Managed Care Arguments

What do you think about this request? On my opinion we shouldn't place the claim on hold b/c we don't know for sure if Medicare will go back date it her coverage.If we place the claim on hold the patient don't go to receive the statement and we don't know if the patient will be continue to f/u her issue with her insurance. What do you think?

State oversight of managed care generally focuses on two aspects: the techniques and processes used by a payer, and in particular an HMO, to deliver or arrange for the delivery of health care services to enrollees, and the organizational structure of the payer. (Kongstvedt 596)

The arguments for/against ObamaCare health care are extensive. This giant law has so many parts that the average American does not even know what is really in this bill. The main supporters argue the bill is constitutional. They believe it is constitutional on three different "powers" of congress under commerce/interstate activity, the necessary and proper clause and the taxing and general welfare clause.

Managed care and its competition is being viewed to solve their issue on the struggle to control

It was interesting that Medicaid is different in all states and they all use different criteria to determine eligibility. I agree that all states should expand their coverage based on the Affordable Care Act and it should not be optional but mandatory. It was also interesting to learn that Medicaid not Medicare is the primary payer of long –term services or the patient if they are not eligible for Medicaid. I believe Medicaid is needed and it should be given to the less advantaged individuals because everyone should have access to health care no matter what.

Many paths will lead to the same goal, but which one is the right one for you? This question revolves around the highly debated Affordable Care Act which saves many lives each year and yet different demographics consider repealing this act necessary without a plan to replace it immediately. Because the Affordable Care Act prevents the escalation of diseases and the deaths of the thousands of Americans, the act should not be repealed but only revised to save lives and progress the country in the direction in universal health care because everyone deserves health care. The Affordable Care Act sparked a debate between Democrats and Republicans when President Obama enforced it in 2010 and continues to do so because the amount of control it gave

HMOs multiplied rapidly with the new federal giveaways. Managed care, now including PPOs, mushroomed. Employers initially perceived managed care plans as cheaper than traditional fee-for-service insurance. Gradually, they stopped offering a choice of health plans, making individual policies more expensive. HMOs' penetration of the industry had been subsidized into existence. Government had instituted managed care. Today, while overall quality of patient care remains the best in the world, doctors practice medicine in an increasingly intricate web of rationing and regulations: Physicians are stripped of professional autonomy. As patients wander the maze of managed bureaucracy, costs rise and quality deteriorates. Every American dependent on a third party for health coverage is a potential victim of managed care. And state sponsored management of medicine

As a group, HHS (Health and Human Services) says, these people “have been particularly vulnerable to insurance industry abuses” and face barriers to obtaining care from qualified providers to help them. Not only does the Affordable Healthcare plan provide a safety net for citizens living with HIV/AIDS, it also expands Medicaid so that those with low incomes can get early access to treatment, while also eliminating limits on their lives. Many citizens living with HIV/AIDS have issues obtaining health Insurance because of their pre-existing condition. At the same time these citizens can not apply for Medicaid because some of them are not ‘sick’ enough to be considered ill or disabled and the government thinks that people have to be in a bad condition

Throughout the last half of the 20th century, employers have acted on their own to regulate health costs by requiring employees to join health maintenance organizations (HMOs). More than 100 million Americans are under managed care. However, many patients and doctors complain that HMOs impose too many regulations and sacrifice healthcare quality. HMOs are undergoing a high level of scrutiny due to criticisms that the network is controlling and jeopardizing the healthcare system of the nation.

Position on Topic: Obamacare is one of the most highly argued topics in today’s economics and politics alike. Many people believe that its goal of universal healthcare is a good thing and that healthcare should be a right as a U.S citizen. Others believe that Obamacare is a disaster causing people to pay more unnecessary taxes in order to compensate for people who are unable to pay for healthcare due to poverty status and is economically unfavorable. There are also people who believe it should be kept but many changes need to be made in order to make it effective. Considering both arguments, I believe Obamacare should be repealed and replaced with a new healthcare policy.

Health care regulations have developed in a lagging fashion throughout the history of the United States health care system. The regulations governing health care are a set of prescriptive rules that have cause the health care system to adjust and improve the quality of care provided to patients. Brennan and Berwick state, “functions for regulation aims at increasing equality in society. In health care, this sort of regulation typically involves efforts to increase access to health care.”2 These regulations have a had far-reaching effect on the safety, efficacy, cost, information, availability of medications. If a society does not have access to unadulterated medications, correctly labeled medications, and truthful information then there

Those against and those rooting for that of managed care agree that the existence of unconstrained health care on demand is declining. As health care costs push very high yearly, some say it 's time for all to comprehend that the medical healthcare industry has financial restrictions just like any other industry.

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

Health insurance is a kind of insurance. Medical and surgical fees are always paid by the insured. Medical insurance can reimburse the fee from illness or injury, or pay for health care providers directly, which usually included in the employee benefits package, as a kind of attractive employee quality. (Investopedia.com 2008) Eli Saslow (2011) in the book Ten Letters shows Natoma Canfield’s story about health insurance. Though Natoma Canfield’s pre-existing condition makes her rejected by nearly all insurance companies and make her live a miserable life, she still wants to have a health insurance. As time goes by, the rate of health insurance fee keeps inflating until she can’t pay for the bill. (Saslow, 2011) This kind of example is quite normal in American, which shows the health insurance is one of the essential parts of daily life, especially for those have low income.

Also, as government programs move to social assurance programs and contracting instruments as ways to expand coverage, the interdependence of public and private sectors has developed, Governments has also develop more rigorous in their regulation of the private sector in an effort to ensure quality. As regulations affect who can provide medical care, what types of treatments are suitable, pricing, taxation, and other features of the health care business, the private sector has well-read to work within the regulatory limitations that are set by the