Health System Reform in the United States: Impact of Rising Premiums and Opportunities for System Improvements to Enhance Access to Healthcare Services
The purpose of the coursework is to undertake a critical analysis and an assessment of the level of competition in the insurance industry of the country of our choice. In my case, I have decided to explore the health insurance industry of the United States. One of our aims is to
The first thing to think about is the fact that health care accounts for approximately 8% of the U.S. economy. The Affordable Care Act, better known as Obamacare or other unsavory names is actually in my mind making the medical field and the availability of care for patients more difficult. Regardless of its benefits to some patients, Obamacare is making things much more difficult for doctors, nurses and anyone that is part of the medical profession. It has done nothing but increase paperwork, which is the major priority, and costs have continued to rise. From what I have witnessed has done nothing to increase the quality of care. Government bureaucrats and insurance companies, not doctors, are in charge of our health care. Obamacare is all about saving money, by not spending it on patient care and where the money is spent is being directed by special interest and profit-making organizations. They are dictating the way care is provided. Basically insurance companies are in control of who lives or who dies. The law contains spending cuts to Medicare that amount to $716 billion from 2013 to 2022. The end result of course is that seniors are the group that suffers the most since they are the group that seeks and needs medical care more than any other age group. Money is the priority and not patient care as government and insurance companies have a different agenda than health care providers. Should “for-profit” insurance companies exist, or should there be only “non-profit”
When one hears the term healthcare it can evoke personal experiences in one’s mind, good and bad. When it comes to obtaining health insurance the system is complex, difficult to navigate and there is no guarantee of approval due to pre-existing conditions or not meeting some specific criteria. To simplify the health care process, there are two basic categories: privately owned insurance companies (i.e Humana, Cigna, Blue Cross Blue Shield, etc) and government-funded insurance (i.e Medicaid, Medicare). Most working Americans get health insurance through their employers or organization called group insurance. However, some employers and organizations do not offer group insurance so an alternative would be to directly purchase their own individual health insurance. A universal health care system would give everyone the same access to the same quality of care. America has some of the best researchers, doctors, and treatment options in the world yet, we spend more money on medical care than any other country, “45 million” (Rashford, 2007) Americans still live without health insurance every day. “Medical problems contribute to 54.5 percent of personal bankruptcies and threaten the solvency of solidly middle-class Americans” (Dranove & Millenson, 2006). In essence, the U.S health care system has become more focused on profit versus patient care. “The five largest
In attempting to remedy the unjust nature of the American health insurance system, one cannot determine what a just system should be based on the current assessment of society. Inequalities within the current system cannot foster discussion for what we believe is justice because preconceived notions cloud the judgment of even the foremost health policy intellectuals. Many philosophers therefore turn to creating hypothetical societies where these inequalities do not exist as a means to facilitate the discussion as to what true justice requires. Two such individuals, Ronald Dworkin and Charles Fried, have constructed such situations as a means to assess what a just healthcare system should be comprised of in a truly fair-market economy. Although they agree on issues pertaining to the resources available to individuals in a fair market, they also disagree on what constitutes justice in regards to how individuals may spend their allocations. An assessment of the disagreements between the two reveals that the main consideration for what justice demands of society boils down to the degree to which individuals are responsible for purchasing their share of health insurance as well as their fellow citizens’.
One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare
The messed up status of the existing healthcare system is so much wanting. Medicaid killed the market forces and Medicare initiated by the government where the insurance given is of poor quality and over taxed on the workers who are the contributors (Mitchell, 2013). This also brought about over insurance, which is not proportional to the service rendered to the contributors when they fall ill. This is all problematic and uneconomical to them (Mitchell, 2013).
In the early 1930’s, the Blue Cross/Blue Shield Organization led consumers to hospitalization and medical coverage under their own charter for everyone who sought coverage for one prepaid fee. Years later, other insurance companies, such as Kaiser Permanente began to offer coverage to consumers within their geographic boundary. However, health care spending is on the rise. Over the last couple of decades the expenditures have risen from 724.0 billion dollars in 1990 to 2,486.3 billion in 2009(US census, 2011). Today, we are a nation with Health Care Reform signed into law by President Obama
The triple aim of PPACA to promote accessible, high quality and cost efficient care involves large number of reforms that influence all the segments associated with healthcare industry. These reforms are affecting various stakeholders such as hospitals, physicians, and patients to varying degrees and therefore policymakers need to consider independent stakeholder priorities along with the impact on society and cost involved in order to achieve this triple aim. The Affordable Care Act introduces payment reforms for individual physicians and for larger, organized health care systems, ranging from bundled payments to payment adjustments for hospital-acquired conditions. Empirical evidence shows that payment structures such as these can improve care delivery, costs, and quality (A Report from Senator Sheldon Whitehouse for the U.S. Senate Committee on Health, Education, Labor &
It might be true that this system is to generate profits but Americans have the highest healthcare costs compared to other countries. Thus chances of the profit being achieved are minimal.
When you think of the American health care system, most people would like to think that it has evolved with the citizen’s best interest in mind. I realized maybe this was not the case after the story I heard from my sister. My sister has dealt with many health problems throughout her whole life from childhood leukemia to extensive back problems and most recently a serious heart condition. She was experiencing shortness of breath and was referred to a specialist to get further testing and imaging done to figure out what the problem was. Her insurance coverage was through the Affordable Care Act but it did not actually help her. Although she is covered, her deductible is through the roof at $12,000 a year. That was the best policy she and her husband could afford as they own their own company and some years barely scrape by. She was unable to get testing to find the problem because the test itself was $10,000 and would have been money out of their pocket which they could not afford. While we see many improvements in the healthcare field, this made it clear to me that it does not actually benefit everyone to the best of its ability. While as citizens we would like to think that the Affordable Care Act has benefited everyone and made health care better, there are still many issues that persist and changes that need to be made. The actual advantages of the system on paper sound great but in the long run, the functionality of the system doesn’t make sense and isn’t beneficial.
Healthcare is a major topic that is constantly being brought up in the news. It is often discussed within categories such as economics, politics, and policy. The reason that is, is because of healthcare's crucial role integration as part of each of these things. With that said, the United States has received back and forth opinions on the healthcare services that it offers. Karl Polanyi defines embeddedness as a way in which economic activity is constrained societies set of institutions (Tuttle 2018). So this implies that there are two main elements that are 'embedded' into the American culture, individualism and capitalism. These two elements shape the way the healthcare system is set up. Capitalism
Humana, Inc. is a health insurance company from Louisville, Kentucky that started in 1961 by Lawyers Wendell Cherry and David A. Jones, Sr. Humana started as a nursing home where it later become the largest nursing home company in the nation. After the nursing homes they soon began to purchase hospitals entirely for expansion. The name of the company changed to Humana, Inc. two years later. Cherry and Jones continued to expand by purchasing other companies. In 1984, the company began focusing on Health Insurance where it remains to focus on even today. Since 2014, Humana has had over 13 million customers and over 52,000, and a revenue of $41.3 billion that was reported in 2013.
The 2002 hit thriller film, John Q, demonstrates how an average working class American family, whom is already experiencing financial hardship, can be faced with an unthinkable family crisis that is brought upon them due to the stipulations of their health maintenance organization, commonly known as an HMO. This film revolves around John Quincy Archibald, played by actor Denzel Washington, who is an ordinary factory worker in Chicago. Archibald recently went from holding a full-time position at the factory to working only 20 hours a week which causes tough times. He is a father and husband whose son is diagnosed with an enlarged heart and then finds out that he cannot receive a
Today’s healthcare executives have become more focus on self than others. The perception of selfishness finds power in greed. Greed is sinful in the eyes of the Lord. “For everyone has sinned; we all fall short of God’s glorious standard” (NLT, Roman 3:23). Living in a sinful mind-set affects the way we think and react to others. There are many reasons why healthcare executives should not be driven by the desire for self-wealth, increasing profits, power, independence, and a need to succeed. However, the main reason is the health and welfare of the patient. Organizations have lost sight on the importance of healing because they are blinded by money and power.