Managed Care Arguments

Some of the pros for managed care are; Preventive care — HMOs pay for programs, they are set up and are intended at keeping one healthy (yearly checkups, gym memberships, etc.)The idea is, so they won 't have to pay for more costly services when and if one gets sick. Lower premiums — Because there are limits set as to which doctors one can see and when one can see them, HMOs charge a premium and usually they are lower premiums. Prescriptions — As part of their precautionary retreat, most prescriptions are covered by HMOs for a co-payment that also can be very low. Fewer unnecessary procedures —doctors are given financial incentives from HMOs , to provide only needed care, so doctors are less likely to

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 Considering both arguments, I believe Obamacare should be repealed and replaced with a new healthcare policy.

Lastly, another popular stance among the opposition is that universal health care is nothing more than welfare, and therefore freeloading off the government. That people who didn’t have insurance weren’t properly preparing and deserve what they get. The examples given in support for this are that only those citizens who are lazy or unwilling to work would ask for such a handout from the government, or that an uninsured citizen didn’t make positive life choices and should get what they deserve. These arguments are difficult to argue against because they are erroneous. While there is a chance that a small amount of the population will fall into the category of lazy and unwilling to work, the number of Americans in need that would benefit from the system would be greater. Also, the people who they assume would abuse the system would already be abusing the current welfare or Medicaid systems. As for those who didn’t properly prepare, poverty stricken families that are unable to afford insurance shouldn’t be continuously punished by keeping a system that doesn’t afford them a fair chance to flourish.

The number of employed doctors has dropped sharply, while salaries from hospitals increased. The four largest health insurance companies in the US denied coverage to more than half a million individuals because of there pre-existing conditions from 2007- 2009, according to a congressional investigation ( US health care Oct 12, 2010). Another roll was that federal government will step in to ensure that the Obama administration healthcare reforms are implemented in every state ( Kathleen Aug 18, 2010). The people of the researchers say that it is all about power. The less the American people know about the facts, the greater the hospitals and insurers gain power. The U.S health care system is the midst of a ferocious war (1). There is only one group that can prevent this damage.

The challenges in our US healthcare system are not new, over the past three decades we have seen an increase in our population, significant fluctuations in our overall economy which increased unemployment, and a growth in health disparities. Unlike, other countries such as Canada, Australia and Europe the United States does not provide a unified healthcare model run by a primary agency for its legal residents. The insurance companies and pharmaceutical companies have been the primary stakeholders in the US system and have continued to profit. It is common knowledge that pharmaceutical companies sponsor diseases and promote them to prescribers and consumers (Moynihan, Heath, & Henry (2002). Since there

The American Health Care system needs to be constantly improved to keep up with the demands of America’s health care system. In order for the American Health Care system to improve policies must be constantly reviewed. Congress still plays a powerful role in public policy making (Morone, Litman, & Robins, 2008). A health care policy is put in place to reach a desired health outcome, which may have a meaningful effect on people. People in position of authority advocates for a new policy for the group they have special interest in helping. The Health care system is formed by the health care policy making process (Abood, 2007). There are public, institutional, and business policies related to health care developed by hospitals, accrediting organizations, or managed care organizations (Abood, 2007). A policy is implemented to improve the health among people in the United States. Some policies

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes

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?

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.

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

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.

The constituent contacted the GAO asking why her father got denied Medicare. Her father is residing in California and he came to visit his family in Oregon.He needed to see a dentist, so he applied for OHP, but got denied. The constituent was informed that her father cannot receive Medicare in two states at the same

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

At the level of regulations, these are generally multiple and a complexity is revealed at the level of compliance. The difficulty in compliance can be generated by a wide array of forces, such as insufficient knowledge of the firm, or even the fact that diverse policies apply to diverse institutions. In such a setting then, the means in which the regulations are applied to the health care institution depend on a wide array of traits, such as the size of the organization, the nature of the services and / or medical products it delivers, the ownership of the entity (i.e. publicly traded or owned by the government) and so on (NetIQ, 2006).

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.