Health insurance has become a politically charged subject, burning anyone that dares to tackle even a small part of the topic. While everyone seems to agree that something needs to be done to control rising costs, the various methods are up for debate.
While there are political challenges, there are areas that conservatives and liberals can agree upon. Both sides are willing to discuss the way in which hospitals and doctors are compensated, where they are rewarded for the quality of the care they provide as opposed to the number of procedures they do. Both groups agree on the need to stop insurance companies from not providing coverage to those that are already sick. Insurance companies agree to this concept, as long as most people carry insurance (the young and healthy must also carry insurance).
According to the congressional research service, it would appear that politicians agree they have twin goals, one of which is to encourage insurance companies to sell more policies to those already sick and another is to encourage healthy people to buy more policies to allow insurance companies to balance their risk portfolio. What complicated the situation was the introduction of the Affordable Care Act designed to force insurance companies to compete. While liberals see this as an option designed to keep companies honest, conservatives see this it as an intrusion on the free market.
Other problems arise as methods to pay for the expected cost increases over the next decade. Many expect that amount to exceed $1 trillion dollars. Obviously any politician worth his salt would have a hard time seeing his poll numbers fall after the introduction of massive tax increases to fund any new government program, especially one that many American perceive as replacing a system that is free today.
According to the Center for Disease Control, during the ten year period between 2000 – 2010 total personal health care expenditures grew from $1.2 trillion to $2.2 Trillion and current projections point to a rise to $3.1 trillion by the end of 2014. The latter increase will be, in large part, because of the uninsured that will seek coverage because of the Affordable Care Act.
Experts debate the percentage change from the ranks of the uninsured to the insured and how that will affect the efficiency of the health care system, but it is apparent that changes are coming. The younger middle class insureds of today act a lot like Groucho Marx in his most famous remark that he would “refuse to join any club that would have me as a member”. As the Affordable Care Act becomes law, health insurance groups are pushing these same healthy young American to do just that, by joining the ranks of the insured. And while there are many reasons for a young person to resist paying for insurance, there are also some really good reasons that they should.
- According to an article by Robert Lewis of InsWeb.com, the cost of an uninsured having a three-day hospital stay could top $27,000, likewise an uninsured individual’s cost for a burst appendix or knee surgery along with its aftercare could be as much as $48,000. The same individual with insurance would see the cost reduced as a result of the competition by health insurers who negotiate fees to physicians and hospitals. Medicaid and Medicare also negotiate fees and pay a rate far below what the uninsured pay.
- People with health insurance also tend to be more likely to access preventative care, which can prevent a minor issue from developing into a severe condition. Being able to get the care when you need it, or even when you desire it, can result in substantial savings.
- And while it is true that all hospitals must accept emergency patients, with or without medical insurance, insureds with insurance will have access to more types of treatments and a much larger variety of doctors or specialists who can attend to their needs.
While the effort continues to attract the previously underinsured middle class, the poor present greater challenges. Long seen as an easy way to manage costs, simply providing money for access to health care has proven to be ineffective. While dollars can easily be directed to the poorer areas, rectifying the shortage of physicians, nurses and medical specialists that are willing to service these areas has been harder. Even when that shortage is addressed, other barriers began to present themselves.
The effort to improve the care of the poor needs to include some specialized programs. Communication plays an increasing role to any program’s success. Unless people are made aware of the basic health needs or have the ability to communicate these preventative options, allowing them to discuss their symptoms with medical personnel, the extra money spent will be wasted. Besides the poverty that has been linked to lower life expectancies and higher instances of illness, other factors like lower education levels and the lack of language skills also contribute to poor health.
Poverty reinforces the lack of good health care and the lack of good health causes more poverty. Unless a person’s ability to work is improved, chances are the basic health care system will also fail. During the ten year period between 2001 and 2011 the percentage of people (ages 18-64) delaying or even avoiding medical treatment5, including prescription drugs and follow-up care, has increased from about 25% of those prescribed to 35% of those prescribed.
While health care has progressed many times since the days of “eat two herbs and recite charms till the morning”, quality health care service remains the territory of specialists who are intensely trained on advanced machinery. The costs involved will not go away and will likely increase further. The goal for any system remains efficiency without sacrificing the human touch.
It is the duo facts that the United States spends the most on health care on a relative cost basis and yet has developed the worst outcome that drives our political debate. Conservative voices like Rick Warren, the Senior Pastor of the Saddleback Church who has stated “I happen to agree with many of the liberal emphasis on compassion, justice and equality. I just disagree that it’s the government’s role to provide everything.” have resonated with a large percentage of the population. But just as forceful are the words of Donald Berwick, former administrator of the centers for Medicare and Medicaid Services, “Any health care funding plan that is just, equitable, civilized and humane must – must – redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition re-distributional.”
It is obvious the national debate will continue as the two sides appear to be equally represented. It will take leadership and compromise to form a consensus that will advance our Nation’s health care system. As Groucho Marx eloquently sums the topic up, “Those are my principles, and if you don’t like them… well, I have others.”
Affordable Care Act
Otherwise known as ObamaCare signed into law on March 23, 2010. It is a law that requires all American to have insurance by 2014 (or pay a tax penalty).
Factors That Influence Health Insurance Premiums
When shopping for health insurance coverage there are a number of personal factors that insurance companies take into account when calculating one’s health care insurance premium.
Designed to cover the extra costs caused by the treatment of cancer. It is a specialized coverage sold as a supplement to other types of insurance.
Catastrophic Health Insurance
High deductible health plans designed for hospitalization or serious injuries. These types of plans usually do not cover services for regular doctor’s visits or immunizations and utilize high deductibles of $5,000-$10,000 to control costs.
Sometimes referred to as DI. Disability Insurance is protection against a risk that creates a disability that limits your ability to do your job. It can be physical or mental and is classed as long term or short term depending on the length of the infirmity.
Growing in popularity as a way to manage dental expenses. While some plans offer limited protection, other plans, normally packaged with other benefits, do offer substantial savings.
Government Health Insurance
A generic term for federal health care designed for federal employees or another name for the new Affordable Care Act.
Hearing Aid Insurance
Insurance to protect you from financial loss due to loss or accidental damage to your hearing aid.
Individual Health Insurance
Although the big headlines are being made in the discussion of ObamaCare (Affordable Care Act), most Americans procure their coverage from private insurers or employer provided plans.
Part of the Affordable Care Act. Can be designed by the individual state to act as a portal to procure insurance protection. The Insurance Exchanges are designed to supplement and/or compete with regular health insurance distribution systems.
International Health Insurance
Designed for expatriates and individuals living abroad. This is a special type of coverage designed for international travel and occupations.
Low Cost / Affordable Health Insurance
Ways to reduce health insurance costs and provide you with an affordable health insurance plan. Independent insurance agents can work with you to analyze your risk tolerance utilizing high deductibles and flexible spending accounts.
Long-Term Disability Insurance
No matter what your high-risk occupation or hobby may be, you may benefit from a long-term disability insurance policy, which can provide an income while you are unable to work.
Average Health Insurance Cost
There is no short answer to the average cost of health insurance because there are a number of factors that dictate what the cost for a policy may be.
Designed to help defray the costs associated with pregnancy and the delivery of a baby.
Medicare Supplemental Insurance
A private insurance plan designed to help cover the costs not covered by the Medicare.
Private Health Insurance
Even though the Affordable Care Act is becoming law, private health care solutions are available. Even if you use the state exchange plans, subsidies may be available for private plans.
Self-Employed Health Insurance
If you are self-employed with no employees, many kinds of insurance protection are available and may have a subsidy available through the Affordable Care Act.
Short Term Health Insurance
Designed to act as a bridge between permanent insurance protections. (For instance, coverage to handle the insurance gap between job changes or early retirement.)
Small Business Health Insurance
A large section of Americans have group health insurance available through their employer or a family member’s employer. Employee and employers share the costs involved in this type of insurance.
Student Health Insurance / Health Insurance for College Students
Health insurance designed for students that are no longer eligible to be on their family’s plan. Because of the recent changes made as a result of the Affordable Care Act, most students (all younger people, students or not) can now remain on their parents’ policies much longer. These plans can involve accident protection during student events and can be used as bridge protection between a parents’ plan and a graduating students plan.
Travel Health Insurance
Not all insurance plans offer protection during worldwide travel. Travel insurance provides protection for those areas for a planned trip.
Normally not provided by a standard insurance plan and “stand alone” plans can be expensive. Flex spending accounts offer one way to manage costs.
Health Insurance Broker
When working with a health insurance broker, you are the boss; they are there to make sure that all of your health insurance needs are met. A health insurance broker works independently to help people find the health insurance they need. They are knowledgeable about the health insurance industry and know the intricacies about a wide variety of policies.
Other helpful terms:
Alternative Medicine is any kind of medical treatment not generally recognized by the standard medical community. These types of treatments often include mixtures of culturally based traditions.
Acute Care is provided by trained medical personnel in a hospital or nursing facility, normally for short durations.
Chronic Illness is considered long term or permanent.
Deductible refers to the amount your insurance company would require you to pay “out-of-pocket” before it begins payments.
Exclusions are specific provisions in an insurance policy listing the services or treatment plans that a company will not pay.
Generic Drugs are drugs that are produced after a patent has expired that is exactly the same formulation as the original drug. These drugs are normally available at a much lower price than the original drug.
Lifetime Maximum used to refer to the maximum amount a health insurance company would pay for a specific individual during their lifetime. Beginning in Sept 2010 that practice is prohibited by a provision of the Affordable Care Act.
Limitations: Insurance policy language that works hand in hand with exclusions to limit the type and amount of benefits paid.
Medicaid Eligibility: Medicaid provides coverage for nearly 60 million Americans. Federal law requires states to cover certain population groups. States set the individual criteria for eligibility within minimum federal guidelines.
Out-of-Network Care refers to the treatment received from a doctor or provider that is not listed by your insurance company in their list of preferred providers. Normally treatment is provided by a network of doctors at a negotiated rate by the company.
Specialist: A doctor or practitioner that provides treatment in a specific field of care. A specialist works in conjunction with your primary care physician.
Treatment Facility: Any residential or nonresidential structures used to treat mental illnesses of substance abuse problems.