The Future of Health Care: Are We Headed for Universal Coverage?

Regular doctor visits are virtually nonexistent for individuals and families without medical coverage. The rising prices for medical services and the recessive economy make it difficult for families to receive much-needed care without incurring large medical bills they can't afford. Emergency care and hospital stays usually result in thousands of dollars worth of medical debt; to avoid the expense, families will often postpone treatment or refuse it all together. While medical insurance is often available privately and through most employers, the deductibles, co-payments, and monthly payments are too high and aren't easily squeezed into the already tight budgets of many households. With only privately-funded health care available to the majority of the population, the access to medical services is severely limited and determined by income. The United States is the only industrialized nation that does not provide sufficient health care for its citizens.

The weak health care system, while not entirely ignored, has failed to generate any significant changes to drastically improve the accessibility and quality of care provided. It has been discussed in the past by numerous presidents, journalists, and the general public; however, the desire for massive reform is lacking in the political arena. While most developed nations possess a government-sponsored system-otherwise known as a universal health care system, our nation ignores the successful examples these nations have set. The current presidential candidates for the November 2008 election have publicly announced their health care reforms.

Jerry Geisel, an editor for the Business Insurance magazine, notes Senator Barack Obama's proposal is almost identical to the reforms done by states like Massachusetts. Discussing Senator Hillary Clinton's proposal, Allison Bell, editor of the National Underwriter magazine, explains the highlights of the Clinton plan-which was allegedly based on Obama's plan. Both proposals are not going to greatly impact the health care system and will only ignore or have little impact on the ongoing problems that are embedded in the system. Howard Larkin, Hilary Beard, and Matthew Weinstock discuss the current problems facing Americans, providing a great insight into the saddening reality faced by millions of people across the nation. The need for a universal system is now, and the greed and wastefulness demonstrated by the medical profession and insurance companies must be recognized and discouraged through strong government regulation. A universal health care system should be established with our nation's unique characteristics and needs as the foundation.

With over 46 million people without health insurance, it is hard to say that our current system is a success. According to Beard, the number of uninsured is increasing due to "job loss and the rising cost of health insurance premiums" (139). In agreement, Larkin, a freelance writer in Illinois, states that "lower-wage workers at smaller employers simply can't afford the employee contribution, prompting many to drop coverage, even when it's available" (46). It is believed by both authors that:

The primary reason is cost. Indeed, the annual cost of family coverage in an employer-based plan is nearing $11,000 annually, more than the yearly earnings of a full-time worker making minimum wage. Individual coverage costs even more, according to the Commonwealth Fund, a private foundation working toward a high-performance health system. To make it worse, many people who are elderly and have chronic health conditions do not even qualify. (Beard 139)

Beard believes that if a universal system was established, thousands of deaths each year would be prevented as people with chronic conditions or undetected illnesses will be able to receive the much needed medical care and attention they deserve (139). In contrast, Larkin emphasizes his bleak outlook on the future of the health care system with the use of a quote by Uwe Reinhardt, a Princeton health care economist; "we sent a very clear signal to the uninsured: 'Take a long walk on a short pier'" (52). He bases his reasoning on the past reluctance for politicians to enact change in the system, even when the funding was readily available.

The uninsured aren't the only problem with the current health care system. Weinstock, senior editor at Hospitals & Health Networks, claims that "one-third of adults with health coverage are, in fact, underinsured" (32). They are the 16 million citizens that to some degree will avoid "preventive care, waiting until an illness becomes an emergency before seeking care, and racking up big bills" (Weinstock 33). The Commonwealth Fund considers a person to be underinsured, if their out-of-pocket medical expenses are at least ten percent of their income or their deductible is at least five percent of their income. Another problem with the system is that people don't always understand what is covered by their insurance and insurance companies change that coverage every year, resulting in large unexpected bills (Weinstock 36).

Weinstock and Larkin discuss the options available to those with medical debt. Many financial institutions are offering zero-interest loans, credit plans connected to health savings accounts, and credit cards for medical expenses (Weinstock 38). Some insurance companies even go as far as limiting rate increases, if employers sign up for a three year contract. This business exchange "requires employers to migrate coverage to high-deductible plans with health saving accounts" (Weinstock 38). Larkin stresses the fact that low-wage workers are not likely to benefit from the high-deductible insurance policies and tax-deductible saving accounts "often touted as a solution for high health insurance costs" (50). The deductible amount is usually $5,000-low-wage workers will virtually have no coverage until they reach that limit. Insurance companies have created new health plans that are targeted at younger consumers willing to have limited coverage. The plans have coverage caps that can be changed at any time with a large "lump-sum payment" (Weinstock 34). The positive aspect of these plans is that coverage can be activated even after "they get sick or have an accident" (Weinstock 34).

The increasing frustration with health insurance has generated a lot of discussion as insurance costs rise at least six percent a year. According to Larkin, in 2005 the interest in universal coverage has gained momentum:

Not surprisingly, the decline in employer-sponsored coverage has prompted new interest in government-sponsored plans. They range from expanding Medicaid and SCHIP programs such as KidCare to adopting a single-payer system. Bills calling for universal coverage have been introduced in at least 18 state legislatures this year, according to the Associated Press. (50)

Massachusetts passed a resolution in 2006 that "has helped to shape reform measures in other states" (Geisel 1). Focusing on offering employer-based coverage, the law requires that "all but the smallest employers must pay an annual fee-up to $295 per employee-if they do not make a 'fair and reasonable' health insurance premium contribution" (Geisel 1). The "fair and reasonable" contribution means that the employer must pay "at least 33% of premiums for individual coverage" or "that at least 25% of full-time employees are enrolled in an employer's plans" (Geisel 1). Massachusetts has also set up what is known as the Connector Authority, which allows people eligible for subsidies to purchase private insurance.

The presidential candidates have "publicly lamented the growing financial strain that health insurance puts on working people" (Weinstock 33). They do so in response to the middle-class voters who are affected-otherwise known as the underinsured. Thus, their strategies are based on solutions to ease the financial discomfort caused by the rising costs of premiums and co-pays. However, they do place some attention, although minimal, on those without insurance. While they are reluctant to propose a universal health care system, they base their ideas on the successful reforms several states have taken. Obama has based his proposal on the fundamental ideas from the Massachusetts example. The key differences are few but significant-Obama's plan lacks a mandate for coverage, while the Massachusetts law fines state residences without health insurance (Geisel 1). Another key difference is the Obama plan "calls for reinsuring employer-sponsored health care for a portion of catastrophic costs above a certain level" with the condition that employers use some of their savings to lower insurance premiums for employees (Geisel 1). The Clinton plan goes into greater detail and claims to offer the insured and uninsured a choice of plans with "tax credits to help pay for it" (Bell 7). If it passes through Congress, it also would strengthen Medicaid and SCHIP (State Children's Health Insurance Program), limit insurance carriers ability to increase rates or refuse members due to a medical condition, provide small businesses with tax credits to assist with payment for coverage, limit insurance premiums according to income, and limit the employer tax exclusions for employees making over $250,000 per year (Bell 7). Although these plans appear to have great potential in the future of the health care system, there are a number of things to keep in mind. Currently, the underinsured face not only high premiums but high co-pays as well-the plans fail to regulate the co-pay required by these plans. Their plans also do not affect the medical industry, failing to address the "excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud" which contribute to the increase in costs of health care and insurance (NCHC 1). Their proposals are merely giant "band-aids" being applied to an old, failing system and do not get to the root of the problem.

The health care system has been leaning towards a universal approach; however, it faces resistance-most likely related to the potential loss of profit from private medical institutions and insurance companies. The possible resistance may also be due to the unfamiliarity with such a system or the fear of change. Many critics of health care reform denounce the statistics and suggest that a universal system would involve too much government control. They fail to acknowledge the fact that government control is needed to fix the internal problems in the system. Furthermore, a universal system would be much cheaper and more efficient than our commercial-driven system ("Universal Health Care" 1). Critics argue that many countries with a universal health care system have unreasonably long waiting lists and that patients are dying while waiting for care. However, the same can be said with the commercial system as the uninsured and underinsured are delaying or neglecting care, possibly resulting in death.

In my opinion, the arguments against the universal system are weak and the proposals made by the presidential candidates are not thorough enough to fix the internal problems. I believe that a universal system is essential to fix the system and provide citizens with the coverage they deserve. There are millions of examples that can be used to describe the inadequate care our system provides, as well as the financial burden it has on families and individuals. One example that I am personally aware of involves my sister and her family. She is married with three kids and they make over $28,000 a year. They are both working; she works part-time, her husband works full-time as the Chief of Police. He has health insurance through his employer, while my sister and her children go without. The premium is far too high to add them to his insurance plan and they are not eligible for Medicaid. Similarly, my family and I face a high premium that we can't afford. While a universal system may not be perfect, it would work far better than our current system and enable families to receive care that otherwise wouldn't be accessible.

Works Cited

Beard, Hilary. "Surviving the Heath Insurance Crisis." Ebony 62.9 (2007): 138-40.

Bell, Allison. "Clinton Releases Health Coverage Proposal." National Underwriter (Life & Health/Financial Services Edition) 111.35 (2007): 7, 49.

Geisel, Jerry. "Sen. Barack Obama has a Detailed Plan for Health Reform." Business Insurance 41.23 (2007): 3. WorldCat Services [1-2].

"Health Insurance Cost." The National Coalition on Health Care. 2008. 21 April 2008 .

Larkin, Howard. "Downsizing Health Coverage." Hospitals & Health Networks 79.9 (2005): 44-6, 48, 50, 52.

"Universal Health Care." Issues & Controversies On File 23 September 2005: 1-13. Facts On File News Services [1-13].

Weinstock, Matthew. "The Undercovered Class." Hospitals & Health Networks 81.12 (2007): 32.