taron haɗin gwiwa na Majalisar Dokoki. Shirinsa ya ambaci: rashin daidaito a fannin kuɗi; rashin barin kamfanonin inshora su nuna bambanci bisa ga yanayin da suka riga suka kasance; rage kashe kuɗi a aljihu; ƙirƙirar musayar inshora ga daidaikun mutane da ƙananan kasuwanci; kuɗin haraji ga daidaikun mutane da ƙananan kamfanoni; kwamitocin masu zaman kansu don gano zamba, ɓarna da cin zarafi; da ayyukan gyaran rashin da'a, da sauran batutuwa. [1] [2]

Daraktan OMB Peter Orszag ya bayyana wasu fannoni na dabarun gwamnatin Obama a wata hira da aka yi da shi a watan Nuwamba na 2009: "Domin taimakawa wajen rage hauhawar farashin [Medicare da Medicaid] a tsawon lokaci, muna buƙatar sabon tsarin kiwon lafiya wanda ke da bayanai na dijital... inda ake amfani da wannan bayanin don tantance abin da ke aiki da abin da ba shi da kyau, kuma a cikinsa muke biyan kuɗi don inganci maimakon adadi yayin da kuma ƙarfafa rigakafi da lafiya." Ya kuma yi jayayya kan haɗa kuɗaɗen shiga da ƙungiyoyin kula da lafiya masu alhaki, waɗanda ke ba wa likitoci lada saboda aikin haɗin gwiwa da sakamakon marasa lafiya. [1]

Shugaban Mayo Clinic kuma babban jami'in gudanarwa Denis Cortese ya ba da shawarar a samar da dabarun da za su jagoranci kokarin gyara. Ya yi jayayya cewa Amurka tana da damar sake fasalin tsarin kula da lafiyarta kuma akwai yarjejeniya mai yawa cewa gyara ya zama dole. Ya bayyana "ginshiƙai" guda huɗu na irin wannan dabarar: [1]

* Mayar da hankali kan ƙima, wanda ya bayyana a matsayin rabon ingancin sabis da aka bayar dangane da farashi;
* Biya da daidaita abubuwan ƙarfafawa tare da ƙima;
* Rufe kowa da kowa;
* Kafa hanyoyin inganta tsarin bayar da sabis na kiwon lafiya a cikin dogon lokaci, wanda shine babban hanyar da za a inganta ƙimar ta.

A rubuce-rubuce a cikin The New Yorker, likitan tiyata Atul Gawande ya kara rarrabe tsakanin tsarin isar da shi, wanda ke nufin yadda ake ba da sabis na kiwon lafiya ga marasa lafiya, da tsarin biyan kuɗi, wanda ke nuna yadda ake aiwatar da biyan kuɗi don sabis. Ya jaddada cewa sake fasalin tsarin isar da shi yana da mahimmanci don samun farashi a ƙarƙashin iko, amma wannan sake fasalin hanyar biyan kuɗi (misali, ko gwamnati ko masu inshora masu zaman kansu suna aiwatar da biyan kuɗi) ba su da mahimmanci duk da haka suna tara rabon kulawa. Gawande ya yi jayayya cewa ingantawa mai ban mamaki da tanadi a cikin tsarin isar da shi zai ɗauki "akalla shekaru goma. " Ya ba da shawarar canje-canje waɗanda ke magance yawan amfani da kiwon lafiya; sake mayar da hankali ga ƙarfafawa akan darajar maimakon riba; da kuma nazarin kwatankwacin farashin magani a duk faɗin masu ba da kiwon lafiyar lafiya daban-daban don gano mafi kyawun ayyuka. Ya yi jayayya cewa wannan zai zama tsari mai maimaitawa, mai kwarewa kuma ya kamata "cibiyar kula da kiwon lafiya ta kasa" ta gudanar da shi don nazarin da kuma sadarwa damar ingantawa.[1]

### Amfani da binciken ingancin kwatantawa

Akwai zaɓuɓɓuka da dama na magani ga wani yanayi na lafiya, tare da farashi daban-daban amma babu wani bambanci na ƙididdiga a sakamakon. Irin waɗannan yanayi suna ba da damar kiyayewa ko inganta ingancin kulawa, yayin da suke rage farashi sosai, ta hanyar binciken inganci na kwatantawa . David Leonhardt, yana rubutu a cikin jaridar New York Times, ya bayyana yadda farashin maganin ciwon daji na mafi yawan lokuta na farkon mataki, wanda ke girma a hankali ya kama daga matsakaicin $2,400 (ana jira a jira don ganin ko yanayin ya lalace) zuwa har zuwa $100,000 (maganin hasken rana): [1]

A cewar masanin tattalin arziki Peter A. Diamond da kuma binciken da Ofishin Kasafin Kudi na Majalisa (CBO) ya ambata, farashin kula da lafiya ga kowane mutum a Amurka ya bambanta sosai dangane da yanayin ƙasa da cibiyar lafiya, tare da ƙaramin bambanci ko babu wani bambanci na ƙididdiga a sakamakon. [1]

Binciken ingancin kwatancen ya nuna cewa akwai yiwuwar rage farashi mai yawa. Daraktan OMB Peter Orszag ya bayyana cewa: "Kusan kashi talatin cikin ɗari na kuɗaɗen Medicare za a iya adana su ba tare da yin mummunan tasiri ga sakamakon lafiya ba idan za a iya rage kashe kuɗi a wurare masu tsada da matsakaici zuwa matakin yankuna masu rahusa." [1]

### Canjin abubuwan da likitan ke motsawa
Masu suka sun yi jayayya cewa tsarin kiwon lafiya yana da wasu abubuwan ƙarfafa gwiwa da ke haifar da tsadar ɗabi'a. Biyu daga cikinsu sun haɗa da: [1]

# Yawanci ana biyan likitoci ne don ayyukan da ake bayarwa maimakon albashi. Wannan tsarin biyan kuɗi (wanda galibi ake kira " kuɗin sabis ") yana ba da kwarin gwiwa na kuɗi don ƙara farashin magani da ake bayarwa.
# Marasa lafiya waɗanda ke da cikakken inshora ba su da wata kwarin gwiwa ta kuɗi don rage farashi yayin zaɓar daga cikin zaɓuɓɓuka. Sakamakon gabaɗaya shine ƙara kuɗin inshora ga kowa.

### Gyaran inshora
Muhawarar ta shafi wasu ayyukan masana'antar inshora kamar sanya iyaka kan inshora, babban matakin biyan kuɗi ko da don muhimman ayyuka kamar hanyoyin kariya, ƙin kamfanonin inshora da yawa su rufe sharuɗɗan da suka riga suka kasance ko ƙara ƙarin nauyin waɗannan sharuɗɗan, da kuma ayyukan da wasu mutane ke ɗauka a matsayin abin ƙyama kamar ƙarin nauyin kuɗin da mata za su biya, batun cewa abokin tarayya ya taɓa cin zarafinsu a baya a matsayin yana da wata cuta da ta riga ta faru, har ma da soke manufofin inshora bisa dalilai masu rauni lokacin da mai da'awa wanda ya biya ƙarin kuɗin da yawa ya gabatar da yanayin lafiya mai tsada. &#x5B; **' &#x5D;</sup>

Shawarwari daban-daban na majalisar dokoki da ake nazari sosai sun gabatar da tarar manyan ma'aikata waɗanda ba sa samar da mafi ƙarancin ka'idojin inshorar lafiya da kuma tilasta wa mutane su sayi inshorar lafiya mai zaman kansa. Wannan shi ne karo na farko da gwamnatin tarayya ta umarci mutane su sayi inshora, kodayake kusan dukkan jihohi a cikin ƙungiyar kwadago a halin yanzu sun ba da umarnin siyan inshorar mota. Dokar ta kuma sanya haraji kan wasu manufofin inshora masu tsada (wanda ake kira "manufofin Cadillac") don taimakawa wajen ba da tallafin kuɗi ga talakawa 'yan ƙasa. Za a bayar da waɗannan a kan sikelin da ba shi da yawa fiye da matakin talauci na tarayya sau huɗu don ba su damar siyan inshorar lafiya idan ma'aikacinsu bai rufe su ba. [ ana buƙatar ambato ]

Batun tattara iko daga masana'antar inshora shi ma ya kasance abin muhawara a kai domin a jihohi da yawa, ƙananan kamfanonin inshora ne suka mamaye kasuwa. Dokar da za ta samar da zaɓi na kamfanin inshora wanda ba na riba ba ne wanda aka yi wa kwaskwarima a kan Medicare amma wanda aka ba shi tallafin kuɗi daga inshora ta kasance batu mai sarkakiya. Muhawara da yawa ta shafi Medicare Advantage da ribar da kamfanonin inshora ke samu daga sayar da ita. [1]

Wasu shawarwari sun haɗa da zaɓin wani kamfanin inshora wanda ba na riba ba ne wanda aka yi wa kwaskwarima a kan Medicare (wani lokacin ana kiransa "zaɓin gwamnati"). 'Yan majalisar Democrat sun fi goyon bayan ƙoƙarin sauye-sauyen da aka gabatar, yayin da 'yan Republican suka soki zaɓin gwamnati ko faɗaɗa ƙa'idojin kiwon lafiya.

Hukumar GAO ta bayar da rahoto a shekarar 2002 (ta amfani da bayanai 2000) cewa: " Matsakaicin adadin masu jigilar kaya masu lasisi a kasuwar ƙananan rukuni a kowace jiha shine 28, tare da kewayon daga 4 a Hawaii zuwa 77 a Indiana. Matsakaicin kaso na kasuwar manyan masu jigilar kaya shine kusan kashi 33, tare da kewayon daga kusan kashi 14 a Texas zuwa kusan kashi 89 a North Dakota." [1]

Hukumar GAO ta bayar da rahoto a shekarar 2008 (ta amfani da bayanai na 2007 a mafi yawan lokuta) cewa: "Matsakaicin adadin masu jigilar kaya masu lasisi a kasuwar ƙananan rukuni a kowace jiha shine 27. Matsakaicin kaso na kasuwar manyan masu jigilar kaya a kasuwar ƙananan rukuni shine kusan 47%, tare da kewayon daga kusan 21% a Arizona zuwa kusan 96% a Alabama. A cikin jihohi 31 daga cikin 39 da ke samar da bayanai kan kasuwar, manyan masu jigilar kaya suna da kaso na kasuwa na kashi ɗaya bisa uku ko fiye. Manyan masu jigilar kaya biyar a kasuwar ƙananan rukuni, idan aka haɗa su, sun wakilci kashi uku ko fiye na kasuwar a cikin jihohi 34 daga cikin 39 da ke samar da wannan bayanin, kuma sun wakilci kashi 90% ko fiye a cikin 23 daga cikin waɗannan jihohi.... matsakaicin kaso na duk masu jigilar kaya na BCBS a cikin jihohi 38 da ke ba da rahoton wannan bayanin a 2008 ya kai kusan 51%, idan aka kwatanta da kashi 44% da aka ruwaito a 2005 da kashi 34% da aka ruwaito a 2002 ga jihohi 34 da ke samar da bayanai a cikin kowanne daga cikin waɗannan shekarun." [1]

=== Gyaran haraji ===

Ofishin Kasafin Kudi na Majalisa ya kuma bayyana yadda tsarin haraji na biyan kudin inshora zai iya shafar hali: [1]<gallery>
Fayil:Budgetary_Impact_of_Health_Reform_Bills.JPG|alt=Budgetary Impact of House and Senate Bills| [http://crfb.org/blogs/interactive-and-sharable-graphs-comparing-health-care-bills Tasirin Kasafin Kudi ga Dokokin Majalisa da na Majalisar Dattawa]
Fayil:Changes_in_Coverage_Health_Care_Bills.png|alt=Changes in Coverage Under House and Senate Bills| [http://crfb.org/blogs/interactive-and-sharable-graphs-comparing-health-care-bills Canje-canje a Tsarin Mulki A ƙarƙashin Dokokin Majalisa da na Majalisar Dattawa]
Fayil:Gross_Costs_of_Health_Coverage.png|alt=Gross Cost of Coverage Provisions in House and Senate Bills| [http://crfb.org/blogs/interactive-and-sharable-graphs-comparing-health-care-bills Jimillar Kuɗin da Aka Kashe a Dokokin Majalisa da na Majalisar Dattawa]
</gallery>A watan Nuwamba na 2009, Jaridar Economist ta kiyasta cewa sanya harajin inshorar lafiya da ma'aikata ke bayarwa (wanda a yanzu ba a biyan haraji ba) zai ƙara dala biliyan 215 a kowace shekara ga kuɗin shiga na haraji na tarayya a lokacin 2013-2014. [1] Peter Singer ya rubuta a cikin Jaridar New York Times cewa cire kuɗin inshora daga diyya a yanzu yana wakiltar tallafin dala biliyan 200 ga masana'antar inshorar masu zaman kansu kuma wataƙila ba zai wanzu ba tare da shi ba. [2] A wata ma'anar, masu biyan haraji na iya son canza hali ko tsarin da kansa idan suna biyan ƙarin dala biliyan 200 a kowace shekara da suka shafi inshorar lafiya. Don a faɗi wannan adadin a mahangar, gwamnatin tarayya ta tara dala biliyan 1,146 a cikin harajin samun kuɗi a 2008, [3] don haka dala biliyan 200 yana wakiltar ƙaruwar kashi 17.5% a cikin ingantaccen ƙimar haraji.

=== Kwamitin ba da shawara mai zaman kansa ===
Shugaba Obama ya gabatar da shawarar "Kwamitin Ba da Shawara Kan Medicare Mai Zaman Kansa" (IMAC) don bayar da shawarwari kan manufofin biyan diyya na Medicare da sauran gyare-gyare. Binciken inganci na kwatantawa zai zama ɗaya daga cikin kayan aikin da IMAC ke amfani da su. An amince da ra'ayin IMAC a cikin wata wasiƙa daga wasu fitattun masana manufofin kiwon lafiya, kamar yadda Daraktan OMB Peter Orszag ya taƙaita: [1]

Shugaban Mayo Clinic, Dakta Denis Cortese da kuma likitan tiyata/marubuci Atul Gawande sun yi jayayya cewa irin wannan kwamitin zai zama muhimmi ga gyaran tsarin bayarwa da kuma inganta darajarsa. David Ignatius, marubucin jaridar Washington Post, ya kuma ba da shawarar Shugaba Obama ya yi aiki da wani kamar Cortese don ya taka rawa sosai wajen haɓaka ƙoƙarin gyara. [1]

=== Rage kiba ===
Hana kiba da yanayin kiba yana ba da babbar dama ta rage farashi. Cibiyar Kula da Cututtuka ta ba da rahoton cewa kusan kashi 9% na kuɗaɗen kula da lafiya a shekarar 1998 sun samo asali ne daga kiba da kiba, ko kuma har zuwa dala biliyan 93 a dala 2002. Kusan rabin waɗannan kuɗaɗen gwamnati ce ta biya ta hanyar Medicare ko Medicaid. [1] Duk da haka, zuwa 2008, CDC ta kiyasta cewa waɗannan kuɗaɗen sun ninka har zuwa dala biliyan 147. [2] CDC ta gano jerin yanayi masu tsada da suka fi faruwa saboda kiba. [3] CDC ta fitar da jerin dabarun hana kiba da kiba, gami da: samar da abinci mai kyau da abubuwan sha; tallafawa zaɓin abinci mai kyau; ƙarfafa yara su zama masu aiki; da ƙirƙirar al'ummomi masu aminci don tallafawa motsa jiki. [4] [5] An kiyasta kashi 26% na manya a Amurka a shekarar 2007 sun kasance masu kiba, idan aka kwatanta da kashi 24% a shekarar 2005. Yawan kiba a jihohi ya kama daga kashi 18% zuwa 30%. Yawan kiba ya kasance daidai tsakanin maza da mata. [6] Wasu sun gabatar da shawarar da ake kira " harajin kitse " don samar da abubuwan ƙarfafawa ga ɗabi'a mai kyau, ko dai ta hanyar ɗaukar harajin kan kayayyakin (kamar abubuwan sha masu laushi) waɗanda ake tsammanin suna haifar da kiba, [7] ko kuma ga mutane bisa ga ma'aunin jiki, kamar yadda ake yi a Japan. [8]

=== Rarraba kulawa ===
Rangwamen kiwon lafiya na iya nufin takaita ayyukan kula da lafiya bisa ga kowace irin ma'auni ko kuma na zahiri. Dan Republican Newt Gingrich ya yi jayayya cewa shirye-shiryen gyaran da Shugaba Obama ke goyon baya sun fadada ikon gwamnati kan shawarwarin kiwon lafiya, wanda ya kira a matsayin wani nau'in rabon kiwon lafiya. [1] Shugaba Obama ya yi jayayya cewa an riga an raba wa harkokin kiwon lafiya na Amurka rabon, bisa ga kudin shiga, nau'in aiki, da kuma yanayin da ake da shi a fannin kiwon lafiya, inda kusan mutane miliyan 46 ba su da inshora. Ya yi jayayya cewa miliyoyin Amurkawa ba a hana su biyan albashi ko kuma suna fuskantar ƙarin kuɗin fansho sakamakon yanayin da ake da shi a fannin kiwon lafiya. [2]

Peter Singer ya rubuta a jaridar New York Times a watan Yulin 2009 cewa ana raba abinci ga marasa lafiya a Amurka kuma ya yi jayayya kan inganta tsarin raba abinci ga marasa lafiya: [1]

A cewar PolitiFact, kamfanonin inshorar lafiya masu zaman kansu sun riga sun raba kiwon lafiya ta hanyar samun kudin shiga, ta hanyar hana wadanda ke da yanayin da suka riga suka kamu da cutar inshorar lafiya da kuma iyakance kudaden inshorar lafiya. Rage rabon abinci yana nan yanzu, kuma zai ci gaba da wanzuwa tare da ko ba tare da gyara kiwon lafiya ba. [1] David Leonhardt shi ma ya rubuta a cikin jaridar New York Times a watan Yunin 2009 cewa raba rabon abinci wani bangare ne na gaskiyar tattalin arziki: "Zaɓin ba tsakanin raba rabon abinci ba ne ko kuma raba rabon abinci. Yana tsakanin raba rabon abinci mai kyau da kuma raba rabon abinci mara kyau. Ganin cewa Amurka ta sadaukar da tattalin arzikinta ga kiwon lafiya fiye da sauran kasashe masu arziki, kuma tana samun sakamako mafi muni ta hanyoyi da yawa, yana da wuya a yi jayayya cewa yanzu muna raba rabon abinci mai kyau." [2]

Jawabin kwamitin mutuwar Palin ya dogara ne akan ra'ayoyin Betsy McCaughey . [1] [2] A lokacin 2009, tsohuwar Gwamnan Alaska Sarah Palin ta rubuta game da zargin raba abinci, tana mai nuni da abin da a ta bakinta "kwamitin mutuwa" "mugunta" a cikin dokar gyara da aka sani da Sashe na HR 3200 1233. [2] Duk da haka, Palin ta goyi bayan irin wannan tattaunawa game da ƙarshen rayuwa da kuma umarnin gaba ga marasa lafiya a 2008. [3] Masu kare shirin sun nuna cewa dokar da aka gabatar ta HR 3200 za ta ba Medicare damar a karon farko ta rufe shawarwarin marasa lafiya da likitoci game da shirin ƙarshen rayuwa, gami da tattaunawa game da tsara wasiyya ta rayuwa ko tsara maganin asibiti. Marasa lafiya za su iya neman irin wannan shawara da kansu, amma ba za a buƙaci hakan ba. Wannan tanadin zai iyakance ɗaukar nauyin Medicare zuwa shawara ɗaya bayan ɗaya bayan kowace shekara biyar. [4] Wakili Earl Blumenauer, D-Ore., wanda ya ɗauki nauyin tanadin shawarwarin ƙarshen rayuwa na HR 3200, ya ce matakin zai toshe kuɗaɗen ba da shawara waɗanda ke nuna kashe kai ko taimaka wa kashe kai a matsayin zaɓi, kuma ya kira ambaton kwamitin mutuwa ko euthanasia "abin da ke ɓata wa hankali". [5] Sanata Johnny Isakson na jam'iyyar Republican, wanda ya ɗauki nauyin tanadin shawarwarin ƙarshen rayuwa na 2007, ya kira da'awar euthanasia "abin ƙyama". [6] Masu sharhi waɗanda suka binciki tanadin ƙarshen rayuwa da Palin ta ambata sun yarda cewa da'awar Palin ba daidai ba ce. [7] [8] [9] [10] [11] A cewar TIME da ABC, Palin da Betsy McCaughey sun yi da'awar euthanasia ta ƙarya. [2] [12] [13]

Bukatar gwamnatin tarayya ta cewa asibitoci su taimaki marasa lafiya da abubuwa kamar wasiyya mai rai ta fara ne lokacin da ɗan Republican George HW Bush ya zama shugaban ƙasa. Sashe na 1233 kawai yana ba da damar a biya likitoci kuɗin lokacinsu. [1] Duk da haka, wani bincike da NBC ta gudanar ya nuna cewa ya zuwa watan Agusta, 2009, kashi 45% na Amurkawa sun yi imani da labarin kwamitin mutuwar. [2]

Christopher Beam, mai sharhi kan harkokin Slate, ya yi amfani da kalmar "masu kisan kai" don nufin waɗanda suka yi imanin cewa raba abinci da kuma kashe tsofaffi zai iya zama haɗari ga tsofaffi. Shirin Rachel Maddow ya watsa wani shiri mai suna "Obama da Masu kisan kai" inda Maddow ya tattauna ka'idojin makirci waɗanda suka haɗa da "makircin ɓoye na kashe tsofaffi." Daily Kos da sauran shafukan yanar gizo sun yi amfani da kalmar tsawon mako guda kafin Hari Sevugan, mai magana da yawun kwamitin ƙasa na jam'iyyar Democrat, ya aika imel mai taken "Murkowski: Masu kisan kai 'Yana Ƙarya' 'Yana Tada Tsoro.'" Saƙon ya haɗa da wani labarin game da sanarwar zauren gari da Sanata Lisa Murkowski, 'yar jam'iyyar Republican daga Alaska, ta yi, cewa babu wani sigar gyaran lafiya da ya haɗa da "kwamitocin mutuwa".

Sevugan ya bayyana kalmar "masu kisan kai" ga Patricia Murphy, wacce ta saba rubuta wani shafi na Politics Daily mai suna "The Capitolist":

Wasu kuma, kamar tsohon Sakataren Kasuwanci na Jam'iyyar Republican Peter G. Peterson, sun nuna cewa wani nau'in rabon kuɗi abu ne da ba makawa kuma abin so ne idan aka yi la'akari da yanayin kuɗaɗen Amurka da kuma tiriliyan daloli na basussukan Medicare da ba a ba su kuɗi ba. Ya kiyasta cewa ana ba da kashi 25-33% na ayyukan kiwon lafiya ga waɗanda ke cikin watanni ko shekarar ƙarshe na rayuwa kuma ya ba da shawarar ƙuntatawa a lokutan da ba za a iya inganta ingancin rayuwa ba. Ya kuma ba da shawarar a kafa kasafin kuɗi don kuɗaɗen kiwon lafiya na gwamnati, ta hanyar kafa ƙa'idodin kashe kuɗi da ƙa'idodin biyan kuɗi kamar yadda kuke so waɗanda ke buƙatar ƙarin haraji ga duk wani ƙarin kashe kuɗi. Ya nuna cewa za a buƙaci haɗakar ƙarin haraji da rage kashe kuɗi. Duk waɗannan batutuwa za a magance su a ƙarƙashin jagorancin kwamitin gyaran kuɗaɗe. 

=== Kudaden da ake kashewa wajen yin sakaci a fannin lafiya da kuma iyakokin gyara (laifi) ===
Masu suka sun yi jayayya cewa kuɗaɗen da ake kashewa wajen yin sakaci a fannin likitanci suna da yawa kuma ya kamata a magance su ta hanyar gyaran fuska .  A lokaci guda, wani bincike da aka yi a Hearst Newspapers ya kammala da cewa har zuwa mutane 200,000 a kowace shekara suna mutuwa sakamakon kurakuran likita da kamuwa da cuta a Amurka.  Babu ɗaya daga cikin manyan kuɗaɗe uku da ake la'akari da su da ke da ƙarancin diyya da za a iya dawo da su a shari'o'in sakaci a fannin likitanci, kamar kurakuran likita da ke haifar da lahani ga marasa lafiya, yana da kuɗaɗen kai tsaye da na kai tsaye:

* alkalai sun bayar da lada ga wadanda suka ji rauni;
* diyya ga ma'aikata ;
* rage yawan aiki na ma'aikata sakamakon rauni;
* ciwo da wahala ga waɗanda suka ji rauni;

Nawa ne kudin da ake kashewa a wannan fanni, abin muhawara ne. Wasu sun yi jayayya cewa kararrakin da ake yi na rashin da'a su ne babban abin da ke haifar da kuɗaɗen magani.  Duk da haka, farashin kai tsaye na kararrakin da ba su da'a ya kai kusan kashi 0.5% ne kawai na duk kuɗin da ake kashewa a fannin kiwon lafiya, kuma wani bincike da Harvard ta yi a shekarar 2006 ya nuna cewa sama da kashi 90% na kararrakin da ba su da'a da aka bincika sun ƙunshi shaidar raunin da aka yi wa majiyyaci kuma kotuna ba sa yin watsi da ƙarar da ba su da amfani.  Wani bincike da aka yi a shekarar 2005 ya kiyasta cewa kudin ya kai kusan kashi 0.2%, kuma a shekarar 2009 kamfanin inshorar WellPoint Inc. ya ce "alhaki ba shi ne ke haifar da kuɗin ba."  Idan aka ƙididdige kuɗaɗen kai tsaye da na kai tsaye, wasu bincike sun kiyasta cewa jimillar kuɗin da ake kashewa na rashin da'a "yana da alaƙa" da tsakanin kashi 5% zuwa 10% na jimillar kuɗin likitancin Amurka.  Wani rahoto da Ofishin Kasafin Kuɗi na Majalisa ya fitar a shekarar 2004 ya nuna cewa kuɗaɗen da ake kashewa wajen rashin da'a a fannin kiwon lafiya a kashi 2% na kuɗin da ake kashewa a fannin kiwon lafiya a Amurka da kuma "ragewa mai yawa" ba zai yi wani tasiri ba wajen rage ƙaruwar kuɗaɗen kula da lafiya. 

Marubucin sharhi kan harkokin mazan jiya Charles Krauthammer ya yi jayayya cewa tsakanin dala biliyan 60-200 a kowace shekara za a iya ceto ta hanyar gyaran laifuka. <sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">&#x5B; **' &#x5D; Likita kuma tsohon Shugaban Kwamitin Jam'iyyar Democrat na Ƙasa Howard Dean ya bayyana dalilin da ya sa gyaran laifi ba ya cikin dokokin da ake la'akari da su: "Lokacin da ka je zartar da wani babban kudiri kamar haka, ƙarin abubuwan da ka saka a ciki, ƙarin maƙiya za ka yi, ko ba haka ba?... Kuma dalilin da ya sa gyaran laifi ba ya cikin kudirin shine saboda mutanen da suka rubuta shi ba sa son ɗaukar lauyoyin shari'a ban da duk wanda suke ɗauka. Wannan ita ce gaskiya mai sauƙi." 

Duk da haka, ko da nasarar gyaran laifuka ba zai iya haifar da ƙarancin ɗaukar nauyi ba: misali, masu sharhi kan harkokin lafiya sun yi jayayya cewa tsarin kuɗin da ake biya a yanzu yana karkatar da shari'o'i zuwa manyan shari'o'i yayin da yake yin watsi da ƙananan shari'o'i masu kyau; daidaita shari'o'i da cancanta na iya ƙara yawan ƙananan kyaututtuka, yana rage duk wani raguwa a manyan kyaututtuka.  Wani bincike na New York ya gano cewa kashi 1.5% ne kawai na sakaci a asibiti ya haifar da da'awa; ƙari ga haka, CBO ya lura cewa "masu ba da kiwon lafiya gabaɗaya ba sa fuskantar haɗarin rashin da'a saboda suna da inshorar alhaki, kuma kuɗin da ake biya don wannan inshorar ba ya nuna bayanan ko salon aiki na masu ba da sabis daban-daban amma abubuwan da suka fi yawa kamar wurin aiki da ƙwarewar likita."  Ganin cewa jimlar alhakin ba ta da yawa idan aka kwatanta da adadin da likitoci ke biya a cikin kuɗin inshorar rashin da'a, an gabatar da wasu hanyoyin da za a gyara inshorar rashin da'a. 

### Magance ƙarancin likitoci, ma'aikatan jinya da kuma ƙarfin asibitoci
Amurka na fuskantar karancin likitoci da ma'aikatan jinya da ake hasashen za su kara tabarbarewa yayin da Amurka ke tsufa, wanda hakan ka iya kara farashin wadannan ayyuka. A cikin wani rubutu da ya yi a *jaridar The Washington Post*, likitan zuciya Arthur Feldman ya yi ambato nazarce-nazarce daban-daban da ke nuna cewa Amurka na fuskantar karancin likitoci "matukar mahimmanci", ciki har da kimanin likitocin tiyata 1,300 nan da shekarar 2010. 

Cibiyar Nazarin Iyali ta Amurka ta yi hasashen ƙarancin likitocin kula da lafiya na farko 40,000 (gami da aikin iyali, maganin ciki, kula da yara da kuma kula da mata/mata) nan da shekarar 2020. Adadin ɗaliban likitanci da ke zaɓar ƙwarewar kula da lafiya ta farko ya ragu da kashi 52% tun daga 1997. A halin yanzu, kashi 2% ne kawai na waɗanda suka kammala karatun likitanci suka zaɓi kula da lafiya ta farko a matsayin aiki. Wani gyara ga dokar lafiyar Majalisar Dattawa ya haɗa da kuɗaɗen dala biliyan 2 a cikin shekaru 10 don ƙirƙirar sabbin guraben horo na zama 2,000 waɗanda aka tsara don kula da lafiya ta farko da tiyata ta gaba ɗaya. A rubuce-rubuce a Forbes, wani likita ya yi jayayya cewa wannan "ƙaramin bandeji ne a mafi kyau," yana mai ba da shawarar biyan cikakken lamuni da matsayi mai garanti bayan kammala karatun. 

Amurka tana da likitoci 2.4 ga kowane mutum 1,000 a shekarar 2002, inda take matsayi na 52. Jamus da Faransa suna da kimanin likitoci 3.4 kuma suna cikin manyan 25.  Matsakaicin OECD a shekarar 2008 shine likitoci 3.1 ga kowane mutum 1,000, yayin da Amurka ke da likitoci 2.4. 

Bugu da ƙari, Amurka ba ta aunawa da kyau idan aka kwatanta da ƙasashen OECD dangane da gadajen asibiti na gaggawa ba. Ƙasashe huɗu na OECD ne kawai ke da ƙarancin gadajen asibiti na gaggawa ga kowane mutum fiye da Amurka, wacce ke da 2.7 a cikin kowace jama'a 1,000 idan aka kwatanta da matsakaicin OECD na 3.8. Japan tana da gadajen kulawa na gaggawa 8.2 a cikin kowace jama'a 1,000. 

### Magance zamba ta Medicare
Ofishin Gudanarwa da Kasafin Kudi ya ruwaito cewa an biya dala biliyan 54 na "biya mara kyau" ga Medicare ($24B), Medicaid ($18B) da Medicaid Advantage ($12B) a lokacin kasafin kuɗi na 2009. Wannan shine kashi 9.4% na dala biliyan 573 da aka kashe a waɗannan rukunan.  Ofishin Kula da Lafiya na Gwamnati ya lissafa Medicare a matsayin shirin gwamnati mai "babban haɗari" saboda raunin da take da shi na biyan kuɗi mara kyau.    Kasa da kashi 5% na da'awar Medicare ana tantance su.  Zamba na Medicare ya kai kimanin dala biliyan 60 a cikin biyan Medicare kowace shekara, kuma "ya zama ɗaya daga cikin laifuka mafi riba a Amurka."  Masu laifi suna kafa kamfanoni na bogi, sannan su yi wa Medicare lissafin ayyukan zamba da aka bayar ga marasa lafiya na Medicare waɗanda ba su taɓa samun ayyukan ba. Waɗannan kuɗaɗen sun bayyana a cikin bayanan Medicare da aka bai wa masu katin Medicare. Shirin yana biyan sama da dala biliyan 430 a kowace shekara ta hanyar da'awa sama da biliyan 1, wanda hakan ya sa aiwatar da aiki ya zama ƙalubale.  Kasafin kuɗin aiwatar da shi yana da "ƙanƙanta sosai" a cewar wani jami'in Medicare. Babban Lauyan Amurka Eric Holder ya ce a wata hira: "A bayyane yake cewa akwai buƙatar yin ƙarin bincike kuma yana buƙatar yin hakan a ainihin lokaci."  Gwamnatin Obama ta bai wa Medicare ƙarin dala miliyan 200 don yaƙi da zamba a matsayin wani ɓangare na kunshin ƙarfafa gwiwa, da kuma biliyoyin daloli don yin amfani da bayanan likita na kwamfuta da haɓaka hanyoyin sadarwa, wanda ya kamata ya taimaka wa Medicare wajen gano da'awar zamba. 

### Tsarin biyan kuɗi mai biyan kuɗi ɗaya
A tsarin biyan kuɗi ɗaya, gwamnati ko gwamnati na tsara hukumomin da ba na riba ba, suna biyan kuɗin kula da lafiya don karɓar kuɗaɗen fansho da kuma biyan kuɗin masu ba da sabis na kiwon lafiya. Misalai sun haɗa da Kanada, Koriya ta Kudu, Sweden, Taiwan da Burtaniya.

Sau da yawa ana kwatanta tsarin Amurka da na maƙwabciyarta ta arewa, Kanada (duba idan aka kwatanta da tsarin kula da lafiya na Kanada da Amurka ). Tsarin Kanada galibi ana ba da kuɗaɗen gwamnati. A shekarar 2006, Amurkawa sun kashe kimanin dala 6,714 ga kowane mutum a fannin kiwon lafiya, yayin da 'yan Kanada suka kashe dala 3,678 ga kowane mutum.  Wannan ya kai kashi 15% na GDP na Amurka a wannan shekarar, yayin da Kanada ta kashe 10%. Wani bincike da Makarantar Likitanci ta Harvard da Cibiyar Bayanai ta Kanada suka gudanar ya gano cewa kusan kashi 31% na kuɗin kula da lafiya na Amurka (fiye da dala 1,000 ga kowane mutum a kowace shekara) ya tafi ga kuɗaɗen gudanarwa na kula da lafiya. 

Masu fafutuka sun yi jayayya cewa mayar da Amurka zuwa tsarin kula da lafiya mai biyan kuɗi ɗaya zai samar da tsarin kula da lafiya na duniya baki ɗaya, zai ba marasa lafiya zaɓin masu samar da lafiya da asibitoci kyauta, kuma ya tabbatar da cikakken tsarin kula da lafiya da kuma samun dama ga duk hanyoyin da suka dace da lafiya, ba tare da ƙara yawan kashe kuɗi ba. Canjawa zuwa tsarin kula da lafiya mai biyan kuɗi ɗaya zai kuma kawar da kulawa daga masu duba kulawa, yana kawar da cikas ga dangantakar likita da marasa lafiya.  Masu adawa suna jayayya cewa canzawa zuwa tsarin kula da lafiya mai biyan kuɗi ɗaya zai haifar da ƙarin matsaloli da koma baya. Ƙungiyar Likitoci ta Amurka ta yi jayayya cewa tsarin kula da lafiya mai biyan kuɗi ɗaya zai fuskanci nauyin lokutan jira na dogon lokaci, ba zai yi tasiri ba idan ana maganar kirkire-kirkire na likita da kula da wurare, kuma babban tsarin gwamnati zai iya "haifar da raguwar ikon marasa lafiya da likitocinsu kan yanke shawara a asibiti." 

Duk da cewa bincike ya nuna cewa 'yan Democrat sun fi goyon bayan tsarin biyan kuɗi ɗaya fiye da 'yan Republican, babu ɗaya daga cikin kudurorin gyaran da aka yi muhawara a kansu a Majalisar Dokokin Amurka lokacin da 'yan Democrat ke da rinjaye daga 2007 zuwa 2010 da ya haɗa da shawarwari don aiwatar da tsarin kula da lafiya na biyan kuɗi ɗaya. Masu fafutuka suna jayayya cewa babban cikas ga tsarin biyan kuɗi ɗaya, na duniya baki ɗaya a Amurka shine rashin son zuciya. 

### Kare Medicare daga masu zaman kansu tare da tsarin baucan

## Shawarwari na Majalisa kan Gyaran Kula da Lafiya

A ranar 7 ga Nuwamba, 2009, Majalisar ta zartar da wani daftarin kudirin gyaran inshorar lafiya, Dokar Kula da Lafiya Mai Sauƙi ta Amurka, 220–215, amma wannan bai zama doka ba.

'Yan Republican suna ci gaba da da'awar cewa suna da wani kudiri mai aiki don fadada kariya ga dukkan Amurkawa kuma ba ya kashe masu biyan haraji komai, kodayake ba a gabatar da komai a bainar jama'a don tallafawa ikirarin ba.  Dokar Karfafa Marasa Lafiya ta Farko wacce aka gabatar a matsayin wani sauyi ga Dokar Majalisar Dattawa yayin tantance kudirin. Duk da haka, Kwamitin Kudi na Majalisar Dattawa ya yi watsi da wannan kudiri na madadin. Ofishin Kasafin Kudi na Majalisa ya ce ba zai rage kaso na mutanen da shekarunsu ke aiki wadanda ba su da inshora a cikin shekaru 10 masu zuwa ba, kuma ya kiyasta cewa zai karfafa masu inshorar lafiya su rage maimakon kara inshorar domin zai cire dokokin kariya da aka wajabta wadanda ke aiki a wasu jihohi. Wannan kudiri zai bai wa masana'antar inshora damar samun kudaden gwamnati ta hanyar sabbin tallafin inshora.  Ba shi da wani tanadin haraji kuma kodayake zai rage gibin a cikin shekaru 10 da dala biliyan 18, wannan ya kasance ƙaramin raguwar gibin fiye da na Majalisar ko Majalisar Dattawa.

### Kamanceceniya tsakanin Dokokin Majalisa da na Majalisar Dattawa
Kudirin biyu iri ɗaya ne ta hanyoyi da dama. Musamman ma, duka kudirin biyu:  

* Umarni mafi ƙarancin fa'idodin inshorar lafiya ga yawancin Amurkawa
* Cire iyakokin inshora na shekara-shekara da na rayuwa akan inshorar kuma iyakance adadin haɗin gwiwa
* Cire haɗin-kuɗi akan wasu ayyuka kamar gwaje-gwajen lafiya da wasu alluran rigakafi
* Sanya sabon harajin fitar da kaya ga na'urorin likitanci da magunguna, gami da alluran rigakafi   (gwamnatin tarayya ta fara biyan haraji kan alluran rigakafi a shekarar 1987  ).
* Kafa musayar inshorar lafiya wanda zai sauƙaƙa kwatanta farashi da ɗaukar hoto da kuma siyan mutane da ƙananan 'yan kasuwa don siyan inshorar kiwon lafiya
* Hana masu inshora su sayar da manufofin inshorar musayar kuɗi waɗanda ba su cika ƙa'idodin ɗaukar nauyin da ya dace ba
* Hana kamfanonin inshora hana mutane ɗaukar nauyin inshora ga mutanen da ke da matsalolin lafiya a da
* Hana nuna wariya ga mata ta hanyar yin amfani da kamfanonin inshora (musamman wariya ga mata a yanzu) wajen tsara biyan kuɗi
* Iyakance wariya ga shekaru daga masu inshora yayin tsara manufofin biyan kuɗi
* Taƙaita ikon kamfanonin inshora na soke manufofin da suke karɓar kuɗin fansho a kai
* Ana buƙatar masu inshora su biya wa yara manya har zuwa tsakiyar shekarunsu na ashirin a matsayin wani ɓangare na tsarin inshorar iyali.
* Faɗaɗa cancantar Medicaid zuwa matakin samun kudin shiga (zuwa kashi 133% na layin talauci a cikin lissafin Majalisar Dattawa da kashi 150% a cikin lissafin Majalisar)
* Bayar da rangwamen haraji ga wasu ƙananan 'yan kasuwa (ƙasa da ma'aikata 25) waɗanda ke ba wa ma'aikata inshorar lafiya
* Sanya hukunci ga ma'aikata waɗanda ba sa bayar da inshorar lafiya ga ma'aikatansu
* A yanke hukunci ga mutanen da ba su da inshorar lafiya (banda 'yan asalin Amurka (wanda Hukumar Lafiya ta Indiya ke kula da shi a yanzu), mutanen da ke da ƙin amincewa da addini da kuma mutanen da za su iya nuna wahalhalun kuɗi)
* Samar da tallafin tallafin inshorar lafiya ga waɗanda ke samun har zuwa kashi 400% na matakin talauci na tarayya waɗanda dole ne su sayi inshorar kansu
* Bayar da sabon shirin inshorar kulawa na dogon lokaci na son rai
* Biyan kuɗi don sabbin kashe kuɗi, a wani ɓangare, ta hanyar rage yawan kuɗaɗen da ake kashewa (a ƙarƙashin dokar da ke akwai) da ake bai wa kamfanonin inshora masu zaman kansu waɗanda ke sayar da tsare-tsaren kula da lafiya na sirri ga tsofaffi (wanda ake kira tsare-tsaren Medicare Advantage ), rage yawan biyan kuɗin masu ba da sabis na Medicare , rage farashin magunguna na Medicare da Medicaid , rage kashe kuɗi na Medicare da Medicaid ta hanyar ingantaccen tsarin lada, da kuma ƙara haraji akan fakitin kula da lafiya mai yawa (yawanci ana bayarwa ga manyan jami'ai) da kuma tarar da za a yi wa manyan kamfanoni rashin bai wa ma'aikatansu inshorar kiwon lafiya da wasu mutanen da ba sa sayen inshorar lafiya.
* Sanya iyaka ta dala $2,500 ga gudummawar da aka bayar ga asusun kashe kuɗi mai sassauƙa (FSAs), fa'idodin kiwon lafiya kafin haraji, don biyan kuɗin gyaran kiwon lafiya.

### Bambance-bambance a cikin Dokokin Majalisa da na Majalisar Dattawa
Ayyukan da aka tallata a matsayin kulawar rigakafi batu ne da ake ci gaba da muhawara a kai. Shekaru da dama na bincike sun nuna cewa yawancin ayyukan da aka saba yi ba sa ba da fa'ida ga marasa lafiya.   Kudirin Majalisar Dokoki da Majalisar Dattawa za su tilasta sayen manufofin da ke biyan kashi 100% na kudin wasu ayyuka, ba tare da biyan kuɗi ba; lokacin da aka gyara kudirin Majalisar Dattawa zuwa ga biyan kuɗin gwaje-gwaje wanda kwamitin tarayya da kuma US News &amp;amp; World Report suka ce "yana yin illa fiye da alheri,"  Jaridar New York Times ta rubuta, "Wannan shirin ba shi da kyau ga ƙoƙarin gyara don rage kashe kuɗi akan wasu hanyoyin bisa ga ingantattun shaidun kimiyya na fa'idodi da haɗarin da ke tattare da su ga marasa lafiya." 

#### Bambance-bambance a yadda kowace majalisa ke tantance tallafin kuɗi

Yadda kowanne kudiri ke tantance tallafin shi ma ya bambanta. Kowace kudiri tana tallafawa farashin kudin fansho da kuma kudaden da za a kashe daga aljihu amma suna da yawa ko ƙasa da haka dangane da dangantakar kudin shiga na iyali da matakin talauci na tarayya. &#x5B; ** &#x5D;

Ana ƙididdige adadin tallafin da aka bai wa iyali don biyan kuɗin tallafin ta amfani da dabarar da ta haɗa da kuɗin shiga na iyali dangane da matakin talauci na tarayya. Matakin talauci na tarayya yana da alaƙa da wani kaso da aka ƙayyade wanda ke bayyana adadin kuɗin shiga na wannan iyalin da za a iya sanyawa ga kuɗin inshorar lafiya. Misali, a ƙarƙashin Dokar Majalisar Wakilai, iyali mai kashi 200% na matakin talauci na tarayya ba zai kashe fiye da kashi 5.5% na kuɗin shiga na shekara-shekara akan kuɗin inshorar lafiya ba. A ƙarƙashin Dokar Majalisar Dattawa, iyali ɗaya ba zai kashe fiye da kashi 6.3% na kuɗin shiga na shekara-shekara akan kuɗin inshorar lafiya ba. Gwamnatin tarayya ce ke biyan bambancin da ke tsakanin mafi girman gudummawar iyali ga kuɗin inshorar lafiya da farashin kuɗin inshorar lafiya. Don fahimtar yadda kowane kuɗi zai iya shafar matakan talauci daban-daban da kuɗin shiga, duba kalkuleta na tallafin  Gidauniyar Kaiser Family Foundation Archived  

##### Tallafin Kuɗi A Ƙarƙashin Dokar Majalisa
Tsarin Majalisar yana tallafawa farashin shirin da kuma kuɗaɗen da za a kashe daga aljihu. Ana ba da tallafin kuɗin shirin bisa ga matakin talauci na iyali, wanda hakan ke rage tallafin yayin da matakin talauci ke kusantowa da kashi 400%. Haka kuma ana ba da tallafin kuɗaɗen da za a kashe daga aljihu bisa ga matakin talauci a waɗannan ƙimar. Ana ba da tallafin kuɗaɗen da za a kashe daga aljihu da farko kuma ba a yarda su wuce wani takamaiman adadin da zai tashi tare da kuɗin inshora na asali ba.

##### Tallafi a ƙarƙashin Dokar Majalisar Dattawa

Dokar Majalisar Dattawa ta kuma nemi rage kuɗaɗen da za a kashe wajen biyan kuɗi ta hanyar tsara ƙa'idodi kan adadin kuɗin da za a iya kashewa ga iyali a cikin kashi 200% na layin talauci. Iyali a cikin kashi 150% na FPL ba za su iya kashe fiye da kashi 10% na kuɗaɗen lafiyarsu a matsayin kuɗaɗen da za a kashe daga aljihunsu ba. Iyali tsakanin kashi 150% zuwa 200% na FPL ba za su iya kashe fiye da kashi 20% na kuɗaɗen lafiyarsu a matsayin kuɗaɗen da za a kashe daga aljihunsu ba.

Dokar Majalisar Wakilai da ta Majalisar Dattawa za ta bambanta, a wani ɓangare, a tasirinsu gabaɗaya. Dokar Majalisar Dattawa za ta rufe ƙarin mutane miliyan 31, a kan kuɗin kasafin kuɗin tarayya na kusan dala biliyan 850 (ba tare da la'akari da umarnin da ba a biya ba) tsawon shekaru goma, ta rage gibin shekaru goma da dala biliyan 130, kuma ta rage gibin a cikin shekaru goma na biyu da kusan kashi 0.25% na GDP. Dokar Majalisar, a halin yanzu, za ta rufe ƙarin mutane miliyan 36, wanda ya kai kusan dala biliyan 1050 a cikin tanade-tanaden ɗaukar nauyin, ta rage gibin shekaru goma da dala biliyan 138, sannan ta rage gibin a cikin shekaru goma na biyu. 

### Sharhi kan nazarin farashi
Ya kamata a lura cewa dukkan kuɗaɗen sun dogara ne da wasu "dabaru" don samun lambobin rage gibin da suka dace. Misali, duka biyun sun kafa inshorar kulawa ta dogon lokaci ta jama'a da aka sani da Dokar CLASS - saboda wannan inshorar tana da lokacin jingina na shekaru 5, da alama za ta tara kudaden shiga a cikin shekaru goma na farko, duk da cewa za a buƙaci a biya duk kuɗin. Idan aka cire Dokar CLASS daga kuɗaɗen, kudirin Majalisar Dattawa zai rage gibin da dala biliyan 57 a cikin shekaru goma, da kuma Majalisar da dala biliyan 37. Baya ga Dokar CLASS, babu ɗayan kuɗaɗen da ya kai kuɗin sabunta biyan kuɗin likitocin Medicare, duk da cewa Majalisar ta yi hakan ne bisa ga gibin da aka samu jim kaɗan bayan ta zartar da kudirin kula da lafiyarsu. 

Dokar Majalisar Dattawa ta kuma fara yawancin tanade-tanaden bayan shekara guda bayan dokar Majalisar domin ta sa farashi ya yi kama da ƙarami:
Fayil:Budgetary_Impact_of_Health_Reform_Bills.JPG|alt=Budgetary Impact of House and Senate Bills| Tasirin Kasafin Kudi ga Dokokin Majalisa da na Majalisar Dattawa
Fayil:Changes_in_Coverage_Health_Care_Bills.png|alt=Changes in Coverage Under House and Senate Bills| Canje-canje a Tsarin Mulki A ƙarƙashin Dokokin Majalisa da na Majalisar Dattawa
Fayil:Gross_Costs_of_Health_Coverage.png|alt=Gross Cost of Coverage Provisions in House and Senate Bills| Jimillar Kuɗin da Aka Kashe a Dokokin Majalisa da na Majalisar Dattawa
Likitan tiyata Atul Gawande ya rubuta a cikin *jaridar The New Yorker* cewa kudurorin Majalisar Dattawa da na Majalisar Wakilai da aka amince da su sun ƙunshi shirye-shiryen gwaji iri-iri waɗanda ka iya yin tasiri mai yawa kan farashi da inganci a cikin dogon lokaci, kodayake ba a haɗa waɗannan cikin kimanta farashin CBO ba. Ya ce waɗannan shirye-shiryen gwaji sun shafi kusan duk wata ra'ayi da ƙwararrun kiwon lafiya ke fafutukar bayarwa, banda gyaran rashin adalci/gazawa. Ya yi jayayya cewa dabarun gwaji da kurakurai, tare da haɗin gwiwar masana'antu da gwamnati, shine yadda Amurka ta shawo kan irin wannan ƙalubalen a masana'antar noma a farkon ƙarni na 20. 

## Yin amfani da ƙarfin gwiwa
Bayanan da OpenSecrets ta tattara sun nuna cewa fannin lafiya da inshora sun bai wa 'yan majalisar wakilai da na dattawa kusan dala miliyan 170 a shekarar 2007 da 2008, yayin da kashi 54% suka ba wa 'yan Democrat. Canjin jam'iyyu ya fi bayyana a cikin watanni uku na farko na 2009, lokacin da 'yan Democrat suka tara kashi 60% na dala miliyan 5.4 da kamfanonin kiwon lafiya da ma'aikatansu suka bayar. 'Yan majalisar da ke jagorantar kwamitoci masu muhimmanci sun kasance kan gaba wajen karbar kudi, wasu daga cikinsu sun sami fiye da dala miliyan 1.0 a cikin gudunmawa. 

Matt Taibbi ya rubuta a cikin *Rolling Stone* cewa Shugaba Obama da manyan sanatoci waɗanda suka ba da shawarar tsarin biyan kuɗi ɗaya a baya ba sa son fuskantar kamfanonin inshora da ƙoƙarinsu na yin amfani da ƙarfi. Manyan 'yan siyasa a Kwamitin Kuɗi na Majalisar Dattawa da ke da hannu a tsara dokoki sun sami sama da dala miliyan 2 a cikin gudummawar kamfen daga masana'antar kiwon lafiya. Da yawa daga cikin kamfanonin da aka gayyata don yin shaida a zaman sauraron ƙararrakin sun aika da masu fafutuka waɗanda suka yi aiki ga Sanata Max Baucus, shugaban kwamitin a baya. Mista Baucus ya bayyana a watan Fabrairun 2009 cewa: "Akwai lokacin da za mu iya matsa lamba don neman mai biyan kuɗi ɗaya. A wannan lokacin, ba za a kai ga tushe na farko a Majalisa ba." 

George McGovern ya rubuta cewa an bai wa shugaban kwamitin kuɗi na Majalisar Dattawa kuma memba mai matsayi a kwamitin kuɗi na Majalisar Dattawa, wanda ke da iko kan dokokin kula da lafiya: "Shugaban kwamitin kula da lafiya Max Baucus na Montana, ɗan jam'iyyar Democrat, da kwamitinsa na siyasa sun sami kusan dala miliyan 4 daga ƙungiyar kula da lafiya tun daga 2003. Babban ɗan jam'iyyar Republican, Charles Grassley na Iowa, ya sami sama da dala miliyan 2. Kuskure ne ga wani ɗan siyasa ya yi hukunci kan dalilan wani. Amma Sen. Baucus da Grassley sun kasance masu adawa da tsarin biyan kuɗi ɗaya, kamar sauran manyan 'yan majalisar da aka ba su lada mai yawa ta hanyar ƙungiyar inshora." 

## Muhawara game da hanyoyin shirya siyasa
Yawancin labaran da aka bayar a muhawarar sun shafi yadda ɓangarori daban-daban ke fafatawa don bayyana ra'ayoyinsu, maimakon takamaiman shawarwarin gyara. Muhawarar gyaran lafiyar da aka yi a Amurka ta sami tasiri daga zanga-zangar da aka yi a Jam'iyyar Tea Party, inda 'yan jarida da 'yan siyasa ke ɓatar da lokaci suna mayar da martani a kai.    Masu goyon bayan babban rawar da gwamnati ke takawa a fannin kiwon lafiya, kamar tsohon shugaban kamfanin inshorar jama'a Wendell Potter na Cibiyar Kafafen Yaɗa Labarai da Dimokuraɗiyya - wanda kuɗaɗen da aka samu daga ƙungiyoyi kamar Tides Foundation -  suna jayayya cewa wuce gona da iri da wannan lamari ya haifar wani nau'i ne na astroturfing na kamfanoni, wanda ya ce ya saba rubuta wa CIGNA .  Masu adawa da ƙarin shiga gwamnati, kamar Phil Kerpen na Americans for Prosperity - wanda kuɗaɗen da aka samu galibi daga kamfanin Koch Industries -  sun yi jayayya cewa waɗannan kamfanoni suna adawa da shirin jama'a, amma wasu suna ƙoƙarin matsa lamba ga ayyukan gwamnati waɗanda za su amfane su ba bisa ƙa'ida ba, kamar tilasta wa kamfanoni masu zaman kansu su sayi inshorar lafiya ga ma'aikatansu.  Ɗan jarida Ben Smith ya ambaci tsakiyar shekarar 2009 a matsayin "Lokacin bazara na Astroturf" idan aka yi la'akari da ƙoƙarin shiryawa da kuma haɗakar ƙungiyoyi daban-daban a ɓangarorin masu goyon baya da kuma masu adawa da sauyi. 

## Hujjoji game da gyaran harkokin kiwon lafiya
Masu sassaucin ra'ayi su ne manyan masu fafutukar kare lafiyar jama'a da kuma Medicare, waɗanda galibi ake mayar da hankali a kansu a matsayin manyan faɗaɗa gwamnati wanda ke da matuƙar gamsuwa tsakanin masu cin gajiyar.  Shugaba Obama ya yi jayayya a lokacin taron haɗin gwiwa na Majalisar Dokoki ta Satumba 2009 cewa gwamnati tana da alhakin ɗabi'a na tabbatar da cewa kiwon lafiya mai inganci ya isa ga dukkan 'yan ƙasa. Ya kuma yi nuni ga wata wasiƙa daga marigayi Sanata Ted Kennedy . 

Muhawara mai ra'ayin mazan jiya da ta 'yanci game da rawar da gwamnati ke takawa a fannin kiwon lafiya ta bayyana a shekarun 1910, yayin da damuwar jama'a ke ƙaruwa game da matsalolin samun damar kula da lafiya da tsadar magani. A shekarun 1930, dokar shugaban ƙasa Franklin D. Roosevelt game da kula da lafiya ta duniya ta fuskanci adawa mai tsanani daga Ƙungiyar Likitoci ta Amurka kuma ta yi suka ga dokar. 

Shugaba Truman, wanda ya kasance mai goyon bayan Dokar Wagner-Murray-Dingell wadda za ta kafa wani shirin inshorar lafiya na ƙasa wanda aka biya ta hanyar haraji, an zaɓe shi a ƙarshen shekarun 1940 kuma AMA ta kashe sama da dala miliyan 1 kan wani kamfen na sake fasalin kiwon lafiya, tana Allah wadai da kudirin kuma ta ƙara rura wutar rikicin gurguzu. Kamar yadda waɗannan rikice-rikicen suka nuna, farfagandar yakin cacar baka da gurguzu sun kasance muhimmai a cikin muhawarar kiwon lafiya har ra'ayoyin inshorar lafiya da damar shiga sun zama ba za a iya raba su daga siyasa ba.

Yawancin maganganun masu ra'ayin mazan jiya a tarihin Amurka sun ta'allaka ne akan farfagandar Yaƙin Cacar Baki da akidar tattalin arziki ta neoliberal. Irin waɗannan maganganun suna bayyana har ma a cikin harshen da Ƙungiyar Likitoci ta Amurka (AMA) ke amfani da shi, wanda ya bayyana manufofin kiwon lafiya na duniya a matsayin "maganin zamantakewa". AMA da likitoci da yawa sun riƙe mukamai na siyasa waɗanda suka yi adawa da ƙungiyoyi da yawa na jama'a don inshorar lafiya ta tilas, saboda ƙarfafa gwiwa ta sirri/riba da kuma ƙiyayya ga "gurguzu".

Shugaban jam'iyyar Republican Reagan ya yi magana game da Socialized Medicine, inda ya "soki Social Security saboda maye gurbin tanadin kuɗi na sirri kuma ya yi gargaɗin cewa tallafin magani zai rage 'yancin Amurkawa" kuma "nan ba da jimawa ba ɗanka ba zai yanke shawara lokacin da yake makaranta ba, inda zai je ko abin da zai yi don rayuwa."

Tattalin arzikin kiwon lafiya ya ci gaba da kasancewa babban abin da ke cikin muhawarar masu ra'ayin mazan jiya, yayin da 'yan siyasa da yawa ke kawo ra'ayin kasuwar kyauta cikin harkokin kiwon lafiya. Misali, marubucin jam'iyyar Conservative ta Republican Bill Kristol ya ba da shawarar yin gyare-gyare da dama a kasuwa maimakon shirin Clinton a lokacin 1993-1994. [undefined] John Stossel, mai ba da rahoto kan bincike kuma marubucin sharhi, ya lura cewa "Inshora tana gayyatar ɓata lokaci. Wannan shine dalilin da ya sa kula da lafiya ke tsada sosai, kuma sau da yawa ba ya da kyau ga masu amfani. A cikin 'yan yankuna kaɗan inda akwai kasuwanni kyauta a fannin kiwon lafiya - kamar maganin kwalliya da tiyatar ido ta Lasik - hidimar abokin ciniki tana da kyau, kuma farashi yana ci gaba da faɗuwa." [1] Sanata kuma likitan likita Tom Coburn na jam'iyyar Republican ya bayyana cewa tsarin kiwon lafiya a Switzerland ya kamata ya zama abin koyi ga gyaran Amurka. Ya rubuta wa New York Sun cewa gyare-gyare ya kamata ya ƙunshi hanyar da ta dogara da kasuwa don canja wurin fa'idodin harajin kiwon lafiya ga mutane maimakon ma'aikata da kuma ba wa mutane ƙarin kuɗi don samun ƙarin ɗaukar hoto. [2]

Wasu masu suka kan kudurorin da aka zartar a shekarar 2009 sun kira su "karɓar gwamnati a harkokin kiwon lafiya."  FactCheck ta kira kalmar "mantra" mara tushe."  (Factcheck ta kuma soki wasu ikirari da dama da masu fafutuka suka yi a shekarar 2009 daga bangarorin biyu na muhawarar).  CBS News ta bayyana shi a matsayin tatsuniya "wanda aka gauraya da wasu dalilai na gaske da ke haifar da damuwa."  Shugaba Obama ya musanta ra'ayin kwace gwamnati kuma ya ce ba ya son jami'an gwamnati su yi katsalandan fiye da yadda yake son jami'an kamfanonin inshora su yi hakan.  Wasu majiyoyi sun yi iƙirarin cewa kudurorin sun kai ga kwace gwamnati ko kwace kamfani, ko duka biyun.      Wannan muhawara ta faru ne a cikin mahallin "juyin juya hali...wanda ke canza yadda ake bayar da kulawar lafiya:" daga 2002 zuwa 2008, kaso na ayyukan likitanci da likitoci ke mallaka ya faɗi daga fiye da kashi 70% zuwa ƙasa da kashi 50%; sabanin al'adar gargajiya da yawancin likitoci ke kula da marasa lafiya a ƙananan asibitoci masu zaman kansu, zuwa 2008 yawancin likitoci sun zama ma'aikatan asibitoci, kusan dukkansu mallakar kamfanoni ne ko gwamnati. 

'Yan Republican kuma suna jayayya cewa harajin da aka tsara kan na'urorin likitanci da magunguna zai ƙara nauyin haraji ga masu yin allurar rigakafi.  

## Duba kuma

* Lafiya ta duniya
* An kwatanta kula da lafiya - kwatantawa a tebur na Amurka, Kanada, da sauran ƙasashe.
* Manufar lafiya
* Tattalin arzikin lafiya
* Dokar Lafiya
* Kamfanin inshorar lafiya
* Tsarin lafiya
* Tarihin gyaran tsarin kiwon lafiya a Amurka
* Jerin ƙungiyoyin fafutukar kawo sauyi a fannin kiwon lafiya a Amurka
* Ra'ayin jama'a kan gyaran kiwon lafiya a Amurka
* Kula da lafiya ta duniya baki ɗaya

## Nassoshi

## Hanyoyin haɗi na waje

* Rahoton Musamman na PBS: Gyaran Kula da Lafiya YANZU akan PBS
* Malhotra, Umang, ''Magance Rikicin Kiwon Lafiya na Amurka'', iUniverse, 2010. ISBN&nbsp;