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  • Subject area(s): Marketing
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  • Published on: 14th September 2019
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Health Insurance is defined as a protection against the cost of medical expenses, but health care began from far less helpful beginnings. Before technology and science, doctors used to be mystics and religious figures offering little more than useless remedies or ridiculous treatments. By the early 1900's, there were educated doctors and hospitals, but they were mostly used for terminal cases; people that were ready to die. Medical professionals, however, wanted to change this. They started marketing their services towards pregnant women and other ill patients.  But hospital stays were expensive and inconvenient, regardless of how effective they could be. Then, in the 1930's, the idea of a payment plan for hospital and medical coverage was born from Baylor University Hospital in Dallas, Texas. After gaining popularity during the Great Depression,  it was named Blue Cross, & Blue Shield.

Although popular, that coverage was far from what Americans receive today. It took a few accidents to get onto that track. During World War II, factory owners used medical benefits as an advertising tool to entice people to be employed at plants that kept increasing production. This was the birth of employer-based insurance. Toward the end of the war and beyond, the government attached tax benefits and stabilization to the employer coverage, which spread the popularity even more. In fact, in the ten years between 1940 and 1950, hundreds of millions of  more people had adopted this coverage; the enrollment jumped from 20,662,000 to 142,334,000 (Health Insurance Institute 1961, Source Book, p. 10).

However, many Americans were unable to receive this private coverage due to being unemployed, impoverished, or elderly. As a part of social security, after much interest in a national insurance program, two bills legislating coverage for the elderly (Medicare) and people with low-income (Medicaid) were passed in 1965. Unfortunately, even with the institution of those programs, non-insured individual in the US has grown since 1994.

Along with the the Medic(are/aid) programs, there are other government/public insurances that are available. These include military programs such as the Veteran Health Administration and Military Health System, and state programs including the State Children's Health Insurance Program and the new Pre-Existing Condition Insurance Plan. Usually to be eligible for these plans, there are requirements that need to be met. There are also multiple types of private insurances besides employer-sponsored coverage. These include college plans for students, insurance for federal employees, Association group insurances, and individual insurance. The majority of these programs are termed ‘managed care'; means of providing low-cost benefits and high-quality care. In 1973, the government passed a Health Maintenance Organization Act to fund such programs. The programs would include a designated standard and network of providers, focus on preventative care, and efficiency.

“Insurance is a bit like a gamble between you and the insurance company. The company bets that they'll take in more money in premiums than they have to pay out in benefits”(Obringer & Jeffries, 2006). A Health insurance policy is essentially a contract stating that an individual will share the cost of medical expenses with the insurance company. Usually, after an out of pocket amount (deductible) has been spent by someone, the insurance will cover the majority of the costs as long as a small co-payment is received from the person needing the services. To take advantage of this policy, the insurance requires a monthly payment called a premium. If a high premium is paid, the out of-pocket amount is relatively low and vice-versa. What is usually covered can include necessary doctor and hospital visits, prescriptions and even major surgeries.

These managed care policies typically have lower costs than fee-for service plans, especially when it comes to preventive care. However, there are limitations to specific facilities and doctors. Fee-for-service plans offer more versatility; no out-of-network issues and endless choices for physicians.  

Despite the measures put in place to keep health costs low, many individuals are unable to afford health care due to the inefficiency of pricing. According to the US Census Bureau, forty-eight million people were uninsured in 2012. There are many reasons for this startling demographic. Some people, although capable of purchasing insurance, can't justify the large price tag; many who have insurance cannot afford the out of pocket expenses. Others are employed through companies that don't offer insurance, or are just without a job. There have been many attempts to remedy that high number; the modern health care system has come a long way to reach a goal of national coverage.

Over the course of American history, there have been people advocating for a all-inclusive system; beginning with Harry Truman in the forties, Ted Kennedy and Richard Nixon in the seventies, and Bill Clinton in the nineties. Finally, in 2010, President Barack Obama passed the Patient Protection and Affordable Care Act (PPACA or ACA). This legislation sought to increase coverage while lowering the cost of insurance. Included in Obamacare, were laws preventing price differentiation due to pre-existing conditions, as well as subsidies for those under the poverty level and medicaid expansion. Due to the large scale of changes to the entirety of the system, implementation was extremely difficult; this includes the initial failure of the online marketplace and all-around adoption of the new plans. Although it has a long way to go, this act was pivotal in introducing a fully universal system.

Even with the implementation of the ACA, the lack of accessibility or adequate coverage in America significantly impacts society and the economy. Those without the means are unable to receive preventative care, which in turn allows for worse illnesses, expensive treatments and excessive hospitalizations that go unpaid for or burden taxpayers. Many individuals try to avoid these situations due to their financial constraints, and end up increasing their rate of death by 25%. The providers also experience high costs when attempting to navigate through private insurance. There are massive amounts of forms, records and bills going to varying insurance companies. Many claims end up being rejected, so negotiations ensue to demand the payment necessary. These outrageous situations lead to immense administration costs.

So, universal healthcare is becoming more and more necessary as time continues. The costs of covering the millions that are uninsured are can be more than compensated for in a universal plan; by allowing access to preventative care, there could be decreased spending on unnecessary and expensive treatments as well as savings of millions of dollars in administrative costs. This provides efficiency and higher quality care, which enables individuals to live and work longer and contribute to society and the economy.

A universal system is not only financially sensible, but it is also ethically necessary as each person is deserving of life-sustaining care and overall wellbeing. That should be the basis for health care and reform, not maximum profit and endless costs at the expense of people only trying to survive. In the U.S. Constitution, all are entitled to life, liberty, and the pursuit of happiness. The current state of the american health system is failing, and a universal system can aid in that equality of life.

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