1.14.2: Healthcare

Health Insurance in the U.S.

No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers essential health benefits critical to maintaining your health and treating illness and accidents, for example getting free preventive care, like vaccines, screenings, and some check-ups, even before you meet your deductible. Health insurance protects you from unexpected, high medical costs by paying less for covered in-network health care, even before you meet your deductible. People without health coverage are exposed to these costs, which can sometimes lead into extreme debt or even into bankruptcy.

The U.S. does not have universal health coverage, meaning the government does not provide health insurance for every person, rather the U.S. health system is a mix of public and private, for-profit and nonprofit insurers and health care providers^[5]. The federal government provides Medicare, medicaid and the Children’s Health Insurance Program (CHIP). Private insurance is provided primarily by employers and people can also purchase their own health insurance coverage. Although there are options for health insurance, there are still about 8.5% of Americans who are un-insured, which is a reduction from 16% in 2010 before the passing of the Patient Protection and Affordable Care Act.

Medicare is health insurance for:

• People 65 or older (eligible to sign up for Medicare 3 months before turning 65)
• Those with a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease) may be able to sign up before 65.

Medicaid is a joint federal and state program that:

• Helps with medical costs for some people with limited income and resources.
• Offers benefits not normally covered by Medicare, like nursing home care and personal care services.

The Children’s Health Insurance Program (CHIP) is a joint federal and state program that:

• provides health coverage to eligible children, through both Medicaid and separate CHIP programs.

Managed Care Plans

• Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network. How much of your care the plan will pay for depends on the network’s rules.
  • With an Health Maintenance Organizations (HMO) you choose a primary care doctor who coordinates most of your care. HMO’s usually only pay for care within their specified network of doctors/providers. HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket.
  • With a Preferred Provider Organizations (PPO) you tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
  • Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care.

If you’re unemployed, or your employer does not provide health insurance, you may be able to get an affordable health insurance plan through the Health Insurance Marketplace. The Health Insurance Marketplace was developed in response to the Patient Protection and Affordable Care Act passed in 2010. Its primary goal is to achieve universal health insurance coverage by facilitating cooperation among employers, citizens, and the government. Its other objectives are to make healthcare more affordable while simultaneously increasing healthcare quality and reducing unnecessary spending^[6].

The Affordable Care Act (ACA) created a dramatically different marketplace for individual health insurance through three key reforms: prohibiting insurers from considering subscribers’ health status or risk; providing substantial subsidies for millions of people to purchase individual coverage, many for the first time in their lives; and creating an “exchange” structure that facilitates comparison shopping. Due to the ACA the uninsured rate has dropped from 16 percent in 2010 to 8.5%.

Universal Healthcare

The World Health Organization states that:

• Half of the world’s population do not have access to the health care they need.
• 100 million people are driven into poverty each year through out-of-pocket health spending.
• 75% of national health policies strategies and plans are aimed at moving towards universal health coverage.
• Over 930 million people spend at least 10% of their household income on health care.

In an effort to bring healthcare to all people across the world, The World Health Organization (WHO) is encouraging all countries of the world to adopt Universal Health Coverage (UHC). The WHO is providing support and technical expertise to advance universal health coverage in 115 countries, representing a population of at least 3 billion people. The goal is to bridge global commitments with country action to achieve universal health coverage.

The WHO defines universal healthcare as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.”

Many countries offer universal healthcare, these include:

• Australia (Healthcare System in Australia)
• Canada (Canadian Health Care System)
• France (French Healthcare System)
• Germany (German Healthcare System – GKV)
• Ireland (Healthcare System in Ireland)
• Italy (Healthcare System in Italy)
• Japan (Japanese Healthcare System)
• New Zealand (New Zealand’s Healthcare System)
• Portugal (Healthcare System in Portugal)
• Spain (Healthcare System in Spain)
• Sweden (Sweden’s Healthcare System)
• United Kingdom (Healthcare System in the UK)