Health Care in the United States
The health care costs in the US have increased greatly. For instance, in 2004, health care spent sixteen percent of the GDP. The ‘Affordable Health Care for America Act (HR 3963)’ President Obama signed in 2010 brought about heated debates. In the US, design and funding in health care has been a cardinal issue.
The Impact of Health Care Costs on US Economy
The rate at which the US health care spending is escalating surpasses the population, inflation, and GDP growth rates by far. From 1940- 1990, the annual growth rate in health care costs per capita varied from 3.6% (1960s) to 6.5% (1990s). On the same note, the GDP share as a result of health care spending increased from 4.5% (1940) to 12.2% (1990) (Newacheck et al., 2010). In 2005, the costs incurred for in health care was approximately 2 trillion dollars (6,697 dollars per capita) that represents sixteen percent of GDP. Health care spending in the US has been on a steady increase for the previous four decades and the sustained increase will continue increasing. The total health care spending is predicted to reach 4 trillion dollars or 20% of GDP by the year 2015.
Employment-based health insurance forms a significant element as far as jobs are concerned in the US. Moreover, it can make the distinction between uninsured family members and working families accessing affordable insurance coverage. As a result of health insurance coverage, families have financial means and can access essential medical care services (Newacheck et al., 2010).However, the link between health insurance and employment, which is a voluntary benefit offered by companies, is at risk as a result of rapidly escalating health insurance premiums and costs.
Employment-based health insurance costs are rising rapidly, which forces companies to delay increasing wages. Employer-sponsored health insurance and the rapidly escalating and high medical costs are borne by workers in the long run. Wage growth has lagged for many workers due to increased costs. This minimizes the take-home pay. A majority of the families are also experiencing medical bill challenges and, therefore, their security and quality of life is threatened by the rising costs (Aday, Andersen & Fleming, 2009).
The Health Care Legislation- opposing and proposing points
The health care legislation influences many areas including the free market, insurance coverage, and health care quality. It has both advantages and disadvantages.
Supporting the Act
In 2014, it is expected that 16 million Americans will have gained health insurance coverage under two cardinal provisions of the legislation. This coverage expansion will be the hugest in US history. Health systems will have an opportunity to soften the challenge of declining admissions, minimize government payments, and provide care outside hospital institutions. Health systems have begun coming up with comprehensive strategies that are aimed at educating, identifying, and assisting in enrolling citizens in private health plans. The strategies are sold via exchanges, which are novel marketplaces offered by the insurance.
The legislation has provisions for ensuring that businesses with more than fifty employees are able to provide affordable health insurance. Businesses with less than fifty full-time employees will not be required to provide health insurance coverage to them. Although one in every four small business operators in US are uninsured, as a result of the legislation, business owners and entrepreneurs can afford personal health insurance. The legislation will permit eighty three percent of the presently uninsured small business operators to become eligible for coverage.
Opposing the Act
The novel health care legislation will result to more Americans who will have insurance coverage. However, the legislation falls vitally short of the universal coverage. This is owing to the fact that by 2019, approximately twenty one million Americans will still not be under medical insurance.
By 2019, the new legislation will have increased taxes by over 569 billion dollars. Moreover, the burdens the legislation has on business will reduce employment and economic growth significantly. The legislation also comes along with huge costs owing to the fact that in ten years of implementation, 2.7 trillion dollars have already been spent. Over the 1st ten years, a debt of 823 billion dollars will be added on the national debt.
Types of Health Insurances in the US
The three main types of health insurance in the US are HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and POS (Point-Of-Service). These three health plans possess provider networks. However, in PPOs and POS, clients can choose to meet with the doctor outside the network and cater for the extra costs. A PPO is very preferable for clients who would like to see providers in the absence of prior approval originating from the medical group or health plan. It is also convenient for people who dislike selecting a primary care professional. A POS includes both PPO and HMO. A client can have a primary care professional and acquire most care from a HMO network. A HMO has a list of different providers and clients have to acquire care from these providers. This list is normally referred to as a network.
My take is that over the next thirty years, HMO has higher chances of surviving as opposed to both PPOs and POS (Aday, Andersen & Fleming, 2009). An argument to support this is that while HMOs assume full risk together with the employer or insurer, POS and PPO assume partial risks downside or upside. The payment structure is different in that HMOs pays per health plan member or employee is certain populations every month while POS and PPOs pay for the delivery of every service. HMOs are more organized in the health care providers are employed in the HMO, the providers chosen have to be from the HMO, and the PCP approves all referrals. Drugs prescribed in HMOs are approved and gotten from the in-network pharmacy while in POS and PPO, the drugs are approved or larger co-pay is paid.
The Private Health Insurance and Standard Insurance Principles
Generally, confidentiality is accepted universally to be a cardinal principle that underlies health care provision. However, the private health insurance claims processing and billing procedures utilized presently, notably the practice where EOBs (Explanation Of Benefit) forms are sent to a policyholder when care is being offered under his policy, is a routine violation of the principal provision for everyone enrolled to be a dependent of someone else’s policy (Newacheck et al., 2010).This causes challenges when the dependent is seeking health care. Nonetheless, the issue is particularly acute for people who require sensitive services including reproductive health care, substance abuse, and mental health.
This breach of privacy has immense impacts on the large population swath. This includes teens and young adults who are covered under the parents’ policies, and the millions of married adult who are insured under the spouses (Aday, Andersen & Fleming, 2009). The health care reform is anticipated to increase insured people and potentially broaden those eligible of being covered as dependents. In essence, this will increase the number of the affected group. On the same note, no payment methodologies have been developed to preserve the billing process’ integrity while providing confidential care.
Private health insurances do not cover catastrophic, high-cost events in addition to routine care. Basically, a key attribute of the present health insurance is a prepayment of medical costs. Private health insurance makes this even worse since it mandates that insurance caters for various forms of insurance care including heath maintenance checks. Since private insurance companies are unable to cater for truly catastrophic events, when clients are most vulnerable, they are less protected. There is an urgent need for private insurance companies to adhere to the true insurance principles.
Health promotion and disease prevention in the US
Disease prevention and health promotion in the US was aggravated as a result of high infections that resulted from yellow fever, typhus, cholera, small pox, and typhoid. It began in mid- 19th century when physicians who were housing advocates and reformers thought of developing strategies for fighting challenges dealing with large-scale immigration, industrialization, and urbanization. As a result, the environment and economy were transformed, and in turn, health took a new turn (Newacheck et al., 2010).Health in American had deteriorated greatly in the mid-19th century. A number of intestinal ailments and epidemic diseases had become vital tools of detrimental social decline and were closely associated with the immigrant poor. Therefore, stakeholders took the initiative to develop health promotion and disease prevention strategies.
Following the election of John F. Kennedy as president in 1960, the national health insurance climate changed in that it was more favorable. However, the American government realized that so as to implement government-sponsored healthcare successfully, there was a need to start slowly, with the elderly being the first target segment.
References
Aday, L. A., Andersen, R., & Fleming, G. V. (2009).Health care in the US: Equitable for whom?. Beverly HillseCA CA: Sage Publications.
Newacheck, P. W., Stoddard, J. J., Hughes, D. C., & Pearl, M. (2010).Health insurance and access to primary care for children.New England Journal of Medicine, 338(8), 513-519.
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