Access to health insurance does not
equal access to quality and affordable
health care or good health.
Good health is beneficial for both the common good and a strong economy. Even though government provided health care is not part of the outlined role of American government or a Constitutional right of American citizens, it is important for the government to promote good health as well as quality and affordable health care throughout the nation.
Addressing the issue of health care reform in the U.S. requires a realistic approach to the problems that we face as individuals, patients, payers, providers, and elected representatives. Despite substantial efforts made to begin to address health care, the focus has been on treating the superficial symptoms of the health care problem instead of the principal and underlying problems that are leading to poor health, increasing costs, and limited access to quality and affordable health care. Access to health insurance does not equal access to quality and affordable health care or good health.
The Affordable Care Act (ACA) required all citizens to purchase health insurance, but as the demand for health insurance was increased, the supply of health care was not. The resulting imbalance between supply and demand has contributed to the overall decrease in access and increase in cost. The continuing high cost of health care is particularly problematic for the working poor whose substantial need for access to quality and affordable health care was not addressed by the legislation. In spite of efforts to improve health care in the U.S., the underlying problems continue.
Individuals and Patients
Americans should adopt healthy lifestyles and obtain preventative care from primary care providers. These simple behaviors prevent illness, minimize the medical care needed, catch illnesses early so that they can be treated early, and lower the cost of treatment. If medical care is needed, patients must obtain primary care from primary care providers and only obtain emergency and specialty care from specialists at hospitals and specialty medical facilities. Obtaining the necessary level of medical care from the corresponding medical provider will minimize the cost of the medical care needed. This process not only minimizes costs but also improves the continuity of care by allowing primary care physicians to monitor the overall health and medical treatment of patients.
In order to prepare to pay for potential medical care, it is important for individuals to educate themselves regarding the available methods of paying for medical care so that they can determine which methods will best meet their needs. Individuals must research health spending accounts, health insurance companies, and health insurance plans; and then carefully consider the terms of contracts in order to prevent any unexpected gaps in coverage, better prepare to meet their potential medical needs, and ensure the portability of their health payment options.
Once patients have been prescribed medical treatment, they need to make responsible and educated decisions regarding the necessity, the benefits, the quality, and the cost of the potential treatments. In addition, patients need to compare the quality and cost of treatments from comparable and competing providers in order to receive the highest quality treatment at the lowest possible price.
Payers: Individuals and Insurance Companies
It is the responsibility of health care payers, whether they are individuals or insurance companies, to evaluate the charges for the medical care being provided in order to determine whether or not they are reasonable and correspond with the cost of the personnel, facilities, procedures, equipment, supplies, operational expenditures, and unpaid medical bills. Insurance companies need to continue to strive to provide quality health care plans, clearly define the terms of their contracts, improve portability, create non-employer group health plans, minimize gaps in coverage, cover pre-existing conditions, and increase the transparency of their fees and the corresponding costs of medical care. In addition, there needs to be a central location where consumers can review and research the insurance companies and the individual insurance plans for consumer protection and to increase the quality and affordability of health insurance.
Providers: Medical Personnel and Facilities
Medical care providers must continue to strive to provide safe, high quality, and affordable health care; minimize the practice of defensive medicine; and maintain the medical staff necessary to meet the needs of patients. For the care provided, there needs to be greater transparency regarding the cost of the facilities, personnel, services, supplies, operational expenditures, unpaid medical bills, and the fees charged, so as to minimize unreasonable disparity between costs incurred and fees charged. Beyond providing health care, medical personnel and facilities must continue to do valuable research and develop new treatments, technologies, and products. In addition, there needs to be a central location where consumers can review and research the quality and affordability of medical providers.
Vendors: Producers and Sellers of Medical Supplies and Services
It is important for vendors to continue to conduct research and develop new treatments, technologies, and products. Vendors must also increase the transparency of the cost of research, development, production, and the marketing and sales of medical products in order to enable patients, as well as medical personnel and facilities to evaluate the cost and quality of comparable products.
There must be action taken to minimize frivolous lawsuits, non-economic damages awards, the cost of medical malpractice insurance, and the practice of defensive medicine. The issue of tort reform has continued to be a topic in health care reform discussions because the threat of legal action and the potentially damaging repercussions cause expensive preventative steps to be taken. Because of the substantial direct and indirect impact of tort reform on health care, it remains one of the key drivers of the high cost of health care.
Role of the Government
The government has an important role to play with regard to the issue of health care in order to support private, quality, affordable, and consumer-driven health care. The gGovernment should continue to promote improved health education, safety, transparency, regulatory and legislative reforms, support for research and development, and help for those who cannot help themselves.
The government should:
Ensure that the public receives education about wellness care, how to obtain medical care, the available options to pay for medical care, and any useful information that will enable citizens to make educated and responsible health care decisions.
Carefully monitor the quality and safety of medical facilities, personnel, products, and services.
Support increased transparency of the costs and quality of all aspects of health care including: providers, insurance companies, insurance plans, individual payment options, vendors, and products.
Facilitate efforts to improve the portability of health insurance.
Minimize any unnecessary legislative or regulatory burdens that may have a negative impact on individuals, companies, and states; limit access to quality or affordable consumer-driven health care; or damage their ability to remain competitive in the global market
Support research and the development of new treatments, technologies, and products, and protect the resulting intellectual property.
Reform government programs in order to better help those who cannot help themselves such as the poor, the elderly, and those with mental and physical disabilities.