The cost of health care in the United States is expensive and is escalating. A majority of Americans cannot afford the cost of medicines, physicians’ fees, or hospitalization without some form of health insurance. Health insurance is a contract between an insurance company and an individual or group for the payment of medical care costs. After the individual or group pays a premium to an insurance company, the insurance company pays for part or all of the medical costs depending on the type of insurance and benefits provided. The type of insurance policy purchased greatly influences where you go for health care, who provides the health care, and what medical procedures can be performed. The three basic health insurance plans include a private, fee-for-service plan; a prepaid group plan; and a government-financed public plan.

Private Fee-For-Service Insurance Plan

Until recently, private, fee-for-service insurance was the principal form of health insurance coverage. In this plan an individual pays a monthly premium, usually through an employer, which ensures health care on a fee-far-service basis. On incurring medical costs, the patient files a claim to have a portion of these costs paid by the insurance company. There is usually a deductible, an amount paid by the patient before being eligible for benefits from the insurance company. For example, if your expenses are $1000, you may have to pay $200 before the insurance company will pay the other $800. Usually the lower the deductible, the higher the premiums will be. After the deductible is met the insurance provider pays a percentage of the remaining balance.

Typically there are fixed indemnity benefits, specified amounts that are paid for particular procedures. If your policy pays $500 for a tonsilectomy and the actual cost was $1000, you owe the health care provider $500. There are often exclusions, certain services that are not covered by the policy. Common examples include elective surgery, dental care, vision care, and coverage for preexisting illnesses and injuries. Some insurance plans provide options for adding dental and vision care. Other common options include life insurance, which pays a death benefit, and disability insurance, which pays for income lost because of the inability to work as a result of an illness or injury. The more options added to the insurance plan, the more expensive the insurance will be.

One strategy insurance companies are using to lower insurance premiums and out-of-pocket costs to the consumer is the formation of preferred providers organization (PPO). A PPO is a group of private practitioners who sell their services at reduced rates to insurance companies. When a patient chooses a provider that is in that company’s PPO, the insurance company pays a higher percentage of the fee. When a non-PPO provider is used, a much lower portion of the fee is paid.

A major advantage of a fee-for-service plan is that the patient has options in selecting health-care providers. Several disadvantages are that patients may not routinely receive comprehensive, preventive health care; health-care costs to the patient may be high if unexpected illnesses or injuries occur; and it may place heavy demands on time in keeping track of medical records, invoices, and insurance reimbursement forms.

Prepaid Group Insurance

In prepaid group insurance, health care is provided by a group of physicians organized into a health maintenance organization (HMO). HMOs are managed health-care plans that provide a full range of medical services for a prepaid amount of money. For a fixed monthly fee, usually paid through pay roll deductions by an employer, and often a small deductible, enrollees receive care from physicians, specialists, allied health professionals, and educators who are hired or contractually retained by the HMO. HMOs provide an advantage in that they provide comprehensive care including preventive care at a lower cost than private insurance over a long period of coverage. One drawback is that patients are limited in their choice of providers to those who belong to an HMO.

Government Insurance

In a government insurance plan the government at the federal, state, or local level pays for the health-care costs of elgible participants. Two prominent examples of this plan are Medicare and Medicaid. Medicare is financed by social security taxes and is designed to provide health care for individuals 65 years of age and older, the blind, the severely disabled, and those requiring certain treatments such as kidney dialysis. Medicaid is subsidized by federal and state taxes. It provides limited health care, generally for individuals who are eligible for benefits and assistance from two programs: Aid to Families with Dependent Children and Supplementary Security Income.

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National health care might be a disaster, due to the cost and the complexity. A government-controlled system also creates agonizing moral dilemmas (read about the eye treatment ruling covered further down). Still, despite my opposition to it, I can see it’s a real possibility, and soon. Keeping that in mind, here is what we can do to solve some of the inherent problems and make the system work better.What’s Your QUALYs Score?

Who gets what health care? That would be a tricky decision for any of us, but some might argue that the bureaucrats in the National Institute for Clinical Excellence (NICE) are pretty good at it. They are evaluate and approve treatments for the National Health Services administration in Britain (their national health care bureaucracy). After all, the life expectancy in Britain is about the same as in the United States, and the government spends less on health care while covering ALL citizens.

Making such decisions, of course, does lead to some interesting problems. One example: In 2002 NICE recommended that a certain treatment for macular degeneration be used only in one eye – the one less affected by the disease. What about the other eye? It is presumably allowed to go blind. They arrived at this decision by using “QUALYs,” or Quality-Adjusted Life Years.

How does this methodology for measuring the value of treatments work? Let’s look at a couple examples. A surgery that gives you an average of ten years of life is better than one that gives you five, and so scores higher on the QUALYs scale. Years added to life matter, but so does quality of those years. Suppose you could be saved by a treatment but be in a coma for six years, while another person could be saved and healthy for six years by some other treatment. If funds are limited (aren’t they always?), the latter would be approved.

Now let’s look again at the case of the eye treatment. The score for QUALYs is high for the first eye, since seeing presumably greatly increases the quality of life over blindness. But seeing with the second eye doesn’t boost the quality of life nearly as much, right?

We don’t need to get into the complexities of the system to understand the logic. Life matters, but quality of life also matters, an idea most of us can agree to. But it leads to some uncomfortable conclusions, doesn’t it?. For example a person with a debilitating disease or handicap presumably scores lower in QUALYs when considered for a life-prolonging heart operation. We might pass her over in favor of a healthier person who would benefit more according to the QUALYs score.

The real truth, normally ignored, is that there a financial limit to any national health care plan. As a result, we have to make decisions that can certainly be uncomfortable, and sometimes downright disturbing. What if a million dollars could prevent ten thousand people from getting a deadly disease, or that same million could be used to treat and possibly cure twenty people who already have the disease. Should we allow the twenty to die in order to prevent the deaths of ten thousand?

Of course, it’s easy to say we should cure the twenty AND run the prevention program. This may even be possible, and we certainly could pay for both eyes to be treated in the case of macular degeneration. On the other hand, we really can’t do everything. Honesty compels us to admit that perhaps going blind in one eye isn’t nearly so tragic as losing sight in both, and if treating just one eye for one patient saves enough money to treat another patient’s heart problem with a new procedure that saves his life, maybe we need to make that kind of decision.

Whatever utopian theorizing we do, tough choices will have to be made at some point if we decide on national health care. We’ll need to put a value on life, or on various qualities of life at least. Yes, we may even have to put a value on one eye versus two, or on eyesight versus saved limbs that might be amputated otherwise. In a market system medical providers compete to provide better treatments for your diabetes, but this will be, in part, a system where your diabetes competes with somebody’s migraine headaches or broken nose.National Health Care – Some Suggestions

If we allow a market system of health care to exist alongside a government system, we could at least pay to have the other eye fixed. The rich will obviously get better care, but I don’t think we are such a petty envious people that we would vote against such a dual-system just because of this. The healthiness of the wealthy doesn’t hurt the rest of us. Also, we all would at least have the hope of raising money for whatever additional health care we desire. So let the market still exists.

There will also be the problem of demand. Free means higher demand, of course. At the moment I have a few teeth that I might have a dentist look at this week if the examination and treatment was free, but since it isn’t I’ll wait a bit. People often delay treatment because of the expense, but they also look for and find cheaper alternatives. That would change if we had free national health care.

There will be a big increase in demand. Naturally, cuts that might be bandaged will be more often be stitched if the service is without cost. A headache or sore throat that would normally be endured might mean a trip to the free hospital or clinic. Sadly, this would use government health care money that might otherwise pay for research or treatment for life-threatening illnesses, meaning more tough decisions.

How do we alleviate this problem of excessive demand? Design a system that isn’t free. After all, the problem isn’t that we have to pay for health care, since we find a way to pay for groceries, clothing and cable television without government handouts. The problem is the high price and unpredictability of health care expenses. An occasional surprise is one thing if it’s a few hundred dollars, but a few weeks in a hospital can eat up a lifetime of savings.

Address THIS issue, instead of encouraging people’s unwillingness to budget for unexpected, but affordable surprises? How? One way is to have national health insurance for all, but with a $500 annual deductible. When a person can’t afford this (it amounts to $42 per month) it usually suggests a budgeting problem, not a problem of over-priced care.

Have each person pay 20% of all costs beyond that deductible as well, up to $1,000 ($5,000 in costs). This would keep people from running to the doctor or hospital for every little thing. This also encourages them to look for cheaper effective treatments, so the system doesn’t destroy the usual incentive (money) for this creative process of health care improvement.

Prescription drugs shouldn’t be covered until the cost goes beyond that $500 annual deductible, and even then the patient should pay his or her 20%. People (even poor people in this country) find a way to pay for bigger expenses in life, and this would keep the system from being abused. What if some people really are too poor to afford even this? Address that problem through general welfare programs, rather than paying for prescriptions for tens of millions who can easily afford them.

I am not thrilled with the idea of a national health care system. On the other hand, if it is going to happen in any case, we at least make it sustainable and leave open more options for all of us. That’s what the system outlined above would hopefully accomplish.

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Health insurance is a very important form of financial protection and it is important that everyone start planning for their health insurance early. Insurance policies that are linked to certain equity assets may also be a useful form of financial investment.
People who have comprehensive health insurance plans get their medical treatments paid out from their insurance policies. This was not always the case in the past when we would have paid the doctors directly for treatments that we received. However, modern medical treatments require more complex medical equipment, better trained doctors and cutting edge medications that are unfortunately very expensive. If individuals who do not have health insurance that they have paid for gradually over several years, have to pay for complex treatments themselves, they would find the costs prohibitive.
It is often said that health is wealth. Our wellbeing is important and the current cost of medical treatment is almost unbearable. Health insurance premiums have continued to rise astronomically over the last few years since advanced treatment methods become more expensive. It is increasingly becoming difficult these days to find a health insurance policy with good coverage and affordable premium.
Many Health Insurance Policies To Choose From
To look out for yourself in the ‘murky waters’ of health insurance plans, you need to ensure that your health insurance is not costly and has adequate coverage. Firstly look at exclusions in the health insurance policy and know which areas are not covered. Also always ask what your premiums will be, the deductibles and their policies regarding pre-existing conditions. It is very important to do your due diligence thoroughly so that you get the health insurance that meets your needs at the right price.
Another important aspect when deciding on a health insurance plan to purchase is to find out what additional costs you will have to bear as a consumer. Costs such as co-pays and deductibles are often raised in order to lower premiums. If you need to see the doctor often or have other chronic illness these expenses could end up costing you lots of money.
It is relatively easy for a generally healthy young person to get coverage. On the other hand, a person with a serious medical condition may get excluded from health insurance coverage altogether. It is important to let your prospective health insurer know than have an insurance claim revoked later on. Other vital information are the limits on benefits and the prescription drug coverage. You must also be armed with the knowledge of whether you need to stay with your current doctor or switch to another.
One way to start your search for a good health insurance plan is first of all by looking for an independent agent. State departments of insurance do have lists of such agents. You can refer to them. Furthermore, you can also check the department for expert advice. It is also advisable to go for reputable companies when looking for good health insurance plans.
Many insurance service providers offer various forms of health insurance plans. It is very tedious and many times confusing to compare the features of competing plans. Unfortunately, this process of due diligence is required to ensure that you choose the right plan with the right features suited to you and your family at the right price.
Do your research over the Internet to get to your initial list of insurance service providers to consider for your needs. During this research phase, you will also understand and appreciate features that you will consider important to you. Contact agents from these selected insurance providers to send you their proposals based on your stated needs. Do not be afraid to clarify your doubts with these agents when you receive their proposals. It is their job to enlighten you about the various features of their proposals. Remove service providers who are unable to answer your questions convincingly or deliberately try to confuse matters, off your hit list.
When you have whittled your list down to the final shortlist, ask your family, friends and colleagues for some feedback if they have had any interactions with the health insurance service providers in your list. You may also choose to discuss your options with some trusted medical professionals.

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