Our Future Path!    A plan for a better world!

Health Insurance (a Health Issue)


Introduction

Prior to the 1920's, there was not much in the way of advanced medical treatment. Back then, the main treatment for most illnesses was to keep someone comfortable while the person's 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, people either suffered a financial loss from lost wages, or they 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, people 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 people, 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.

Rising Costs

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 people are able to 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 adequately subsidize health Insurance coverage.

Many people seem to be under the mistaken belief that if there is any treatment or medication that could help them that they should be able to get it and that their 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 actually worth living. Where do we draw the line?

Limited Coverage

People who work for big companies would most likely have access to subsidized health insurance provided as part of their company's benefits package. Of course, this coverage may be limited to just a few options. People on welfare would have access to the government subsidized Medicaid program. People over 65 would have access to the government subsidized Medicare program. On the other hand, people who work in a small company, are self employed, or are unemployed would probably not have access to any subsidized health insurance at all.

Several problems arise from this system. Anyone who needs his or her health coverage would find it hard to move from a big company or welfare to a small company or to self employment. Some people may even find it hard or impossible to move from one big company to another, because the new health insurance may not cover their preexisting conditions. People may also find that they cannot keep their same doctor, because their doctor may not take their new health care plan.

Remove Single State Restrictions

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 companies to bring their costs down in order to stay competitive. This would also allow people to keep their health insurance when they move to another state where their health insurance company operates. In addition, people would be able to more easily shop for health care treatment options in other states, which would force health care providers to control their costs.

Independent Health Insurance Agencies

The next thing to do is to free people from being tied to the specific health insurance plans provided by employers and the government. Everyone would be able to get his or her own health insurance coverage directly from an insurance company or through an insurance agency that had plans from numerous insurance companies. These plans could be better tailored to the individual’s or family’s needs.

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.

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 as a way to encourage their employees to stay healthy.

Of course companies should not be able to save money by hiring people who, for some reason, no not want health insurance or who have very low cost health insurance. Any money that could have gone towards subsidizing an employee’s health coverage, but did not, should go into a medical fund for research or to help medical institutions cover losses from people 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 people 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 health care plans for their clients.

This change would fix or reduce many of our existing health insurance problems. It would open up many more health care options for everyone and allow everyone to more easily compare the benefits and costs of each plan. It would allow employees to easily move from company to company without losing their health coverage or being forced to switch doctors. In addition, employees working for small companies or only part-time, who would not normally be covered might be able to get their employer to put some amount towards subsidizing their health insurance. If they wanted, people could even keep their same health insurance from cradle to grave.

Preexisting Conditions

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 people might wait to get insurance until they needed it or might change to a new plan to get better coverage for their 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 the person developed the condition, even if they 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. In order to prevent disputes over who pays for what treatment, strict criteria would need to be used in order 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.

Emergency Care

One area where the government should provide some health benefits is with emergency medical care. A hospital should not need to worry about whether or not patients have medical insurance when they are brought in for emergency treatment. The hospital should always be able to provide at least the minimum care needed to stabilize the patient without worrying about who pays for it.

If the patient has health insurance, the insurance company would take care of paying their bill. Otherwise it should be the patient’s responsibility to pay. If the patient does not have insurance and does not pay their bill, then the government would take care of paying the bill and would try to get what reimbursement they could from the patient, based on what he or she could afford. This would save the hospitals from financial loss while ensuring that everyone 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 by an insurance company or by the patient.

Regulation

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 people can go to get a quick resolution when their claims have been denied or the insurance company is taking too long to make a decision. This means having a review board that can evaluate an insurance policy to determine if a treatment would be covered and whether or not the patient needed that treatment.

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 the insurance companies to all 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 people to compare insurance policies and determine what coverage they 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.

Coverage Options

It seems like a lot of people expect their health insurance to cover all their medical needs and treatments, no matter what their level of coverage. As a result, this can limit the coverage options that are 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, people 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 almost everyone else, 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 people may feel that any amount is worth the peace of mind provided by knowing that all their medical needs will be taken care of with whatever treatment is needed. On the other hand, some people may want to have more money to spend on necessities such as housing, food and clothes, and on enjoying their lives, so they many just want to have some good basic catastrophic health care coverage. In some cases, people may prefer to die rather than have their lives extended through extensive or painful medical treatments. Since the potential cost of providing health care to these individuals would be very different, each individual would pay according to his or her own level of coverage.

In a free society, people should have the right to decide how to spend their money. People have different priorities when it comes to quality of life and what they want to do with their lives. In addition, they should have the right to balance their spending between the here and now and the future, and to decide how much risk they 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 to have 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 available or that comes along for whatever illness they might ever have. Of course, each health insurance plan would still have a full range of deductible, co-payment and percentage of costs covered options.

As a result of these greater coverage options, everyone should 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 someone’s plan. Therefore, insurance companies would not have to charge higher premiums for any new treatments that may or may not come along. People would then be given the option whether or not to add these new treatment options to their plans, along with any associated higher premiums.

Of course, a simple and low cost option for anyone who does not think they 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, a person would end up paying for most routine medical needs, but would be covered in case of a major illness that could have bankrupted the individual.

Premium Discounts

Many current health insurance plans give premium discounts to people who have certain healthy living habits. The logic behind this is quite sound. On average, people working to keep themselves healthy do not need as much medical care as other people, so their health insurance companies would not need to pay out as much for them 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 people who had healthy lifestyles. Therefore, the restrictions that some states have that prevent these discounts should be removed.

There are many things that a person 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 the covered individuals are actually maintaining the healthy lifestyles for which they are getting a discount. Nevertheless, since it is in the best interest for the insured and the insurer for the covered individual 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. As long as the covered individual maintains the healthy lifestyle habits for which they are getting discounts, then they would continue to get the premium discounts.

Genetic Defects

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 people carrying them. In fact, under the right environmental conditions, some genetic defects are actually 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 cause problems for people in future generations.

Today, people 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 people are free to make and to take responsibility for their own choices, so others 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 people 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 people 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 in order to ensure that their children will not be carriers.

Combined Health, Disability and Life

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 verses 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, people could choose the coverage levels that best fit their idea of their own worth, which could help determine how much health care coverage they should get.

Prescription Drug Plans

In the United States, the yearly total purchases of outpatient prescriptions drugs rose from about 2 billion dollars in 1997 to about 3 billion dollars in 2004. In 2004, the average cost of these drugs was about 2 thousand dollars per year for senior citizens and about 850 dollars for everyone else. Of course, this is the average, which includes a lot of people who do not regularly use prescription drugs, so the cost is much higher for many people. For those people 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 people for more problems. Not only does it seem that more people are suffering with previously know problems, but new problems are surfacing for which drugs are now needed. There is also a rising number of people who are being prescribed and taking multiple drugs at the same time. With people taking so many different drugs, some people even have to take additional drugs designed just to lessen the side effects of the other drugs.

The problems stemming from people taking all these drugs are growing. First off, it can be very expensive for people to take multiple drugs at the same time, especially with the high cost of some of these drugs. Then, there are many risks to health and life from the side effects and the bad interactions that can come with taking multiple drugs at the same time. For some patients, 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 a person’s drugs, but they still add to the high cost of health care and can eat into the profits of drug companies and pharmacies and increase the costs for people without a drug plan. Of course, a lot of people feel that the drug companies make too much money, but they need to make enough profit in order 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, people 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 used properly, they 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 a person’s diet and lifestyle before prescribing drugs, because these could be causing their health problems. Doctors should make sure that patients are getting enough exercise, eating healthy foods, and managing their stress levels. Of course, some patients may be so out of shape, overweight, or stressed out that they temporarily may need some drugs to help them until they can get healthier.

Only when patients are otherwise taking care of themselves should doctors prescribe drugs. Although this may require doctors to learn more about their patients before they can resort to just prescribing drugs, it will be far better for the current and future health and finances of their patients. It can also help to control health care costs and direct more drug research towards finding drugs to help real health problems and not towards drugs that would allow people 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 people buy drugs in foreign countries or over the internet, they do not have the same guaranties. If someone actually gets the drugs that they 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

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 loses his or her license in one state, he or she may simply move to another state and resume practicing medicine.

In order 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.

Next Section

Legislative Issues - Introduction to the Legislative Issues affecting Our Future Path.

Last Updated:
Sunday, November 26, 2017
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