Problems in American Health Care

Health Insurance Options

• Universal health care system: system of health care, typically financed by the government, that ensures health care coverage for all members

• The United States is the only developed country without universal healthcare

  • Private insurance coverage exists mainly through employers and employee contributions

  • Private insurance is also purchased by individuals through Affordable Care Act exchanges

• Managed care: any medical insurance plan that controls costs through monitoring and controlling the decisions of health care providers

• Medical debt: debt that results when people cannot afford to pay their medical bills

• Medicare

  • Federally funded program provides health insurance benefits to elderly, disabled, and those with advanced kidney disease

  • Medicare recipients pay monthly premiums, copays, and partial or full costs for long-term care, vision, dental, and prescriptions

  • Over seven million seniors cannot afford prescriptions

• Medicaid

  • Public health insurance funded by federal and state governments and covers individuals who meet low-income eligibility criteria

  • Physicians less likely to accept Medicaid over private insurance because government reimbursement for fees are lower and slower

• Children’s Health Insurance Program (CHIP)

  • A public health insurance program, jointly funded by the federal and state governments, that provides health insurance coverage for children whose families meet income eligibility standards

• Military Health System (MHS) and TRICARE

  • The federal entity that provides medical care in military hospitals and clinics, and in combat zones and at bases overseas and on ships, and that provides health insurance known as Tricare to active duty service members, military retirees, their eligible family members, and their survivors

• Veterans Health Administration (VHA)

  • A system of hospitals, clinics, counseling centers, and long-term care facilities that provides care to military veterans

  • Recent changes impact more co-payments especially for family members and conditions not related to military service

• Indian Health Service

  • A federal agency that provides health services to members of 566 federally recognized American Indian and Alaska Native tribes and their descendants

  • Funding appropriated annually by Congress

  • Lower coverage than Medicare, Medicaid, and VHA leaving many Indigenous Americans and Alaskans without access to health care

• Uninsured

  • In 2019, 8% (29.3 million Americans) did not have health insurance for the entire year

    • People of color, nonelderly adults, and children are less likely to be insured

    • 73% of noninsured families had one or more full-time employed member

      • Companies do not offer insurance, employees might not be eligible due to part-time status or waiting periods, and some employees cannot afford the premiums

High Health Care Costs

• The United States spends more on health care per person than any other country in the world

  • Health care costs average $10,966 per person

  • Health care is 17% of the national GDP (Gross Domestic Product)

  • Two-thirds of all bankruptcies are related to health care debt

  • One-fourth of U.S. adults report that they or a family member postponed treatment for a serious medical condition due to cost

  • Compared to other industrialized countries, the U.S. has lower life
    expectancies and higher maternal and infant mortality rates

• Factors contributing to health care costs

  • High cost of administration

  • U.S. spends three times more on health administrative costs

  • Higher-cost services and prescription drugs

  • In the U.S., people spend more on medical procedures

  • In 2019, nearly one-third of U.S. adults reported not taking prescription medications at some point in the previous year due to cost

  • One estimate suggests there are 125K deaths annually associated with skipping medications

Other Major Issues

• Lack of competition and transparency

  • Patients often experience surprise billing especially common for emergency services

  • Medical practitioners often charge patients with private insurance higher fees than are allowed for Medicare patients

• Higher utilization of hospitals and specialists

  • A third of all health care expenditures in the U.S. are for hospitals

  • In communities where uninsured people lack access to health clinics, they are more likely to utilize emergency services

• Preexisting conditions: illnesses or injuries that occurred before a person begins coverage under a new health insurance plan

• Parity: a concept requiring equality between mental health care insurance coverage and other health care coverage

Understanding Epidemiological and Health Care-Related Problems

• The sociological view of illness and health care examines both social causes and social consequences of health problems

• Families, communities, and society are impacted when individuals cannot support themselves due to physical or mental illness

• COVID-19 showed how illness can affect all aspects of social life

• A comprehensive approach to improving the health of a society requires a society-wide commitment to addressing diverse societal issues

Strategies for Action

• Expanding U.S. health coverage

  • The Affordable Care Act (ACA) expanded health coverage and mandated coverage for pre-existing medical conditions

    • Health care reform legislation that President Obama signed into law in 2010, with the goal of expanding health insurance coverage to more Americans. Also known as the Patient Protection and Affordable Care Act, or Obamacare

  • Supporters for a single-payer health care system in which a single tax-financed public insurance program replaces private insurance, argue that the $400 billion in potential savings would cover every U.S. resident