Not only are costs increasing, but the choices of a health provider are decreasing. Employees who once participated in the PPO programs are now being forced to sign on with HMOs because their employers are making the PPO too expensive, and not covering enough of the costs32. In this way, PPOs are essentially being phased out in exchange for more frequent HMO usage. Besides cost, one of the main reasons that many choose not to subscribe to healthcare is because they feel that the availability of emergency room and free charity care is abundant, and can be utilized if necessary33. However, by not having insurance, and waiting until an emergency situation to see a doctor (such as not going to the doctor for lower abdominal pains but instead waiting until they are unbearable, and then going to the emergency room and finding out one needs hernia surgery), drives up costs, as emergency rooms are extremely expensive to utilize.
By far the largest criticism of the American healthcare system is that of the HMOs. HMOs have started to ration care in an attempt to try and lower their costs, and in turn have caused disputes over who should get healthcare. “HMOs that are serving the lowest-income population on the state’s dime are making huge profits. It’s a great time to be an HMO investor but a bad time to be a patient,34” said Jerry Flanagan, who is a director with the non-profit Foundation for Taxpayer and Consumer Rights.
All HMOs require ‘preauthorization’ for specialty procedures to ensure that reimbursement will occur, and that the procedure is indeed necessary and recommended by a doctor. HMOs have also been criticized for limiting patient’s access to emergency rooms, access to specialists, and access to new and experimental treatments by paying for none or virtually none of these services35. Because HMOs have started to ration health care, Americans began to demand the right to sue their HMOs for not providing adequate and speedy treatment, which often times leads to the death of loved ones who don’t receive proper healthcare in a timely manner.
Another criticism of HMO overage is the widespread lack of prescription drug coverage. Prescription drug costs and coverage is often a main debating point. As prices continue to soar for these sought after drugs, patients are searching for other cheaper retailers, such as online drug wholesalers and other countries. This has led to the creation of a ‘prescription drug black market’. Horror stories of diluted drugs, fake prescriptions and contaminated drugs that have been available on the market, are the new reality of prescription drugs in the United States. These black market drugs are mostly unbeknownst to patients who, in an attempt to save money, are blind to the fact that it could cost them their lives36.
Health care in the United States is based on four major pillars, often referred to as “the diamond”. The diamond includes: high quality care, freedom of choice, efficiency and cost control, and equity and access37. As Americans, we want to have all of these four categories when it comes to our healthcare, and are not willing to sacrifice one in exchange for the other. Every individual would love to choose an extremely certified and highly educated doctor, while paying an affordable amount, at any hospital in the United States. However, being realistic, experiencing these four points to the fullest extent is not a feasible reality. We must decide which qualities are the most important to us, and from there devise a healthcare system that attempts to provide the majority of the components in a cost efficient and effective manner.
The Canadian system emphasizes the equity and access point, by providing undeniable basic care for all residents, however the United States does not. Canada also manages all costs so the patients are not burdened with excess bills and fees, whereas the United States almost always requires the patient to intervene financially, and pay at least a small fee for all services if not a larger percentage.
Both Canada and the United States provide high quality primary care for most patients, but the United States greatly outweighs Canada when it comes to the quality of specialized procedures and treatments. Not only does the United States provide more widespread access to elective and other surgeries, but also the wait to have an operation performed is often times much shorter than the wait that is experienced in Canada. Another downside to the Canadian system is its impact on immigration laws. If a person attempts to move to Canada after the age of 50, they are often not granted access because the government views the person as a loss of economic funds, since the person did not contribute to the healthcare system economically like other Canadian residents, but will undoubtedly utilize the resources as they age.
In both countries, primary care physicians are often the gatekeepers to seeing a specialist, as a referral is almost always needed in Canada, and is usually needed in the United States unless one pays extra for a selective health coverage plan. However, Canadians are allowed to choose their primary care physicians, whereas most insurance plans in the United States have designated/contracted partners with which a patient can be treated.
In a study done by the Center for Studying Health System Change, HMOs and non-HMOs were compared in relation to the four goals. They found that HMOs lowered the financial barriers to care, but they raised administrative barriers to specialized care (i.e. a patient must go through the HMO gatekeeper and have their specialized treatments ‘preauthorized’ in order for it to be covered, but once the treatment is approved, the wait is usually minimal).
While Americans are segregated about selecting a new health policy for the citizens, most agree that major changes need to be made to the system for it to function adequately in this new millennium. Managed care has far too many flaws for the program to continue for much longer, especially as more and more HMOs are being held accountable for the quality and timeliness of the healthcare they provide, which will cost them millions.
A new proposal, Medical Savings Accounts (MSA’s) could be in the future for United States healthcare. Proponents think that MSA’s will work because they employ opposite ideas than those of managed care. MSA’s lower the participation of a third-party payer system and allow patients to pay more out of pocket to see a more qualified doctor. This is appealing to most upper middle class and upper class families, who believe that it is their right to contract higher quality healthcare if they can afford it. They also lessen the administrative burden, and attempt to put the patient in a position of power. MSA’s also encourage the patient/physician relationship, and believe in innovative medicine. They encourage not only treating the specific problem, but the whole body and person. MSA’s also allow patients to play a larger role in their own healthcare, which HMOs do not38.
Milton Friedman, a proponent of the MSA program, believes it holds the key to solving many of the current problems with healthcare in the United States. He states: “Yet it seems clear from private experience that a program along these lines would be less expensive and bureaucratic than the current system, and more satisfactory to the participants. In effect, it would be a way to voucherize Medicare and Medicaid. It would enable participants to spend their own money on themselves for routine medical care and medical problems, rather than having to go through HMOs and insurance companies, while at the same time providing protection against medical catastrophes…This reform would solve the problem of the currently medically uninsured, eliminate most of the bureaucratic structure, free medical practitioners from an increasingly heavy burden of paperwork and regulation.”
Friedman is convinced that implementing the MSA program would help both families and the government, as well as the future of healthcare in general, because patients would receive treatment for their health, without worries of insurance reimbursement and coverage. As with all healthcare plans, downfalls with the MSA also exist. First, skeptics are worried that the program will create an even further gap between the rich and the poor; the rich will be able to afford cutting edge technology and can hire best providers, whereas the poor might not be able to afford basic healthcare.
In addition to this, people are worried that a distinction between the healthy and the sick will be made, and cherry picking will occur (i.e. some companies will only insure the healthy, not the ill in order to save money)40. People who are sick will use all of their funds that are in their MSA account, whereas people who are healthy will be able to accumulate their health savings and save up in case of an illness later in life (such as cancer therapy or cardiac surgery) This makes MSAs a poor health choice for those who get severely ill at a young age, and those who have chronic syndromes. These two factors make establishing a socioeconomic and health blind insurance system difficult, even with the idea of MSAs.
Many Americans look at the Canadian-style healthcare system and cannot fathom establishing such system in America. However, the MSA is not as large of a change in policy as is the Canadian-style government, but it does propose ways to provide healthcare in a more economical and medically sound approach as opposed to HMOs. This is why the MSA program is being seriously considered as a viable healthcare option in the United States
Another threat to the current United States health system is aging of the Baby Boomer generation. As people begin to live longer, there will become an increasing need for more geriatric care in the United States. Because of the unusually large population of the Baby Boomers, the United States is experiencing changing demographics as the Boomer generation grows older. Currently, the rate of elderly people is doubling, while all other age populations are remaining virtually the same. As Ken Dychtwald, health and aging expert believes, the longevity of people is being extended tremendously as cutting edge research and technology is searching for the answer to human enhancement and life extension.
Dychtwald emphasizes the impact of science on life extension, and how new research about nutrition, hormone therapies, bionics and organ/gene cloning will essentially allow people to live until 100 or older, and then their body will fall apart due to usage. He also poses the idea that if science can find a way to eliminate or cure Alzheimer’s disease, the population will have a chance at living an even longer life; as Alzheimer’s attacks the brain, which is the main control system of the body.