Health Care Issues
Opposing Viewpoints Online Collection, 2015
In recent years, the availability and affordability of health insurance in the United States has become the subject of much debate. The United Nations’ Universal Declaration of Human Rights lists medical care among the basic human rights to which all people are entitled. In 2011, however, about 17 percent of Americans had no health insurance at all. For many people who are insured, the cost of coverage is a financial hardship. This situation has led some people to call for the government to provide health insurance for all citizens. Others, however, are skeptical of government’s ability to efficiently manage health insurance and oppose any plans that involve government. The issue is made more urgent by rapidly rising health care costs that threaten to overwhelm the country’s current system of health insurance, and the national economy in general. Health care reform has become one of the most important issues in contemporary American politics.
The Basics of Health Care
In most developed countries, health care systems involve government control or sponsorship. For instance, in Great Britain, Scandinavia, and the countries of the former Soviet Union, the government controls almost all aspects of health care, including access and delivery. For the most part, health services in these countries are free to everyone; the systems are financed primarily by taxes. Other countries, such as Germany and France, guarantee health insurance for almost all their citizens, but the government plays a smaller role in managing health care. Both systems are financed at least in part by taxes on wages.
The US government, by contrast, does not pay for most of its citizens’ health care. Generally, Americans receive health care through employer-sponsored insurance, or they arrange to pay for insurance on their own. Like all forms of insurance, health insurance operates by pooling the resources of a group of people who face similar risks. This creates a common fund that members can draw upon when needed. Each person in the group pays a certain amount, called a premium, every month. These premiums are used to cover the medical expenses of group members who become sick or injured.
Health Insurance in the United States
Today, most Americans receive health insurance through their place of work. Employers typically pay for part of the premiums. Most employer-sponsored plans are administered through payroll contributions. People who are self-employed and those whose employers do not provide health insurance must purchase individual health insurance. Individual plans are generally more expensive than group plans. Certain low-income individuals and families may be eligible for Medicaid, a form of government-sponsored health insurance. In 1997, the US government introduced the Children’s Health Insurance Program (CHIP) to assist the children of families who do not qualify for Medicaid but
cannot afford the cost of private insurance. People older than sixty-five years of age and people with certain disabilities may be eligible for Medicare, another federally funded health insurance plan.
There are two basic types of health insurance plans in the United States: indemnity plans and managed care. Under an indemnity plan (also called fee-for-service plan), the insurance company pays a percentage of the cost of medical services provided (typically 70 to 80 percent). The insured person is responsible for the remaining 20 to 30 percent. Indemnity plans do not limit patients in their choice of doctors or hospitals. Managed care controls the use of medical services in an effort to keep costs low. An example of a managed care plan is a health maintenance organization (HMO). Participants in an HMO plan are limited in their choice of doctors and hospitals. They must receive medical services at HMO-operated facilities or visit physicians and hospitals that are affiliated with the plan. The cost to the participant is usually much lower, however, limited to a small co-payment for visits to a doctor or hospital emergency room.
Each type of plan has advantages and drawbacks. Indemnity plans are more expensive than managed care plans but they offer great flexibility. Managed care plans may require individuals to choose primary care physicians, or doctors who monitor their health care. Plan participants must consult their primary care physicians to get a referral to a specialist. Managed care plans emphasize preventive care such as office visits and immunizations, but they may limit coverage for medical tests, surgery, mental health care, and other support. By contrast, indemnity plans may not pay for some types of preventive care, such as checkups and immunizations.
Both government-based health care systems and the mixed public/private system of the United States offer benefits but also have serious flaws. The former provide universal coverage, guaranteeing access to health care regardless of income or employment. Most government-based plans also provide better care for pregnant women and newborn babies than the US system. Supporting these health care systems, however, requires higher levels of government spending than the public/private system.
Furthermore, the goal of providing good care for everyone cannot always be reached in government- based systems because of limited money and resources. The pressure to keep spending under control leads to tight government restrictions. As a result, patients in some countries, such as Canada and Sweden, sometimes have to wait a long time for certain services.
The health care system in the United States is more flexible than government-controlled systems because providing universal health care and containing costs are not its main goals. In the United States, patients can obtain virtually any kind of medical service. When a person becomes ill, however, treatment will usually depend on the nature of his or her health insurance. Someone who does not have insurance or the resources to pay the health care provider may not be able to get the necessary treatment.