Access to Health Insurance
A growing number of people in the United States are uninsured.
In 2000, about 39 million Americans (about 14.3 percent of us) had no health insurance. Many of those without insurance do have jobs. They may be self-employed, work part-time, or work in low-wage jobs. These people cannot afford care but still do not qualify for government assistance.
Many others, cannot get health insurance because of pre-existing conditions. Insurers will not cover people who are at high risk. For example, some companies will not offer coverage to an individual with a known family history of cancer. Few companies are willing to insure people at risk of developing the acquired immunodeficiency syndrome (AIDS).
Introduction of preexisting condition clauses in insurance policies became especially widespread in the 1980s and early 1990s. In the future, insurers may use genetic testing to exclude people with higher than average risks.
Insurance Costs and Quality of Health Care
The costs of health care have increased dramatically for consumers and insurers, particularly during the 1980s and early 1990s. For example, in 1980 Americans spent $247.3 billion on health care. By 1999 that figure had more than quadrupled to $1.2 trillion.
Costs have increased because Americans are living longer. In 1900 the average American had a life expectancy of about 50 years. In 2000 the average life expectancy was about 76 years. New technologies also allow us to treat more problems than ever before. Unfortunately, these new treatments are often costly. MRI scans, arthroscopic surgery, robotic surgery, minimally invasive surgery and some of the newer drugs are particularly costly.
Increased use of health care has also led to a growth in health care costs. Americans are more likely than ever to seek professional health services for medical problems. For example, in 1991 there were an estimated 669.7 . In 1999 there were an estimated 757 million visits to doctors' offices.
REASONS FOR HEALTH INSURANCE
The cost of a one-day stay in a hospital can be more than $1000.
By combining, or pooling, many people into a single group, insurance can spread the financial risks over a larger group. Experts can't predict if one person will be sick but can estimate how many people in a large group will require care. Essentially, everyone with insurance makes payments to cover the expensive treatments for the few who need them.
Medicare Health Insurance, established in 1966, provides health insurance coverage for Americans above the retirement age of 65, or those disabled by illness or injury.
Medicare provides a foundation , but it also leaves gaps in its coverage. Some people with Medicare also buy private insurance, or called “Medigap” insurance. Some employers offer supplemental coverage to their retired workers. Insurance is regulated on a state-by-state basis, Medicare supplement policies can vary from one state to the next.
Medicaid and MediCal
Medicaid programs (called MediCal in California) provides care for some people with low incomes, especially children and pregnant women. On average the coverage is not good. Many doctors and hospitals do not accept Medicaid or MediCal because they loose money. At Northern California Neurosurgery, we are unable to take this plan.
Advocates for the poor have demanded better coverage and Medicaid reform. Given the current budget crisis, reform seems unlikely.
People can obtain individual health insurance or get coverage as part of a group . People who obtain health insurance as individuals are typically self-employed or work for small companies that do not provide insurance.
Group and Employer Plans
Groups of people can join forces to purchase health insurance. For example, individuals who all work for the same employer may join a group health insurance plan. Members of some clubs, professions or unions can do so. Group plans tend to be less costly.
The Consolidated Omnibus Budget Reconciliation Act (COBRA), enacted by the U.S. Congress in 1985, requires most American companies to allow employees, their spouses, and their dependent children to stay on the company’s medical plan after they stop working for a company. Unfortunately the care is costly and is paid entirely by the employee.
Long-Term Care Policies
In about 80 percent of American families, at least one family member will eventually need long-term care. Americans increasingly buy long-term care policies to cover nursing home costs. Medicare and most private medical insurance policies, severely limits long-term care. Long-term care policies are an excellent idea but are very costly.
Each health plan defines the services which are covered. For example, covered providers usually include physicians and hospitals, but the policy may not pay for nurse practitioners, midwives, chiropractors, and naturopaths.
Almost all health insurance plans cover the cost of diagnostic tests and hospitalizations. Some policies also provide coverage for such things as prescription drugs to be taken outside of hospital settings.
Most insurance policies cover emergency care provided in hospital emergency departments, but they generally discourage the overuse of emergency room visits by requiring the patient to make a large copayment. Ambulance services are not always covered.
Substance Abuse and Alcoholism Treatment
Most comprehensive policies only offer very limited coverage for the treatment of alcoholism and other substance abuse.
Alternative medicine is rapidly gaining popularity. An increasing number of health insurance policies provide benefits for alternative medicine. Policies that cover alternative medicine may provide benefits for such treatments as acupuncture, chiropractic care, therapeutic massage, and naturopathy but strictly limit the amount of the care.