 |
|
« Burning Question | Main | Diagnosis: Medical Device Industry Looks Healthy »
March 27, 2007
America's Health Care Conundrum
We've all heard about the "health care crisis," so it should come as little surprise that there are more than 48 million Americans without health insurance and approximately 32 million others who are under-insured. Here we offer benefits spending trends for employers and insurance tips for employees.
The United States is the only industrialized nation that does not have universal health coverage. This, in addition to other facts, has made the rising cost of U.S. health care the most pressing concern for 85 percent of U.S. adults, more so than the war in Iraq, rising fuel costs and the threat of global warming, according to a recent survey sponsored by the American Society for Quality (ASQ) and conducted by Harris Interactive.
The number of uninsured rose by 6 million people over the past four years, according to AmericanHealthCareReform.org, while more Americans each year are forced to file for bankruptcy due to medical bills. In fact, people file for bankruptcy at a rate of one every 30 seconds (1,051,200 annually) because of medical bills. According to the ASQ survey, more than one in four U.S. adults have not filled a prescription or have delayed a medical procedure due to expense.
Basically, Americans now have a two-caste system: people who, by nature of the type of work they do and where they are in an organization, have health insurance; and those in the other group who are deemed not important enough to have insurers support their health. Actually, it isn't that simple, either. Even among those who do have health insurance, there is a wide variation in how much they must contribute to health insurance costs. Furthermore, Medicaid and Medicare pay for people over 65 and for the very low-income people.
Economist Jonathan Skinner says the powerful health care lobbies and Americans' suspicion of what many see as socialized medicine make a radical overhaul of the system difficult, Voice of America reports. Yet Skinner says "the increasing financial strain of health care spending on American businesses, government and families will make some change inevitable," as VOA reports.
By "strain," you can bet that it's a strain on competitiveness, too. When an automaker spends more for an employee's health care than for steel in a vehicle, a huge problem can't be denied.
Oddly enough, it is IBM that sums up the health care dilemma rather succinctly:
For employers, the health care crisis presents a range of business problems: it not only affects the bottom line, but as part of a benefits package, it is key to helping companies attract and keep the best people. Just as they work to plan and shape the future of their own industries, businesses need to take an active role in creating a new health care system — one that is value-based, affordable and sustainable.
Trends For Employers
From 1960 to 2002, employer spending on health benefits increased threefold, according to the Employee Benefit Research Institute in January 2005. Last year, overall health care costs grew by 8 percent, a level at which costs are expected to remain in 2007 and 2008, representing sharp declines since 2002 when costs grew by 14.7 percent, according to a Watson Wyatt/National Business Group on Health annual survey published this month (via Workforce Management). (According to Cowden Associates, Inc., the national average increase in the cost of health care premiums for employers was 7.4 percent in 2006. This figure remains unchanged from 2005.)
As for the future, we look to PricewaterhouseCoopers' recent "Behind the Numbers: 2007 Medical cost trends for employers" report:
Health care spending in the U.S. is expected to increase by double digits in 2007. The medical cost trend projections are used by insurance carriers and employers to set health insurance premiums levels and design benefit packages offered in 2008. Early estimates reflect widespread optimism that health spending can be curbed if consumers share more of the costs.
When health care costs began to show a significant year-over-year rise, employers started offering HMO plans. This allowed insurers to bargain with health care providers, shunting those with insurance but unable to afford the extra cost of the privilege of choosing the physicians and specialists they preferred to seek services from those selected by the insurer. Unfortunately, this wasn't enough to keep medical costs from skyrocketing.
More recently, many employers offer higher-cost insurance with higher deductibles as well as fewer health care benefits. Some employers do what they can to minimize costs for employees but feel forced to pass along some increases or live dangerously in terms of investing in essential research and development (R&D) for new services and products.
(For information about the role prescription drugs play in American health care, see "Do Drugs Make Us Feel Better or Worse?")
Tips For Employees
"Until recent years, the overwhelming majority of Americans received health insurance through their jobs," law firm Young Ricchiuti Caldwell & Heller, LLC notes. Although those numbers "have declined somewhat in recent years," employer-sponsored health insurance "remains the most common source of health insurance."
The law firm has come up with some tips for preventing medical disputes. Foremost:
The most important point, by far, is communication with doctors, nurses, and therapists. Talk to them. Know what they are doing for you or your loved one, and know what they think will help. Find out what they think, what the prospects are, what the treatment options are, and what treatment settings are appropriate and will be appropriate in the future. If you don't think you know what is going on, ask the health care providers for some time. If you are in a hospital or other institutional setting, a social worker will often set up a meeting to discuss treatments and treatment options.
Further, there are some other straightforward things that you can and should do if there is any prospect at all that a dispute might arise with the health insurer:
1. Obtain a copy of the insurance contract that establishes and governs the available benefits (sometimes referred to as a "plan document"). The law requires health insurance companies to provide these documents.
2. Know and understand the nature of the injuries, the treatment being recommended and its alternatives, and the reasons for the recommended treatment.
3. Be persistent. When dealing with a claims person or adjuster, do not be afraid to ask to speak to a supervisor.
4. Keep records of your managed care contacts.
5. If a managed care representative tells you that he or she will get back to you, ask for an expected timeframe. Also, ask for a way you can get back in touch with the representative.
6. Whenever you write to an insurer, keep a copy of what you send and make a note of when and how you sent it.
7. Be aware of the health care coverage provider's claims and appeals procedures. Ask about these deadlines, and ask the insurer to send you information in writing that tells you what the appeal procedures are and how you can follow them.
"The complicated administrative processes established by many managed care providers can be daunting for even the most motivated and focused family members," notes Young Ricchiuti Caldwell & Heller, LLC.
Of course, understanding them is becoming increasingly necessary. According to AARP, about 18,000 people a year die prematurely because they lack insurance.
We are each a patient or potential patient.
To see how your employer compares with others, visit the Employee Benefit Research Institute.
Resources
Adults More Concerned About Rising Cost of U.S. Healthcare Than Iraq War
American Society for Quality (via CNW Telbec) , March 22, 2007
Even Republicans Hate Our Health Care System
by David Moberg
In These Times (via AlterNet), March 12, 2007
There are over 48 Million Americans with No health insurance
American Health Care Reform
U.S. Health Care: World's Most Expensive
by Zlatica Hoke
Voice of America, Feb. 28, 2006
Everyone's business: Fixing healthcare
IBM e-magazine, Jan. 1, 2007
Study: Firms Want Workers to Be Health Care Consumers
Workforce Management, March 16, 2007
2006/2007 Tri-State Area Employee Benefit Survey
Cowden Associates, Inc.
Behind the Numbers: 2007 Medical cost trends for employers
PricewaterhouseCoopers
Guide to Rights: Health Insurance
Young Ricchiuti Caldwell & Heller, LLC
Healing Our System
by Patricia Barry and Barbara Basler
AARP Bulletin, March 2007
Typical Health Benefit Package in Private Industry
Employee Benefits Research Institute, April 2006
Trackback Pings
TrackBack URL for this entry:
http://news.thomasnet.com/mt41/mt-tb.cgi/967
|
Advertisement
|
Comment
15 CommentsTo: ThomasNet.com & Fred White
I find it hard to believe that America's Healt Care Conundrum" was presented without mention of facts relating to the predicament European countries find themselves in with their "Socialized Health Care system". Not to have presented such facts, you performed a disservice to all who have & will read your article.
The problems faced by the Canadian Health Care system is fast approaching the predicament already faced European countries.
The U.S. Health Care system, with all of it's problems, is greatly supperior to anything offered by the EU countries or Canada!
If anyone cares to get the facts on all of the "Health Care Systems" referneced above, The Heartland Institute has wonderful information relating thereto.
Cordially, I sign
James P. Sammon
Insurance Broker (not Medical Plans)
206-953-8757 - Phone
425-368-1239 - Phone
jpsammonhallcj.com
If we took the lawyers out of the equation, it would be cheaper to do the right thing.
March 27, 2007 4:45 PMMr. Sammon:
Thank you for sharing your thoughts about comparing the current health care systems in the U.S. with those of Canada and some European countries. You are quite right that Europeans and Canadians do have some problems. What I have heard indicates delays in getting health care for many people. Or, perhaps in some cases, they may not get health care at all if their case is deemed too insignificant.
I think what many Americans who have health insurance coverage appreciate is being able to get care soon and being in a society where we make a serious attempt to create the best technology, medications and processes we can. I also think that many people probably like it that their health care providers are held accountable through a robust (though not altogether flawless) legal system.
I might also add that I wonder how many fewer Americans would lack health care insurance if they took what they spent on luxury items and entertainment and spent it on health care coverage. Thus, please feel assured that I take your comment as worth noting and I respect your view.
I prefer to think that when we spend many scarce dollars for a 12-year or 16-year education of our young people that we don't throw away 48 million of those educational investments if the person becomes ill. Perhaps the question is: Do we want to spend more to protect the initial investment so the person can continue to add value to services and products?
Also, I recently heard or read that as far as Canada goes, no politician (even conservative ones) would think of running for election on a platform that backs switching from socialized medicine to private medicine. To me, this doesn't show rabid displeasure among the citizens regarding their health care system. No matter the system, there will always be those critical of the system, but to compare the moans and groans of the irritated with the million people annually who go bankrupt due to medical bills AND those who die for lack of care seems an unbalanced comparison.
I might add, the original article I wrote was longer, but it was cut for length concerns. Again, we appreciate the feedback.
Cordially,
Fred White
March 27, 2007 5:02 PMGood day: Following up on your well-written article, your readers may want to look at Expansion Management's 2007 Healthcare Cost Quotient, which notes which of the 50 states lead the way in affordable employer healthcare costs, and healthcare quality and availability. The report is especially useful for businesses looking to expand. Please go to:
www.expansionmanagement.com/emstatic/research/healthquotient.asp
Mike Keating
Expansion Management Magazine
PH: 216-931-9657
All of these concerns will be answered by Sen. Clinton, should she be elected President... in all of her public campaign appearances, she has said there WILL be universal health care coverage, I GUARANTEE IT!!!!
What is of interest to me, given the track record of her past and the past of her mentor/husband, is how she will
support a failure of the Guarantee; A) Will she resign if it does not pass? B) If it does pass, will she and all members of her administration forgo the luxury plan they will still have and take what the rest of us will be stuck with? C) Will she "feel our pain" as she and her mentor so often state? D) Will all in Congress who vote for it follow the lead of the administration in health coverage? E) If it is passed, is a failure in scope and function, what will be left of the private health insurance industry to step in?
A guarantee is a statement of remedy for failure to perform as designed or promised and is a binding contract to the issuer. Given the track record of government in general, and the Clintons in particular, where do you believe the plan will go? Her mentor could not sustain his marriage "guarantee" provisions, how will this Guarantee perform? Perhaps the answers are in the definition of "IS" as similar definitions of the past.
Do not construe this as support for the Bush administration, thank God, given his performance, he had not tried to push the unworkable also.
March 28, 2007 1:20 PMMy biggest problem with "universal health care" is the failure to hold "professionals" to account.
My car was rear ended by a pickup truck doing 35 MPH on 12/4/2000. Two years later, because I "didn't show enough pain," I was told "there's nothing wrong with you. It's all in your head." Last August, with the recommendation of a new PCP (I'm disabled and on Medicare/Medicaid), an MRI was done. Right where I claimed pain and problems in 2000-20005, I have degenerative arthritis of the Lumbar Spine. So bad that it's inoperable, and progressively costing me the ability to walk.
I couldn't then, and still can't sue, for one reason. The clinic where I was grossly misdiagnosed, is part of a city hospital, and immune. Will the "universal health care" be the same?
April 20, 2007 8:25 PMIt is not having the best health system and best hospital in the world, it is if we can afford to use them. The cost is too high, the American health system is like having a diamond behind a glass that only can see it through, but can afford to buy it, only rich people. Health insurance in America is like having a Mercedes Ben, not everybody has a Mercedes Ben in America, just rich people have one.
It is about time to fix the system, that way everybody could able to used when needed. Around 80 million are without insurance, if we enforce every body to pay a least $20.00 for each person at months, the 80 billion will be come 80 million x 20 =1,600 million x 12 192,000 million just on those uninsured not included the one who insured, there is the money once everybody is insured. I have not visited a hospital for more than 15 years. I go to see the doctor about 2 times a year.
Instead they installed red light and speed camara on the road an excuse that many state government used it is that they want to save life, if they really they want to save life, they must give insurance to his people in the state.
April 21, 2007 2:23 PMIn my opinion: It is disgraceful for America not to have health care for ALL citizens after all these years. The health care citizens should have - is coverage for everything - which means whole body: dental, eyes, mind and body. Plus it should include preventive care AND it must allow alternative care (chiropractic, accupuncture, massage therapy, ect.); medications, herbs and supplements. Other countries support this broader coverage and it is very important to the people to get all this whole body, whole care health insurance, now.
July 23, 2008 8:06 AM
