Healthcare today is a big issue for a lot of individuals, and families. Because it’s not affordable and some plans are lacking the necessary coverage people need these days. There are many ways to make healthcare more affordable, adequate, efficient, and patient-centered. That being said there are also various healthcare plans that are suited for many different people such as HMO’s, PPO’s, POS’s, Medicaid, and Medicare. This is why government should develop a reform plan that focus on all of the above issues and much more.
That being said many observers; believe the reason healthcare has become so unaffordable because of the new drug developments as well as the need for new medical technology. “Others say healthcare is to expensive due to, administrative cost, marketing and profits, which account for 22 to 31 percent of the U. S. ” (Haaland, R. 2007). I know in my experience healthcare insurance is not affordable because the deductibles, and coinsurance are outrageous. Some just say the premium themselves are very high, making it even more unaffordable for families to have.
Lots of people say the rise in healthcare is because of the number of lawsuits due to malpractice. Another issue with the healthcare plans is the inadequate coverage that some of them provide. Some plans don’t include dental coverage; others only include discount vision plans that only cover certain aspects. There are some plans that don’t even cover preexisting condition. For instance if you are receiving treatment for cancer, or sickle cell anemia, some insurances would require you to be on their plan for at least 6 to 12 months.
Until that time, in which they will cover these types of conditions. Statistics, also say that about 6 percent of insured older adults in working families, or 1. 8 million people, are underinsured: Their healthcare coverage does not protect them against medical expense that are high relative to their income” (O’Brien, 2008). As you can see thousands of people have to worry about these things every day. It is also known that “In general, about two in five American adults who do not have health insurance end up going without needed care” (Kronenfled, 2004).
Some other statistics that were found in an article called Massage & Body work state that “50 percent of adults have seen their healthcare coverage cut or cost go up. It also say that two out of three adults now believe that healthcare coverage should be available to Americans as it is in other countries such as Canada, and Britain” (Massage & Bodywork, 2005). There are several solutions that the government could use to help the U. S and foreign countries to solve these issues with healthcare.
Like, providing more funds for the healthcare plans to make it more affordable for people. Another solution is to allow the consumers to be involved in making, or picking the right healthcare packages that will suit their needs, as well as their family’s needs. The government can also make it more efficient and adequate enough for Americans to cope with. Healthcare systems should also lower their standards for when coverage can start because of preexisting conditions. The best solution of all is to establish a healthcare system that covers all Americans.
However, there are several healthcare insurance plans that are reliable enough for different families such as HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), and POS (Point-of-Service) plans. HMO is a prepaid group health insurance plan that entitles members to services of participating physicians, hospitals, and clinics. In the Article Understanding the Difference between HMO, PPO, and POS: Say on average, HMO’s are the least expensive health option and the least flexible.
Doctor’s visits, preventive care, and medical treatment are given in exchange, for a monthly premium as well as a co-pay of roughly $5-$10. To keep Its cost down, HMO requires that you only see doctors who are in your HMO network. (Understanding the Difference, 2004) Some reason people choose the HMO plan, because of the low deductible and are more affordable for most low income families. They also have lower health premiums for both employees and employers. Not only that there is no filing of claims for patient on the HMO plan and there are low co-pays for prescription.
Even though the plan sounds good there are some downfalls to HMO such as, you can only go to prescribed doctor’s and specialist with your doctors referral. Or if you have been seeing a doctor for along time and choose this plan he/she may not be, under the list of PCP (Primary Care Provider) provide by the HMO plan. Leading you to choose from other primary care providers as well as getting use to another one. Another downfall is that the doctors might skimp on your treatment because all of the incentives that they receive from the Health Maintenance Organization.
There is also another plan Known as the PPO or Preferred Provider Organization in which is a step up from the HMO plan. PPO is a medical insurance plan in which members receive more coverage if they choose health care providers approved by or affiliated with the plan. Some advantages of using the PPO plan is: More flexibility than the HMO plan, No referrals need to go and see specialist, freedom to choose the provider you want. Another advantage PPO allows the insurance companies to negotiate with the hospitals and doctors to get you service charges at a lower rate than normally charged.
As with all plans there are some downfalls for PPO the premiums are a lot more expensive. Co-pays are usually higher because they only pay 80% of the fees. You also have to pay 20% of all medical treatments including overnight stays at the hospital. One of the biggest downfalls is that you might have an annual deductible; you must meet before your coverage can start each year. You may even have to feel out claims forms as well. PPO is might be suitable for people who can afford these types of deductibles required of patients to pay or the patients who need a plan with less restriction on it.
For those who would like a little bit of both plans you can go with the POS plan also known as the Point-Of-Service plan. The POS is a combination of both the HMO and PPO plans. Members of this plan do not have to make a choice about what system to use until the point at which the service is being used. For the POS plan many of the advantages are similar to that of the HMO plan as far as paper work if you choose an in network doctor there are no medical bills to mail in or claims form to fill out.
Whereas, if you were to choose an out of network doctor like you do with a PPO plan, you would have to fill out the paper work, and other claims forms in order to get that bill paid. The only way to get around this is for your PCP to refer you to that particular doctor or specialist. Also if you choose to go with an out-of-network specialist or doctor you might have to pay a predetermined amount of coinsurance. Or if you choose to go with a network doctor there is no deductibles. As you can see there are many plans to choose from it just all depends on who the individual is.
Another source of healthcare is the Medicaid plan, which is a program in the United States, jointly funded by the states, and the federal government, that reimburses hospitals and physicians for providing care to qualifying people who cannot finance their own medical expenses. Low-income families and children are considered to be in this category of qualifying people. Some advantages of being on this plan are that “all eligible children will receive benefits on a state wide basis” (Families USA, 1997).
Medicaid also covers basic health care and long-term services for eligible people. In my experience one of the biggest benefits of having Medicaid is, knowing that your kids will be able to get the proper healthcare that they need. Also with this plan there is no filing of claims form as well. However, there are some disadvantages of having Medicaid, for instance I know from experience that Medicaid only covers certain prescriptions brands. Another disadvantage is not everyone in the low-income bracket qualify for Medicaid.
For, example if you are a single parent with kids, but make a falling decent monthly income your children may be eligible for it, but you as a single parent that might not be able to afford regular healthcare may not qualify for Medicaid, due to your income. For those that are 65 and over, as well as some people with disabilities under age 65 are provided with a program called Medicare, it is a program under the U. S. Social Security Administration that reimburse hospitals and physicians for medical care provide to these group of qualifying people.
Medicare is also the largest health insurance program in the United States. With this program it is divided into four different categories referred to as Part A, Part B, Part C, and Part D Medicare plans. “Part A plan is hospital insurance that provides basic coverage for hospital stays and post hospital nursing facilities, home health care, and hospice care. As for Part B it covers most fees that are associated with basic doctor visits and laboratory testing. It also covers some outpatient services as well.
Part C is for those who have Part A and B and would like to receive all of their healthcare services through one of these provider Organizations under this plan. As for the last and final Part D, helps cover your prescriptions prescribed by your doctor” (Medicare, 2008). All of these issues are just some of the reasons, why the government should come up with a reform plan: To help provide healthcare for all Americans.
The healthcare reform plan should include a proposal on how the government is going to make the U. S.healthcare more affordable, adequate, and efficient enough for all Americans. In which would allow the U. S. economy to acquire the medical treatments and preventative care when needed. As Halvorson said in his book, if we really want to reform the healthcare system, we need to focus on some key factor’s such as “1) Healthcare cost are unevenly distributed in America, 2)Care linkage deficiencies abound and can impair or cripple care delivery, 3) Economic incentives significantly influence health care” (Halvorson, 2007).
I think these are just some of the key factors the government should focus on. Now going back to the first key factor if we as nation work harder to provide necessary care for certain groups such as patients with Asthma, or Diabetes, and heart problems we could cut back on some of those unnecessary spending of having to go back and forth to the hospital. Second key factor we talked about care linkage meaning that we shouldn’t have to go to two or three different doctors for different diseases.
The Third key factor Economic incentives, by using incentives, healthcare purchasers hope to encourage patients to take action that either may improve the results of their treatment, such as selecting a high quality physician, reducing or eliminating high risk behavior and using preventative service; or may reduce costs by eliminating unnecessary visit to the emergency room. The need for reform is what our country needs because more people everyday are going with out healthcare, or for that matter going into debt, because all of the medical bills we can’t afford to pay.
There are many reason healthcare reform is one of the major subjects in the United States today. One of the main reason that’s stated in Healthcare Reform in America “compared to almost all other industrialized countries in the world today, the United States has not resolved some very basic issues about the role of the government in provision of care and assuring that all citizens are able to receive, good-quality care when they most need” (Kronenfled, 2004).
As time goes on decade to decade you notice that each president try to come up with the best reform plan that they think suits our country best. Does it matter what the public wants, or does it matter what the government say is the best for us. In the book Health care Reform: Ethics and Politics Talks about how more and more people are being priced out of the health care system. It also mentions that the healthcare system is being skewed more and more everyday to exclude those most in need such as our children and low income families.
The book also discusses how “Senator Dole claimed during the Clinton administration that there was no crisis in the healthcare and all it need was some find tuning” (Engstrom, Robison, 2006) Because healthcare is one of the biggest issues in the world, it should be addressed by everyone and not just the government. I believe once all these issues have been addressed, it will allow people to feel the confidence that knowing their coverage want rise within the next month or two.
Furthermore, it will make America just that much better for our kids and us, to know that we will have affordable, adequate, efficient, patient-centered healthcare insurance.
References Engstrom, T. H. & Robison, W. L. (2006). Health care reform: Ethics and Politics. Rochester, NY: University of Rochester. Families USA (1997, September). AChildren’s Health Insurance Factsheet. Retrieved October 14, 2008 from, Web site: http://www. familiesusa. org/resources/publications/fact- sheets/expanding-medicaid-is-the-best-option. html Haaland, R. (2007, January).
Why healthcare is so expensive? Retrieved September 13, 2008 From, Web site: http://leftinsf. com/blog/index. php/archives/1527 Halvorson, G. C. (2007). Healthcare reform now! : A prescription for change. (1st ed. ). San Francisco, CA: John Wiley & Sons, Inc. Kronenfled, J. J. & Kronenfled M. R. (2004). Healthcare reform in America: A reference handbook. Santa Barbara, CA. Devry University. Massage & Bodywork (2005, January). Healthcare in poor shape. Consumers Health Complete, 19(6), 13-13. Retrieved October 3, 2008 from EBSCOhost database. Medicare (2008, May).
Retrieved October14, 2008 from Social Security Online. http://www. ssa. gov/pubs/10043. html O’Brien, S & About. com (2008). Baby Boomers and Healthcare: What are the problems and what can be done? Retrieved September 11, 2008 from, Senior Living Newsletter Web site: http://seniorliving. about. com/od/manageyourmoney/a/healthcarecosts. htm Understanding the Difference Between HMO, PPO, and POS. , (2004, September 16).
Retrieved September 30, 2008 from Health Insurance Center Web site: http://www. insurance. com/article. aspx/Understanding_the_Difference_Between_HMO,_PPO,_and_POS/artid/70.