Health Insurance (a Health Issue)
Prior to the 1920's, we did not have much in the way of advanced medical treatment. Back then, the main treatment for most illnesses was to keep us comfortable while our body tried to heal itself. Of course, there were some home remedies that had been around for a long time. A few doctors were available, but they only had access to a few medicines and could only perform a few procedures. Health insurance didn’t really exist. In general, we either suffered a financial loss from lost wages, or we died.
Starting in the 1950's, the face of medicine began to change rapidly. This was the beginning of an ever-increasing supply of new and improved medications, vaccines, and surgical techniques. There was even the first organ transplant. With all this new medical care, the cost of health care began to rise rapidly, which resulted in a need for health insurance. By 1958, 75% of Americans had some form of health insurance coverage.
Today, there are tests, treatments, procedures, and medications for things that could never have been treated before. In the past, we would have had to live with or to die from these problems. In addition, many conditions that were never much of any real problem started to be treated. For most of us, this has led to higher medical costs and an even greater need for health insurance coverage. To help meet this need, we now have a hodgepodge of subsidized health insurance coverage provided by big business and the government.
Recently, there has been a rapidly increasing financial cost for the growing list of modern medical treatments that we hope will give us longer and healthier lives. These growing costs are causing the cost of our health insurance coverage to get more and more expensive. This means that fewer and fewer of us can afford health insurance. In fact, health insurance has become too expensive for the average person to afford. With the cost of health care rising at a faster rate than inflation, health insurance is now becoming too expensive for even big business or the government to subsidize health Insurance coverage adequately.
Many of us seem to be under the mistaken belief that if there is any treatment or medication that could help us then we should be able to get it and our health insurance should cover it. It doesn’t seem to matter that some of these treatments can now cost millions of dollars and that there may be much less expensive alternatives available.
Let’s say that tomorrow, a new vaccine is found that would cure the common cold, but it costs ten million dollars per person. If insurance companies were forced to cover the cost of this vaccine, premiums would need to skyrocket to the point where only the super-rich could afford health insurance coverage. There needs to be a point where we draw the line or one day all our resources would be needed just to cover health care costs, and nothing would be left over to make life worth living. Where do we draw the line?
Most of us who work for a big company are likely to have access to subsidized health insurance provided as part of our company's benefits package. Of course, this coverage may be limited to just a few plans with a limited number of options. Those of us on welfare would have access to the government subsidized Medicaid program. Those of us over 65 would have access to the government subsidized Medicare program. Some of us can also get subsidized medical insurance under the Affordable Care Act. On the other hand, those of us who work in a small company, are self-employed, or are unemployed may not have access to any subsidized health insurance at all.
Several problems arise from this system. Those of us who need health coverage would find it hard to move from a big company or welfare to a small company or to self-employment. Some of us may even find it hard or impossible to move from one big company to another, because the new health insurance may not cover our preexisting conditions. We may also find that we cannot keep the same doctor, because our doctor may not take our new health care plan.
The first thing to do is to remove the restrictions that prevent health insurance companies from selling health insurance in multiple states and enact national health insurance standards. This would allow health insurance companies to compete in many different states or even nationally.
The increased completion would force health insurance companies to bring their costs down to stay competitive. If we were to move to another state where our health insurance company operates then we might be able to keep our health insurance. In addition, if we could shop for health care treatment options in other states where our health insurance company operates, then that would force health care providers to control their costs.
The next thing to do is to free us from being tied to the specific health insurance plans provided by our employers and the government. We would all be able to get our own health insurance coverage directly from an insurance company or through an insurance agency that had plans from numerous insurance companies. With more plans to choose from we would be able to find a plan better tailored to our individual or family needs. The Web Sites set up under the Affordable Care Act, which allows some of us to select from different plans, are a step in this direction.
At first, many companies would still offer their own health insurance plans to their employees, but they would be required to include the option to subsidize an employee’s plan. In this case, the company’s subsidy would need to match what they would have spent had the employee gone with the company’s plan up to the actual cost of the employee’s health insurance, but now paid to the employee’s health insurance provider. These subsidies could work something like direct deposit, with the money being sent directly to the employee's health insurance provider. The same would apply to the government’s Medicaid and Medicare plans, which would be like Medicare Part C.
In time, companies and the government would get out of the business of providing health coverage. Some companies might replace the subsidies by simply increasing employee salaries, but other companies may wish to continue subsidizing the cost of their employee’s health coverage up to some dollar amount or up to some percentage of the employee's salary to help encourage their employees to stay healthy.
Of course, companies should not be able to save money by hiring individuals who do not want health insurance for some reason or who have very low-cost health insurance. Any money that would have gone towards subsidizing an employee’s health coverage, but did not, would go into a medical fund for research or to help medical institutions cover losses from individuals who do not pay their medical bills.
With this option, smaller companies that could not afford to provide health coverage themselves might now be able to subsidize at least a small portion of their employees’ health care coverage. Spouses who work for different companies and individuals who work for multiple companies could have part of their health insurance subsidized by each employer. Of course, controls would need to be in place to ensure that the subsidies did not add up to more than the cost of the insurance.
This would get employers and the government out of the business of providing health insurance and streamline and simplify the way in which we get health insurance. Companies could spin off their health insurance groups to form new independent health insurance agencies. Some of the smaller agencies might then combine so that they are large enough to negotiate adequately with the insurance companies to get the best healthcare plans for their clients.
This change would fix or reduce many of our existing health insurance problems. It would open many more health care options for us and allow us to compare the benefits and costs of each plan more easily. It would allow us to easily move from company to company without losing our health coverage or being forced to switch doctors. In addition, those of us working for small companies or only part-time, who would not normally be covered might be able to get our employer to put some amount towards subsidizing our health insurance. If we wanted, we might even be able to keep our same health insurance from cradle to grave.
Although having health insurance separated from employment will make changing jobs easier, there is still a problem with changing insurance companies. What do we do about any preexisting medical conditions that would not be covered by a new insurance plan? Forcing an insurance company to cover them would not work, since we might wait to get insurance until we needed it or we might change to a new plan to get better coverage for our medical condition.
The way to handle this would be to have each condition taken care of under the health insurance plan in effect at the time we developed the condition, even if we later dropped that plan or switched to a new one. If some new complication arises from the old condition, then it should be covered by the old plan. Otherwise, any new condition would be covered under the new plan.
We can compare this to the way auto insurance works. If we have an accident, the insurance we have at the time of the accident should cover it, and not be covered by some new plan that we got after the accident.
To prevent disputes over who pays for what treatment, strict criteria would need to be used to determine if a medical problem is a complication of an existing condition to be taken care of under the old plan or a new condition that would be taken care of under the new plan.
One area where the government should provide some health benefits is with emergency medical care. A hospital should not need to worry about whether we have medical insurance or not when we are brought in for emergency treatment. The hospital should always provide at least the minimum care needed to stabilize us without worrying about who pays for the emergency care.
If we have health insurance, our insurance company should take care of paying the bill. Otherwise, it should be our responsibility to pay. If we do not have insurance and do not pay the bill, then the government would take care of paying the bill and would try to get what reimbursement they could from us, based on what we could afford. This would save the hospitals from financial loss while ensuring that all of us would at least get emergency treatment. Beyond emergency care, hospitals should not be forced to provide any treatment unless they knew they would get paid for it by our insurance company or by us.
Another area where the government can play an important role in health care is in regulation. We want to make sure that the insurance companies provide the benefits that they have agreed to provide. There needs to be a place where we can go to get a quick resolution when our claims have been denied or our insurance company is taking too long to decide. This means having a review board that can evaluate an insurance policy to determine if a treatment would be covered and whether we needed that treatment or not.
To help this review board evaluate an insurance policy and to reduce overall health insurance costs, there needs to be a standard way to describe medical needs and coverage. It should be up to the medical profession to spell this out and all insurance companies to use it. There also needs to be a standard way of submitting claims. With everyone speaking the same language, it will be much easier for us to compare insurance policies and determine what coverage we need, want, and can afford.
In addition, a standard automated medical system needs to be developed where all medical information is entered, and all claims are filed. In this way, a medical professional would only have to worry about entering what needs to be done and what has been done, and not worry about entering the information based on what health insurance a patient has or does not have.
This standard medical system would take care of evaluating what is covered by insurance, what information needs to be submitted to the health insurance company, and what needs to be billed to the patient. This will greatly simplify and reduce the cost of doing the medical paperwork and allow medical professionals to spend more time with patients.
It seems like a lot of individuals want and expect their health insurance to cover all their medical needs and treatments, no matter what their level of coverage. As a result, this has limited the types of options provided by most health insurance plans. Therefore, in general, the big differences between plans lie in where you can get treated, the deductibles, the co-payments, and the percentages of costs covered. There are some additional differences in what is and what is not covered, but these are usually in those gray areas around optional treatments. (Although, there seems to be enough disagreement over what each plan covers that there are numerous challenges that are made when coverage is denied.)
With the current selection of health insurance plans, we do not have much choice. For the wealthy, even the best insurance is affordable, but they probably could afford most medical care even without insurance. For most of us, there is a financial or medical risk no matter what we do. One option is to get health insurance that we cannot really afford to pay for. Another option is for us to get insurance with high deductibles, high co-payments, and low percentages of costs covered. This option may be more affordable if we stay healthy, but it can leave us with a lot more expenses when we get sick. On the other hand, we have the option to go without health insurance altogether and hope that we do not get too sick.
Some of us may feel that any amount is worth the peace of mind provided by knowing that all our medical needs will be taken care of with whatever treatment is needed. On the other hand, some of us may want to have more money to spend on necessities such as housing, food, and clothes, and on enjoying our lives, so we may just want to have some good basic catastrophic health care coverage. In some cases, we may prefer to die rather than have our lives extended through expensive, intensive, or painful medical treatments. Since the potential cost of providing these levels of health care would be very different, we should all pay according to our own level of coverage.
In a free society, we should have the right to decide how to spend our money. We have different priorities when it comes to quality of life and what we want to do with our lives. In addition, we should have the right to balance our spending between the here and now and the future, and to decide how much risk we are willing to take.
Of course, this should also apply to health insurance, which means we should demand and be given more health insurance choices. We should be able to choose between how much we want to spend and what medical needs and treatments we want covered. Therefore, insurance companies should provide a full range of health insurance plans with a full range of coverage options, with detailed descriptions of what is and what is not covered.
For instance, a low-cost plan might only cover basic preventative and emergency care. With a moderate cost plan, cancer treatment might cover the surgery to remove the cancerous tissue, and some radiation or chemotherapy treatments, but not cover some other more expensive or experimental treatments. On the other hand, a high-cost plan might cover every possible procedure and medicine that exists or that comes along. With a very expensive top-of-the-line plan, a patient would have access to the best medical facilities and personnel and to every possible treatment that exists or comes along to care for whatever illness they might ever get. Of course, each health insurance plan would still have a full range of options for deductible, co-payment and percentage of costs covered.
As a result of these greater coverage options, we should all be able to afford at least some basic health coverage. In addition, insurance companies could better plan their potential expenses, since each plan would clearly state what is and what is not covered. For instance, new and often expensive medicines and procedures would not be covered unless explicitly stated in our plan. Therefore, insurance companies would not have to charge higher premiums to cover any new treatments that may or may not come along. We would then be given the option of whether to add any of these new treatment options to our plans or not, along with any associated higher premiums.
Of course, a simple and low-cost option for those of us who do not think we can afford insurance is to get a high deductible plan. In most cases, these plans would cost a fraction of what a low deductible one would cost. With a high deductible plan, we would end up paying for most routine medical needs but would be covered in case of a major illness that could otherwise have bankrupted us.
Many current health insurance plans give premium discounts to individuals who have certain healthy living habits. The logic behind this is quite sound. On average, those of us working to keep ourselves healthy do not need as much medical care as others, so our health insurance companies would not need to pay out as much for us in medical bills. It only makes sense that the insurance company should pass along some of their savings in the form of discounts to those of us who have healthy lifestyles. Therefore, the restrictions that some states have that prevent these discounts should be removed.
There are many things that we can do to stay healthy such as not smoking, exercising regularly, drinking in moderation, eating a balanced diet, maintaining a healthy weight, having safe sex, staying away from illegal drugs, and refraining from other risky behavior.
The problem for the insurance companies is ensuring that we are maintaining the healthy lifestyles for which we are getting a discount. Nevertheless, since it is in the best interest of the insured and the insurer for us to live a healthy lifestyle, insurance companies should give discounts for as many things as they can verify.
Healthy lifestyle verifications could be done during regular medical checkups or, if needed, during special verification exams. If we maintain the healthy lifestyle habits for which we are getting discounts, then we would continue to get the premium discounts.
When it comes to the coverage of certain genetic defects, there is a need for some further discussion. First off, many genetic defects are easily treated and may not even pose much of a problem for the individuals carrying them. In fact, under the right environmental conditions, some genetic defects are beneficial for their carriers.
For instance, the genetic defect that can cause sickle cell anemia can help to protect the carrier against malaria. On the other hand, many genetic defects are life threatening and may cause a fetus to be aborted or to be stillborn, or a child to die soon after birth. In these cases, the genetic defect at least does not stay in the gene pool and does not cause problems for us in future generations.
Today, those of us with many types of severe genetic defects can be treated with modern medical treatments. Let’s suppose that a child is born with a genetic defect that would need to be treated with very expensive surgery or medical treatments. Of course, we have a society where we are free to make and to take responsibility for our own choices, so we should never be forced to pay for this or any other medical treatment. On the other hand, if the child’s parents had paid the higher health insurance premiums needed to cover this condition or were wealthy enough then there would be money for the needed surgery or medical treatments.
Now, what happens when this person lives and grows up with this genetic defect and wants to have children? First off, we know that the odds of this genetic defect causing a problem will depend greatly on whether the gene is dominant or recessive. We also know that if a child is born with this gene being active, then it will be expensive to treat. Therefore, unlike his or her parents, this person will know that his or her descendants could inherit this defect. Therefore, this person should understand that he or she must take responsibility for whatever happens and know that any health insurance coverage for this genetic defect should be correspondingly expensive.
There is one more important aspect to how we handle these severe genetic defects. If we keep treating and saving the individuals with them, these defects could be passed on to their descendants. That means that future generations could see more and more cases of these defects. If we continue treating those individuals with these genetic defects, then the medical expenses will continue to mount, and the cost of the health insurance plans that cover them will continue to rise. It makes more sense to eliminate the genetic defect than to burden future generations with their cost. To do this, carriers should refrain from having children or have appropriate genetic tests done to ensure that their children will not be carriers.
Another interesting idea would be to have insurance companies combine health, disability, and life insurance options into single insurance packages. For insurance companies, it would no longer be about minimizing the health care costs versus minimizing any litigation over denied coverage. Instead, the insurance companies would need to ensure that they provided enough health care to keep an insured person alive and healthy long enough, so they would not have to pay out any extra life insurance or disability benefits.
Of course, we would have the right to choose the coverage levels that best fit our idea of our own worth, which could help determine how much health care coverage we get. However, by combining health, disability, and life insurance into a single plan we would stand the best chance of getting the best healthcare coverage we could get for our money.
In the United States, the yearly total purchases of prescription drugs rose from about 579.1 billion dollars in 2022 to about 633.5 billion dollars in 2023. In 2023, the average cost of these drugs was more than 2 thousand dollars per year for senior citizens and more than a thousand dollars for everyone else. Of course, these are averages, which includes a lot of individuals who do not regularly use prescription drugs, so the cost is much higher for many individuals. For those individuals with prescription drug plans, the costs are about half these amounts, but it can still be quite a financial burden.
Each year, doctors are prescribing more drugs to more of us for more problems. Not only does it seem that more of us are suffering with previously known problems, but new problems are surfacing for which drugs are now needed. There is also a rising number of us who are being prescribed and taking multiple drugs at the same time. With us taking so many different drugs, some of us even need to take additional drugs designed just to lessen the side effects of the other drugs.
The problems stemming from us taking all these drugs are growing. First off, it can be very expensive for us to take multiple drugs at the same time, especially with the high cost of some of these drugs. Then, there are many risks to our health and life from the side effects and the bad interactions that can come with us taking multiple drugs at the same time. For some of us, it many come down to hoping that the benefits of taking all these drugs will outweigh all the ill effects.
A good prescription drug plan can help to reduce the cost of our drugs, but they still add to the high cost of our health care and can eat into the profits of drug companies and pharmacies and increase the costs for those of us without a drug plan. Of course, a lot of us feel that the drug companies make too much money, but they need to make enough profit to continue funding their drug research.
Changing drug plans to reduce the cost to those in the plans only shifts some of the costs to those who are not in these drug plans. The only way to really reduce the costs of prescription drugs is to reduce the cost to make them, but that is something that drug companies already have plenty of incentive to do.
A better course of action would be to find ways to reduce the need for drugs. In many cases, we are taking drugs to cure problems that are caused by our modern diets and lifestyles. Our bodies were not designed to handle our rich diets, and our sedentary and stressful lifestyles, so, like any machine that is not well maintained and not used properly, we develop problems. In these cases, drugs may mask these problems, but they do not really fix them.
The first step should always be to try to fix any problems with our diet and lifestyle before we are prescribed drugs, because these could be causing our health problems. Doctors should make sure that we are getting enough exercise, eating healthy foods, and managing our stress levels. Of course, some of us may be so out of shape, overweight, or stressed out that we temporarily may need some drugs to help us until they can get healthier.
Only when we are otherwise taking care of ourselves should doctors prescribe drugs. Although this may require doctors to learn more about us before they just resort to prescribing drugs, it will be far better for our current and future health and finances. It can also help to control our health care costs and direct more drug research towards finding drugs to help real health problems and not towards drugs that would allow us to continue having poor diets and unhealthy lifestyles.
Another important concern is the safety of imported drugs. It is the responsibility of the FDA to ensure that drugs sold in the United States are safe and effective. When we buy drugs in foreign countries or over the internet, they do not have the same guaranties. If we get the drugs that we expected, then these drugs may turn out to be less expensive to buy. The problem is that there are a lot of fake and unsafe drugs being sold. In these cases, the financial and health costs can be very high. It is better to be safe than sorry, so drugs should only be allowed to be bought from sources that can be controlled by the FDA. With the proper inspections, tests, and other controls there is no reason that these could not include drugs imported from other countries.
Malpractice Insurance premiums are a big expense for many doctors. The cost of this insurance needs to be passed along to their patients. Doctors who make a lot of medical mistakes drive up the cost of malpractice for all doctors. In many cases, a state medical board will suspend or revoke the license of a doctor who makes a lot of medical mistakes, but not always. Unfortunately, when a doctor does lose his or her license in one state, he or she may simply move to another state and resume practicing medicine.
To help bring down the cost of malpractice insurance, a couple of things need to be done. First, medical boards need to do a better job of weeding out the doctors who do not do a good job. Second, make it harder for doctors to resume practicing medicine in another state without a thorough review of their cases.
Not only will these changes help to drive down the cost of malpractice insurance and healthcare costs, but they will also help to reduce the suffering that would have been caused by these doctors continuing to make mistakes.
Drugs -
Legalize Drugs in a way that protects society and eliminates the criminal element.
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