Health Care Reform Essay, Research Paper

HEALTHCARE REFORM

In the United States, more than forty million people are without health insurance. Of these people, many are employed by firms that do not offer coverage and many others fall just below the poverty line. Many are poor but still do not qualify for Medicaid. At least twelve million of those without health insurance are children. Reliable sources indicate that the number of uninsured people could rise as high as sixty million by the year 2007.

There is also a dilemma that the insured United States citizens face, that their healthcare system is sick, and everyone is aware of its illness: profit. In 1997, Malike Hassan’s, an HMO stockholdings CEO, salary was 166.4 million dollars. Most experts agree that the lack of plan participants’ personal involvement in the healthcare system is largely responsible for inflation within the plans.

However, as the debate rages on about how to best resolve the issues, it is certain that, as individuals become more involved in the healthcare process, they become an integral part of the solution. If people wish to change the system, they must change their role in healthcare reform from passive to active. In order to bring unification and unconstrained functionality to the U.S. healthcare system, people must first educate themselves on how their healthcare works, voice their opinions, and finally join together to bring reform.

The first action people must take to insure their own well being and safety is to stay thoroughly informed on how their HMO plans run. Managed care is often criticized for encouraging the withholding of beneficial care from patients. People need to be aware that many HMOs contain Gag Rules. These rules, in contracts between managed-care organizations and physicians, expressly prohibit the physician from telling patients about therapies that are not covered by the plan. Therefore, the physicians are not part of the decision making process involved in determining what services to provide. These rules can apply even when the patient’s life is at stake.

Other terms prohibit the physician from disclosing how he or she is paid, especially when payment methods reward limiting referrals to patients. Why do HMOs want physicians to be less than honest with their patients? Because patients might demand care that would raise costs and reduce profits.

According to Jeffrey Koplan, M.D., “Patients should learn how to become active participants in their own healthcare, which means taking part in decisions involving diagnosis and treatment.” Koplan is the president of Prudential Center for Health Care Research which conducts research to evaluate and improve how healthcare is delivered to managed care customers. If all insured citizens were more aware of the actions of their HMO, then there would be a decline in the immoral policies.

Also, there are few American citizens who are striving for a real cure. The current fashion is to impose incremental reforms. For instance, Congress passed a new program to finance healthcare reforms for some uninsured children. They are also attempting to push bills to make it difficult for HMOs to deprive people of needed care.

These bills are a much-needed step in the right direction. However, none of these reforms address the underlying problem: The US healthcare system is driven by giant insurance conglomerates supplemented by an inadequate patchwork of public programs. These programs segment the population into unequal fragments: rich and poor, healthy and sick, young and old, unemployed and employed.

There is no real solution, short of, creating one unified publicly funded system that treats everyone the same. Furthermore, the experience of other countries tells the United States that this kind of system can be highly successful.

For instance, suppose a Canadian injures himself and the injury requires stitches. He or she would simply go the emergency room, show their national healthcare card, receive treatment and go home.

Now, consider the same example in the United States, assuming of course that the U.S. citizen is healthy and insured. The person must first attempt to contact their “primary provider” in an effort to obtain a referral to the emergency room. Assuming the doctor is in, the person waits on hold, while the physician’s assistant must interrupt the doctor from his treatment of other patients. The doctor will most likely authorize the visit. Then the injured person must lengthy paperwork at the hospital.

After the person receives treatment, there are also follow-up HMO phone calls and paperwork, an arduous and time-consuming task. All of this is done to guarantee that the injured person will not receive a bill, however, there is still a chance that his HMO will not pay in full and the hospital will bill the patient for the balance.

The whole process of receiving emergency treatment is approaching the absurd. An emergency is defined as an unforeseen combination of circumstances that calls for immediate action. It is not uncommon for people who are insured, to refuse needed medical treatment to avoid the hassles of insurance.

There are also countless horror stories of what happens to people in need of emergency assistance who are uninsured. Elderly citizens often fall in between the Medicare cracks and die leaving enormous medical bills. Then there are citizens who are caught in the surreal world of Workers Comp, where money, if it ever shows up, is often too late.

Healthcare is the one asset that affects every United States citizen. US citizens need to realize that the demand for healthcare services starts and ends with individuals. As personal involvement and education increase, people become empowered to make informed healthcare decisions, and that is good medicine for America as a whole.

Bibliography

2

1. Orient Jane M M.D. Your Doctor Is Not In

Healthy Skepticism About National Healthcare

Crown Publishing, Inc., Macon, GA, 1997.

2. National Organization of Physicians Who Care

http://www.pwc.org/

3. Daniels Norman. Benchmarks of Fairness for Health Care Reform Oxford Univ Press, London, UK, 1996.

4. Labor Party Online

http:www.ipc.apc.org