One of the greatest issues facing the nation today is the number of people who do not have access to health care coverage. Americans are struggling to pay medical bills and are accumulating medical debt at an alarming rate. Approximately two-thirds of the working-age population are uninsured or underinsuredand did not seek health care due to the cost."More than two in five adults in the 19-to-64 age group reported problems paying medical bills" (Quality of Care, 2010). Their difficulties include not being able to afford medical attention when needed, running up medical debts, dealing with collection agencies about unpaid bills, or having to change their lifestyle to repay medical debts.Health-care costs are limiting what the consumer can pay for daily necessities. Of those facing mounting medical bills, "39 percent used all their savings, 30 percent incurred large credit card debt, and 29 percent said medical bills left them unable to pay for basic necessities such as food, heat or rent" (Nicholson, 2010).
By the 1960's, the system of private health insurance in the United States was well established.Public programs provided the primary source of coverage for most senior citizens and for low-income children and families who met certain eligibility requirements.One of the primary public programs is Medicare, a federal program approved by Congress in 1965 for seniors and certain disabled individuals that consisted of two separate parts.Part A represented the hospital insurance program that people were automatically enrolled in at age 65 and Part B provided supplemental medical insurance for physician services.In contrast to Medicare, Medicaid was developed and funded jointly by the federal government and states, to cover expenses for certain very low income children and their families who could not afford private coverage."In 1966, Medicaid provided benefits for 10 million recipients.By 1999, 37.5 million people receive care under Medicaid" (Henderson, 2002, pg. 433).
Today the number of people without health insurance has drastically risen over the past few years.According to the U.S. Census Bureau "47 million people, or 15.8 percent of the U.S. population, were without health insurance during 2006 - a 4.9 percent increase. In 2005, census figures showed that 44.8 million people, or about 15.3 percent of the population, lacked health insurance coverage.The number of uninsured Americans has increased 22 percent since 2000, at which time 38.4 million people lacked health insurance." (Nations Health. 2007; 37(8) © 2007 American Public Health Association.)
So what happens when the uninsured need access to health care?Most rely heavily on the emergency room to provide them the care they need.According to a national ambulatory care survey "emergency room visits have increased by 20% since 1995" (Sultz, H., Young, K.2009; 133(4).Health Care USA. Jones and Bartlett Publishers).The number of free care and self pay patients has also increased due to the economy and high unemployment rate. There are a number of patients that use the emergency room as a free clinic for minor illnesses or chronic problems that would be best suited to a regular doctor's office.According to Health Care USA, 2009 edition, more and more people are "utilizing emergency rooms as a basis to obtain routine medical care or a quick fix for chronic illnesses that would be better served by a specialist due to the fact that they have no insurance or cannot pay" (2009.Health Care USA).The influxes of non-paying or underinsured patients who arrive at the emergency room for treatment are driving the cost up while driving the quality of care provided down.While emergency room physicians are trying to quickly free up rooms due to the greater volume of patients, they might overlook an important symptom that they might not have otherwise missed.This will lead to more cases of medical malpractice.The physicians will then also be forced to increase their charges in order to cover the high rates of medical malpractice premiums being charged by the insurance company.That cost will then be referred down to the consumer.
Emergency room budgets are set up to care and provide services for patients with acute illnesses.Federal law does compel hospitals to provide emergency health care, but does not fund that mandate."Hospitals must absorb the cost of patients who can't pay for treatment, and to offset the losses, they often hit uninsured, middleclass paying patients with bigger bills because the hospital is not bound by the much lower negotiated fees they are paid by insurance companies.In other words, whether you are paying out of your own pocket or you are relying on your own health insurance to pay for your treatment, a percentage of every hospital's bill is a provision against bad debts from the uninsured" (Managed Care Law Weekly, 1778.Retrieved August 15, 2010).So this will in fact raise the cost of medical care for the consumers who can afford it in order for those hospitals to maintain their profit margin - otherwise smaller hospitals will be forced to shut down programs in order to keep their doors open.If every patient had access to insurance to help pay for services, that would eliminate millions of dollars each year of lost revenue for hospitals.
One of the focuses being raised in the new health care reform bill is that preventative care is important for everyone's overall health and well-being.When the new health care reform is enacted, it will help to provide all Americans access to medical insurance.People who in the past have not been able to afford medical care or regular checkups, will finally have the means available to them to establish care with their own health care physician.They will finally be able to afford medications and routine diagnostic testing (i.e. mammograms, lab work, sigmoidoscopy, etc) to prevent hospitalizations or routine visits to the emergency room."Studies have shown that regular visits with the same physician over time leads to better health and lower overall cost of care" (Joseph Nicholson.(2010, June 8). Commentary: Office Visit: Moving from careless to wellness. Journal Record, Retrieved September 6, 2010, from ProQuest Newsstand. (Document ID: 2058015621).
It is my hope that if everyone has access to quality health insurance, patients will be referred to the appropriate facility for treatment.Let me give you an example - I worked in a hospital emergency room and one night all the exams rooms were tied up with patients who had either minor illnesses or chronic medical problems.We had a patient come in who could not breathe due to an acute asthma attack.We needed to rush that patient in for treatment before their condition worsened resulting in either their airway closing or death.Because all the rooms were tied up with non-emergent patients, we had to treat that patient in the hallway.So yes all patients deserve to be treated and given high quality medical care, and yes hospitals are obligated to provide that care, but the issue remains that health care has seen a rising of cost and negligence cases due to the inappropriate misuse of emergency rooms.I only hope that with the health care reform, we will see a change in this by enabling all to receive quality medical insurance coverage.
However as consumers, we must also take a look at why insurance company premiums are so high that the average consumer cannot afford them.This is a difficult question to address because there are so many areas to consider.One consideration is that the government should be responsible for setting guidelines and establishing oversight committees to watch over insurance companies to ensure that they are providing adequate coverage for all Americans.There are so many people who do not have the ability to pay for insurance due to the high premiums being charged.With the new advances in medical technology growing every year and the costs associated with them, the insurance companies are increasing the percentage of premiums charged to employers who have no option but to increase the cost to their employees."The average worker with a family plan was hit with a 14 percent premium increase this year, pushing the bill to nearly $4,000 a year, according to a survey by the nonprofit Kaiser Family Foundation and the Health Research and Educational Trust" (Noam N Levey.(2010, September 3). Benefits cost workers more: Survey shows employees are asked to shoulder entire increase in health insurance. Chicago Tribune, p. 21.Retrieved September 6, 2010, from Chicago Tribune. (Document ID: 2128253731).
"That is the largest annual increase since the survey began in 1999 and a marked change from previous years when employers generally split the cost of rising premiums with their employees.Indeed, the average employer contribution to a family plan did not go up at all.At the same time, nearly a third of employers reported that they either reduced the scope of benefits they are offering this year or increased what workers must pay out of pocket for their medical care.Workers saw average co-pays for routine office visits rise 10 percent and deductibles continue their surge upward.In 2010, more than a quarter of American workers with employer-provided health coverage had deductibles of at least $1,000" (Noam N Levey; 2010, September 3. Benefits cost workers more: Survey shows employees are asked to shoulder entire increase in health insurance. Chicago Tribune, p. 21.Retrieved September 6, 2010, from Chicago Tribune. (Document ID: 2128253731).
I personally know of a family who is faced with just this dilemma.They are a middle class family of four.Both parents have good jobs (the wife works as a part-time teacher and the husband is a manager for a small law firm).The insurance for their family is provided by the husband's job. Because the law firm he works for is a smaller business (just around twenty-five employees), they are charged much higher premiums than other firms because of the size of the company.They can barely afford the cost of medical insurance for their family.They also have a child who has extensive medical needs (seizure disorder).So basically what the mother earns at her teaching job goes directly towards medical expenses and premiums.Hopefully with the new health care reform in place, the government will put a cap on what insurance companies are charging otherwise you will have families choosing between basic life expenses or the ability to obtain health insurance.
There is also a need to have oversight committees take a look at what insurance companies are denying for coverage.Where I work at the hospital, we have so many patients that have to jump through hoops just to get life saving medicines approved by their insurance company.You basically have an administrator on the other end of the phone (with no medical degree) stating what medicines they prefer the patient to be on and what testing is adequate or not.I personally do not understand this.Without giving specifics (patient confidentiality) I will give another example.We have a patient who has severe heart disease and is waiting for a transplant.The doctors have found that he needed to be on double the dose of a particular medicine that is quite costly but there is no generic form of this medicine available yet.The insurance company denied payment for the prescription because the higher dose was outside the "norm" of what is regularly prescribed.So even though he had tried the normal dose and developed severe complications which further weakened his heart, the insurance company would not reverse their decision.It took several weeks and multiple phone calls and letters to finally get it approved.In the meantime, the patient was hospitalized twice due to a worsening of his condition.How can this be acceptable?
The complexity of the healthcare system has resulted in a variety of problems for the American public.A recent study conducted by the American Health Journal found that "62% of persons declaring bankruptcy in 2007 had unpaid medical expenses of over of $1000 or more, and in 92% of these cases the medical debts exceeded $5000.The Medicare and Medicaid programs were estimated to soon account for 50 percent of all national health spending" (American Health Journal).These factors and many others fueled interest in an overhaul of the health care system in the United States.In the proposed health care reform bill, President Obama is hoping to provide more security and stability to people who have health insurance and will also establish guidelines for insurance companies regarding payment of expenditures.The insurance companies will no longer have free rein to do what they want.They will be held to a standard of providing access and quality of care to all.This new bill will also provide coverage for people who do not have insurance and will lower the cost of health care for everyone.However, there is a "strong possibility that insurance companies, which remain subject to state control, will raise their rates unjustifiably for the benefits, both to boost profits and to undermine support for insurance reforms" (New health reform benefits. (2010, August 17). Chattanooga Times Free Press, B.6.Retrieved September 6, 2010, from ProQuest Newsstand. (Document ID: 2112796951).This is where the government will need to step in and make sure that "insurance companies don't overcharge for new benefits and that state legislatures enforce the rules promptly" (New health reform benefits. (2010, August 17). Chattanooga Times Free Press, B.6.Retrieved September 6, 2010, from ProQuest Newsstand. (Document ID: 2112796951).
Once these bills are passed, it is my hope that one day, very soon, we may actual see a health care system that is more concerned with the public's health than how much money they can make off of consumers.
