There
are currently approximately 40 million Americans without health care. This is a
growing problem across America. There are many children, women, infants, plus
many others that go without any health care at all. Many people suffer because
of high insurance costs and lack of care. Even though there are a lot of
changes being made in the health care industry, there needs to be a balance
between essential and affordable so that people may receive appropriate care
without putting them into a financial crisis (Trapp 1). One of the biggest
questions, for many people, is how things can change for the American people.
Many people are struggling because
of high insurance premiums. According to a new Rand Corp. study, more than 40
percent of people’s income has been spent on health care over the last decade
(Rising Health Care Costs). Premiums have increased anywhere from 40-60 percent
(Pear). Even with the new health care reform, insurance premiums are
rising. Researchers have found after
interviewing 2,000 employers that insurance premiums rose three times faster
between 2010 and 2011 than they did the previous year. Premiums are costing the
American people approximately between $5,000 and $15,000 every year
(Healthcare).
Most
Americans are used to paying deductibles and co-pays, but these increases have
not only affected employees but also employers because of the increased costs
of premiums. Employers have to pay a lot more money to insurance companies,
making it harder to give necessary raises to their employees (Rising Health
Care Costs). Everyone is feeling the effects of this, particularly small
business owners. Americans cannot afford the high increases, because with all
of the increases on food and cost of living expenses, it has put people in over
their heads with expenses.
Some
of the changes that have recently been put in place by the government health
care reform could help those who have been diagnosed with cancer or other life
threatening diseases have the opportunity to receive appropriate care without
having their insurance benefits run out. Insurance companies, before some of
the recent changes, were able to put lifetime limits on their coverage forcing
people to go without treatments that were vital to their well being. Insurance
companies can no longer put the lifetime limits on the coverage enrollees
receive. Annual limits have also been restricted (Health Reform). This makes it so that families will feel some
relief and live within some comfort knowing that they will be covered if they
have a medical problem that needs to be cared for.
In addition to these things, insurance
companies can no longer drop coverage on a person if they become sick. Before
the reform was put in place, a lot of insurance companies dropped enrollees
simply because they did not want to pay the high medical costs. Besides this, insurance
companies are not able to discriminate against people with pre-existing
conditions. This will help many Americans receive the care that they need.
Furthermore,
it has also made it so that young adults can be added onto their parents
insurance until the age of 26, unless they are offered insurance through their
employment (Health Reform). Most young adults cannot afford to pay for their
own health insurance. Hopefully having this option available to them will help young
adults be more aware of their health needs. Therefore if any problems arise
they can be addressed before they become problematic and costly.
The recent changes bring us to
another point of how they will affect the American people in the long run. Not
only physicians and hospitalists, but many others are worried about the long
term effects from the new changes. Will all of these changes be a benefit to the
American people or is it going to cause more problems over the next decade.
Many changes have taken place over
the last several years. Having worked in a medical office for the past 16
years, I have experienced the ups and downs of insurance. There are a lot of
people that go without insurance simply because it is too much money. We have
had patients tell us that the costs of their medicines every month are costing
some well over five hundred dollars. We also have had patients that have been
dropped off of their insurance coverage because of surgeries or other test that
have been performed. With the research that I have read, and the knowledge I
have as a medical biller, the new health care reform gives the American people
a chance to be put on an insurance plan regardless of any preexisting condition
they may have had. Although this may drive the insurance premiums even higher
than they already are.
One
of the most recent changes that have been made is making preventative health
available to all patients. The insurance companies have to pay preventative
care at 100 percent., Preventative tests include, yearly preventative visits
with a physician, mammograms, colonoscopies, immunizations, prenatal and baby
care, plus many other preventative tests, Many people wonder how insurance
premiums will ever be lowered. A lot of people today don’t go in to see their
physician every year. Having these entire preventative tests paid at full
coverage, makes people believe that it will cost the insurance companies too much
money, making it so that down the road it may be causing more problems than we
have now.
On the other hand there are many people who
believe of the importance of preventative medicine. A wellness exam is when a
patient goes to the doctor for no other reason than a general overall checkup,
similar to a routine physical. This past year patients have been using this
benefit. Many people like this benefit because they feel that they are
receiving something back for all the money that they put into their insurance
plan each year. If this plan can stay in effect, and people take advantage of
it and make the best of it, then over the next several years we could be on our
way to a healthier society.
The
government implementation of the new health care reform is in high hopes that if
patients receive appropriate preventative treatments it will cut medical costs
significantly. Many people would also agree that they would like their medical
costs to be decreased. Screening for things such as high blood pressure, blood
sugar, and high cholesterol is not only inexpensive but will help identify
problems, making it possible for them to be controlled early. He states that
people who receive proper screening usually live longer and healthier lives.
They also save a substantial amount of money where they don’t have to pay high
medical bills. Benjamin also says that “If the preventative fund survives for a
long period of time, it may help our current rising health care costs.” (Benjamin).
Everyone
wants to have the opportunity to benefit from health care. The government is
trying hard to make changes that will help the American people so that they
will be able to receive the care that they need. Giving the incentive for
people to go in and receive their preventative care screening and testing will hopefully
make the long term effects of all the changes be more beneficial and not
catastrophic.
Another
idea given is capping expenditures. White argues that the only way to constrain
the rising costs of health insurance is to cap the expenditures. Medical costs
need to be controlled. He mentions that a big factor of the rising costs is
from pharmaceutical companies, hospitals and physicians. There are many people
who are paying hundreds of dollars every month for medications. Some seniors
that live on tight budgets are being hit the hardest. Some patients have to pay
hundreds of dollars a month just on prescriptions, not including the money that
they have to pay on insurance premiums.
Medicare
premiums are expected to rise over the next several years considerably. This
year the deductible per person for Medicare is $165.00. Three years ago it was
only $100.00. When a person reaches the
age 65 they qualify for their Medicare benefits. If caps are put on Medicare
and Medicaid it will force the elderly to pay even more money on the yearly
deductibles that they have, not only with their primary insurance but also
their secondary insurance premiums.
Another
problem is how some prescriptions are overpriced. Testing is done by drug
research companies which drive some of the costs of medications up. Although it
is necessary for testing to be done in order for new medications to be put out
on the market because it will help find new treatments for different diseases
and illnesses. The American people should not have to pay the high costs that
are charged when new medications are put out on the market. There should be
more federal money involved with the studies and research that goes into
developing new medicines.
Once a medication is tested and put out on the
market it does not have a generic until the money is recouped from all of the
research and testing that was done on the product. Many people would agree that the prices have
to cost more for new medications when they first come out in order to pay for
the research that was done. On the other hand a lot of the research that was
being done in our country is being done in other countries, making it so that many
of the research companies are also struggling.
There
have been many changes made over the past several years with the pharmaceutical
companies, there needs to be more made to help cut the costs for the American
people. They have already made thousands of cuts in jobs and also have been forced
in cutting their incentive programs for physicians. Several years ago
pharmaceutical companies were allowed to give physicians money and gifts for
prescribing their companies drugs. Some of these gifts included buying not only
small gifts but huge gifts such as snowmobiles and boats. There was also a lot
of money spent on trips and dinners for the physicians, their family and staff.
This played a big part in what drove the costs of medications up considerably.
Even though there have been many changes, there still needs to be more
observation on the monies spent by the pharmaceutical companies (White 485-489).
The
American people have questions of why some people that have insurance get
charged higher prices than those who don’t have insurance when going to the
hospital or doctors office. Insurance companies along with the government set
the prices that can be charged to patients. The interesting thing here is that
all insurance companies don’t charge the same amount of money. Even though they
are supposed to follow what the government has set for limits to what a
physician or hospital can charge, a lot of doctors are charging what they want and
not accepting insurance. This is making it so that the patient has to bill
their own insurance and a lot of times the insurance companies will not pay for
the amount that has been charged, making it so that the patient is stuck with
the remainder of the bill. It would be a good idea for someone to make sure
that the doctor they are seeing will accept their insurance before making an
appointment with them. This will help cut the out- of- pocket expenses.
Many people after they pay their deductible or
co-pays are still left paying a percentage of the services rendered. There are
a few reasons why people who are self pay are getting charged less money. One
of the reasons is because every year there is many people who donate hundreds
of thousands of dollars to hospitals to help with those in need. These donations
are used to help people so that it is not a huge burden on their pocket book. One
example of this would be the money that is donated to hospice patients. Money
that is donated helps the patient and family so that they can pay for expenses
that they would not be able to pay for themselves.
One
of the biggest reasons that people who do have insurance are charged more money
is because that when the hospital or physician has to send a claim to the
insurance company, they have to sometimes rebill the insurance company several
times before they receive payment, making it so that the hospital or physician
has to pay out more money to their employees. Even though this may seem unfair
to some people, the fact is that when someone pays private pay, it cuts down on
the amount of time spent on billing.
Another
look on the current problems with our health care system is from Kahn, who says
that the United States spends twice as much on health care as they do food. He
argues that there needs to be more quality care rather than physicians sending
their patients for unnecessary tests. Many people when they are sick go to see
the doctor and then are being sent for tests. A lot of the time the tests
ordered has nothing to do with why they are sick (Kahn). Many of us probably
know of someone that has felt this way before and wondered why we were being
tested for something that didn’t seem to have anything to do with the illness.
We have the right to ask our doctor why certain tests are being ordered, and we
also have the right to choose not to have certain tests done. Although we need
to remember the importance of some testing needs to be done in order to find
underlying health issues.
On
the other hand, there are many doctors who are charging people for services
that the patient never received. In the podiatrist forum there are articles of
podiatrists that were charging insurance companies thousands of dollars for
simply clipping the patients toe nails. John S. Lanham a podiatrist in Wisconsin
charged his patient Cliff Blake $4,378.00 for simply giving him cortisone shot
and an armful of foot and ankle products. This normally would cost someone a
few hundred dollars, if that, and most of the time the insurance will pay for
most of the cost. This is just one example of how Lanham has overcharged his
patients.
Another example is of a women going in and
being charged $1700.00 for a medication that only costs $15.00. “A few years ago, patients complained about Lanham's
high bills to the state podiatric society. That prompted an investigation into
the doctor on suspicion of fraudulent billing. The state eventually suspended
him for 90 days.” (Country Specific Issues). There have been many other
physicians in the country that have also been warned to quit overcharging their
patients. Lanham is not the only physician in the country to overcharge
his patients. Kahn states that there are no limits on outpatient services.
Something needs to be done to help Americans get the proper, good quality care
that they deserve. This is another reason that there should be caps put on what
physicians can bill. If physicians can charge whatever they want to, it will
definitely cause money issues for the American people.
Insurance
companies are now making it mandatory for physicians to get preauthorization
for many tests such as MRI’s and CT scans. Several people in local physician
offices have said that this has caused a big problem when a patient comes in
with a problem and the doctor orders a test. Sometimes they do not get approval
from the insurance company for several days. Recently, we had a patient come in
our office that was in severe pain. The doctor ordered an MRI to be done. The
test was scheduled and when the patient went over to the hospital to have the
procedure done, she was told that they could not do the test because it had not
been approved by her insurance company. In this particular situation, the
patient had to wait for seven days until it was approved by her insurance. This
makes it unfair for patients to have to wait for approval from their insurance
to receive the necessary tests that have been ordered by their physician. If a
patient has to wait for approval, especially when they are suffering from
severe pain or other ailments, there may be other problems in the long run.
Most patients feel that the insurance
companies should not have the final say of whether a patient needs a test that their
doctor has ordered. It should be the one who went to medical school and
received the education and has the knowledge of what to order for certain
symptoms. Not the insurance companies, especially when the doctor is the person
taking the responsibility in caring for the patient. Even though there are
physicians that order tests that are unnecessary, sometimes it takes those
tests to find other underlying issues that a patient may have. Sometimes it is
hard for the patient to understand how things all work.
We
need to have a strong government in order to cap the expenditures so that we
gain control. If America would follow examples from other countries, with the
caps that were placed on physician spending, we would probably see dramatic
effects similar to those in other countries (White).
Some
caps have already been placed on flexible spending accounts. People are only
allowed to put a certain amount into this type of an account and if it is not
used by the end of the year they lose it (Carter). A lot more people are
choosing the Health savings account or health savings reimbursement. The reason
for this is so that if you don’t use the money that they have put into these
accounts they can roll it over into their IRA. Other caps being placed might
have a big impact on Medicare and Medicaid benefits.
A
great benefit to physicians and patients is that they have the support from the
American Medical Association. This company was established in 1847. AMA’s
mission is “to promote the art and science of medicine and the betterment of
the public health.” AMA puts forth an effort to help doctors help their patients.
They say that the most important thing is uniting physicians nationwide in
“professional and public health issues.” The main goal for the American Medical
Associations is to ensure the essential health benefits package is affordable,
maximize the number of insured, protect the most vulnerable, encourage better
care practices, focus on high value services and protect against catastrophic
events or illnesses. In 2011 their strategic plan focuses on five areas, access
to care, quality of care, cost of health care, prevention and wellness and
payment models that encompass the central elements in health system reform.
These topics represent the major areas of emphasis in which the AMA carries out
its mission in the current environment. (AMA)
Another
benefit to the American people is the different health savings plans that are
available to them. Carter says that having a health savings account with an
employer matching what you put in is a great savings plan. Many people don’t
take advantage of the different accounts that they could be benefiting from.
The health savings accounts let a person put money into an account, and then
they are able to use these funds until the age of 65. Many people do not know
of the different health savings plans that are available to them. He would
advise that you ask your employer or insurance company.
An idea that could be an incentive for the
American people is if they put money into an insurance plan and they don’t use
it on trivial things, they could receive a reimbursement for part of the money
or roll it over into a savings plan. With how are economy is, more and more
people are opting for high deductible insurance plans because having to pay for
a full coverage, medical insurance plan, is costing too much money. Insurance
companies have made high deductible plans available with high hopes that if the
person has to pay a lot of money out of pocket it will force them to be better
managers of their own health. This could also help with preventative care for
those who take care of their health (Healthcare).
Families
are finding it harder to pay the high premium costs, therefore a lot of people
are living without any health insurance coverage. There are many who go without
any health care at all making their life more difficult, especially when they
are suffering from sickness or disease. In the long term, hopefully the new
health care reform will help slow down medical expenses. With all of the
problems with health care that we have in America, people cannot wait for the
long wait. Changes need to be made now, not just for the future.
Can
the health care issues ever be resolved? Many researchers believe that they can
be improved but it may take many years for the necessary changes to take place.
Whether it is that we put caps on the physician spending, making preventative
health care mandatory, or having people put more money into health savings
plans. It may not be soon enough to see the effects that are needed in the
country today. Pear states that, “the true issues of rising premiums will never
be resolved until the cost of health care itself is addressed.”
Many people over the last 20 years have seen
many changes come about with the health care industry. It used to be that a
person could go to one doctor to be treated. Now people sometimes have to go to
several different doctors in order to receive the treatment that they need.
This not only drives the costs up for the patients but makes it harder for
those who do not have any insurance at all, unable to receive the appropriate
care that they deserve (Trapp).
There
are high hopes and expectations that in the next few years, with all the new
changes being made, that we can become a healthier and stronger people. Many
other countries have seemed to function just fine with the health care laws in
place. Why is it that when it comes to health care, America is struggling more
so than seen in other countries? We as Americans need and deserve changes now
so that we can receive the care and treatments that we deserve without paying
high premiums. Hopefully, over the next few years we will see changes that will
benefit us and not cause more problems than we already have in this country.
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