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Your Guide to the Difficulties of American Healthcare

Your Guide to the Difficulties of American Healthcare

The current United States healthcare system is a heavily debated topic as the 2020 election comes into full swing. Some are proclaiming a transition to Medicare for all and others are pushing for a public option that allows individuals to choose their plans, including government-provided options. To help you better understand the difficulties facing the healthcare system, as well as the challenges of navigating it, let’s explore in-depth just how the system works and what can be done to mitigate the stress of accessing care.

The Financial and Legal Challenges of Navigating Healthcare

Over 44 million Americans are uninsured with another 38 million having inadequate insurance. The lack of insurance or appropriate coverage is one of the biggest hurdles facing Americans when it comes to accessing healthcare services. Without necessary coverage, millions of Americans face crushing medical debt or the possibility of forgoing needed treatment to avoid debt they cannot pay.

These facts have been thrown to the forefront of the 2020 political debates, with each candidate putting forth their solutions to help lift this burden off the shoulders of the people. However, regardless of who enters into office, the difficulties facing Americans now and those already struggling with medical debt is something that must also be taken into consideration.

Already it costs over $250 billion to process the 30 billion healthcare transactions that occur every year. Adding to that are the 20,000 malpractice claims which are filed by patients and family members each year. The problem here comprises both how the medical industry is structured and how lower rates of coverage result in underinsured Americans receiving a lower standard of care. Studies indicate that uninsured or underinsured individuals are less likely to receive preventative care or services for both major health issues and chronic conditions that would otherwise be treatable.

Arguments against Medicare for all and healthcare reform insist that a higher influx of patients now able to seek affordable treatment will result in even higher rates of malpractice, though many counter-argue that adequate reform will reduce the number of claims due to more readily accessible superior care programs. To understand the truth, let’s look that the top reasons people file malpractice claims as reported in a study published in J Law Med Ethics.

  • 33 percent of respondents answered that they were advised to sue from someone outside of their immediate family, 56% of which were advised by someone in the medical field.
  • 24 percent of respondents said that they sued for malpractice because they needed money for long-term care.
  • Another 24 percent said that they were intentionally misled by a healthcare provider.
  • 20 percent of respondents said they sued because their child wouldn’t be able to have a future.
  • Another 20 percent said they filed a claim to get more information that they felt had been withheld from them.
  • 19 percent of respondents filed because they wanted to prevent future errors or get justice for their malpractice injury.

As this study shows, out of 127 families surveyed, a majority of malpractice cases were filed at the advice of a medical professional or because a family either needed money or felt they had been misled intentionally. Though the survey conducted was only on a small group, it shows that one of the top concerns facing Americans is the high cost of care which leads to legal entanglement in the hopes of mitigating the burden.

Power of Attorney

Another legal issue that many Americans face is obtaining acceptance as powers of attorney. About 63 percent of those surveyed by the Joint Editorial Board of Uniform Trust reported that they had occasional difficulty, with another 17 percent saying they had frequent difficulty. Having the power of attorney over healthcare is important if an individual is incapacitated and unable to make healthcare decisions for themselves. When family members have difficulty being accepted in this role, it can lead to unnecessary stress, especially if the problems are occurring in the middle of a medical emergency. If the power of attorney is rejected, it’s often up to the family to seek out a lawyer to help them get approval. These difficulties, coupled with the challenges of haggling with insurance companies or navigating healthcare costs upfront, contributes to the growing frustration and outright avoidance of medical intervention for potentially treatable issues and concerns.

The Debate in 2020

As we’ve discussed, healthcare is one of the foremost debate topics of the 2020 election, but voters need to understand the differences in the plans that are being put forth. Universal coverage, for instance, would attempt to provide insurance for all American residents. In other countries that have this system implemented, these services are paid for by either public or private programs, sometimes a combination of both. Alternatively, a single-payer healthcare system utilizes one entity — not necessarily the government — which pays for all healthcare services. Contrary to popular belief this is not a form of socialized medicine, which would instead consist of government ownership over all medical facilities, professionals, and payment plans.

That said, a majority of Americans are also split on how healthcare should be reformed, with most being concerned about the overall cost they are paying, as opposed to the system used to insure them. As of 2016, the United States has been spending twice as much as other Western nations on healthcare, with the U.S. spending 25 percent more than the second-highest spending nation, Switzerland. And a recent survey of voters in Iowa, South Carolina, and New Hampshire show that voters there are more concerned about out of pocket costs and not the insurance coverage itself.

Different Ideas

Both parties have various solutions on how to fix the rising costs of healthcare, though even along party lines there are not concrete agreed on solutions. Most in the Democratic party wish to see the government play a larger role in healthcare, while Republicans are rallying for less government interference and more free-market programs. Both solutions bear weight, though unless a solution can be agreed upon, healthcare will likely remain a hot debate topic for decades of elections to come.

In addition to access to care, there are also different ideas about types of care. Long-term care, mental health services, and addiction rehabilitation have also become hot button issues that hopeful candidates are talking about this election season. Once again at the heart of these problems lies the cost of care and accessibility. Mental health and addiction services, in particular, are areas in which the healthcare system is severely lacking. Even as though some candidates have put forth plans for reform in these areas, only a few have devised plans regarding Americans in rural areas and those living with disabilities.

What Can Be Done to Mitigate Difficulty in Accessing Care?

First and foremost the healthcare system needs to be reformed to match the current needs of American citizens and it needs to be done in a way that the common public can understand. This means removing unnecessary jargon and instead laying out healthcare plans in a way that doesn’t exclude individuals without a medical degree. Often families have the most difficulty when it comes to trying to understand exactly what their insurance plans cover and what all they are being charged for. This confusion can lead to people being overcharged for services and paying more simply because they cannot understand the ins and outs of the current medical system.

Furthermore, there needs to be a collective move to bring down the price of necessary treatments and drugs to ensure that they are both accessible and affordable for every American. Because cost is the number one concern of voters in this election, this issue is likely to be the one talked about and targeted the most. Until healthcare costs can be reigned in, we will likely continue to see the same aversion to care and the denial of treatment in fear of debt accumulation that we have seen for the past decade.

While these changes are likely to not be seen immediately, what we can do now is not hesitate to ask questions and demand answers to all of our healthcare concerns. If you don’t understand your current policy and feel that you are underinsured, speak to your insurance company and ask them to explain your policy in full.

If you’re currently without insurance and need care, you can call doctors, hospitals, and urgent care centers in your area and ask for prices. Often urgent care centers offer faster and more affordable care than hospitals or doctor’s offices. You can also ask your doctor to prescribe a generic version of a prescription you need or use a discount app to save on the cost.

The healthcare system is tricky at best to navigate, but if people continue to speak up about their difficulties, it’s likely that soon there will be a solution reached that can better benefit the American people.

Is America’s Healthcare Ready For The Silver Tsunami?

Is America’s Healthcare Ready For The Silver Tsunami?

With the Baby Boomer generation aging and gradually having advanced healthcare needs, America seems like it’s going to have a hard time keeping up. The so-called “silver tsunami” isn’t a natural disaster that causes flooding, but rather a test of the United States’ healthcare capacities. This tsunami carries a hefty amount of power just like its natural namesake, as it could potentially force change in the U.S over time. Already, the impacts of generational population sizes are beginning to show where the weak points are in the nation’s care options.

Baby Boomers Aging

Every generation has some natural fluctuations in numbers, but the Baby Boomer generation has been notoriously large. Because of this, many current systems in place are unequipped to deal with the generation’s large numbers. Now, as the generation ages and the Silver Tsunami approaches, more members of the generation will require additional medical intervention.

Many of these medical needs are fairly commonplace, such as hearing aids and similar assistive devices. More than 10 million people in the U.S. use hearing aids. However, with more strain being put on the nation’s healthcare system, some Boomers are falling through the cracks. This neglect can have a major impact on the health of Boomers, especially in the face breakouts of diseases. The common cold may be easy enough for an older American to overcome since the average person makes a full recovery in about 10 days, but viruses like influenza and measles pose a serious danger. If at-risk seniors don’t have access to the vaccines and care they need to fight afflictions like these, they could lose their lives.

Cracks In System Exposed

With more people relying on healthcare and even assisted living, more problems with the systems currently in place are being exposed. In some cases, this can take the form of highly costly procedures that are necessary for comfortable aging. This is particularly true of complicated interventions, such as cardiopulmonary bypass. Gibbon developed the cardiopulmonary bypass in 1953, and it’s still often a necessary measure in healthcare. The high cost, unfortunately, leads many individuals to not receive the care they need to live longer, healthier lives.

Cost isn’t the only harmful element of the current American healthcare system. When it comes to treating the elderly, malpractice and even abuse occur at alarmingly high rates. Elderly patients often lack necessary representation and advocacy when it comes to their care. A recent study estimated that only one in 14 cases of elder abuse are ever reported to authorities. With an aging population, the United States will be in need of better, more reliable care for the elderly.

Preparing Future Healthcare

Luckily, some are taking steps to begin preparing for the Silver Tsunami today. Improving the nation’s healthcare system will take time, and as the next presidential election approaches, healthcare will continue to be a subject of debate. However, some areas across the nation have already begun training additional medical care staff in order to prepare for the needs of an older demographic of patients. With improved training and changes to healthcare, it’s possible that medical treatment across the board will become more affordable. This could even extend into procedures often seen as aesthetic in nature; today, some four million Americans are wearing braces, according to the American Association of Orthodontists. With potentially drastic measures needed to make healthcare affordable enough for the vast aging population, it’s possible that healthcare could gradually become more affordable.

With the Baby Boomer population aging rapidly, adaptations in healthcare must be created in order to accommodate the increased demands. Currently, the healthcare system will struggle to care for everyone reaching their elderly years. In the years to come, the United States will need to adapt in order to care for all of its elderly citizens effectively and affordably.

Healthcare Costs Impacting Children Nationwide

Healthcare Costs Impacting Children Nationwide

As healthcare costs continue to climb into the new decade, many families are feeling the strain more than ever. Unlike other insurances like life insurance, which 60 percent of Americans have, health insurance is essential for people of all ages to have access to. This necessity puts a huge weight on parents’ shoulders. While some protections are in place to support those in need of assistance, gaps in coverage and certain restrictions can leave middle-class families and their children in a precarious position. The new year will undoubtedly be a notable year for American politics. With this in mind, only time will tell what the future holds for the nation’s healthcare.

Healthcare Access Limited, Harming Children

With healthcare costs climbing rapidly for both the insured and uninsured, many parents are being forced to make incredibly difficult decisions when it comes to the care and protection of their children. In some cases, parents are unable to afford basic healthcare costs for their children, veering into a state of neglect. Neglect was the top reason why Kentucky children were removed from their homes between 2010 and 2015, making up 68.6 percent of removals. However, this is not always due to genuine malintent on the part of the parents. In some cases, costs have simply spiraled out of control, and they’re no longer able to support their children as well as themselves.

The result is a young population with worsening healthcare. Children in lower-income communities often lack resources such as mental healthcare support, routine exams, and more. However, this lack of resources isn’t exclusively due to an increasingly high cost; some areas simply lack the staff to support these services.

Staffing Shortages Despite High Costs

While costs remain high, the funds aren’t always directed where they need to be in order to provide more support for struggling communities. Many areas, particularly when it comes to psychiatry and psychology, are critically understaffed. Some studies show there are about 7.2 million open healthcare positions available in the world today because of staffing shortages. Shortages tend to be particularly high in low-income communities, as the positions often pay less than the average salary for the job. This pushes doctors and medical professionals to wealthier communities, rather than to communities that are most in need of additional medical services.

Long-Term Impacts On Population

Over time, the lack of medical resources in necessary areas could lead to long-lasting consequences. Being healthy doesn’t just consist of eating nutritious food and going on hikes, a mile of which can burn over 500 calories. To have the best chances of living a healthy life, you need easy access to professional healthcare. Children who grow up in communities that lack vital health resources will likely be less healthy than their peers. The cycle tends to perpetuate itself, as those who are less healthy may struggle with maintaining long-term jobs or higher-paying careers.

In theory, various government-supported programs exist to interrupt this cycle. However, these programs often are difficult to access and can have vital gaps in coverage. The Americans with Disability Act provides that reasonable accommodations must be provided to individuals who have a qualifying disability, absent a hardship caused to the employer. However, not every disability will qualify, and assistance may not be available to those who make just enough to not meet financial assistance requirements.

As 2020 quickly approaches, it’s uncertain what the future of the nation’s healthcare holds. The upcoming year will be an important one for American politics, and the debate over healthcare will continue up to and beyond the next presidential election. With so many of the nation’s most vulnerable population riding on the healthcare debate, hopefully a solution to the dilemma will be reached soon.

Uninsured Rates Fell Under Obamacare, But Who’s Reaping The Benefit?

Uninsured Rates Fell Under Obamacare, But Who’s Reaping The Benefit?

By Chad Terhune, Los Angeles Times (TNS)

LOS ANGELES — Hospitals and health insurers have reaped a financial windfall from the 2014 rollout of the federal health law, even beyond what was expected.

Now, employers and consumers are seeking a share of the Obamacare dividend.

For years, insurance companies and hospitals told Americans that one reason their insurance bills were so high was because they were paying the hidden cost of medical care for the uninsured.

The Affordable Care Act sought to remedy much of that by unleashing the biggest expansion of insurance coverage in half a century. Ten million Americans became newly insured, and federal officials estimate that $5.7 billion in uncompensated care was wiped out this year as hospitals received more paying patients.

Now it’s time to share the bounty from Obamacare, said Bill Kramer, director of national health policy at the Pacific Business Group on Health, which represents big employers like Wells Fargo and Chevron.

“Consumers and businesses have been absorbing this cost shift for decades,” he said. “Employers need to step up and put pressure on hospitals and health plans. Show us the money.”

In a similar vein, consumer groups are questioning why these savings aren’t showing up in health insurers’ latest rates. By some estimates, the cost shifting in recent years typically has raised the average family premium by $1,000 or more annually.

But there have been benefits for employers and consumers — even though they may not be readily apparent, industry officials say. They point to historically low increases in overall medical spending and affordable premiums in government-run exchanges.

“The dividend is being shared,” said Charles Kahn, chief executive of the Federation of American Hospitals, an industry trade group in Washington. “There are a lot of factors indicating the costs to many are coming down or moderating. But all the problems that brought about cost shifting aren’t being washed away.”

Providers say government reimbursements for patients on Medicare and in particular Medicaid don’t always cover their costs. The health law also imposes funding cuts to hospitals.

Health insurers insist they always bargain for the best deal from medical providers, and they say other factors are pushing up costs at the same time. They fault pharmaceutical companies for charging exorbitant amounts for some specialty drugs and worry that a wave of hospital consolidation will drive up prices even further.

“While this cost shifting is decreasing, theoretically that should drive down health care costs,” said Dr. J. Mario Molina, chief executive of Molina Healthcare Inc., a health insurer based in Long Beach. “People are going to scratch their head and say, ‘What happened?'”

Molina’s short answer: “It’s the drugs. A huge pipeline of new pharmaceuticals is going to push us back into double-digit health care inflation.”

That hasn’t happened yet, and hospital chains and insurers have posted strong results, to the delight of Wall Street.

Profits at HCA Holdings Inc., the largest publicly traded hospital chain, jumped 18 percent to $1.7 billion for the first nine months of 2014 compared with the same period a year earlier. The Nashville company’s shares have soared 53 percent this year.

Likewise, health insurance stocks have rallied as the federal government guaranteed millions of new customers and spent billions of taxpayer dollars subsidizing their premiums. Insurers are handling much of the Medicaid expansion under state contracts.

Insurance giant Anthem Inc. signed up nearly 800,000 people on Obamacare exchanges across the country. Its shares rose 33 percent year to date — three times the increase in the broader Standard & Poor’s 500 stock index.

The biggest changes have occurred in the 27 states that have expanded Medicaid, the government health insurance program for the poor. HCA reported a 55 percent decline in uninsured patients and 30 percent growth in Medicaid business in five states where it operates and where the program was expanded.

Megan Neuburger, a Fitch Ratings analyst who tracks the for-profit hospital industry, said the turnabout has been dramatic.

“I think the Affordable Care Act has been more positive for the hospital industry than analysts had expected or even the industry expected it to be,” she said.

Uncompensated care totaled about $50 billion for hospitals last year, studies show. The Obama administration said the federal government has typically covered about 60 percent of those medical bills.

But the health law anticipated the decrease in bad debt and reduces future government payments to hospitals. The American Hospital Association estimates that hospitals have already experienced $122 billion in funding cuts since 2010.

U.S. workers aren’t likely to feel much sympathy. Medical costs are taking a bigger bite out of their paychecks while wages are largely stagnant.

Family premiums for an employer health plan rose 73 percent in the last decade, and workers’ share of the bill jumped 93 percent, according to a new report from the Commonwealth Fund.

On average this year, employers and workers combined spent $16,834 annually for a family health plan.

Dena Mendelsohn, a health policy analyst at Consumers Union in San Francisco, challenged 6 percent rate increases by Anthem and Blue Shield of California this year in a report to state regulators. She cited, among other issues, their failure to account for the drop in uncompensated care.

“We were puzzled because they didn’t factor it in,” she said. “The amount of cost shifting should go down.”

Insurers say it takes time for these changes to filter through and the effect remains unclear. The rate hikes for more than 1 million individual policyholders take effect next month.

The prospect of financial relief for consumers may vary across the country depending on whether a state expands Medicaid as well as the balance of power between hospitals and health plans locally.

The sterling reputation of some hospitals makes it difficult for insurers to bargain effectively or follow through on the threat to drop them from an insurance network, said Paul Ginsburg, a professor at the University of Southern California’s Schaeffer Center for Health Policy and Economics.

Without outside pressure, he said, the first inclination of many hospitals may be to spend any extra money themselves.

“There are clearly some hospitals that have enormous leverage with insurers,” Ginsburg said. “Hospital administrators and their boards see opportunities to fund all these things they haven’t been able to do until now.”

AFP Photo/Karen Bleier