Harrison Taylor
Engs 13
Rosen and Robbie
The Problem with Insurance
Patient Story: The story I plan to address will be that of Brady Ferren. Mr. Ferren was walking across a parking lot when his knee hit an exposed trailer hitch, causing a hospitalizing tendon tear. He was driven to the hospital by his wife, where he received care, but not before learning that he was no longer covered by
However, he was unable to afford care, since due to his premature retirement a few weeks earlier at age 45, he was no longer covered by his employer’s insurance, but had not yet obtained public coverage. As a result, he was left with debt, but not only that, he was sent to a specialist for additional surgery he did not need, adding to his burden.
This story illuminates the problem with insurance uniformity across the United States, and how some practices in healthcare are taking the “care” out of the equation.
C. The approach you are going to take to address this story, analysis, research and
Recommendations
The problems facing the U.S. health care system are not new; they have been discussed for the last 60 years. The problems have not been solved because, due to fears of government involvement, we have been reluctant to impose central planning and management on the system. Reliance on the free market and fee-for-service reimbursement to allocate health resources, to contain costs and to determine who has health insurance has failed. The result is that the U.S. spends more per capita on health services than any other country in the world, but lags behind many other countries on such health indicators as life expectancy and infant mortality. Several criteria for evaluating proposals for health reform are offered and ten such proposals are discussed. “It is likely that, in the short run, the U.S. will adopt reforms that require the least change in the current system. However, these changes will not address adequately the fundamental problems with the system and, ultimately, major changes will have to be undertaken”. Although written in 1993, following the proposal of the Clinton Health Plan, this statement stands true today. As we have heard many times in class, the healthcare system is relatively unchanged, with extreme measures having to occur to ensure the implementation of new tools, such as the V.A., which threatened not to pay its physicians unless they utilized the provided EMR (electronic medical record) software.
I will examine insurance as a business, then explain how that relationship causes tension with Physicians and Patients alike, with the story serving as one example of a patient being left to chance. Then I will compare the US system to nationalized healthcare systems such as Canada and France, and see what pieces of those systems can be adapted to the United States.
For this reason, the results of a fascinating real-life experiment in Oregon were very significant. In 2008, Oregon decided to expand its Medicaid coverage. Because it could not accommodate all the poor Oregonians who were otherwise uninsured, it had them apply for Medicaid by lottery. Researchers then compared the ongoing health of those who ended up on Medicaid with that of those who remained uninsured. Because the two groups resulted from random assignment, any differences between the groups in subsequent years was deemed statistically relevant.
Although this study is ongoing, initial results obtained a year after it began showed that Medicaid coverage had already made quite a difference. Compared to the uninsured “control” group, the newly insured Oregonians rated themselves happier and in better health and reported fewer sick days from work. They were also 50 percent more likely to have seen a primary care doctor in the year since they received coverage, and women were 60 percent more likely to have had a mammogram. In another effect, they were much less likely to report having had to borrow money or not pay other bills because of medical expenses.
A news report summarized these benefits of the new Medicaid coverage: “[The researchers] found that Medicaid’s impact on health, happiness, and general well-being is enormous, and delivered at relatively low cost: Low-income Oregonians whose names were selected by lottery to apply for Medicaid availed themselves of more treatment and preventive care than those who remained excluded from government health insurance. After a year with insurance, the Medicaid lottery winners were happier, healthier, and under less financial strain.”
Because of this study’s experimental design, it “represents the best evidence we’ve got,” according to the news report, of the benefits of health insurance coverage. As researchers continue to study the two groups in the years ahead and begin to collect data on blood pressure, cardiovascular health, and other objective indicators of health, they will add to our knowledge of the effects of health insurance coverage.
A final set of problems concerns questions of medical ethics and outright medical fraud. Many types of health-care providers, including physicians, dentists, medical equipment companies, and nursing homes, engage in many types of health-care fraud. In a common type of fraud, they sometimes bill Medicare, Medicaid, and private insurance companies for exams or tests that were never done and even make up “ghost patients” who never existed or bill for patients who were dead by the time they were allegedly treated. In just one example, a group of New York physicians billed their state’s Medicaid program for over $1.3 million for 50,000 psychotherapy sessions that never occurred. All types of health-care fraud combined are estimated to cost about $100 billion per year.
Other practices are legal but ethically questionable. Sometimes physicians refer their patients for tests to a laboratory that they own or in which they have invested. They are more likely to refer patients for tests when they have a financial interest in the lab to which the patients are sent. This practice, called self-referral, is legal, but does raise questions of whether the tests are in the patient’s best interests or instead in the physician’s best interests.
In another practice, physicians have asked hundreds of thousands of their patients to take part in drug trials. The physicians may receive more than $1,000 for each patient they sign up, but the patients are not told about these payments. Characterizing these trials, two reporters said that “patients have become commodities, bought and traded by testing companies and physicians” and said that it “injects the interests of a giant industry into the delicate physician-patient relationship, usually without the patient realizing it” .
These trials raise obvious conflicts of interest for the physicians, who may recommend their patients do something that might not be good for them but would be good for the physicians’ finances.
D. Sources to use:
An article from UMich Ann Arbor, lays out clear problems and proposed solutions for the US healthcare situation.
Aaron, Henry J. “Why Has Health Care Reform Failed?” Brookings, Brookings, 28 July 2016, www.brookings.edu/opinions/why-has-health-care-reform-failed/.
Henry J. Aaron, expert in economic studies, analyzes the healthcare problem, and why it is so hard to fix.
Although not a recent publication, it brings to light problems with ethics directly following a large economic downturn, which illuminates a different perspective.
Christensen, Clayton M., et al. The Innovators Prescription: a Disruptive Solution for Health Care. McGraw-Hill, 2009.