The U.S. has experienced a significant increase in the cost of health care. In 2004, 16% of
the Gross Domestic Product (GDP) was spent on health care. In 2010, President Obama
signed the “Affordable Health Care for America Act (HR 3962)” that has been a topic of
heated debate since discussions began decades ago. Health care funding and design has
been a major issue for U.S.
Address the following directives below.
- Provide a discussion that demonstrates you have an understanding of the impact the cost
of health care has on the economy. Be sure to discuss the Gross Domestic Product (GDP). - Health care legislation impacts an array of factors such as quality of health care,
insurance coverage, the free market, etc. Select two to three (2-3) areas impacted by health
care legislation such as HR 3962, and provide an argument in support of the health care act
and two arguments that are in opposition to such a health care act. - Compare the three (3) main types of health insurance in the U.S. and assess the solvency
of each. Make a prediction regarding the longevity of each type over the next 30 years. - Debate whether or not private health insurance violates the standard principles of
insurance. - Analyze the evolution of the promotion of health and disease prevention in the U.S. and
identify the point at which a clear shift in the thinking in the dominant culture occurred
resulting in the greatest impact on the health care insurance system in the U.S.
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
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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
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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 1 st 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
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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
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(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- 19 th 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,
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and in turn, health took a new turn (Newacheck et al., 2010).Health in American had deteriorated
greatly in the mid-19 th 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.
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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.