Confronting Challenges in the US Healthcare System —
How to Write a Strong Discussion Paper
Your assignment asks you to read the JAMA Health Policy article, discuss its findings, evaluate whether the healthcare field’s safety record has improved, and integrate considerations of diversity, equity, and inclusion — all within a 2–4 page APA-formatted paper. That is four distinct tasks packed into a short deliverable. This guide maps the article’s key themes, explains how to frame the safety record question, and shows you how to weave DEI throughout — without writing the paper for you.
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The assignment has four components that must all appear in a 2–4 page paper. First, discuss the findings of the article — this means summarizing and explaining its core claims, not listing everything it says. Second, evaluate whether the healthcare field’s safety record has improved based on those findings — this requires analytical judgment, not further summary. Third, weave in DEI considerations throughout — not as a separate paragraph, but as a lens applied across the discussion. Fourth, format and cite correctly using APA. Students who produce summary-only papers without the safety record evaluation, or who treat DEI as a checklist item in one sentence, are missing the core analytical tasks the rubric is grading.
The distinction between discussing findings and evaluating a safety record is where most papers lose marks. Discussing findings means accurately conveying what the article argues: what problems the US healthcare system faces, what the authors say caused them, and what they recommend. Evaluating the safety record means stepping back from the article and asking: given everything the article describes, does the evidence point to a system that is safer and more reliable now than it was — or not? That is a judgment call that requires you to weigh what the article presents as progress against what it presents as ongoing or worsening failure.
The DEI requirement is explicitly framed in the instructions as something to consider as you write — not as an add-on. The article itself raises equity and access directly. Your paper earns marks on DEI by integrating that lens into the analysis of each finding, not by adding a paragraph at the end that mentions disparities in isolation.
Read the Article Twice Before You Write Anything
Read the article once to understand the overall argument, and a second time to map the specific findings you will discuss. On the second read, annotate: mark every distinct problem the authors identify, every cause they attribute, and every solution or opportunity they describe. The article moves quickly through seven or eight distinct challenge areas — students who read it once often miss the structural argument that connects them all, which is that the COVID-19 pandemic exposed pre-existing systemic failures and created an opportunity to address them. That framing is central to answering the safety record question well.
The Article’s Key Findings — What You Need to Discuss and How to Frame Each One
The article is not a research study — it is a policy commentary that synthesizes multiple JAMA Health Policy Viewpoints to identify the most pressing challenges facing US healthcare. That means it does not present original data; it presents a synthesized argument about what the system’s problems are, why they exist, and what should be done. Understanding this about the source shapes how you cite and discuss it. You are not reporting on a study’s methodology or results — you are engaging with a policy argument.
The Article’s Core Challenge Areas — What Each One Means for Your Discussion
Use this framework to identify which findings to prioritize. Your 2–4 page paper cannot address every point in depth — select the three or four that most directly bear on the safety record question.
Cost as the System’s Primary Structural Weakness
- National health expenditures reached approximately $4 trillion in 2020 — roughly 18% of GDP
- High prices, not utilization, account for most of the gap between US spending and other developed nations
- Surprise billing is one symptom of a broader pricing problem tied to consolidation and market power
- DEI connection: high prices and high premiums fall disproportionately on lower-income populations and those ineligible for exchange subsidies
Market Consolidation Driving Higher Prices
- Consolidation of hospitals, insurers, and practices accelerated during the pandemic
- The article cites research projecting that consolidation will lead to higher commercial market prices
- Market power creates a cycle: higher prices → higher premiums → less coverage → worse outcomes → higher costs elsewhere
- DEI connection: communities with fewer provider options — often rural and low-income — experience the effects of consolidation most severely
Incomplete Insurance Coverage and Its Consequences
- High premiums mean many people not eligible for subsidies find insurance unaffordable — creating coverage gaps above and below income thresholds
- 12 states had not expanded Medicaid at the time of writing, citing cost concerns — leaving millions uninsured who would otherwise qualify
- High cost-sharing reduces access to necessary care — people delay or forgo treatment due to out-of-pocket costs
- DEI connection: Medicaid non-expansion states have significantly higher rates of uninsurance among Black, Hispanic, and low-income populations
Neglected Public Health Infrastructure
- Spending on public health has been inadequate relative to clinical care investment — surveillance, stockpiles, and preparedness have been chronically underfunded
- The COVID-19 pandemic exposed the consequences of this neglect directly and catastrophically
- The authors argue that public health must be central not just to health policy but to economic and national security policy
- DEI connection: underfunded public health systems hit hardest in communities already underserved by clinical care — the same communities that suffered the highest COVID-19 mortality rates
Misaligned Incentives Rewarding Margin Over Value
- The US system creates incentives to deliver high-margin specialty and surgical care rather than primary care, prevention, and public health
- This misalignment is described as a fundamental shortcoming — not a side effect but a structural feature
- Fee-for-service payment accelerates this problem by rewarding volume and procedure rather than outcomes
- DEI connection: primary care deserts — which disproportionately affect rural and low-income communities — are partly a product of these incentive structures
Digital Transformation as Opportunity
- The pandemic accelerated telemedicine adoption and demonstrated rapid system adaptability
- Real-time data systems could enable continuous population-level monitoring, preparedness planning, and equity tracking
- Administrative costs are estimated at $2,500 per person per year — digital systems could reduce this burden
- DEI connection: digital transformation’s benefits depend on equitable access to technology — broadband deserts and digital literacy gaps must be addressed for these gains to reach all populations
When discussing these findings in your paper, do not simply list them. The assignment asks you to discuss them — meaning you should explain the connections the authors draw between problems, identify which ones the article treats as root causes versus symptoms, and engage with the argument’s logic. The authors’ central framing — that COVID-19 is a clarion call, comparable to a cardiac event prompting a patient to address underlying conditions — is worth naming and engaging with directly, because it shapes everything else in the article.
How to Decide Which Findings to Prioritize
Your paper cannot address all six challenge areas in depth at 2–4 pages. Prioritize the findings most directly relevant to the safety record question — which is the central analytical task. Cost and consolidation, insurance coverage gaps, and public health infrastructure are all directly linked to whether the system can deliver safe, consistent, equitable care. Misaligned incentives and digital transformation are important but secondary. Choose three or four findings, discuss each with enough specificity to demonstrate engagement with the article’s actual argument, and connect each one to DEI and the safety record question. Depth on three findings is stronger than surface treatment of six.
Has the Healthcare Field’s Safety Record Improved? — How to Frame a Defensible, Evidence-Based Answer
This is the analytical core of the assignment and the part most students handle least well. The question is not asking you to do original research on healthcare safety. It is asking you to evaluate the evidence presented in the article — and potentially to bring in supplementary context — to reach a defensible conclusion about whether the system’s capacity to deliver safe care has improved. That answer is not in the article as a direct claim. You have to construct it from the evidence the article provides.
The question is not whether individual hospitals or individual clinicians have improved their practices. It is whether the system — its coverage, its financing, its infrastructure, its equity — is safer and more reliable for the people who depend on it.
— The systemic framing your evaluation requiresThe article presents a mixed picture. Some evidence points toward progress: rapid telemedicine adoption, the emergence of value-based care frameworks, the availability of real-time data dashboards during the pandemic, and the recognition by policymakers of the need for change. Other evidence points toward persistent or worsening failure: consolidation accelerating, public health infrastructure still underfunded despite pandemic exposure, 12 states still not expanding Medicaid, and incentive structures still rewarding margin over value. A strong evaluation engages with both sides of this picture and reaches a qualified conclusion — not a simple yes or no.
Where the Safety Record Has Not Improved
Consolidation has accelerated, not reversed. Public health infrastructure remained inadequate through the very pandemic that exposed its inadequacy. 12 states had still not expanded Medicaid. Administrative costs — estimated at $2,500 per person per year — persist. The incentive structure that rewards high-margin care over prevention and primary care was identified as a fundamental, not peripheral, problem. These are not new failures — they are longstanding ones the pandemic made undeniable.
Where Progress Is Visible or Possible
Telemedicine expanded dramatically and rapidly during the pandemic — demonstrating the system’s adaptability. Data dashboards reached millions of people and drove public accountability. Policymakers were debating subsidy expansions to higher income groups. The Center for Medicare and Medicaid Innovation existed as a framework for accelerating demonstration projects. Policy proposals targeting market consolidation, backstop prices, and digital transformation were being actively discussed at the time of writing.
Safety Record Improvement Is Uneven Across Populations
Any evaluation of the safety record must address for whom it may have improved and for whom it has not. The article explicitly names inequities in access and outcomes as a core challenge. A safety record that has improved on average while disparities have widened is not a straightforward improvement story — it is a story of improvement that excludes the populations most at risk. This is where DEI integration is essential to the safety record analysis, not separate from it.
Your paper’s evaluation of the safety record should be structured as a qualified claim supported by specific evidence from the article. Avoid the extremes: a response that says “yes, it has improved significantly” without engaging with the article’s extensive list of persistent failures, and a response that says “no, nothing has improved” without acknowledging the evidence of adaptation and emerging policy frameworks. The article itself is cautiously optimistic — it ends with “hope” that leaders can confront these crises — and your evaluation should reflect that complexity rather than flattening it into a simple verdict.
Do Not Confuse Clinical Safety With Systemic Safety
A common error is answering the safety record question with a discussion of clinical safety improvements — reduced hospital-acquired infections, better surgical checklists, lower medication error rates. The article is not about clinical safety in that sense. It is about whether the healthcare system is structured to deliver safe, equitable, high-value care to the population it is meant to serve. Market consolidation, insurance coverage gaps, and public health infrastructure are all safety issues in this broader sense — because a system that leaves millions uninsured, underfunds public health, and creates perverse incentives cannot deliver safe care consistently regardless of how skilled its individual providers are. Keep the safety record analysis at the systems level, consistent with the article’s framing.
How to Incorporate Diversity, Equity, and Inclusion Meaningfully — Not as a Checklist
The assignment instruction to “consider how diversity, equity, and inclusion can be included” is asking you to apply a DEI lens throughout the paper — not to add a section on disparities after you have finished the main discussion. The article itself supports this approach: it explicitly names “inequities in health care access and outcomes” as one of the central challenges the system faces, and it connects digital transformation directly to the potential to identify and reduce disparities. DEI is not external to the article’s argument; it is woven into it.
| Article Finding | DEI Dimension | How to Integrate It in Your Discussion |
|---|---|---|
| High healthcare costs and premium unaffordability | Equity — cost burdens fall disproportionately on lower-income workers, those in non-group markets, and those above subsidy eligibility thresholds who remain uninsured | When discussing cost findings, note that the affordability crisis is not uniform across the population. Workers in low-wage employment face both high cost-sharing and lower employer contributions — creating a compounding equity problem that premium subsidies alone do not resolve. |
| Medicaid non-expansion in 12 states | Equity and inclusion — the populations most affected by non-expansion are disproportionately Black, Latino, and rural, concentrated in Southern states where political opposition to expansion has been strongest | Discuss this not simply as a coverage gap but as a policy decision with documented, racially disparate consequences. The article notes the fiscal concern driving non-expansion; your DEI lens adds the human cost borne by specific, identifiable population groups. |
| Underfunded public health infrastructure | Equity — COVID-19 mortality was not distributed equally. Communities of color, low-income communities, and essential workers bore disproportionately higher infection and death rates, partly as a consequence of the infrastructure failures the article identifies | Connect the public health infrastructure finding directly to the pandemic’s differential impact. The article argues that neglecting public health after a pandemic compromises the next crisis response — your DEI integration makes clear that “the next crisis” has already arrived for communities that never fully recovered from the last one. |
| Misaligned incentives favoring specialty over primary care | Diversity and equity — primary care deserts are concentrated in rural, low-income, and minority communities. The incentive structure that under-rewards primary care physically removes accessible care from the communities that most depend on it | Note that specialty care concentration in urban centers is not simply a geographic coincidence — it is a predictable consequence of a reimbursement structure that steers providers toward high-margin procedures unavailable in underserved settings. |
| Digital transformation potential | Inclusion — the article frames digital tools as a mechanism to monitor and reduce disparities, but this potential is conditional on equitable digital access | Discuss the digital transformation opportunity while raising the equity condition: the communities that would benefit most from real-time health monitoring are often those with the least broadband access and lowest digital literacy. An unreflective digital transformation risks widening the disparities it is meant to address. |
| Safety record improvement question | All three DEI dimensions — the safety record evaluation is fundamentally incomplete without asking: safer for whom? | Frame your safety record conclusion through the equity lens explicitly: if average outcomes have improved while disparities have held or widened, that is a partial improvement with a significant equity cost. A system that is safer on average but less equitable in distribution is not safer in any meaningful sense for the populations it disproportionately fails. |
What DEI Integration Looks Like at the Sentence Level
DEI integration does not require separate paragraphs or explicit transitions like “from a DEI perspective…” It means writing every finding with an awareness of who bears its costs most heavily. When you write about insurance coverage gaps, the sentence “Millions of people who are not eligible for subsidies find insurance unaffordable” becomes stronger when followed by: “This burden falls disproportionately on workers in low-wage employment, self-employed individuals, and people of color concentrated in states that have not expanded Medicaid.” That is not a separate DEI section — it is the same sentence with an equity lens applied. That is what the assignment is asking for.
How to Structure Your 2–4 Page Paper — a Paragraph-Level Breakdown
A 2–4 page paper at double spacing with 12-point Times New Roman and one-inch margins contains roughly 500–1000 words of body text. That is a tight space for four distinct tasks. Structuring it efficiently — so each paragraph does more than one job — is what separates a complete response from a partial one. The structure below assumes a 3-page target (approximately 750 words of body text), which gives you room to discuss three or four findings in adequate depth while leaving space for the evaluation and DEI integration.
One paragraph. Introduce the article — its source (JAMA Health Policy series), its purpose (identifying key challenges facing the healthcare system), and its central framing (the pandemic as a catalyst for systemic reform). End with a thesis-like sentence that previews your evaluation of the safety record and names DEI as a dimension of the analysis. This is not a full thesis statement — it is an orientation sentence that tells the reader where the paper is going.
Two to three paragraphs. Each paragraph covers one or two related findings from the article. Do not summarize the article chronologically — group findings thematically. A paragraph on cost and consolidation, a paragraph on coverage gaps and Medicaid, a paragraph on public health infrastructure and incentive misalignment. Each paragraph should close with a sentence connecting the finding to the safety record or equity dimension.
One to two paragraphs. This is the analytical core. Present the evidence for improvement (telemedicine adoption, data systems, policy momentum) and the evidence against (persistent consolidation, coverage gaps, infrastructure neglect). Reach a qualified conclusion. Apply the equity lens: the safety record question is not fully answered without asking whether improvement has reached populations that historically experienced the worst outcomes.
Integrated throughout — not a separate section. However, if your paper needs to make the DEI analysis more explicit, the safety record evaluation paragraph is the right place to consolidate it. Address the distribution question directly: safer for whom? Name the populations most affected by the failures the article identifies. Connect digital transformation’s potential to the equity conditions that must be met for it to close rather than widen gaps.
One paragraph. Restate your evaluation of the safety record as a qualified claim grounded in the article’s evidence. Name the most important structural change the article identifies as necessary. End with a sentence that acknowledges the article’s cautious optimism — the opportunity the pandemic created — while grounding it in the DEI reality that improvement must be equitable to be meaningful.
Pre-Submission Checklist for This Assignment
- Your paper discusses the article’s findings — not a list of healthcare facts you already knew
- You have engaged with at least three distinct findings from the article, each with enough specificity to show you read it carefully
- Your paper includes a direct evaluation of whether the healthcare safety record has improved — not a list of problems without a conclusion
- DEI is integrated into the discussion of findings, not confined to one isolated paragraph
- You have cited the article in APA format both in-text and in a reference list
- Your paper is formatted correctly: double spacing, 12-point Times New Roman, one-inch margins
- Your paper has a title page (APA format) if required by your course conventions
- You have not simply summarized the article’s structure paragraph by paragraph — you have grouped and analyzed its findings
- Your conclusion reaches a qualified claim about the safety record — not a hedge that avoids the question
- The paper falls within the 2–4 page requirement, not below the minimum
How to Cite This Article in APA — and What to Watch For
The article is a commentary published in the JAMA Health Policy series. The citation format follows standard APA journal article conventions. The article was authored by multiple contributors, and the introductory piece framing the series has its own authorship distinct from the individual Viewpoints cited within it. When you cite the framing article, cite the authors of that piece — not all the individual Viewpoint authors quoted within it, unless you are directly referencing a specific Viewpoint.
APA Reference List Format for Journal Articles
- Author, A. A., & Author, B. B. (Year). Title of article in sentence case. Journal Name in Title Case and Italics, Volume(Issue), page range. https://doi.org/xxxxx
- Identify the exact authors, volume, issue, and DOI from the article itself — do not construct a citation from memory
- JAMA is a weekly journal — include the volume and issue number as well as the page range
- If the article was accessed online without a print version, use the DOI or stable URL
- The title of the article goes in sentence case (only the first word and proper nouns capitalised); the journal name goes in title case and italics
In-Text Citation Format and Common Situations
- Paraphrase with citation: (Author & Author, Year) at the end of the sentence before the period
- Narrative citation: Author and Author (Year) found that… — use when introducing the article by its authors’ names
- Multiple claims from the same article on the same page: cite once per paragraph, not after every sentence, unless clarity requires it
- When citing a specific statistic from the article (e.g., $4 trillion, 18% of GDP), include the page or paragraph number if available: (Author & Author, Year, p. X)
- When the article itself cites another source (e.g., Dafny, Chernew) and you want to reference that finding: use “as cited in” format — but prioritise paraphrasing the framing article’s presentation of those findings
Handling the Article’s Internal Citations
The article cites multiple Viewpoint authors (Colla, Dafny, Chernew, Gee et al., Frank and Neuman, Venkataramani, Berwick and Gilfillan, Adler-Milstein, Kocher et al.). You do not need to track down and cite all of these separately. When you reference a finding the article attributes to one of these authors — for example, the estimate that administrative costs run $2,500 per person per year (attributed to Kocher et al.) — you have two options: cite the framing article as your source and note the attribution within the text (“the authors report, drawing on Kocher et al., that administrative costs…”), or locate the original Viewpoint and cite it directly. For a 2–4 page assignment, citing the framing article with internal attribution noted in prose is sufficient and appropriate.
Strong vs. Weak Responses to This Assignment — What the Difference Looks Like
The critical difference is specificity and analytical integration. The strong example names a specific claim from the article ($4 trillion, 18% of GDP, prices not utilization), connects it to a specific DEI dimension (cost distribution across income groups), and draws a direct conclusion about the safety record (pricing people out of care is a safety failure). Every sentence does work. The weak example makes general observations that could apply to any healthcare article and never demonstrates engagement with this specific text’s argument.
The Most Common Errors on This Assignment — and How to Avoid Them
| # | The Error | Why It Costs Marks | The Fix |
|---|---|---|---|
| 1 | Summarizing the article paragraph by paragraph instead of analyzing its findings | A paragraph-by-paragraph summary demonstrates that you read the article but not that you engaged with its argument. The assignment says “discuss the findings” — which requires you to group, connect, and evaluate, not simply restate in order. Summary-heavy papers consistently score below analytical ones on rubrics that grade critical thinking. | Read the article, then close it and write from notes. This forces you to synthesize rather than transcribe. Group related findings thematically (cost and consolidation together, coverage and Medicaid together) rather than following the article’s own sequence. Start each body paragraph with a claim — what the finding means — not with a summary of what the article says. |
| 2 | Answering the safety record question with a list of clinical safety improvements unrelated to the article | The article does not discuss clinical safety in the narrow sense (surgical checklists, infection control, medication safety). It discusses systemic safety — whether the healthcare system is structured to deliver equitable, high-value care reliably. Answering with a list of clinical safety innovations the article does not mention demonstrates a misreading of the question’s scope. | Keep the safety record evaluation at the systemic level the article operates on. Coverage gaps, consolidation, public health infrastructure, and incentive misalignment are all safety issues in this context because they determine who can access care, how consistently it is delivered, and whether the system is resilient when crisis hits. Engage with what the article actually says. |
| 3 | Treating DEI as a separate section rather than an integrated lens | A paper that discusses findings without DEI considerations for three pages and then adds a paragraph noting that “minorities face disparities” has not integrated DEI — it has appended it. This approach misses the explicit instruction to “consider how diversity, equity, and inclusion can be included” throughout the paper and typically scores low on any DEI rubric criterion. | Apply the equity lens at every finding. When a finding names a structural problem, the DEI integration asks: which populations bear this burden most heavily and why? That question has a specific, article-grounded answer for every finding in the text. Write those answers into the same paragraphs where you discuss the findings, not after them. |
| 4 | Reaching no conclusion on the safety record question | The question “has the safety record improved?” requires a direct answer with qualifications — not a list of factors on both sides that ends without a conclusion. An evaluative question that is answered with “there are arguments on both sides” scores near the bottom of any rubric that grades analytical reasoning, because it demonstrates no analytical judgment, only compilation. | After writing your evidence paragraphs, write one sentence that states your qualified conclusion: “Based on the article’s findings, the US healthcare system’s safety record shows selective improvement in adaptability and technology adoption, but persistent and in some cases worsening failures in the structural conditions — coverage, cost, and public health infrastructure — that determine whether safe care reaches the entire population.” That is a defensible claim. Build your conclusion paragraph to support it. |
| 5 | Not citing the article in the paper or using incorrect APA format | A discussion paper that does not cite its primary source has a fundamental attribution problem regardless of content quality. APA citations are an explicit requirement of this assignment. Missing them signals inattention to requirements and costs marks on the formatting criterion. | Every specific claim that comes from the article needs an in-text citation. Set up your reference list entry before you start writing so you have the correct format available. Cite the article by its authors, year, and include the DOI. Use parenthetical citations at the end of sentences when paraphrasing; use narrative citations when introducing the article or its authors by name. |
| 6 | Writing a paper shorter than 2 pages | The 2–4 page range is a floor as well as a ceiling. A paper that discusses four complex findings, evaluates a systemic safety record, integrates DEI, and meets APA formatting requirements cannot do so in fewer than 2 pages without being superficial. Under-length papers are almost always under-analytical — they list rather than discuss, and they hedge rather than evaluate. | If your draft is under 2 pages, identify which of the four requirements is under-addressed. The safety record evaluation and DEI integration are the most commonly skimped sections. Add depth to those sections specifically — not padding sentences, but additional analytical content connecting the findings to the evaluation and equity dimensions the assignment requires. |
FAQs: Confronting Challenges in the US Healthcare System Assignment
What Your Instructor Is Looking For in a Strong Response
This assignment is testing three things simultaneously: whether you can accurately identify and discuss the key findings of a policy article, whether you can perform analytical evaluation rather than summary, and whether you understand DEI as an analytical lens rather than a checklist category. A strong paper does all three — and the students who score highest are the ones who treat the safety record question as the analytical core and use the findings discussion to build toward it, rather than treating the two as separate tasks.
The article itself is carefully argued and directly relevant to contemporary healthcare policy debates. A paper that engages with its specific claims — the $4 trillion expenditure figure, the 12 non-expansion states, the $2,500 per person administrative cost estimate, the projection that consolidation will drive commercial prices higher — signals genuine engagement. A paper that discusses healthcare challenges in general terms without demonstrating that it is specifically about this article signals surface reading. The difference shows at every paragraph.
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