Public Health Insurance - An Essential Lifesaver For the American Health System

There is much debate about the type of insurance proposals that will be required in the new health system currently being negotiated in Congress. President Obama has just come out in support of a public health plan, which is opposed by private insurers who say that they could not compete with a public health plan that didn't have to make a profit. Supporters of the public plan proposal correctly say that it would give people more choices and create more competition. Opponents argue that private health plans would go out of business, leaving only an entirely government-run health care system.

Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don't seem to be thinking of the person at the center of all this - the patient. It is widely acknowledged that health care costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don't have it, then you just continue to suffer. What a dreadful choice. What an indictment of America.

The goals of overhauling the health care system are to lower costs and extend care to the uninsured. Obama wants a bill on his desk in October at the latest. Where can Congress begin to compromise, and why is it that Republicans in particular, believe that public health plans are likely to be so dreadful. What is the evidence for this belief beyond their own philosophical ideas. They regularly bring up the supposed ogre of "socialized medicine" whenever public plans are discussed, but there is no evidence whatsoever that countries with more federal control over their health systems, especially in Europe, have worse health outcomes that the USA. In fact the contrary is true, health outcomes are much better overall, and cost a lot less money per capita of population.

As a physician who has lived and worked in the USA, Australia and Britain, and who has an interest in how health services are organized, I think America could move forward in a relatively simple way as long as we always keep the patient at the center of any health system we plan. It is essential that we do not design a health system primarily to protect profit levels for some or all of the various constituents, whether they be providers, health insurers or pharmaceutical companies. We have the opportunity of picking the best parts of other health systems from around the world and including these in the eventual plan to reform American health care, and we should learn from other countries.

What should we do?

Firstly we need a public-private partnership philosophy. Australia is a good example where this works excellently. That means public and private, not just private. American core business and social philosophies are based on capitalist principals so any new approach to health care must combine the need for profits in certain sectors of the health system, with the need to develop a number of core public health services that may be less likely to ever achieve a profit. Funding for care has to involve choice and should be provided in many instances through payment for annual or episodic whole of person care, rather than on individual piece rates as at present. These capitated payment systems work well for Kaiser Permanente, and in Britain. The primary gain from this approach is that it tends to force more resources into the prevention of illness and wellness promotion, rather than into the treatment of illnesses that have already commenced.

The public component of the health care system, seemingly strongly supported by President Obama, would include universal basic health insurance as well as catastrophic care insurance. We know that this type of system works well in America and is widely accepted and popular, because we have the very successful example of Medicare for seniors. Effectively broadening the base of Medicare for other populations would prevent many of the bankruptcies caused by healthcare costs, and would cover many of the current uninsured. Public insurance would then be likely to pay for many emergency and geographically isolated health services, as well as public health services, pre and postnatal and early child care as well as care of some special populations who cannot afford private health insurance such as the unemployed, and certain impoverished or geographically isolated groups. Medicare for seniors would of course continue. These are areas where there will be less competition from private insurers who have typically kept away from them, but of course any private health insurers would be able to enter these markets and compete if they wished.

The private component would be funded with the aid of broader tax incentives or similar financial tools to encourage most people (or companies) to take out private insurance. The aim should be that at least 80-90% of the population should have private insurance, whether it be comprehensive insurance, or top-up insurance to support core government provided insurance. It is important to reach this level of insurance to ensure that we all are financially responsible for at least a reasonable proportion of our health care costs. Here the Republicans are right as it is important that we do not see health care as something that is provided for free. The private sector should offer a full range of services from birth to death, but the industry should be more carefully regulated so that they would, for instance, be prevented from excluding patients on the grounds of pre-existing conditions. They should also have the ability to charge extra for certain "non-essential" services such as cosmetic surgery.

These ideas are taken from what I consider to be the best parts of the American, Australian and British health systems. No country has a perfect health system, and no country ever will. America can afford to choose the best from other countries as it debates how to improve its health care system. Lets hope that Congress can be creative, look outwardly, and not get bogged down in political dogma.

How to Compare Low Cost Health Insurance in Alabama

Being able to afford health insurance is a big problem for many people here in Alabama. In fact, the problem has become so severe that close to 17% of all Alabama residents cannot afford health insurance of any kind.

Fortunately the state of Alabama has made low-cost health insurance available to many people who might not otherwise be able to afford it. Children under the age of eighteen, college students, pregnant women and others may be able to qualify for low-cost health insurance through one or more state-sponsored programs.

For those individuals who do not qualify for a state-sponsored program there are still several simple things you can do that may help to reduce the cost of your monthly health insurance premium. And once you know what things you can do to lower the cost of your health insurance, then it will be time to get online and compare the cost of your premium-saving policy at every health insurance company that sells policies in Alabama until you have found the very lowest cost possible for the insurance you need.

Let's start with some lifestyle changes. These are the most difficult things for most people to do, even though they can potentially save the most on your health insurance.

Don't smoke or use chew or any other tobacco product. You know in your heart of hearts that tobacco products are not good for your health, and insurance companies know this too. That's why they charge tobacco users anywhere from 20% to 50% more for their health insurance than they charge non-smokers.

Losing weight is even more difficult than stopping smoking for most people, but if you are overweight you are going to pay more for your health insurance. Again, this is simply a fact of life. The good news is that losing even a small amount of weight can potentially drop you down on the insurance company's weight chart and can potentially save you hundreds of dollars each and every year in premium payments. Every little bit can potentially help.

Are your weekends filled with extreme or dangerous sports or hobbies? As fun and exciting as they may be, the fact is you are going to pay more for health insurance if you put your life and health at risk unnecessarily. The same goes for driving a fancy sports car.

And were you aware that your credit rating can also affect how much you pay for your health insurance? As strange as it may seem, the better your credit score the lower your health insurance premium.

Group health insurance is always less expensive than individual health care, plus group plans will often overlook smoking, weight and some pre-existing conditions that would drive the cost through the roof if you were purchasing an individual policy. If your place of employment does not offer a group plan start asking around at any club, organization or association you belong to. You may be surprised to find that some group you never even thought about offers its members group health insurance. Ask your friends and co-workers if any of them belong to a group, club or association that offers group health insurance - and then see if you can join. Ask if any religious organization you belong to offers its members group health insurance.

Look into joining an HMO a PPO or some other form of health maintenance organization. If your favorite doctor is not part of an HMO then you may have to switch doctors, but often you can keep your same doctor if you join a PPO. See if one of these types of groups makes economic sense to you.

If you own a home-based business it may be possible to qualify for group health insurance even if your only employee is a spouse. Ask your insurance agent if this is possible in your case. But even if group health is not a possibility, it still may be possible to deduct your health insurance payments from your taxes if you own your own business - and the tax savings could help offset the cost of your premiums to the point where health insurance is more affordable than you thought.

What about your co-pay and your deductible? If you can increase your co-payment and/or your deductible you can lower the cost of your health insurance. Obviously increasing your co-pay and/or your deductible must be considered carefully as any increase in either represents cash that is coming out of your pocket.

It's finally time for you to take the tips and tricks you picked up from this article and use them when filling out the form on at least 3 of the websites which allow you to compare health insurance prices among the different insurance companies.

Make sure that you fill out the form exactly the same way on all three of the comparison websites you've chosen and then simply pick the company with the lowest cost (being careful to choose a company that you feel confident will still be around when you need them), and your job is done!

You have now compared low cost health insurance in Alabama, you've picked the lowest-priced company and you can feel good about the fact that you are getting the coverage you need at a price you can afford.

Health Reform Has a History of Failure

Health care reform is on everyone's mind.   It's an idea, they say, whose time has come. The cost of health insurance is out of control. 40 plus million Americans cannot afford or cannot qualify for health insurance.

But health care reform has been here before.  Actually, about every 15 years there is a push for reforming health care in America.   It started way back in 1912 when Theodore Roosevelt's Bull Moose Party  introduced a platform calling for national health insurance for industry.

In 1934 as part of the New Deal, Franklin Roosevelt considered proposing universal health coverage as part of the Social Security Act.  Presidents as diverse as Truman, Carter, Ford, George H.W. Bush and Clinton have all introduced various proposals for health care reform.  Universal health coverage is always the stated goal.  All the proposals put forth by all these administrations, dating back to the early 1900's  have only thing in common-failure.

In 1943 President Truman proposed a single insurance plan that would cover all Americans.  His plan allowed for public subsidies for the poor.  This universal, comprehensive plan was to be run as part of Social Security.  But  Truman was faced with an economy that was transitioning from a war time economy  to a peace time economy.   For a time Truman lost the confidence of the general public.  Republicans gained control of both houses of Congress in 1946 and branded Truman as a lame duck. 

But Truman campaigned in 1948 on a promise to extend the New Deal and specifically targeted Congressional Republicans who has opposed national health insurance.  Truman defeated these Republicans and seemed to have a mandate from the people to implement national health insurance.  But despite having a Congress that had a Democratic majority,  Truman could not pass his health reform plan. His plan failed because powerful Southern Democrats, all of whom held key leadership positions in Congress, feared that federal involvement in health care would lead to desegregation of hospitals that still separated patients by race.

Labor unions also played a part in the defeat of Truman's plan. The AFL-CIO supported the plan for universal coverage as did the UAW.  But then, the UAW negotiated a deal with General Motors that included payment by GM of health insurance and pensions.   Unions then believed that they could negotiate better benefits for their members than they could get under a federal universal health plan and they abandoned their support of universal care. 

The AMA also opposed the Truman plan but they based their opposition on the unpopular concept of socialized medicine.  As anti-communist sentiment rose,  the public support for universal health care declined.   Most large associations including the Chamber of Commerce, the ABA and the American Hospital Association supported the concept of voluntary and private health insurance.  This was also the position favored by most of the nation's media.

Universal health insurance failed again in 1950.  By that time the employer sponsored plans were deeply entrenched as an employee benefit.  This was the time that insurance companies began to experience rate premiums.  The result of this new rating system was that older, sicker people found it harder to get affordable coverage. In 1960 Congress passed the Kerr-Mills Act. This Act provided federal funds to the states to cover the health costs of the elderly who were too poor to afford health insurance.  But this Act, with all its well meaning hope, failed completely because by 1963, only 28 states had agreed to participate and even those states did not budget correctly to support the plan.  This Act became the precursor to Medicare and Medicaid.

From 1970 through 1976 more competing plans were proposed  But compromises came and went and no significant bill ever reached the House floor because of lack of Committee consensus.   President Ford withdrew his attempt at universal health reform fearing that  it would make inflation worse.  President Carter campaigned on the promise of a comprehensive national health plan but once elected shifted his priorities to cost containment, specifically hospital cost control, and told the American people that national health insurance would have to wait until the economy was stronger.

About that time, Senator Edward Kennedy introduced a new proposal which called for private health insurance companies to compete for customers. The private plans would sell an insurance card to be used for hospital and physician care.  The cost of the card would depend on income and employers would be expected to cover the majority of the cost for their employees.  The federal government would pick up the cost of the card for the poor.  Neither the Carter nor the Kennedy  proposal made it through the Congress.

The Clinton plan also supported universal health insurance through the enforcement of individual and employer mandates.  The government would control the competition between private insurance companies  The Health Care Task Force, chaired by Hillary Clinton when she was first lady,  gave President Clinton a complex plan in September 1993.  Despite a Democratic Congress,  the size and complexity of the plan slowed its progress through Congress and lost the interest of the general population.

Now in 2009, another administration is proposing health care reform. The White House has created the Office on Health Care Reform. Members of Congress are polishing up their own creations for solving this problem. The administration believes that popular opinion will compel our elected officials to end what might be considered a national embarrassment of having millions of American unable to afford or have access to quality health insurance. But as far back as the 1930's, public support quickly began to fail as the insured were advised that the goal would only be achieved if they contributed more to the cost, either directly or through some added taxes.

The United States spends twice as much per capita as the average of the 10 next richest countries in the world.  Yet, despite this expenditure, 1 out of 6 Americans under the age of 65 are uninsured and/or individually uninsurable.

One of the problems facing reform is that the 80% or so of American who have health insurance are generally happy with the care they receive. They like their doctors and the freedom to make their own choices when it comes to doctors and hospitals. Most think they already pay too much for health insurance. Most believe, and there is evidence to support this belief, that the red tape and the administrative expenses of their health insurance plan are part of the reason their cost has increased. Why can't someone fix that, they wonder?

The insured fear change.  Any proposal that threatens their current insurance arrangement will be regarded with deep suspicion. Everyone is aware of the power of special interest groups.  Our political system is set up in such a way as to frustrate action on any large and socially controversial idea.  Congressional committees wield enormous power. The interest of each state in controlling its own health insurance programs can, in itself, bring down the whole idea of reform.

We have had some success in improving access to health care for million through some of the Children's Health Insurance Programs. But note that most of the  programs to cover uninsured children are state based.

We seem to be unable to learn from past mistakes or take advantage of the concepts that actually have worked.  Anyone who has done even a cursory study of history should realize that we have been here before.

Yes health reform is back again. What will happen this time? Stay tuned.