health care essay cost access and quality

Cost, Access, and Quality of Healthcare Essay

Introduction, interrelation of cost, access, and quality, critical policy issues.

Cost, access, and quality have long been considered the primary elements of the healthcare system. They are the main indicators of how well care is supplied to patients. These three measurements are incorporated into the “Iron Triangle” introduced by William Kissick in 1994. There was a time when care costs, accessibility, and quality were not static and caused adverse health outcomes (Vogenburg, 2019). Hence, it was necessary to balance these factors to make healthcare delivery more accessible and better by all means. Even though the elements seem to be functioning separately, they are interrelated in every sense.

A medical service, like any product, has a value, a monetary expression, which is the price. Prices for services consist of two main elements: costs and profits. Healthcare services are not ordinary commodities, the production, and consumption of which are determined by the effective supply and demand ratio. The price is formed based on the cost of providing paid medical services, taking into account the need for medical services and requirements for the quality of paid services. The fees for healthcare services are rapidly rising due to several factors. These are the growing population, aging generations, service prices and their distribution, pandemic, the spread of chronic diseases, and others. Considering the growth of costs, the services may be inaccessible to some groups.

Accessibility to medical care is free to access medical services regardless of geographical, economic, social, cultural, organizational, or linguistic barriers. This is a multidimensional concept that includes a balance of many factors within the strict practical limitations caused by the peculiarities of the country’s resources and capabilities (Shi & Singh, 2019). These factors include human resources, financing, vehicles, freedom of choice, public education, and quality and distribution of technical resources. The general criteria for the quality of medical care are the correctness of the introduction of medical technologies, risk reduction for the condition of patients, optimal use of resources, and satisfaction of consumers of medical care.

The quality of medical care is the degree to which medical services provided to individuals and groups of the population increase the likelihood of achieving desired health outcomes and correspond to evidence-based professional knowledge. This definition of the quality of medical care extends to health promotion, prevention, treatment, rehabilitation, and palliative care and proceeds from the fact that the quality of medical care can be measured and continuously improved. It is possible because medical care is provided based on evidence and taking into account the needs and preferences of service users – patients, families, and local communities. However, quality is difficult to measure and define for the standards of care are not static, and the system itself fluctuates.

Cost, access, and quality affect each other in the structure of the healthcare system. Access defines the population groups that may use the medical services, costs determine the prices for these services and products, while quality stands for patient health outcomes. These indicators must be balanced to reach stability in the system. Numerous fluctuations are occurring because these criteria fluctuate. For instance, when the costs grow, the level of accessibility drops because some groups can barely afford the services; the rise in price does not guarantee an increase in quality. The other situation is when the costs remain on the same level, the access soars up, and the quality lowers. It happens because healthcare professionals do not manage to serve many patients at once and have to reduce treatment time.

On the other hand, there is an opportunity to improve the situation in the healthcare system by equating the indicators. The ideal circumstances are the following: cost reduction which guarantees more access to medical care for patients; this causes quality increase. Even though expanding access increases health care costs, it allows for the amelioration of services’ quality. However, the model still lacks validity because, with the rapid changes in the economy and the spread of technologies, numerous threats can disrupt this triangle. Nonetheless, the system’s flexibility makes it possible to adjust to the new requirements. Healthcare policymakers would be able to stabilize the costs in case the crisis occurs and ensure equal access to the majority of the population. The quality is the most controversial indicator because the system lacks statics and can alter at any time.

There have been numerous attempts to equate cost, access, and quality to reach a perfect balance in healthcare. Governmental and commercial organizations, health professionals, and individuals aimed to implement policies related to these three constituents. The primary critical policy issue is cost containment because as the economy grows, the expenses of healthcare soar. The problem here is to maintain the same level of expenditures and unnecessary spending without any risks and damage to the company or other stakeholders. The access-associated policy issue relates to the insurance and its eligibility criteria. It is still troublesome for some groups to obtain a plan that would cover their healthcare expenses. Finally, a quality-related policy issue is establishing communication between a health professional and a patient. It is especially difficult to provide comprehensible care if a patient speaks a different language.

In conclusion, the healthcare system is highly dependent on three constituents: cost, access, and quality. These determinants have proven to be interrelated and interdependent to a certain degree. Even though the elements affect each other, the perfect balance cannot be reached because cost, access, and quality cannot be improved simultaneously. Considering that these indicators are vital for issuing a policy, it was necessary to elaborate on critical issues. Cost containment, insurance eligibility, and medical worker-patient communication are the main issues within the specified framework. As a result, by eliminating at least one of the problems, it is possible to solve the other one partially.

Shi, L. & Singh, D.A. (2019). Delivering healthcare in America: A systems approach (7th Ed.). Jones and Bartlett Learning.

Vogenburg, F.R. (2019). U.S. healthcare trends and contradictions for 2019. American Health and Drug Benefits, 12(1), 40-47.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2023, March 18). Cost, Access, and Quality of Healthcare. https://ivypanda.com/essays/cost-access-and-quality-of-healthcare/

"Cost, Access, and Quality of Healthcare." IvyPanda , 18 Mar. 2023, ivypanda.com/essays/cost-access-and-quality-of-healthcare/.

IvyPanda . (2023) 'Cost, Access, and Quality of Healthcare'. 18 March.

IvyPanda . 2023. "Cost, Access, and Quality of Healthcare." March 18, 2023. https://ivypanda.com/essays/cost-access-and-quality-of-healthcare/.

1. IvyPanda . "Cost, Access, and Quality of Healthcare." March 18, 2023. https://ivypanda.com/essays/cost-access-and-quality-of-healthcare/.

Bibliography

IvyPanda . "Cost, Access, and Quality of Healthcare." March 18, 2023. https://ivypanda.com/essays/cost-access-and-quality-of-healthcare/.

• Cost Containment in the United States' Healthcare
• Risk Factors and Health Outcomes Interrelation
• Containment of Aggression and Violence in Inpatient Psychiatric Settings
• Pay-for-Performance Initiative in the United States
• The Healthcare Cost Interview with a Family Member
• Health Outcome of Quadrivalent and Trivalent Influenza Vaccines
• Reimbursement and Revenue Cycle in Healthcare
• The Cost of Healthcare and Privatization

Cost, Access, and Quality in Healthcare

The health care system nowadays is entirely concentrated upon such factors as quality, access, and cost. Each element helps to provide patients and society with high-quality medical care. The paper is aimed at defining the role of each aspect of modern healthcare. The purpose is to decide which point is more critical for the system and develop the concept of improvement one of the factors.

Cost, access, and quality are interrelated in such a way that if one aspect is at its highest point, one of them or even two others may be scaled down. For instance, the number of people who can afford healthcare services decreases with the increase in cost. However, the higher prices are more likely to guarantee higher care quality. Thus, cost, access, and quality can hardly ever be kept at the same level.

The goal of medicine is to provide high-quality care to all the people at an affordable cost. Therefore, the resources should be pointed at increasing the access, for the right to get medical care determines the fundamental value of an individual. Preventive care is of help here as it is cheaper than disease-treatment and can potentially decrease costs. Such measures will make medicare accessible and can include information popularization with special programs for people predisposed to some diseases. For example, people with the risk of diabetes may be involved in programs to control their weight and physical exercises.

Consequently, keeping the decent access rate is possible if we take the measures that will keep costs at their lowest and provide the community with respectable quality rates. As a result, the healthcare industry will save money on treatment, and our society will have healthier and happier members who trust the healthcare industry. The quality of care, thus, has a good chance to increase automatically.

Cite this paper

• Chicago (N-B)
• Chicago (A-D)

StudyCorgi. (2022, March 23). Cost, Access, and Quality in Healthcare. https://studycorgi.com/cost-access-and-quality-in-healthcare/

"Cost, Access, and Quality in Healthcare." StudyCorgi , 23 Mar. 2022, studycorgi.com/cost-access-and-quality-in-healthcare/.

StudyCorgi . (2022) 'Cost, Access, and Quality in Healthcare'. 23 March.

1. StudyCorgi . "Cost, Access, and Quality in Healthcare." March 23, 2022. https://studycorgi.com/cost-access-and-quality-in-healthcare/.

Bibliography

StudyCorgi . "Cost, Access, and Quality in Healthcare." March 23, 2022. https://studycorgi.com/cost-access-and-quality-in-healthcare/.

StudyCorgi . 2022. "Cost, Access, and Quality in Healthcare." March 23, 2022. https://studycorgi.com/cost-access-and-quality-in-healthcare/.

This paper, “Cost, Access, and Quality in Healthcare”, was written and voluntary submitted to our free essay database by a straight-A student. Please ensure you properly reference the paper if you're using it to write your assignment.

Before publication, the StudyCorgi editorial team proofread and checked the paper to make sure it meets the highest standards in terms of grammar, punctuation, style, fact accuracy, copyright issues, and inclusive language. Last updated: March 23, 2022 .

If you are the author of this paper and no longer wish to have it published on StudyCorgi, request the removal . Please use the “ Donate your paper ” form to submit an essay.

• Issue Brief

Health Care Costs: What’s the Problem?

The cost of health care in the United States far exceeds that in other wealthy nations across the globe. In 2020, U.S. health care costs grew 9.7%, to $4.1 trillion, reaching about $12,530 per person. 1 At the same time, the United States lags far behind other high-income countries when it comes to both access to care and some health care outcomes. 2 As a result, policymakers and health care systems are facing increasing demands for more care at lower costs for more people. And, of course, everyone wants to know why their health care costs are so high.

The answer depends, in part, on who’s asking this question: Why does U.S. health care cost so much? Public policy often highlights and targets the total cost of the health care system or spending as a percentage of the gross domestic product (GDP), while most patients (the public) are more concerned with their own out-of-pocket costs and whether they have access to affordable, meaningful insurance. Providers feel public pressure to contain costs while trying to provide the highest-quality care to patients.

This brief is the first in a series of papers intended to better define some of the key questions policymakers should be asking about health care spending: What costs are too high? And can they be controlled through policy while improving access to care and the health of the population?

What (or Who) Is to Blame for the High Costs of Care? 

Total U.S. health care spending has increased steadily for decades, as have costs and spending in other segments of the U.S. economy. In 2020, health care spending was $1.5 trillion more than in 2010 and $2.8 trillion more than in 2000. While total spending on clinical care has increased in the past two decades, health care spending as a percentage of GDP has remained steady and has hovered around 20% of GDP in recent years (with the largest single increase being in 2020 during the COVID-19 pandemic). 1 Health care spending in 2020 (particularly public outlays) increased more than in previous years because of increased federal government support of critical COVID-19-related services and expanded access to care during the pandemic. Yet, no single sector’s health care cost — doctors, hospitals, equipment, or any other sector — has increased disproportionately enough over time to be the single cause of high costs.

One of the areas in health care with the highest levels of spending in the United States is hospital care, which has accounted for about 30% of national health care spending 3 for the past 60 years (and has remained very close to 31% for the past 20 years) (Figure 1). Although hospital spending is the focus of many cost-control policies and public attention, the increases are consistent with the increases seen across other areas of health care, such as for physicians and other professional services. Total spending for some smaller parts of nonhospital care has more than doubled over the past few decades and makes up an increasing proportion of total spending. For instance, home health care as a percentage of total spending tripled between 1980 and 2020, from 0.9% to 3.0%, and drug spending nearly doubled as a proportion of health care spending between 1980 and 2006, from 4.8% to 10.5%, and currently represent 8.4% of health care spending. 1  

image description

The largest areas of spending that might yield the greatest potential for savings — such as inpatient care and physician-provided care — are unlikely to be reduced by lowering the total number of insured patients or visits per person, given the growing, aging U.S. population and the desire to cover more, not fewer, individuals with adequate health insurance. 

In the past decade, policymaker and insurer interventions intended to change the mix of services by keeping patients out of high-cost settings (such as the hospital) have not always succeeded at reducing costs, although they have had other benefits for patients. 4  

Breaking Down the Costs of Care

Thinking about total health care spending as an equation, one might define it as the number of services delivered per person multiplied by the number of people to whom services are delivered, multiplied again by the average cost of each service: 

Health Care Spending=(number of services delivered per person)×(number of people to whom services are delivered)×(average cost of each service) 

Could health care spending be lowered by making major changes to the numbers or types of services delivered or by lowering the average cost per service? 

Although recent data on the overall utilization of health care are limited, in 2011, the number of doctor consultations per capita in the United States was below that in many comparable countries, but the number of diagnostic procedures (such as imaging) per capita remained higher. 5 Furthermore, no identifiable groups of individuals (by race/ethnicity, geographic location, etc.) appear to be outliers that consume extraordinary numbers of services. 6 The exception is that the sickest people do cost more to take care of, but even the most cost-conscious policymakers appear to be reluctant to abandon these patients. 

In addition to the fact that the average number of health care services delivered per person in the United States was below international benchmarks in 2020,7 the percentage of people in the United States covered by health insurance was also lower than that in many other wealthy nations. Although millions of people gained insurance8 through the Affordable Care Act and provisions enacted during the COVID-19 pandemic, 10% of the nonelderly population remained uninsured in 2020. 9 When policymakers focus on reducing health care spending, considering the equation above, and see that the United States already has a lower proportion of its population insured and fewer services delivered to patients than other wealthy nations, their focus often shifts to the average cost of services.

It's Still the Prices … and the Wages 

A report comparing the international prices of health care in 2017 found that the median list prices (charges) for medical procedures in the United States heavily outweighed the list prices in other countries, such as the United Kingdom, New Zealand, Australia, Switzerland, and South Africa. 10  

For example, the 2017 U.S. median health care list price for a hospital admission with a hip replacement was $32,500, compared with $20,900 in Australia and $12,200 in the United Kingdom. In comparisons of the list prices of other procedures, such as deliveries by cesarean section, appendectomies, and knee replacements, the U.S. median list prices of elective and needed services were thousands of dollars — if not tens of thousands of dollars — more. 10 Yet, the list price for these services in the United States is often much higher than the actual payments made to providers by public or private insurance companies. 11

Public-payer programs (particularly Medicare and Medicaid) tend to pay hospitals rates that are lower than the cost of delivering care12 (though many economists argue these payments are slightly above actual costs, and providers argue they are at least slightly below actual costs), while private payers historically have paid about twice as much as public payers. 13 (See another brief in this series, “ Surprise! Why Medical Bills Are Still a Problem for U.S. Health Care ,” for more information about public and private payers’ role in health care costs.) However, the average cost per service is still high by international standards, even if it’s not as high as list prices may suggest. The high average costs are partially driven by the highly labor-intensive nature of health care, with labor consuming almost 55% of the share of total U.S. hospital costs in 2018. 14 These costs are growing due to the labor shortages exacerbated by the COVID-19 pandemic. 

Reducing U.S. health care spending by reducing labor costs could, theoretically, be achieved by reducing wages or eliminating positions; however, both of those policies would be problematic, with potential unintended consequences, such as driving clinicians away from the workforce at a time of growing need. 

Wage reductions, particularly for clinicians, would require a vastly expanded labor pool that would take years to achieve (and even then, lower per person wages for nonphysicians may not decrease total spending related to health care labor). 15 Reducing or replacing clinical workers over time would require major changes to policy (both public and private) and major shifts in how health care is provided — neither of which has occurred rapidly, even since the implementation of the Affordable Care Act. 

What’s a Policymaker to Do?

Nearly one in five Americans has medical debt, 16 and affordability is still an issue for a large proportion of the population, whether uninsured or insured, which suggests that policymakers should focus on patients’ costs. This may prove more impactful to the individual than reducing total health care spending. 

A majority of the country agrees that the federal government should ensure some basic health insurance for all citizens. 17,18 Although most Americans consider reducing costs to individuals and expanding insurance coverage to be important, no clear consensus about who should bear any associated increased costs exists among patients or policymakers. Half of insured adults currently report difficulty affording medical or dental care, even when they are insured, because of the rising total costs of care and the increasing absolute amount of out-of-pocket spending. 19 Out-of-pocket spending for health care has doubled in the past 20 years, from $193.5 billion in 2000 to $388.6 billion in 2020. 1 These rising health care costs have disproportionately fallen on those with the fewest resources, including people who are uninsured, Black people, Hispanic people, and families with low incomes. 19 Increased cost sharing through copays and coinsurance may force difficult spending choices for even solidly middle-class families. 

The severity and burden of out-of-pocket spending are hidden by the use of data averages; on average, U.S. residents have twice the average household net adjusted disposable income 20 of many other comparable nations and spend more than twice 21 as much per capita on health care. Yet, for those who fall outside these averages — average income, average costs, or both — the financial pain felt at the hospital, clinic, and pharmacy is very real. 

In any given year, a small number of patients account for a disproportionate amount of health care spending because of the complexity and severity of their illnesses. Even careful international comparisons of end-of-life care for cancer patients demonstrate costs in the United States are similar to those in many comparable nations (although U.S. patients are more likely to receive chemotherapy, they spend fewer days in the hospital during the last 6 months of life than patients in other countries). 22 Similarly, although prevention efforts may delay or avoid the onset of illness in targeted populations, such efforts would not significantly reduce the number of services delivered for many years and may lead to an increase in care delivered over the course of an extended life span.

To the average person in the United States, immediate cost-control efforts might best be focused on reducing the cost burden for families and patients. Policymakers should continue to seek ways to promote better health care quality at lower costs rather than try to achieve unrealistic, drastic reductions in national health care spending. Investing in prevention, seeking to avoid preventable admissions or readmissions, and otherwise improving the quality of care are desirable, but these improvements are not quick solutions to lowering the national health care costs in the near term. Long-term policy actions could incrementally address health care spending but should clearly articulate the problem to be solved, the desired outcomes, and the trade-offs the nation is willing to make (as discussed in two companion pieces). 

The U.S. health care system continues to place a disproportionate cost burden on the patients who can least afford it. In the short term, policymakers could focus on targeted subsidies to specific populations — the families and individuals whose household incomes fall outside the average or who have health care expenses that fall outside the average — whose health care costs are unmanageable. Such subsidies could expand existing premium subsidies or triggers that increase support for costs that exceed target amounts. Targeted subsidies are likely to increase total health care spending (especially public spending) but would address the problem of cost from the average consumer, or patient, perspective. Broader policies to ease costs for patients could also be considered by category of service; for instance, consumers have been largely shielded from the increased costs of care related to COVID-19 by the waiving of copays for patients and families. These policies would likely increase national spending as well, but they would make medical care more affordable to some families.

Download Brief

Cite this source: Grover A, Orgera K, Pincus L. Health Care Costs: What's The Problem? Washington, DC: AAMC; 2022. https://doi.org/10.15766/rai_dozyvvh2

• Centers for Medicare & Medicaid Services. National Health Expenditure Data. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet . Published Dec. 1, 2021. Accessed Feb. 24, 2022.
• Schneider EC, Shah A, Doty MM, Tikkanen R, Fields K, Williams RD II. Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries. Washington, DC: The Commonwealth Fund. https://doi.org/10.26099/01DV-H208 . Published August 2021. Accessed April 21, 2022.
• Centers for Medicare & Medicaid Services. National Health Expenditure Data: Historical. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical . Published Dec. 15, 2021. Accessed April 22, 2022. 
• Berkowitz S, Ricks KB, Wang J, Parker M, Rimal R, DeWalt D. Evaluating a nonemergency medical transportation benefit for accountable care organization members. Health Affairs. 2022;41(3):406-413. doi:10.1377/hlthaff.2021.00449.
• Organisation for Economic Co-operation and Development. Health Care Utilisation. Paris, France: Organisation for Economic Co-operation and Development. https://stats.oecd.org/index.aspx?queryid=30166# . Published Nov. 9, 2021. Accessed Feb. 24, 2022.
• Abelson R. Harris G. Critics question study cited in health debate. New York Times. June 2, 2010. https://www.nytimes.com/2010/06/03/business/03dartmouth.html?ref=business&pagewanted=all . Accessed Feb. 24, 2022.
• The Commonwealth Fund. Selected Health & System Statistics: Average Annual Number of Physician Visits per Capita. https://www.commonwealthfund.org/international-health-policy-center/system-stats/annual-physician-visits-per-capita . Published June 5, 2020. Accessed April 21, 2022.
• Tolbert J, Orgera K. Key Facts About the Uninsured Population. San Francisco, CA: KFF. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ . Published Nov. 6, 2020. Accessed April 21, 2022.
• Tolbert J, Orgera K, Damico A. What Does the CPS Tell Us About Health Insurance Coverage in 2020? San Francisco, CA: KFF. https://www.kff.org/uninsured/issue-brief/what-does-the-cps-tell-us-about-health-insurance-coverage… . Published Sept. 23, 2021. Accessed April 21, 2022.
• Hargraves J, Bloschichak A. International Comparisons of Health Care Prices From the 2017 iFHP Survey. Washington DC: Health Care Cost Institute. https://healthcostinstitute.org/hcci-research/international-comparisons-of-health-care-prices-2017-ifhp-survey . Published Dec. 2019. Accessed April 21, 2022.
• Bai G. Anderson G. Extreme markup: The fifty US hospitals with the highest charge-to-cost ratios. Health Affairs. 2015;34(6):922-928. doi:10.1377/hlthaff.2014.1414.
• Congressional Budget Office. The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services. Washington, DC: Congressional Budget Office. https://www.cbo.gov/system/files/2022-01/57422-medical-prices.pdf . Published January 2022. Accessed April 21, 2022.
• Lopez E, Neuman T, Jacobson G, Levitt L. How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature. San Francisco, CA: The Henry J. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/ . Published April 15, 2020. Accessed March 22, 2022.
• Daly R. Hospitals Innovate to Control Labor Costs. Westchester, IL: Healthcare Financial Management Association. https://www.hfma.org/topics/hfm/2019/october/hospitals-innovate-to-control-labor-costs.html . Published Oct. 1, 2019. Accessed Feb. 24, 2022. 
• Batson BN, Crosby SN, Fitzpatrick, JM. Mississippi frontline: Targeting value-based care with physician-led care teams. J Miss State Med Assoc. 2022;63(1):19-21. https://ejournal.msmaonline.com/publication/?m=63060&i=735364&p=20&ver=html5 .
• Kluender R, Mahoney N, Wong F, et al. Medical debt in the US, 2009-2020. JAMA. 2021;326(3):250-256. doi:10.1001/jama.2021.8694.
• Jones B. Increasing Share of Americans Favor a Single Government Program to Provide Health Care Coverage. Washington, DC: Pew Research Center. https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/ . Published Sept. 29, 2020. Accessed April 21, 2022.
• Bialik K. More Americans Say Government Should Ensure Health Care Coverage. Washington, DC: Pew Research Center. https://www.pewresearch.org/fact-tank/2017/01/13/more-americans-say-government-should-ensure-health-care-coverage/ . Published Jan. 13, 2017. Accessed March 22, 2022.
• Kearney A, Hamel L, Stokes M, Brodie M. Americans’ Challenges With Health Care Costs. San Francisco, CA: The Henry J. Kaiser Family Foundation. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/ . Published Dec. 14, 2021. Accessed Feb. 24, 2022.
• Organisation for Economic Co-operation and Development. Income. Better Life Index. Paris, France: Organisation for Economic Co-operation and Development. https://www.oecdbetterlifeindex.org/topics/income/ . Accessed April 21, 2022.
• Wager E, Ortaliza J, Cox C; The Henry J. Kaiser Family Foundation. Health System Tracker. How Does Health Spending in the U.S. Compare to Other Countries? San Francisco, CA: The Henry J. Kaiser Family Foundation. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries-2/ . Published Jan. 21, 2022. Accessed April 21, 2022.
• Bekelman JE, Halpern SD, Blankart CR, et al. Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries. JAMA. 2016;315(3):272-283. doi:10.1001/jama.2015.18603.

Connect on Whatsapp : +1 206 673 2541 , Get Homework Help 24x7, 100% Confidential. Connect Now

Health Care Essay: Cost, Access, Quality, and Role Technology Plays

The United health care system is considered the most intricate and decentralized sector, globally. Moreover, the health care system is managed as a cottage industry, whereby there exist small, big, and bigger cottages with up-to-date technology with infrastructures. America’s health system is a culture and organization of health care that splits care into separate systems, for instance, hospital facilities, home-based care, skilled nursing amenities with little to no official communication, relations, or partnerships. This paper aims to elaborate on the aspects that facilitate the surge in healthcare costs, technology’s impact on healthcare accessibility, and the provision of quality care.

Contributing Factors

Within the United States Healthcare framework, numerous factors exist regarding the constant surge in healthcare costs as the United States administration allocates a considerable amount of money towards the health care sector. A rise in healthcare costs was initially recorded in 1965 after the inception of Medicare and Medicaid and integrated as part of the Social Security Act. Both government policies facilitated improved access to health care services. Aspects that contributed to the rise in medical costs comprise the medical model, the growing populace, chronic ailments, and administrative charges. The United States consists of an increasing populace that experiences prolonged living as a result of progress in the medical field. According to Sorenson Drummond and Bhuiyan Khan (2013) , the United States has experienced a surge in the number of senior citizens who need increased medical services to lead a long life. In these cases, healthcare practitioners incorporate curative medical treatments as compared to preventive medicine. As a result, there is a significant number of individuals believed to obese, diabetic, and ailing from other chronic ailments that strain the healthcare system. In regard to the administration costs, they advance the quality of care and are linked with health insurance coverage for the patients. This includes the fees for the provision of care and typically results in an increase in the cost of healthcare by approximately 25%. In most cases, the healthcare providers and the United States administration should devise ways of delivering quality care to patients devoid of an increase in the cost of healthcare and enhancing affordability to every citizen. The cost of health care should also reduce to cater to quality health care devoid of compromising the healthcare quality received.

The impact that cost and technology are having on access to care

In current society, advancements in technology have resulted in a drastic increase in healthcare prices. Advances in medical technology have proven to have significant benefits such as aiding proper diagnosis and accurate patient treatment. Nonetheless, these results in high medical bills that may prove to be unaffordable to the patients. Integration of advanced technologies by medical facilities, for instance, allows the most susceptible populace to access quality healthcare in health care systems. According to Shi & Singh (2019) , technology developers and researchers are continuously working towards the development of enhanced medical equipment to improve efficiency. This would lead to the time required in conducting a diagnosis and treatment of the patient nut may also be considered expensive. The rising demand for quality medical equipment will increase the cost of healthcare during the purchase of the equipment and increase the cost of use by the patients.

The existence of global health threats necessitates the use of advanced technology in medical facilities; however, patients will be unable to utilize them as a result of treatment. Despite the existence of medical equipment such as magnetic resonance imaging and x-rays, the research and development of more technology may bear a price on American citizens will ultimately for and this reduces healthcare accessibility attributed to the high costs. Technology is critical in access to healthcare through the Affordable care Act. The act compels that each hospital indicates a price list of the services on the websites. Patients now have the ability to access the cost of care on hospital websites easily. With patients and hospital facilities now conscious of the medical services costs, it allows them to shop for the most cost-effective selections. Hospitals and clinics around the nation are lowering the prices to facilitate the accessibility of quality healthcare. As a result, there ought to be a balance between the price of integrating up-to-date technology for medical benefits and what it costs to acquire the advancement for the medical organization.

Provision of Quality Care

In the U.S., the ability to offer quality healthcare remains one of the fundamental aspects amongst healthcare practitioners. Various reasons within the healthcare sector hinder the accessibility to quality healthcare services. The grounds include insufficient healthcare environment and strategies, cost of healthcare, obsolete medical amenities, and inadequate resources. Patients fail to gain confidence in the form of care received if medical personnel fail to consider safety amongst patients. Lack of care and inadequate safety may result in patients delaying care or failing to seek enhanced care in the future.

Possessing bad healthcare plans is considered part of the healthcare system that health practitioners may be unable to alter. It is basically a contract between the patients and insurance providers. On the other hand, an inadequate healthcare strategy may prevent healthcare professionals from the delivery of quality care covered by the health insurance policy as they may escalate the cost of treatment. Additionally, poor hospital environments, for instance, dirty facilities and run-downs, are viewed as a hindrance to the delivery of quality care.

A clean and maintained health facility is vital in the provision of quality health services as it increases the patients’ assurance and conviction in the medical facility in the hospital at every level of the organization. Technology is essential in providing care as it facilitates quick detection and treatment of ailments before they are considered life-threatening and necessitating more extensive care (Norbeck, 2013). Moreover, the provision of good quality health care has turned out to be an indispensable aspect of the healthcare sector as a mode of instituting trust between patients, doctors, and the medical facility.

The constant development of technology pertaining to the health sector, accessibility, and health care quality bears a significant impact on how healthcare services are delivered in the United States. The healthcare sector in the United States is continually trying to enhance service provision while also increasing accessibility to the marginalized population. Demand for quality health services has risen significantly over the years and bears a substantial effect on the healthcare sector. This has also resulted in a surge in healthcare costs and is considered to be challenging in an attempt to devise solutions for every American citizen. It is upon the administration to find ways of regulating the cost of healthcare while enhancing access to health services.

Cite this Page

WhatsApp us

Health Care Access and Quality

Goal: increase access to comprehensive, high-quality health care services..

Many people in the United States don’t get the health care services they need. Healthy People 2030 focuses on improving health by helping people get timely, high-quality health care services.

About 1 in 10 people in the United States don’t have health insurance. 1 People without insurance are less likely to have a primary care provider, and they may not be able to afford the health care services and medications they need. Strategies to increase insurance coverage rates are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses.

Sometimes people don’t get recommended health care services, like cancer screenings, because they don’t have a primary care provider. Other times, it’s because they live too far away from health care providers who offer them. Interventions to increase access to health care professionals and improve communication — in person or remotely — can help more people get the care they need.

Objective Status

Learn more about objective types

Related Objectives

The following is a sample of objectives related to this topic. Some objectives may include population data.

Health Care Access and Quality — General

• Adolescents

Drug and Alcohol Use

Family planning.

• Health Care

Health Communication

• Health Insurance
• Oral Conditions

Pregnancy and Childbirth

Sensory or communication disorders, sexually transmitted infections, other topics you may be interested in.

Berchick, E.R., Hood, E., & Barnett, J.C. (2018). Health Insurance Coverage in the United States: 2017. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf  [PDF - 1.4 MB]

The Office of Disease Prevention and Health Promotion (ODPHP) cannot attest to the accuracy of a non-federal website.

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

Mobile Menu Overlay

The White House 1600 Pennsylvania Ave NW Washington, DC 20500

Fact Sheet: Biden- ⁠ Harris Administration Expands Health Coverage to DACA   Recipients

President Biden Announces Final Rule that will Allow Eligible DACA Recipients to Enroll in Affordable Care Act Coverage

Today, the Biden-Harris Administration is expanding access to affordable, quality health care coverage to Deferred Action for Childhood Arrivals (DACA) recipients.  In 2012, President Obama and then Vice President Biden created the DACA policy to transform the lives of eligible Dreamers – young people who came to this country as children—allowing them to live and work lawfully in our country.  Over the last decade, DACA has brought stability, possibility, and progress to hundreds of thousands of Dreamers.    While President Biden continues to call on Congress to provide a pathway to citizenship to Dreamers and others, he is committed to protecting and preserving DACA and providing Dreamers with the opportunities and support they need to succeed, including access to affordable, quality health care coverage.  Thanks to the Biden-Harris Administration’s actions, today’s final rule will remove the prohibition on DACA recipients’ eligibility for Affordable Care Act coverage for the first time, and is projected to help more than 100,000 young people gain health insurance.  Starting in November, DACA recipients can apply for coverage through HealthCare.gov and state-based marketplaces, where they may qualify for financial assistance to help them purchase quality health insurance. Four out of five consumers have found a plan for less than $10 a month, with millions saving an average of about $800 a year on their premiums.   President Biden and Vice President Harris believe that health care should be a right, not a privilege. Together, they promised to protect and strengthen the Affordable Care Act, lowering costs and expanding coverage so that every American has the peace of mind that health insurance brings.  Today’s final rule delivers on the President’s commitment by giving DACA recipients that same peace and opportunity.     Today’s rule also reinforces the President’s enduring commitment to DACA recipients and Dreamers, who contribute daily to the strength and vitality of our communities and our country.  On day one of his Administration, President Biden committed to preserving and fortifying the DACA policy.  While only Congress can provide Dreamers permanent status and a pathway to citizenship, the Biden-Harris Administration has continued to vigorously defend DACA against ongoing legal challenges and strengthened DACA by codifying the 2012 policy in a final rule.   

Stay Connected

We'll be in touch with the latest information on how President Biden and his administration are working for the American people, as well as ways you can get involved and help our country build back better.

Opt in to send and receive text messages from President Biden.

• Share full article

For more audio journalism and storytelling, download New York Times Audio , a new iOS app available for news subscribers.

The Protesters and the President

Over the past week, thousands of students protesting the war in gaza have been arrested..

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

From “New York Times,” I’m Michael Barbaro. This is “The Daily.”

Free, free, Palestine!

Free, free Palestine!

Free, free, free Palestine!

Over the past week, what had begun as a smattering of pro-Palestinian protests on America’s college campuses exploded into a nationwide movement —

United, we’ll never be defeated!

— as students at dozens of universities held demonstrations, set up encampments, and at times seized academic buildings.

[PROTESTERS CLAMORING]:

response, administrators at many of those colleges decided to crack down —

Do not throw things at our officers. We will use chemical munitions that include gas.

— calling in local police to carry out mass detentions and arrests. From Arizona State —

In the name of the state of Arizona, I declare this gathering to be a violation of —

— to the University of Georgia —

— to City College of New York.

[PROTESTERS CHANTING, “BACK OFF”]:

As of Thursday, police had arrested 2,000 students on more than 40 campuses. A situation so startling that President Biden could no longer ignore it.

Look, it’s basically a matter of fairness. It’s a matter of what’s right. There’s the right to protest, but not the right to cause chaos.

Today, my colleagues Jonathan Wolfe and Peter Baker on a history-making week. It’s Friday, May 3.

Jonathan, as this tumultuous week on college campuses comes to an end, it feels like the most extraordinary scenes played out on the campus of the University of California Los Angeles, where you have been reporting. What is the story of how that protest started and ultimately became so explosive?

So late last week, pro-Palestinian protesters set up an encampment at the University of California, Los Angeles.

From the river to the sea!

Palestine will be free!

Palestine —

It was right in front of Royce Hall, which I don’t know if you are familiar with UCLA, but it’s a very famous, red brick building. It’s on all the brochures. And there was two things that stood out about this encampment. And the first thing was that they barricaded the encampment.

The encampment, complete with tents and barricades, has been set up in the middle of the Westwood campus. The protesters demand —

They have metal grates. They had wooden pallets. And they separated themselves from the campus.

This is kind of interesting. There are controlling access, as we’ve been talking about. They are trying to control who is allowed in, who is allowed out.

They sort of policed the area. So they only would let people that were part of their community, they said, inside.

I’m a UCLA student. I deserve to go here. We paid tuition. This is our school. And they’re not letting me walk in. Why can’t I go? Will you let me go in?

We’re not engaging with that.

Then you can move. Will you move?

And the second thing that stood out about this camp was that it immediately attracted pro-Israel counterprotesters.

And what did the leadership of UCLA say about all of this, the encampment and these counterprotesters?

So the University of California’s approach was pretty unique. They had a really hands-off approach. And they allowed the pro-Palestinian protesters to set up an encampment. They allowed the counterprotesters to happen. I mean, this is a public university, so anyone who wants to can just enter the campus.

So when do things start to escalate?

So there were definitely fights and scuffles through the weekend. But a turning point was really Sunday —

[SINGING IN HEBREW]:

— when this group called the Israeli American Council, they’re a nonprofit organization, organized a rally on campus. The Israeli American Council has really been against these pro-Palestinian protests. They say that they’re antisemitic. So this nonprofit group sets up a stage with a screen really just a few yards from the pro-Palestinian encampment.

We are grateful that this past Friday, the University of California, stated that they will continue to oppose any calls for boycott and divestment from Israel!

[PROTESTERS CHEERING]

And they host speakers and they held prayers.

Jewish students, you’re not alone! Oh, you’re not alone! We are right here with you! And we’re right here with you in until —

[WORDLESS SINGING]:

And then lots of other people start showing up. And the proximity between protesters and counterprotesters and even some agitators, makes it really clear that something was about to happen.

And what was that? What ended up happening?

On Monday night, a group of about 60 counterprotesters tried to breach the encampment there. And the campus police had to break it up. And things escalated again on Tuesday.

They stormed the barricades and it’s a complete riot.

[PROTESTER SHOUTING]:

Put it down! Put it down! Put it down!

I went to report on what happened just a few hours after it ended.

And I spoke to a lot of protesters. And I met one demonstrator, Marie.

Yeah, my first name is Marie. M-A-R-I-E. Last name, Salem.

And Marie described what happened.

So can you just tell me a little bit about what happened last night?

Last night, we were approached by over a hundred counterprotesters who were very mobilized and ready to break into camp. They proceeded to try to breach our barricades extremely violently.

Marie said it started getting out of hand when counterprotesters started setting off fireworks towards the camp.

They had bear spray. They had Mace. They were throwing wood and spears. Throwing water bottles, continuing fireworks.

So she said that they were terrified. It was just all hands on deck. Everyone was guarding the barricades.

Every time someone experienced the bear spray or Mace or was hit and bleeding, we had some medics in the front line. And then we had people —

And they said that they were just trying to take care of people who were injured.

I mean, at any given moment, there was 5 to 10 people being treated.

So what she described to me sounded more like a battlefield than a college campus.

And it was just a complete terror and complete abandonment of the university, as we also watched private security watch this the entire time on the stairs. And some LAPD were stationed about a football field length back from these counterprotesters, and did not make a single arrest, did not attempt to stop any violence, did not attempt to get in between the two groups. No attempt.

I should say, I spoke to a state authorities and eyewitnesses and they confirmed Marie’s account about what happened that night, both in terms of the violence that took place at the encampment and how law enforcement responded. So in the end, people ended up fighting for hours before the police intervened.

[SOMBER MUSIC]

So in her mind, UCLA’s hands-off approach, which seemed to have prevailed throughout this entire period, ends up being way too hands off in a moment when students were in jeopardy.

That’s right. And so at this point, the protesters in the encampment started preparing for two possibilities. One was that this group of counterprotesters would return and attack them. And the second one was that the police would come and try to break up this encampment.

So they started building up the barricades. They start reinforcing them with wood. And during the day, hundreds of people came and brought them supplies. They brought food.

They brought helmets, goggles, earplugs, saline solution, all sorts of things these people could use to defend themselves. And so they’re really getting ready to burrow in. And in the end, it was the police who came.

[PROTESTERS SHOUTING]:

So Wednesday at 7:00 PM, they made an announcement on top of Royce Hall, which overlooks the encampment —

— administrative criminal actions up to and including arrest. Please leave the area immediately.

And they told people in the encampment that they needed to leave or face arrest.

[DRUM BEATING]: [PROTESTERS CHANTING]

And so as night falls, they put on all this gear that they’ve been collecting, the goggles, the masks and the earplugs, and they wait for the police.

[DRUM BEATING]:

And so the police arrive and station themselves right in front of the encampment. And then at a certain point, they storm the back stairs of the encampment.

[PROTESTERS CHANTING]:

And this is the stairs that the protesters have been using to enter and exit the camp. And they set up a line. And the protesters do this really surprising thing.

The people united!

They open up umbrellas. They have these strobe lights. And they’re flashing them at the police, who just slowly back out of the camp.

[PROTESTERS CHEERING]:

And so at this point, they’re feeling really great. They’re like, we did it. We pushed them out of their camp. And when the cops try to push again on those same set of stairs —

[PROTESTER SHOUTS]:

Hold your ground!

— the protesters organized themselves with all these shields that they had built earlier. And they go and confront them. And so there’s this moment where the police are trying to push up the stairs. And the protesters are literally pushing them back.

Push them back! Push them back!

Push them back!

And at a certain point, dozens of the police officers who were there, basically just turn around and leave.

So how does this eventually come to an end?

So at a certain point, the police push in again. Most of the conflict is centered at the front of these barricades. And the police just start tearing them apart.

[METAL CLANGING]

[CLAMORING]

They removed the front barricade. And in its place is this group of protesters who have linked arms and they’re hanging on to each other. And the police are trying to pull protesters one by one away from this group.

He’s just a student! Back off!

But they’re having a really hard time because there’s so many protesters. And they’re all just hanging on to each other.

We’re moving back now.

So at a certain point, one of the police officers started firing something into the crowd. We don’t exactly know what it was. But it really spooked the protesters.

Stop shooting at kids! Fuck you! Fuck them!

They started falling back. Everyone was really scared. The protesters were yelling, don’t shoot us. And at that point, the police just stormed the camp.

Get back. Get back.

Back up now!

And so after about four hours of this, the police pushed the protesters out of the encampment. They had arrested about 200 protesters. And this was finally over.

And I’m just curious, Jonathan, because you’re standing right there, you are bearing witness to this all, what you were thinking, what your impressions of this were.

I mean, I was stunned. These are mostly teenagers. This is a college campus, an institution of higher learning. And what I saw in front of me looked like a war zone.

[TENSE MUSIC]

The massive barricade, the police coming in with riot gear, and all this violence was happening in front of these red brick buildings that are famous for symbolizing a really open college campus. And everything about it was just totally surreal.

Well, Jonathan, thank you very much. We appreciate it.

Thanks, Michael.

We’ll be right back.

Peter, around 10:00 AM on Thursday morning as the smoke is literally still clearing at the University of California Los Angeles, you get word that President Biden is going to speak.

Right, exactly. It wasn’t on his public schedule. He was about to head to Andrews Air Force base in order to take a trip. And then suddenly, we got the notice that he was going to be addressing the cameras in the Roosevelt Room.

They didn’t tell us what he was going to talk about. But it was pretty clear, I think. Everybody understood that it was going to be about these campus protests, about the growing violence and the clashes with police, and the arrests that the entire country had been watching on TV every night for the past week, and I think that we were watching just that morning with UCLA. And it reached the point where he just had to say something.

And why, in his estimation and those of his advisors, was this the moment that Biden had to say something?

Well, it kind of reached a boiling point. It kind of reached the impression of a national crisis. And you expect to hear your president address it in this kind of a moment, particularly because it’s about his own policy. His policy toward Israel is at the heart of these protests. And he was getting a lot of grief. He was getting a lot of grief from Republicans who were chiding him for not speaking out personally. He hadn’t said anything in about 10 days.

He’s getting a lot of pressure from Democrats, too, who wanted him to come out and be more forceful. It wasn’t enough, in their view, to leave it to his spokespeople to say something. Moderate Democrats felt he needed to come out and take some leadership on this.

And so at the appointed moment, Peter, what does Biden actually say in the Roosevelt Room of the White House?

Good morning.

Before I head to North Carolina, I wanted to speak for a few moments about what’s going on, on our college campuses here.

Well, it comes in the Roosevelt Room and he talks to the camera. And he talks about the two clashing imperatives of American principle.

The first is the right to free speech and for people to peacefully assemble and make their voices heard. The second is the rule of law. Both must be upheld.

One is freedom of speech. The other is the rule of law.

In fact, peaceful protest is in the best tradition of how Americans respond to consequential issues. But, but, neither are we a lawless country.

In other words, what he’s saying is, yes, I support the right of these protesters to come out and object to even my own policy, in effect, is what he’s saying. But it shouldn’t trail into violence.

Destroying property is not a peaceful protest. It’s against the law. Vandalism, trespassing, breaking windows, shutting down campuses —

It shouldn’t trail into taking over buildings and obstructing students from going to class or canceling their graduations.

Threatening people, intimidating people, instilling fear in people is not peaceful protest. It’s against the law.

And he leans very heavily into this idea that what he’s seeing these days goes beyond the line.

I understand people have strong feelings and deep convictions. In America, we respect the right and protect the right for them to express that. But it doesn’t mean anything goes.

It has crossed into harassment and expressions of hate in a way that goes against the national character.

As president, I will always defend free speech. And I will always be just as strong and standing up for the rule of law. That’s my responsibility to you, the American people, and my obligation to the Constitution. Thank you very much.

Right, as I watched the speech, I heard his overriding message to basically be, I, the president of the United States, am drawing a line. These protests and counterprotests, the seizing and defacing of campus buildings, class disruption, all of it, name calling, it’s getting out of hand. That there’s a right way to do this. And what I’m seeing is the wrong way to do it and it has to stop.

That’s exactly right. And as he’s wrapping up, reporters, of course, ask questions. And the first question is —

Mr. President, have the protests forced you to reconsider any of the policies with regard to the region?

— will this change your policy toward the war in Gaza? Which, of course, is exactly what the protesters want. That’s the point.

And he basically says —

— no. Just one word, no.

Right. And that felt kind of important, as brief and fleeting as it was, because at the end of the day, what he’s saying to these protesters is, I’m not going to do what you want. And basically, your protests are never going to work. I’m not going to change the US’s involvement in this war.

Yeah, that’s exactly right. He is saying, I’m not going to be swayed by angry people in the streets. I’m going to do what I think is right when it comes to foreign policy. Now, what he thinks is that they’re not giving him enough credit for trying to achieve what they want, which is an end of the war.

He has been pressuring Israel and Hamas to come to a deal for a ceasefire that will, hopefully, in his view, would then lead to a more enduring end of hostilities. But, of course, this deal hasn’t gone anywhere. Hamas, in particular, seems to be resisting it. And so the president is left with a policy of arming Israel without having found a way yet to stop the war.

Right. I wonder, though, Peter, if we’re being honest, don’t these protests, despite what Biden is saying there, inevitably exert a kind of power over him? Becoming one of many pressures, but a pressure nonetheless that does influence how he thinks about these moments. I mean, here he is at the White House devoting an entire conversation to the nation to these campus protests.

Well, look, he knows this feeds into the political environment in which he’s running for re-election, in which he basically has people who otherwise might be his supporters on the left disenchanted with him. And he knows that there’s a cost to be paid. And that certainly, obviously, is in his head as he’s thinking about what to do.

But I think his view of the war is changing by the day for all sorts of reasons. And most of them having to do with realities on the ground. He has decided that Israel has gone far enough, if not too far, in the way it has conducted this operation in Gaza.

He is upset about the humanitarian crisis there. And he’s looking for a way to wrap all this up into a move that would move to peacemaking, beginning to get the region to a different stage, maybe have a deal with the Saudis to normalize relations with Israel in exchange for some sort of a two-state solution that would eventually resolve the Palestinian issue at its core.

So I think it’s probably fair to say that the protests won’t move him in an immediate kind of sense. But they obviously play into the larger zeitgeist of the moment. And I also think it’s important to know who Joe Biden is at heart.

Explain that.

He’s not drawn to activism. He was around in 1968, the last time we saw this major conflagration at Columbia University, for instance. At the time, Joe Biden was a law student in Syracuse, about 250 miles away. And he was an institutionalist even then.

He was just focused on his studies. He was about to graduate. He was thinking about the law career. And he didn’t really have much of an affinity, I think, for his fellow students of that era, for their activist way of looking at things.

He tells a story in his memoir about walking down a street in Syracuse one day to go to the pizza shop with some friends. And they walk by the administration building. And they see people hanging out of the windows. They’re hanging SDS banners. That’s the Students for a Democratic Society, which was one of the big activist groups of the era.

And he says, they were taking over the building. And we looked up and said, look at those assholes. That’s how far apart from the antiwar movement I was. That’s him writing in his memoir.

So to a young Joe Biden, those who devote their time and their energy to protesting the war are, I don’t need to repeat the word twice, but they’re losers. They’re not worth his time.

Well, I think it’s the tactics they’re using more than the goals that he disagreed with. He would tell you he disagreed with the Vietnam War. He was for civil rights. But he thought that taking over a building was performative, was all about getting attention, and that there was a better way, in his view, to do it.

He was somebody who wanted to work inside the system. He said in an interview quite a few years back, he says, look, I was wearing sports coats in that era. He saw himself becoming part of the system, not somebody trying to tear it down.

And so how should we think about that Joe Biden, when we think about this Joe Biden? I mean, the Joe Biden who, as a young man, looked upon antiwar protesters with disdain and the one who is now president and his very own policies have inspired such ferocious campus protests?

Yeah, that Joe Biden, the 1968 Joe Biden, he could just throw on a sports coat, go to the pizza shop with his friends, make fun of the activists and call them names, and then that’s it. They didn’t have to affect his life. But that’s not what 2024 Joe Biden can do.

Now, wherever he goes, he’s dogged by this. He goes to speeches and people are shouting at him, Genocide Joe! Genocide Joe! He is the target of the same kind of a movement that he disdained in 1968. And so as much as he would like to ignore it or move on or focus on other things, I think this has become a defining image of his year and one of the defining images, perhaps, of his presidency. And 2024 Joe Biden can’t simply ignore it.

Well, Peter, thank you very much. We appreciate it.

[UPBEAT MUSIC]

Here’s what else you need to know today. During testimony on Thursday in Donald Trump’s hush money trial, jurors heard a recording secretly made by Trump’s former fixer, Michael Cohen, in which Trump discusses a deal to buy a woman’s silence. In the recording, Trump asks Cohen about how one payment made by Trump to a woman named Karen McDougal would be financed. The recording could complicate efforts by Trump’s lawyers to distance him from the hush money deals at the center of the trial.

A final thing to know, tomorrow morning, we’ll be sending you the latest episode from our colleagues over at “The Interview.” This week, David Marchese talks with comedy star Marlon Wayans about his new stand-up special.

It’s a high that you get when you don’t know if this joke that I’m about to say is going to offend everybody. Are they going to walk out? Are they going to boo me? Are they going to hate this. And then you tell it, and everybody cracks up and you’re like, woo.

Today’s episode was produced by Diana Nguyen, Luke Vander Ploeg, Alexandra Leigh Young, Nina Feldman, and Carlos Prieto. It was edited by Lisa Chow and Michael Benoist. It contains original music by Dan Powell and Marion Lozano, and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for “The Daily.” I’m Michael Barbaro. See you on Monday.

• May 8, 2024   •   28:28 A Plan to Remake the Middle East
• May 7, 2024   •   27:43 How Changing Ocean Temperatures Could Upend Life on Earth
• May 6, 2024   •   29:23 R.F.K. Jr.’s Battle to Get on the Ballot
• May 3, 2024   •   25:33 The Protesters and the President
• May 2, 2024   •   29:13 Biden Loosens Up on Weed
• May 1, 2024   •   35:16 The New Abortion Fight Before the Supreme Court
• April 30, 2024   •   27:40 The Secret Push That Could Ban TikTok
• April 29, 2024   •   47:53 Trump 2.0: What a Second Trump Presidency Would Bring
• April 26, 2024   •   21:50 Harvey Weinstein Conviction Thrown Out
• April 25, 2024   •   40:33 The Crackdown on Student Protesters
• April 24, 2024   •   32:18 Is $60 Billion Enough to Save Ukraine?
• April 23, 2024   •   30:30 A Salacious Conspiracy or Just 34 Pieces of Paper?

Hosted by Michael Barbaro

Featuring Jonathan Wolfe and Peter Baker

Produced by Diana Nguyen ,  Luke Vander Ploeg ,  Alexandra Leigh Young ,  Nina Feldman and Carlos Prieto

Edited by Lisa Chow and Michael Benoist

Original music by Dan Powell and Marion Lozano

Engineered by Chris Wood

Listen and follow The Daily Apple Podcasts | Spotify | Amazon Music | YouTube

Warning: this episode contains strong language.

Over the past week, students at dozens of universities held demonstrations, set up encampments and, at times, seized academic buildings. In response, administrators at many of those colleges decided to crack down and called in the local police to detain and arrest demonstrators.

As of Thursday, the police had arrested 2,000 people across more than 40 campuses, a situation so startling that President Biden could no longer ignore it.

Jonathan Wolfe, who has been covering the student protests for The Times, and Peter Baker, the chief White House correspondent, discuss the history-making week.

On today’s episode

Jonathan Wolfe , a senior staff editor on the newsletters team at The New York Times.

Peter Baker , the chief White House correspondent for The New York Times covering President Biden and his administration.

Background reading

As crews cleared the remnants of an encampment at U.C.L.A., students and faculty members wondered how the university could have handled protests over the war in Gaza so badly .

Biden denounced violence on campus , breaking his silence after a rash of arrests.

There are a lot of ways to listen to The Daily. Here’s how.

We aim to make transcripts available the next workday after an episode’s publication. You can find them at the top of the page.

The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Mike Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, John Ketchum, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Dan Farrell, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Summer Thomad, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Paula Szuchman, Lisa Tobin, Larissa Anderson, Julia Simon, Sofia Milan, Mahima Chablani, Elizabeth Davis-Moorer, Jeffrey Miranda, Renan Borelli, Maddy Masiello, Isabella Anderson and Nina Lassam.

Jonathan Wolfe is a senior staff editor on the newsletters team at The Times. More about Jonathan Wolfe

Peter Baker is the chief White House correspondent for The Times. He has covered the last five presidents and sometimes writes analytical pieces that place presidents and their administrations in a larger context and historical framework. More about Peter Baker

Luke Vander Ploeg is a senior producer on “The Daily” and a reporter for the National Desk covering the Midwest. More about Luke Vander Ploeg

Advertisement

The Federal Register

The daily journal of the united states government, request access.

Due to aggressive automated scraping of FederalRegister.gov and eCFR.gov, programmatic access to these sites is limited to access to our extensive developer APIs.

If you are human user receiving this message, we can add your IP address to a set of IPs that can access FederalRegister.gov & eCFR.gov; complete the CAPTCHA (bot test) below and click "Request Access". This process will be necessary for each IP address you wish to access the site from, requests are valid for approximately one quarter (three months) after which the process may need to be repeated.

An official website of the United States government.

If you want to request a wider IP range, first request access for your current IP, and then use the "Site Feedback" button found in the lower left-hand side to make the request.