Term Paper: Uninsured for Health Care Our Healthcare System

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Uninsured for Health Care

Our healthcare system is not a bowl that catches everyone. it's more like a sieve. As our population pours into this sieve, some people remain in the bowl while others slip through. 38% of employed Americans under the age of 65 do not get health care. They aren't eligible for Medicare yet, and aren't protected by safety nets such as California's State Children's Health Insurance. Because of our piecemeal system, nearly 45 million Americans lack health care today (KFF, 2004). This number has risen dramatically in the last five years, and now more than one in six adults under the age of sixty-five have no health care.

And, we don't know what to do about it. We see ourselves as a compassionate and caring country. When the media reports how well our hospitals have been ranked, we take pride in the fact that we live in a community where such good health care is available. And yet, for 15% of the population, access to that health care is quite restricted.

Unfortunately, low income correlated with lack of health care. The majority of uninsured people in this country are the "near-poor," or people close to but not at the poverty level (KFF, 2004). For these people, providing more choice in health insurance, one strategy for managing the marketplace, will not help them: they can't afford any insurance plan. The majority of uninsured are adults below the age of 65. They qualify for neither Medicare nor for the programs put in place for children who don't qualify for Medicaid (KFF, 2004).

This group of uninsured adults is growing. These adults accounted for 80% of the growth of uninsured people between 2000 and 2003. They cannot afford individual policies, and some cannot afford the amount their companies require them to pay toward company-provided insurance (KFF, 2004), a price that has been continually rising for several years (Nichols, et. al., 2004).

Incredibly, this situation exists in the wealthiest country in the world. It doesn't help that health care consumers here conflicting information about the state of our health care finances. Unfortunately, it's easy to 'cook the books' when looking at what the United States spends on health care. The statistics are very clear. After all, the World Health Organization says that the United States spends considerably more per capita than any other country in the world (Anderson & Hussey, 2001). Is the W.H.O. wrong? Well, yes and no. Dollar for dollar, we DO spend more than any other country. However, if those numbers are compared to the amount of wealth our country produces, we should spend nearly $2,900 per person, per year. But in fact, we spend only about $1,558 per person each year. In addition, that money is distributed unevenly, which is how we have so many working adults without health coverage. In the United States, it may take money to make money, but it clearly takes money to get health care. The people with marginal incomes and no health insurance cannot afford health care and often can only get it when a medical emergency occurs.

Even though we live in the wealthiest country in the world and have some of the best hospitals ever seen, our health care system leaks like a sieve. While we accomplish a great deal, we do it inefficiently, and a significant minority of our population do not have access to all that excellence. We spend more on health care than any other country, and yet cannot provide health coverage for at least 15% of our population (Nichols, et. al., 2004). Among first world countries, we don't compare well for either life expectancy or infant mortality (Nichols, et. al., 2004). Meanwhile, over four out of five of the uninsured live in families where at lest one parent is employed full time. However, they don't earn high wages, work for a small business or in the service industries (KFF, 2004). Not all full time jobs offer insurance, and of those that do, sometimes what the employer has to pay for the employee share iis simply more than he or she can afford.

The issue of health care for all is of course a significant political issue. Universal coverage for all, paid for the government, would be expensive, and many don't want to turn all health care over to total government control (Nichols, et. al., 2004). In addition, it is easy to spot inefficiencies in the current system, and this raises the concern that tax dollars for health care will be used inefficiently (Nichols, et. al., 2004).

Two solutions are often put forth as ways to make our health care more financially efficient. One approach allows individuals and not employers to choose what insurance coverage they will have. This approach can include tax credits that would help subsidize what the employee must spend out-of-pocket (Nichols, et. al., 2004). This approach introduces a higher level of competition into the health care market, an approach some feel would result in more affordable health care for all.

Others suggest that the government should play some kind of regulatory role in the health care market, and that this federal and/or state pressure would lead to lower costs. In this system, the employee would pay part of the cost for employee health insurance, but would be able to choose from all health care options available in that community. This would introduce competition into the system, resulting in more financially efficient health care costs. In effect, the health care companies would have to compete for their customers (Nichols, et. al., 2004), just as auto dealers compete for car sales.

Such an approach would also limit the amount of governmental intervention needed. The problem with this approach is that individual communities do not always have enough health insurance options to establish any real marketplace competition. Many cities are dominated by two companies, and some, by only one (Nichols, et. al., 2004). In such cities no real competition could be established.

But one of the biggest problems with these approaches is that while they may bring positive changes for those who have health insurance, they do not address the needs of the 15% who have no health insurance and would be shut out no matter how much competition could be established among the providers.

Those 15% are another significant force on the economics of health care. What happens now is that those who have no health care typically use the emergency room as their primary doctor. All too often, they don't go until they are more sick than they would have been if they could have afforded to get help earlier. The only thing that saves these people at all is that hospitals are compassionate places that won't turn a person in a medical crisis away. But they will still send the bill for the care, as they have to. Inability to pay healthcare bills leads to a significant number of the bankruptcies in this country, and the hospitals that provided the care must absorb the loss -- raising health care costs.

Because people delay medical care as a financial management strategy, they often don't get medical care until they are sicker than they would have been if they could have afforded to go to a doctor. They are sicker than they needed to be, and it is more expensive to treat them.

Analyses of health care reform oven look at what the market can accomplish on its own, and what the government could do to reduce costs while providing health care to those who do not have it. Currently, health care is distributed inequitably (Nichols, et. al., 2004), and while few want socialized medicine, most people realize that we should not have 15% of our population without health care options. Meanwhile, without effective solutions, health care costs will continue to soar, and unless we come up with a better solution, employers' response will be to require employees to pay more and more of the costs for health care coverage. This will increase the number of people without coverage, because health care costs are rising at a significantly faster rate than income (Nichols, et. al., 2004).

Several factors block our health care system from adjusting in a way that would allow more to participate through health plans. First, the health care providers often have considerable power in local markets because of lack of competition. For example, the entire city of Cleveland has only two health insurance companies providing policies for employers (Nichols, et. al., 2004).

Second, consumers often have preferences, especially for specific hospitals. If consumers look at several health care plans and find that their doctor, or their preferred hospital, is only on one plan, that is the one they are likely to choose (Nichols, et. al., 2004). So, if companies are to compete well, they have to find ways to include the health care outlets consumers are likely to choose.

Third, making health care more financially efficient is a complex and difficult… [END OF PREVIEW]

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