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The Need for Changes in U.S Health Insurance

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

The United States House of Representatives has passed a health care reform bill for the nation. Now, the bill goes before the Senate for debate, modification and passage or rejection. That there is a need for health care reform no one seems to question. However, the nature of the reform is being hotly debated once again, as it has for many years.

Kaiser Health News, (unaffiliated with Kaiser Permanente health insurance company), publishes a monthly newsletter named, KHN. This month, in conjunction with the LA Times, they discussed the serious issue of health care in the United States. What they had to say was sobering indeed. What they pointed out was that there is not much difference between those who are uninsured and those who are.

How is this possible?

The answer is multi faceted. For example, 1. many people who were insured have lost their jobs, throwing into unemployment without any coverage. In other words, they join the ranks of the uninsured.

Those who remain employed or who find new jobs, discover that their coverage is grossly inadequate if they or an immediate family member develops a catastrophic illness. These are people for whom medical bills are covered by their policy only up to an allowable limit. Because medical costs today far surpass that limit, they find themselves quickly in debt as a result of the illness.

I expect some readers to protest that these people should have saved and invested their money so that they could have paid the balance of their bills. The answer is that many of them did just that thing, paid all their medical bills until the bank account was empty with no further ability to pay.

2. Many others are finding themselves caught in the web of co-pays. As the cost of medical treatment has risen, insurance companies have increased the amount of the bill patients are expected to lay out before they will reimburse doctors and hospitals. At one time, a copy pay for an office visit might have been five dollars per visit. Today, many co pays are as high as twenty to thirty dollars per visit. When you add to that the fact that prescription drugs require another co pay, the entire venture becomes quite expensive. If their is a chronic or catastrophic illness, such as cancer, the results can and do ruin peoples financial well being. By that I mean that people in this category find themselves unable to pay their mortgages and find the banks pushing them into foreclosure. Remember, these are not people who speculated when they bought their homes, nor are they people who became trapped by questionable mortgage companies so that they purchased a house they could not afford. The loss of their homes is due to the advent of a serious medical problem and inadequate insurance coverage.

3. Yet another problem is that, the way the medical system works today is that, if someone has been hospitalized for surgery or some other procedure, the doctors who provide these services send their bills after the hospital charges are paid.

The problem is that this catches many families by surprise. Given a hefty bill from the hospital and having their insurance reimburse for the charges, these people believe all their charges have been paid. Suddenly, they begin to receive bills from doctors they never heard of or whom they incorrectly believed, had been paid. These charges often come to thousands of dollars. Like it or not, these patients remain fully responsible.

Will their insurance pay? Not an easy answer. Here is why:

1. The bills from these doctors must be submitted before a deadline set by the insurance company. If the bill fails to be submitted on time, they will not pay.

2. If the doctors are not in the network of the person’s insurance company, the insurance company that the patient has may pay part or none of the bill, depending on how their policy is written.

As KHN and the LA Times jointly point out, the problem is not that these people have no insurance. The problem is that they have inadequate insurance.

In my very humble opinion, I believe we need universal health insurance so that every citizen will be able to feel certain that their illnesses will be treated without the threat of being driven into bankruptcy or homelessness.

What is your opinion?

I want to make two final statements:

1. I invite those who agree and disagree, to submit their points of view. In no way am I attempting to impose my views on those who may disagree.

2. I also invite those of our readers who live in other nations to participate in what I hope will be a good discussion. Our audience extends well beyond readers in the U.S. Therefore, I want invite those who live in other nations and have different insurance systems, to discuss their experiences. Many, but not all of these people come from the UK and Canada. U.S. citizens regularly refer to these two countries when discussing the U.S health care crisis. I am not sure that we in the U.S. have an accurate view of what happens there. Of course, there is also France and many other countries that have medical systems that vary from that of ours.

So, I invite everyone to weigh in on this important issue.

Allan N. Schwartz, PhD

Keep Reading By Author Allan Schwartz, LCSW, Ph.D.
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