HMO on providing high quality services to the citizens who normally cannot afford them. This system has been in place for years and until now it did a fairly decent job. The problem today is money; the cost of hospital services and doctor fees are rising faster than ever before. The government has been trying to come up with a new plan these past few years even though there has been strong opposition against a new Health Care system. There are many reasons why it should be changed and there are many reasons why it shouldnt be changed. The main thing that both sides heads towards is money. Both sides want to save money just in different ways.
The movement for changing the Health Care system believes that there is a need for change because of the problems that the system faces today cannot be handled. Every month, 2 million Americans lose their insurance. One out of four, 63 million Americans, will lose their health insurance coverage for some period during the next two years . 37 million Americans have no insurance and another 22 million have inadequate coverage . Losing or changing a job often means losing insurance. Becoming ill or living with a chronic medical condition can mean losing insurance coverage or not being able to obtain it. Long-term care coverage is inadequate. Many elderly and disabled Americans enter nursing homes and other institutions when they would prefer to remain at home. Families exhaust their savings trying to provide for disabled relatives. Many Americans in inner cities and rural areas do not have access to quality care, due to poor distribution of doctors, nurses, hospitals, clinics and support services. Public health services are not well integrated and coordinated with the personal care delivery system. Many serious health problems — such as lead poisoning and drug-resistant tuberculosis — are handled inefficiently or not at all, and thus potentially threaten the health of the entire population. Rising health costs mean lower wages, higher prices for goods and services, and higher taxes. The average worker today would be earning at least $1,000 more a year if health insurance costs had not risen faster than wages over the previous 15 years . If the cost of health care continues at the current pace, wages will be held down by an additional $650 by the year 2000. More and more Americans have had to give up insurance altogether because the premiums have become prohibitively expensive. Many small firms either cannot afford insurance at all in the current system, or have had to cut benefits or profits in order to provide insurance to their employees. Those problems are just with the system, the main part of the problem comes from the insurance agencies. Quality care means promoting good health. Yet, the agencies waits until people are sick before they starts to work. The agencies are biased towards specialty care and gives inadequate attentions to cost-effective primary and preventive care. Consumers cannot compare doctors and hospitals because reliable quality information is not available to them. Health care providers often don’t have enough information on which treatments work best and are most cost-effective. Health care treatment patterns vary widely without detectable effects on health status. Some insurers now compete to insure the healthy and avoid the sick by determining “insurability profiles” while they should compete on quality, value, and service. The average doctor’s office spends 80 hours a month pushing paper. Nurses often have to fill out as many as 19 forms to account for one person’s hospital stay. This is time that could be better spent caring for patients. Insurance company red tape has created a nightmare for providers, with mountains of forms and numerous levels of review that wastes money and does nothing to improve the quality of care. America has the best doctors who can provide the most advanced treatments in the world. Yet people often can’t get treated when they need care. The medical malpractice system does little to promote quality. Fear of litigation forces providers to practice defensive medicine, ordering inappropriate tests and procedures to protect against lawsuits. Truly negligent providers often are not disciplined, and many victims of real malpractice are not compensated for their injuries. Purchasing insurance can be overwhelming for consumers. With different levels of benefits, co-payments, deductibles and a variety of limitations, trying to compare policies is confusing and objective information on quality and service is hard for consumers to find. As a result, consumers are vulnerable to unfair and abusive practices. Insurers have responded to rising health costs by imposing restriction on what doctors and hospitals do. A system that was complicated to begin with has become incomprehensible, even to experts. Each health insurance plan includes different exclusions and limitations. Even the terms used in health policies do not have standard definitions. Small business owners, who cannot afford big benefits departments, have to spend time and money working through the insurance maze. For firms with fewer than five workers, 40 percent of health care premiums go to pay administrative expenses. Administrative costs add to the cost of each hospital stay with the number of health care administrators increasing four times faster than the number of doctors. Health claim forms and the related paperwork are confusing for consumers, and time-consuming to fill out. Insurance coverage for most Americans is not a matter of choice at all. In most cases, they are limited to whatever policy their employer offers. Only 29% of companies with fewer than 500 employees offer any choice of plans. With a growing number of insurers using exclusions for pre-existing conditions, arbitrary cancellations and hidden benefit limitations, consumers have few choices for affordable policies that provide real protection.
The movement for Health Care reform has created a plan to cover every American. The plan is called the Health Security plan. The Health Security plan guarantees comprehensive health benefits for all American citizens and legal residents, regardless of health or mployment status. Health coverage is seamless; it continues with no lifetime limits and without interruption if Americans lose or change jobs, move from one area of the country to another, become ill or confront a family crisis. Every American citizen will receive a Health Security Card that guarantees comprehensive benefits that can never be taken away. Fundamental principles underlie health care reform, the guarantee of comprehensive benefits for all Americans, effective steps to
control rising health care costs for consumers, business and the nation, improvements in the quality of health care, increased choice for consumers, reductions in paperwork and a simplified system, making everyone responsible for health care. Americans and their employers are asked to take responsibility for their health coverage and, in return, they are guaranteed the security that they will always be covered under a comprehensive benefit. The Health Security plan creates incentives for health care providers to compete on the basis of quality, service and price. It unleashes the power of the market and puts American consumers in the driver’s seat. Consumers choose from whom and how they get their care.
The plan empowers each state to set up one or more “health alliances” that contract with health plans and bargain on behalf of area consumers and employers. Health plans must meet national standards for coverage, quality, and service set by the National Health Board. But each state tailors its approach to local needs and conditions. The Health Security plan frees the health care system of much of the paperwork and regulation, allowing doctors, nurses, hospitals and other health providers to focus on providing high-quality care. It cracks down on abuse, reforms malpractice law and policy and outlaws insurance practices that hurt small businesses and imposes the first national standards for the protection of patient privacy and confidentiality in medical information and records.
This plan that has been developed by this movement is under serious scrutiny by the people that dont want to see a change, mainly Republicans. Their main argument is that by allowing the states to run health care insurance agencies will run out of control.. Unfortunately, reforms have generally relied on increasing government control rather than expanding market choices. A review of nine states’ reforms reveals a host of negative consequences: insurance premiums increase; access to medical care is not improved; jobs are lost; spending on Medicaid
goes up; insurance companies leave the market; and medical care is explicitly rationed. The Republicans are completely against state run health care and are fighting for federal
government health control. The Republican plan allows workers to keep their health insurance if they leave or lose their job, even if a worker has a pre- existing condition. Allows the self-
employed to deduct from their taxes 80 percent of their health insurance premiums . Allows the self-employed and small businesses with 50 or fewer employees to open tax-free Medical Savings
Accounts to pay for routine medical expenses. In the year 2000, MSAs will be made available to businesses with more than 50 workers unless Congress prevents the expansion . Allows tax deductions for long-term health care, including nursing-home and home-health care. Fights fraud
and abuse in the health care system and reduces burdensome paperwork..
The Republican national health plan that would be funded by the federal government and administered by the federal government. The plan would fully cover everyone via a comprehensive public insurance pool, paid for by taxes from individuals and businesses. The plan has provisions to limit over-treatment and insufficient care, designed to both protect patient interests as well as contain costs. Costs would also be controlled by cutting the current administrative overload and through health care planning. The plan would not result in an increase in total health expenditures. The people who are now uninsured will be insured with funds deriving from massive savings that will occur from the elimination of the inherent waste in the current system. With more than 1500 insurance companies and virtually countless payment plans and policies, our administrative costs have exploded. A single payer system has a much more basic payment scheme. Doctors would spend less time on paperwork, and potentially more time with patients. Clinics and hospitals would need fewer staff members, and would require less costly, redundant equipment.
The details of the Republican plan are as followed. All essential care would be incorporated into the plan, including: mental health, acute care, ambulatory care, long term care and home health care, prescription drugs and medical supplies, rehabilitation services, occupational therapy, and preventive medicine. Exclusions would be made for unnecessary and ineffective procedures. These exclusions would be determined by expert panels, most probably made of doctors, nurses, other health care workers, and health planners. Everyone in the U.S. would receive a national health care plan card, with necessary identification encoded on it. The card can then be used to gain access to any fee-for-service practitioner, hospital or clinic. HMO members can receive non-emergency care through the HMO. As mentioned before, to implement the national health program, health care costs do not need to increase. It would however produce a major shift in payment toward government and away from private insurers and out-of-pocket payments. Individuals and businesses would pay the same amount for health care, on average, but the payments would be in the form of taxes. The taxes contributing to the plan can be found for businesses, for instance, by adding up the amount spent currently by business for health care. This would approximately add up to a 9% tax increase for midsize and large employers . Hospitals and clinics would receive a global sum on a yearly basis, in addition to allowances for new technology. Funds would be distributed to physicians and other health care workers in one of three ways: through fee-for-service arrangements with a simplified billing schedule, through capitation, paying health care providers on the basis of how many patients they serve, or through global budgets established for hospitals and clinics employing salaried health care professionals.
The debate stands now between letting the states run health care or continuing control by the federal government. Both make valid points as to why they are the way to go, but my stance after careful thought is one of compromise. Let the federal government standardize health care
while the state governments fund it on a state to state level. With a national standard to follow prices would be forced to keep the same through out America. Procedures for problems would not be questioned. Finally there will be less paperwork. Making the state governments fund their own health care system at first lance seems to be cost inefficient. At another look and a explanation I can dispute that. With the government in total control it had one big pile of money it had to divide to all the states and no real way to determine how to divide it. With the individual states involved in funding health care, they know the size of their population, who needs care in their population and can do a more efficient job on a smaller scale. Also by letting the governments on the state level run everything the problem of the government giving to little to states that need funding and to much to states that dont need it
will not occur.
Unfortunately due to the way the government handles major changes health care reform will most likely be debated for another ten years. The way the debate is moving it seems to be heading towards the state controlled health care, but there doesnt appear to be enough power behind the movement to get it approved. The dream of universal coverage s it a dream or is it a near future for all Americans, only with patience by the people will they find out.
Category: Social Issues