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The United States spends more on health care than any other country in the world. But who is really paying for it? Health insurance provides Americans and health care provider’s a safeguard against the financial risk related to the health care costs. One of the most challenging tasks policy makers face is tackling healthcare reform. Everyone wants change and improvement but no one knows just how to reach that goal. Under the current health care system there is a certain level of health insurance coverage as well as financial protection provided by that coverage. As of 2009, the United States spends approximately 17.6 % GDP’s on health care. There is a large reliance on private healthcare for the funding (Ridic, 2012). The United States doesn’t have a single payer nationwide healthcare system for health insurance. Instead, health insurance is most often bought in the private marketplace or provided by the government to for qualifying individuals. According to Santerre, “about 84% of the population is covered by either public (26%) or private (70%) health insurance. Approximately 61% of health insurance coverage is employment related, largely due to the cost savings associated with group plans that can be purchased through an employer” (Santerre, 2013, p.46).
Those that are insured in the United States have access to quality care that is constantly evolving due to advances in science and technology, but there are many left out. One of the most significant problems with health care in the United States is the amount of uninsured individuals. A new health care reform policy must seek to provide greater access, high quality, and affordable costs. The Obama administration passed the Affordable Care Act (ACA) that sought to address these areas of concern but ultimately fell short when many were left unsatisfied and paying more for less care. There aspects that can be used to analyze the impact of healthcare reform as it pertains to insurance coverage, patient outcomes, and financing. Health Care’s Iron Triangle is made up of quality, cost, and access to care. President Obama published an article that addressed healthcare reform and the ACA. He explained that in order for the ACA to be successful the cost of care must be affordable, high quality, and easily accessible (Obama, 2016). The ACA’s greatest shortfall was quality. Quality is of utmost prominence to Americans. Challengers of reform appeal to doubts of reduced quality, cautioning of long wait lists, rationing, and government control (Schiff, 1994). Those on the left side of the political spectrum believe that health care is a right and should be provided by the government through single payer healthcare. This type of system can be observed by looking at Canada’s health care system. There are both benefits and shortcomings. Canadians often experience long wait times for medical procedures and services, most commonly for high tech specialty care. To bypass treatment delays Canadian citizens travel to the United States for more advanced treatment (Ridic, 2012).
In the United States about 16% of the population is uninsured. Even though these individuals do not have health care coverage they still obtain health care services. Health care for the uninsured is often provided by public clinics and hospitals, state and local health programs, or private providers through charity and by shifting costs to other payers (Ridic, 2012). Most of these methods require funding through tax payer dollars that come out of the pockets of insured individuals. Even with the help of government programs, uninsured people often experience devastating financial hardships for expensive medical bills. Because the uninsured are often worried about the cost care, they often wait to seek care when experiencing medical issues because they are worried about the cost and then end up with more advanced and more expensive health issues.
Uninsured patients have an effect on insured patients as well as health care providers and providing healthcare services in this country. Hospitals stated that they were left with $20.8 billion in expenses for services to patients who failed to pay their medical bills, which makes up 6.2 percent of total hospital expenses (Institute of Medicine, 2003). This increases the costs of Medicare and Medicaid funding that the government must finance by way of the tax payers who are also patients. Medicare is funded though pay roll taxes and employers and employees. Medicare costs make up 15% of the federal budget. Providers often reduce fees to uninsured patients and volunteer at clinics to provide care. The unpaid costs of the uninsured are distributed among the state and federal government and private sponsors, and in the long run individuals stomach the financial burden of these uncompensated services as taxpayers, providers, employees, and health care consumers (Institute of Medicine, 2003).
A way to ensure that there is quality, access, and reasonable costs is through competition. Insurance companies compete against each other to obtain more customers by offering high quality care through their coverage, competitive pricing, and access to all. Successful healthcare reform will address all of these components by way of competition. There are small steps that can be taken to reform healthcare as a whole. Price transparence would make a huge impact and influence competitive pricing. The government could pass legislation requiring health care organizations to list prices for procedures and services and pharmaceutical companies to list prices for all medications. This will allow patients and consumers to shop around easier and create a competitive market that forces competitive pricing.
Another plan to improve health care reform is through individuals taking on more responsibility and investing in their health care themselves. A health savings account (HAS) allows individuals to set aside money on a pre-tax basis to pay for qualifying health care expenses. The use of untaxed dollars in an HAS allows for deductible payments, copayments, coinsurance, and other expenses, and ultimately lowering the cost of health care (Healthcare.gov, n.d.). Lowering costs through competition and encouraging individuals to invest in their own health is an excellent reform policy alternative to constructively influence insurance coverage and finance the delivery of healthcare in the United States.
In the United States the advances in technology are truly remarkable and should be taken advantage of as much as possible. An expensive health care cost comes from minor office visits. Office visits can end up being expensive and intimidating to individuals that may need only acute preventative care or care for minor illnesses. By using technology to allow providers to talk to their patients directly through video it saves the patient money and the provider time to spend with other patients. By allowing this type of care by a physician the costs are lowered and may encourage less insured individuals to seek care initially opposed to waiting for health issues to worsen and then run up costly emergency bills that they are unable to pay.
- Healthcare.gov. (n.d.). Health Savings Account (HSA) – HealthCare.gov Glossary. Retrieved from https://www.healthcare.gov/glossary/health-savings-account-HSA/
- Institute of Medicine (US) Committee on the Consequences of Uninsurance. (2003). Spending on Health Care for Uninsured Americans: How Much, and Who Pays? Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221653/
- Obama B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA, 316(5), 525–532.
- Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia socio-medica, 24(2), 112–120.
- Schiff, G. D. (1994). A Better-Quality Alternative. Jama,272(10), 803.
- Santerre, R. E., & Neun, S. P. (2013). Health economics: Theories, insights, and industry studies. Mason, OH: South-Western, Cengage Learning.
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