From a healthcare perspective, there are a few ethical and moral issues presented in this article. One issue with the Patient Protection and Affordable Care Act (also known as Obamacare) is cost control. By failing to maintain cost control, Obamacare may not be able to ensure widespread access to healthcare (ACEP, n.d.). The main issue with cost control is distributive justice (ACEP, n.d.). Patient responsibility is another issue found within Obamacare. There are fewer taxes on harmful behaviors and more positive incentives (ACEP, n.d.). The issue with this is they are silent on harmful behaviors that cause the highest amount for the healthcare system. The last issue found in this article is about crowded emergency departments. One study found that people were visiting the emergency department even though they had a primary care physician (ACEP, n.d.). I agree with all of the issues presented. I know personally how hard it is to try to get in to see my primary care physician on short notice. It is frustrating when a sudden illness happens, and I can’t get in to see my doctor for three weeks. This makes me have to choose to either go to the ER or wait it out and be miserable and possibly get worse.
A major issue that came up was the growing population. I think that while attempting healthcare reforms in the future, this should be taken into account. Not only should they study the population growth, but attempt to estimate whether it will continue to increase or if it will decrease, and include that information in the planning of any reforms.

The article described first what the morals or fundamental goals of every American want and expect from our health care system. There are four fundamental goals and desires that have shaped the US health care system.  First, there’s quality care.  Second, there’s freedom of choice in health care.  Third, health care must be affordable. Fourth, we want our fellow citizens to share in the considerable benefits of health care (ACEP, n. d.).  Some of the ethical issues the article referred to were for instance a serious constitutional challenge to the PPACA is grounded on claims for individual liberty: it asserts that requiring Americans to purchase health insurance exceeds the authority placed in the hands of Congress by the US Constitution. Other countries, however, accept significant responsibility for the material welfare of their fellow citizens. These nations clearly place a high priority on the egalitarian goal of universal access to health care (ACEP, n. d.). I grew up in Germany where the employer and employee both pay 50% of the healthcare insurance and everyone has to have insurance. Another ethical issue the article was dealing with was tort reform of cost containment. I can see where defensive medicine results in costly diagnostic testing, hospitalizations, and therapeutic interventions. There needs to be some legal intervention to prevent frivolous lawsuits (ACEP, n. d.).  Access of care and emergency room crowding was another ethical and moral issue discussed. Many Americans who have been hard to insure because of pre-existing conditions had no choice but to go to the emergency room. I know I have a hard time to get in with my primary care physician and I have been told that I can always be seen at the ER if it gets too bad. I don’t agree with this because it’s passing the bug mentality. The last ethical issue the article talked about was end-of-life issues. I agree that communication, education, and joint decision-making plays a vital role in this situation.
I think for future healthcare reform we really need to look at how insurance companies can turn away customers with pre-existing health conditions. 

From a healthcare administrator’s perspective, the ethical issues in regards to the Affordable Care Act, present unique issues that still need to be addressed. The main issues presented in the article by the ACEP (n.d.) are, ”cost containment, public health, access to care, ED crowding, and end-of-life issues.” I would definitely have to agree that these issues are the leading cause of the fiscal fiasco that is the American healthcare system. According to the OECD (2018), on average, the US spends twice ($10,348) what other comparable western countries ($5,169) spend on health care. This ties into the ethical ramification of distributive justice in a fiscal perspective as we as a nation are spending so much money for a product that is not comparable any better than other western countries. The cost of access is so high that it discourages those who can’t afford it from receiving proper medical care. Cost transparency for multiple payers and standard rules for submission was suggested by Blanchfield (2010) that would, hypothetically, save $7 billion in billable time. Saving both time and money in this instance would effectively increase access to care as well as ED overcrowding. Utilizing savings from wasted man-hours increases funds available for ED renovations.

synthesis the 3 paragraphs above, at least 250 words.