A New Idea To The Health Insurance Crisis In America

By Spencer Fraise 

Lack of health insurance coverage for over 41 million Americans is one of the nation's most pressing problems. While most elderly Americans have coverage through Medicare and nearly two-thirds of non-elderly Americans receive health coverage through employer-sponsored plans, many workers and their families remain uninsured because their employer does not offer coverage or they cannot afford the cost of coverage. Medicaid and the State Children's Health Insurance Program (SCHIP) or HAWK-I here in Iowa help fill in the gaps for low-income children and some of their parents, but the reach of these programs is limited. As a result, millions of Americans without health insurance face adverse health consequences because of delayed or foregone health care and extending coverage to the uninsured has become a national priority. -(Information taken from kff.org)
The number of people that are forced to go without health insurance is nothing less than a crisis in this country today. We have fallen into a vicious cycle over the last few decades in which health insurance premiums have become too expensive for even a middle class family to afford. This in turn results in the inability of the uninsured to cover medical costs which often times results in the financial ruins of the family, and in turn results in the continuing loss of income by the medical community, which in turn drives the cost of medical expenses higher, finally cycling back to the insurance company which then must drive the premiums of health insurance higher to help cover the rising cost of health care.
Many proposals have been tossed around by politicians on both sides of the isle ranging from socializing health care comparable to the Canadian system, to endorsing health savings accounts and cracking down on frivolous law suits against the medical community. Many of these proposals have good points, but along with whatever good points they bring they also bring major downfalls. For instance; a socialized national health care program would eliminate the need for health insurance all together and the cost would be taken on by taxes, which in theory doesn't seem like a bad idea. However, the downfalls to this system include a deficit in new doctors willing to get into the field due to the inevitable decline in income while the demand would grow due to no personal responsibility. In short if people didn't have to worry about deductibles or copays that would normally keep the person from seeking medical treatment for minor things, they would simply go to the doctor every time they had an ache or pain. So now we have waiting lines for people with major health problems since everyone is scheduling an appointment while at the same time we are loosing doctors due to lack of incentive.
The current battle cry by the republican Bush administration is to push HSA's (Health Savings Accounts) which reduce premium by taking a less expensive high deductible health insurance plan with a tax deferred savings account that earns a small interest on the side that you contribute to along with your premiums each month. Any money withdrawn from the savings account for qualified medical expenses are taken "tax-free", and unlike a flex spending account like many people are familiar with in employer based plans, you don't lose the money you put into the account that you don't use. Basically if you never used any of that money in the savings account you could withdrawal or roll it over into another vehicle once you turn 62 1/2 penalty free to be used for retirement. This is a viable option for some people, however for many the premiums for these plans are still too expensive, and the problem remains that if you need major treatment in the first few years of the policy you will not have a big enough amount in the savings account to help cover the gaps leaving that person responsible for a large portion of the cost out of pocket.
Now we come to what I believe is one of the biggest problems from a health insurance agent's point of view, which is the inability for persons with pre-existing health conditions to obtain coverage. From the number of people that contact my office searching for health insurance coverage, I would have to say that about half of them have a health condition that will either result in an insurance company declining that persons application, or result in an amendment rider which basically excludes coverage for any claims related to that condition. An example of a condition that I run across constantly is hypertension or high blood pressure. This condition will sometimes result in a company declining an application all together if other factors are involved, but most generally result in an amendment exclusion rider. You may think that this isn't that big of a deal, after all, blood pressure medicine is about the only thing they would have to pay for out of pocket, but what many people don't realize is that this rider will exclude ANYTHING that could be considered part of this condition including heart attacks, strokes, and aneurisms which would all result in a huge out of pocket claim. Consider the fact that my father had a double by-pass surgery recently that ended up with a final bill of around $150,000. This whole amount would have had to come out of pocket had he had a hypertension rider on his health insurance policy, not to mention the added cost of 2 months off of work thrown into the mix. On a modest income of $40,000 per year this would have ruined him financially.
So what how do we fix this problem? Obviously the proposals thus far have been flawed from the beginning, and even if one of these plans gained support from the American people chances are it would never be passed into law simply due to political infighting. One side wants to keep health care privatized while the other wants to socialize it, which as we discussed before both have upsides and downsides. It seems that we are doomed on this issue and there is no real ideas or light at the of the tunnel right? Maybe not, let me tell you about a client I had in my office a couple of years ago.
A young woman came in wanting to compare health insurance plans to see if there were any options for her and her family. She had several children and had been on Title 19 Medicaid and had been going to college paid by the state. She had recently graduated from college and had gotten a job with the local school system, however for whatever reason she was not eligible for health insurance benefits. Obviously she still couldn't afford 5 or 6 hundred dollars per month for a plan so she went back to the aid office and explained her situation. They ended up working with us to find an acceptable private health insurance plan and reimbursed her for a percentage of the cost which I didn't even know was possible!
This got me thinking, consider how many more people would be able to obtain coverage if they could be reimbursed by the government a percentage of the premium according to their income. For example; take a young married couple in their 20's with one child, let's say that their family income is $25,000 and that the average premium for a $500 deductible health insurance plan for them is $450. Just as an example let's say that the government determined that a three person family with an annual income of $25,000 is reimbursed 50% of their premium taking the actual cost to the family to $225 per month. This is now an affordable enough premium for the family to consider.
With this merging of private insurance with government assistance we get the best of both worlds. Of course the next question goes to cost, how much more would this cost the American tax payer and how much would this raise taxes? I don't think that it would cost the tax payers much more an here's why I think that: First off we would bring down significantly the amount of uninsured people that are unable to pay for the medical care they get in turn driving down the total cost of health care. Secondly the number of people that are forced into bankruptcy and driven to Medicaid Title 19 assistance due to medical bills stemming from catastrophic medical conditions that don't have health insurance coverage would be significantly reduced. This is important to keep in mind considering that once someone is on Medicaid they are receiving health care basically 100% covered by the government so there is no more incentive to not seek treatment for minor or non-existing conditions. On the flip side many conditions that would have not been caught before they became severe because a person didn't seek treatment due to not having insurance coverage would now be caught before they turned into a catastrophic claim. Finally, if the government allocated a certain amount of money to help cover claims by people that have pre-existing conditions the private insurance companies could do away with exclusions and declines due to already existing health problems, this is already done is some states such as the HIPIOWA Iowa Comprehensive Plans which insures Iowa residents that can not obtain coverage elsewhere.
You may be sitting there thinking that this is all just wishful thinking and that these ideas could never be implemented, but all of these ideas are already being implemented. The problem is that only some states do some programs and not even most health insurance agents know that some low income families can get reimbursed for health insurance premiums. If these programs were all standardized and put into effect on a national well publicized level I believe it would put one hell of a dent in the uninsured population in this country. Now I don't pretend to know what the reimbursement levels should be for what income levels but I do know that anything is better than nothing, and in my opinion this is the best middle ground we could find. The Democrats would be happy with the socialized aspect of the reimbursement, and the republicans should be happy that health care remains privatized giving this solution a better chance at a by-partisan backing.
I have faxed this idea to several senators and congressmen but always received the same type of standard response about how they are concerned with health care and that they are working hard to find a solution knowing full well that no one really even read my letters. The only way to get these ideas out into the public is for you that read this to pass it on to others by word of mouth, by email, or by linking your websites to this webpage. If enough buzz is created than these ideas would get the consideration that they deserve, and if enough people like you and I demanded that a solution be found than perhaps enough stress can be placed on the politicians to get something done. The number of uninsured Americans is only going to go up, the cost of health care is only going to go up, and the cost of health insurance premiums are only going to go up if something isn't done now! Until then the only thing that I as a health insurance agent can do is to compare all of the options out there and present you with the lesser of all of the evils, which in too many cases the option that is chosen is the biggest evil of going without coverage.

Written by Spencer L Fraise - Agent/Manger MultiQuote Insurance
[http://www.iowahealthinsurance.biz]

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The Easy Guide To Finding The Best Health Insurance Coverage

By Tim Gorman 

Health insurance coverage is a major necessity for today's active consumer. Taking the chance of not setting enough money aside in order to pay your monthly health insurance premium is basically gambling with your financial and physical well-being. Typically, health insurance benefits and coverage vary widely among the many different health insurance providers. However, they all have one common trait or feature and that is they all pay for a pre-determined amount of incurred medical cost for the policy holder or insured individual.
Health insurance may not seem as important to you right now and in many cases most people don't acknowledge the fact that they even need health insurance until it's to late. This usually happens right around the time when a consumer requires significant medical attention or assistance. For some folks even routine doctor's exams and medical appointments can be the catalyst or wake up sign that health insurance is very vital to living a health and stress free life.
The United States health care system is unique in its own right due in large part to the privatization that has occurred in the medical and health care community. This is spurned the demand and need for an adequate health insurance policy and coverage system. Many other countries actually use a government-sponsored form of health care that doesn't require insurance coverage in any form.
The three primary forms of health care insurance include the self-insured and uninsured consumers, managed care plans and indemnity health care plans. The self-insured and uninsured group of consumers normally consist of the self-employed and unfortunately folks that are currently not working or out of work. The latest figures show that about 35% of the folks needing health care insurance fall into this category.
Chances are you've probably already familiar with what a managed health care plan is, thanks in large part to the stories discussed in the newspapers, TV and local radio stations. After all, health care is a hot topic for many consumers living in the United States. Basically all a managed care plan does is offer contracted health care providers at pre-negotiated prices. There are three different versions of the managed health care plans provided in today's medical community. The most commonly known is the Health Maintenance Organization or HMO. This plan requires its insured members to contribute a set dollar amount or fee each month in exchange for medical care. The typical medical services that are readily provided by an HMO include routine appointments, surgery and some outside specialization treatments (although the HMO plan usually frowns upon seeking medical assistance outside of the HMO network of providers).
The next managed care plan is the Preferred Provider Organizations or PPO. This health service plan normally requires the insured to make payment up front and then provides a re-imbursement to the member of the health care plan. Much like HMOs the PPO has a set network of doctors and health care providers that ity has negotiated with in advance in order to obtain better rates for medical treatment that may be required by its members.
The final plan offered by the managed health care plan is the Point of Service or POS plan. This plan isn't really talked about as much as the HMO and PPO health insurance plans based on the fact that it's not as common. A member of this plan avoids having to pay a deductible and a small co-payment fee provided they use a doctor that is a member of the POS network. The major drawback with this plan is if the insured member seeks treatment outside of the referral network then a rather large deductible is incurred along with some rather stiff charges.
Aside from the self-insured/uninsured plan and the managed health care plan there is still one more form of health insurance coverage that can be obtained by consumers who have a little more money that they wish to spend on their health insurance coverage. This plan is the indemnity plan and although it offers the least amount of restrictions when compared to all other health care plans it is also the most expensive. The reason for the high cost associated with this form of health insurance coverage is due to the ability for the plan member or insured consumer to visit any doctor or health care specialist they want to receive health care from as often as needed or required.
With several choices between which health insurance plan or coverage to choose from it really boils down to each individual consumer's own unique needs, wants and desires when it comes to the health care they want provided to them. Searching for the right health insurance coverage can be a mundane and laborious task but it doesn't have to be difficult if you know what you're choices are prior to beginning your quest to find the best health insurance plan at the most affordable price.

Timothy Gorman is a successful Webmaster and publisher of Easy Health Insurance Guide. A website that specializes in providing health insurance advice to include easy ways to find cheaper managed health care plans that you can research in your pajamas from the comfort of your own home.

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Health Savings Accounts - An American Innovation in Health Insurance

By Parveen Kumar Bhagat 

INTRODUCTON - The term "health insurance" is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government. Synonyms for this usage include "health coverage," "health care coverage" and "health benefits" and "medical insurance." In a more technical sense, the term is used to describe any form of insurance that provides protection against injury or illness.
In America, the health insurance industry has changed rapidly during the last few decades. In the 1970's most people who had health insurance had indemnity insurance. Indemnity insurance is often called fee-forservice. It is the traditional health insurance in which the medical provider (usually a doctor or hospital) is paid a fee for each service provided to the patient covered under the policy. An important category associated with the indemnity plans is that of consumer driven health care (CDHC). Consumer-directed health plans allow individuals and families to have greater control over their health care, including when and how they access care, what types of care they receive and how much they spend on health care services.
These plans are however associated with higher deductibles that the insured have to pay from their pocket before they can claim insurance money. Consumer driven health care plans include Health Reimbursement Plans (HRAs), Flexible Spending Accounts (FSAs), high deductible health plans (HDHps), Archer Medical Savings Accounts (MSAs) and Health Savings Accounts (HSAs). Of these, the Health Savings Accounts are the most recent and they have witnessed rapid growth during the last decade.
WHAT IS A HEALTH SAVINGS ACCOUNT?
A Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States. The funds contributed to the account are not subject to federal income tax at the time of deposit. These may be used to pay for qualified medical expenses at any time without federal tax liability.
Another feature is that the funds contributed to Health Savings Account roll over and accumulate year over year if not spent. These can be withdrawn by the employees at the time of retirement without any tax liabilities. Withdrawals for qualified expenses and interest earned are also not subject to federal income taxes. According to the U.S. Treasury Office, 'A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care.
HSA's enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.' Thus the Health Savings Account is an effort to increase the efficiency of the American health care system and to encourage people to be more responsible and prudent towards their health care needs. It falls in the category of consumer driven health care plans.
Origin of Health Savings Account
The Health Savings Account was established under the Medicare Prescription Drug, Improvement, and Modernization Act passed by the U.S. Congress in June 2003, by the Senate in July 2003 and signed by President Bush on December 8, 2003.
Eligibility -
The following individuals are eligible to open a Health Savings Account -
- Those who are covered by a High Deductible Health Plan (HDHP).
- Those not covered by other health insurance plans.
- Those not enrolled in Medicare4.
Also there are no income limits on who may contribute to an HAS and there is no requirement of having earned income to contribute to an HAS. However HAS's can't be set up by those who are dependent on someone else's tax return. Also HSA's cannot be set up independently by children.
What is a High Deductible Health plan (HDHP)?
Enrollment in a High Deductible Health Plan (HDHP) is a necessary qualification for anyone wishing to open a Health Savings Account. In fact the HDHPs got a boost by the Medicare Modernization Act which introduced the HSAs. A High Deductible Health Plan is a health insurance plan which has a certain deductible threshold. This limit must be crossed before the insured person can claim insurance money. It does not cover first dollar medical expenses. So an individual has to himself pay the initial expenses that are called out-of-pocket costs.
In a number of HDHPs costs of immunization and preventive health care are excluded from the deductible which means that the individual is reimbursed for them. HDHPs can be taken both by individuals (self employed as well as employed) and employers. In 2008, HDHPs are being offered by insurance companies in America with deductibles ranging from a minimum of $1,100 for Self and $2,200 for Self and Family coverage. The maximum amount out-of-pocket limits for HDHPs is $5,600 for self and $11,200 for Self and Family enrollment. These deductible limits are called IRS limits as they are set by the Internal Revenue Service (IRS). In HDHPs the relation between the deductibles and the premium paid by the insured is inversely propotional i.e. higher the deductible, lower the premium and vice versa. The major purported advantages of HDHPs are that they will a) lower health care costs by causing patients to be more cost-conscious, and b) make insurance premiums more affordable for the uninsured. The logic is that when the patients are fully covered (i.e. have health plans with low deductibles), they tend to be less health conscious and also less cost conscious when going for treatment.
Opening a Health Savings Account
An individual can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. However not all insurance companies offer HSAqualified health insurance plans so it is important to use an insurance company that offers this type of qualified insurance plan. The employer may also set up a plan for the employees. However, the account is always owned by the individual. Direct online enrollment in HSA-qualified health insurance is available in all states except Hawaii, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Vermont and Washington.
Contributions to the Health Savings Account
Contributions to HSAs can be made by an individual who owns the account, by an employer or by any other person. When made by the employer, the contribution is not included in the income of the employee. When made by an employee, it is treated as exempted from federal tax. For 2008, the maximum amount that can be contributed (and deducted) to an HSA from all sources is:
$2,900 (self-only coverage)
$5,800 (family coverage)
These limits are set by the U.S. Congress through statutes and they are indexed annually for inflation. For individuals above 55 years of age, there is a special catch up provision that allows them to deposit additional $800 for 2008 and $900 for 2009. The actual maximum amount an individual can contribute also depends on the number of months he is covered by an HDHP (pro-rated basis) as of the first day of a month. For eg If you have family HDHP coverage from January 1,2008 until June 30, 2008, then cease having HDHP coverage, you are allowed an HSA contribution of 6/12 of $5,800, or $2,900 for 2008. If you have family HDHP coverage from January 1,2008 until June 30, 2008, and have self-only HDHP coverage from July 1, 2008 to December 31, 2008, you are allowed an HSA contribution of 6/12 x $5,800 plus 6/12 of $2,900, or $4,350 for 2008. If an individual opens an HDHP on the first day of a month, then he can contribute to HSA on the first day itself. However, if he/she opens an account on any other day than the first, then he can contribute to the HSA from the next month onwards. Contributions can be made as late as April 15 of the following year. Contributions to the HSA in excess of the contribution limits must be withdrawn by the individual or be subject to an excise tax. The individual must pay income tax on the excess withdrawn amount.
Contributions by the Employer
The employer can make contributions to the employee's HAS account under a salary reduction plan known as Section 125 plan. It is also called a cafeteria plan. The contributions made under the cafeteria plan are made on a pre-tax basis i.e. they are excluded from the employee's income. The employer must make the contribution on a comparable basis. Comparable contributions are contributions to all HSAs of an employer which are 1) the same amount or 2) the same percentage of the annual deductible. However, part time employees who work for less than 30 hours a week can be treated separately. The employer can also categorize employees into those who opt for self coverage only and those who opt for a family coverage. The employer can automatically make contributions to the HSAs on the behalf of the employee unless the employee specifically chooses not to have such contributions by the employer.
Withdrawals from the HSAs
The HSA is owned by the employee and he/she can make qualified expenses from it whenever required. He/She also decides how much to contribute to it, how much to withdraw for qualified expenses, which company will hold the account and what type of investments will be made to grow the account. Another feature is that the funds remain in the account and role over from year to year. There are no use it or lose it rules. The HSA participants do not have to obtain advance approval from their HSA trustee or their medical insurer to withdraw funds, and the funds are not subject to income taxation if made for 'qualified medical expenses'. Qualified medical expenses include costs for services and items covered by the health plan but subject to cost sharing such as a deductible and coinsurance, or co-payments, as well as many other expenses not covered under medical plans, such as dental, vision and chiropractic care; durable medical equipment such as eyeglasses and hearing aids; and transportation expenses related to medical care. Nonprescription, over-the-counter medications are also eligible. However, qualified medical expense must be incurred on or after the HSA was established.
Tax free distributions can be taken from the HSA for the qualified medical expenses of the person covered by the HDHP, the spouse (even if not covered) of the individual and any dependent (even if not covered) of the individual.12 The HSA account can also be used to pay previous year's qualified expenses subject to the condition that those expenses were incurred after the HSA was set up. The individual must preserve the receipts for expenses met from the HSA as they may be needed to prove that the withdrawals from the HSA were made for qualified medical expenses and not otherwise used. Also the individual may have to produce the receipts before the insurance company to prove that the deductible limit was met. If a withdrawal is made for unqualified medical expenses, then the amount withdrawn is considered taxable (it is added to the individuals income) and is also subject to an additional 10 percent penalty. Normally the money also cannot be used for paying medical insurance premiums. However, in certain circumstances, exceptions are allowed.
These are -
1) to pay for any health plan coverage while receiving federal or state unemployment benefits.
2) COBRA continuation coverage after leaving employment with a company that offers health insurance coverage.
3) Qualified long-term care insurance.
4) Medicare premiums and out-of-pocket expenses, including deductibles, co-pays, and coinsurance for: Part A (hospital and inpatient services), Part B (physician and outpatient services), Part C (Medicare HMO and PPO plans) and Part D (prescription drugs).
However, if an individual dies, becomes disabled or reaches the age of 65, then withdrawals from the Health Savings Account are considered exempted from income tax and additional 10 percent penalty irrespective of the purpose for which those withdrawals are made. There are different methods through which funds can be withdrawn from the HSAs. Some HSAs provide account holders with debit cards, some with cheques and some have options for a reimbursement process similar to medical insurance.
Growth of HSAs
Ever since the Health Savings Accounts came into being in January 2004, there has been a phenomenal growth in their numbers. From around 1 million enrollees in March 2005, the number has grown to 6.1 million enrollees in January 2008.14 This represents an increase of 1.6 million since January 2007, 2.9 million since January 2006 and 5.1 million since March 2005. This growth has been visible across all segments. However, the growth in large groups and small groups has been much higher than in the individual category. According to the projections made by the U.S. Treasury Department, the number of HSA policy holders will increase to 14 million by 2010. These 14 million policies will provide cover to 25 to 30 million U.S. citizens.
In the Individual Market, 1.5 million people were covered by HSA/HDHPs purchased as on January 2008. Based on the number of covered lives, 27 percent of newly purchased individual policies (defined as those purchased during the most recent full month or quarter) were enrolled in HSA/HDHP coverage. In the small group market, enrollment stood at 1.8 million as of January 2008. In this group 31 percent of all new enrollments were in the HSA/HDHP category. The large group category had the largest enrollment with 2.8 million enrollees as of January 2008. In this category, six percent of all new enrollments were in the HSA/HDHP category.
Benefits of HSAs
The proponents of HSAs envisage a number of benefits from them. First and foremost it is believed that as they have a high deductible threshold, the insured will be more health conscious. Also they will be more cost conscious. The high deductibles will encourage people to be more careful about their health and health care expenses and will make them shop for bargains and be more vigilant against excesses in the health care industry. This, it is believed, will reduce the growing cost of health care and increase the efficiency of the health care system in the United States. HSA-eligible plans typically provide enrollee decision support tools that include, to some extent, information on the cost of health care services and the quality of health care providers. Experts suggest that reliable information about the cost of particular health care services and the quality of specific health care providers would help enrollees become more actively engaged in making health care purchasing decisions. These tools may be provided by health insurance carriers to all health insurance plan enrollees, but are likely to be more important to enrollees of HSA-eligible plans who have a greater financial incentive to make informed decisions about the quality and costs of health care providers and services.
It is believed that lower premiums associated with HSAs/HDHPs will enable more people to enroll for medical insurance. This will mean that lower income groups who do not have access to medicare will be able to open HSAs. No doubt higher deductibles are associated with HSA eligible HDHPs, but it is estimated that tax savings under HSAs and lower premiums will make them less expensive than other insurance plans. The funds put in the HSA can be rolled over from year to year. There are no use it or lose it rules. This leads to a growth in savings of the account holder. The funds can be accumulated tax free for future medical expenses if the holder so desires. Also the savings in the HSA can be grown through investments.
The nature of such investments is decided by the insured. The earnings on savings in the HSA are also exempt from income tax. The holder can withdraw his savings in the HSA after turning 65 years old without paying any taxes or penalties. The account holder has complete control over his/her account. He/She is the owner of the account right from its inception. A person can withdraw money as and when required without any gatekeeper. Also the owner decides how much to put in his/her account, how much to spend and how much to save for the future. The HSAs are portable in nature. This means that if the holder changes his/her job, becomes unemployed or moves to another location, he/she can still retain the account.
Also if the account holder so desires he can transfer his Health Saving Account from one managing agency to another. Thus portability is an advantage of HSAs. Another advantage is that most HSA plans provide first-dollar coverage for preventive care. This is true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. It was also true of over half (59%) of the plans which were purchased by individuals.
All of the plans offering first-dollar preventive care benefits included annual physicals, immunizations, well-baby and wellchild care, mammograms and Pap tests; 90% included prostate cancer screenings and 80% included colon cancer screenings. Some analysts believe that HSAs are more beneficial for the young and healthy as they do not have to pay frequent out of pocket costs. On the other hand, they have to pay lower premiums for HDHPs which help them meet unforeseen contingencies.
Health Savings Accounts are also advantageous for the employers. The benefits of choosing a health Savings Account over a traditional health insurance plan can directly affect the bottom line of an employer's benefit budget. For instance Health Savings Accounts are dependent on a high deductible insurance policy, which lowers the premiums of the employee's plan. Also all contributions to the Health Savings Account are pre-tax, thus lowering the gross payroll and reducing the amount of taxes the employer must pay.
Criticism of HSAs
The opponents of Health Savings Accounts contend that they would do more harm than good to America's health insurance system. Some consumer organizations, such as Consumers Union, and many medical organizations, such as the American Public Health Association, have rejected HSAs because, in their opinion, they benefit only healthy, younger people and make the health care system more expensive for everyone else. According to Stanford economist Victor Fuchs, "The main effect of putting more of it on the consumer is to reduce the social redistributive element of insurance.
Some others believe that HSAs remove healthy people from the insurance pool and it makes premiums rise for everyone left. HSAs encourage people to look out for themselves more and spread the risk around less. Another concern is that the money people save in HSAs will be inadequate. Some people believe that HSAs do not allow for enough savings to cover costs. Even the person who contributes the maximum and never takes any money out would not be able to cover health care costs in retirement if inflation continues in the health care industry.
Opponents of HSAs, also include distinguished figures like state Insurance Commissioner John Garamendi, who called them a "dangerous prescription" that will destabilize the health insurance marketplace and make things even worse for the uninsured. Another criticism is that they benefit the rich more than the poor. Those who earn more will be able to get bigger tax breaks than those who earn less. Critics point out that higher deductibles along with insurance premiums will take away a large share of the earnings of the low income groups. Also lower income groups will not benefit substantially from tax breaks as they are already paying little or no taxes. On the other hand tax breaks on savings in HSAs and on further income from those HSA savings will cost billions of dollars of tax money to the exchequer.
The Treasury Department has estimated HSAs would cost the government $156 billion over a decade. Critics say that this could rise substantially. Several surveys have been conducted regarding the efficacy of the HSAs and some have found that the account holders are not particularly satisfied with the HSA scheme and many are even ignorant about the working of the HSAs. One such survey conducted in 2007 of American employees by the human resources consulting firm Towers Perrin showed satisfaction with account based health plans (ABHPs) was low. People were not happy with them in general compared with people with more traditional health care. Respondants said they were not comfortable with the risk and did not understand how it works.
According to the Commonwealth Fund, early experience with HAS eligible high-deductible health plans reveals low satisfaction, high out of- pocket costs, and cost-related access problems. Another survey conducted with the Employee Benefits Research Institute found that people enrolled in HSA-eligible high-deductible health plans were much less satisfied with many aspects of their health care than adults in more comprehensive plans People in these plans allocate substantial amounts of income to their health care, especially those who have poorer health or lower incomes. The survey also found that adults in high-deductible health plans are far more likely to delay or avoid getting needed care, or to skip medications, because of the cost. Problems are particularly pronounced among those with poorer health or lower incomes.
Political leaders have also been vocal about their criticism of the HSAs. Congressman John Conyers, Jr. issued the following statement criticizing the HSAs "The President's health care plan is not about covering the uninsured, making health insurance affordable, or even driving down the cost of health care. Its real purpose is to make it easier for businesses to dump their health insurance burden onto workers, give tax breaks to the wealthy, and boost the profits of banks and financial brokers. The health care policies concocted at the behest of special interests do nothing to help the average American. In many cases, they can make health care even more inaccessible." In fact a report of the U.S. governments Accountability office, published on April 1, 2008 says that the rate of enrollment in the HSAs is greater for higher income individuals than for lower income ones.
A study titled "Health Savings Accounts and High Deductible Health Plans: Are They an Option for Low-Income Families? By Catherine Hoffman and Jennifer Tolbert which was sponsored by the Kaiser Family Foundation reported the following key findings regarding the HSAs:
a) Premiums for HSA-qualified health plans may be lower than for traditional insurance, but these plans shift more of the financial risk to individuals and families through higher deductibles.
b) Premiums and out-of-pocket costs for HSA-qualified health plans would consume a substantial portion of a low-income family's budget.
c) Most low-income individuals and families do not face high enough tax liability to benefit in a significant way from tax deductions associated with HSAs.
d) People with chronic conditions, disabilities, and others with high cost medical needs may face even greater out-of-pocket costs under HSA-qualified health plans.
e) Cost-sharing reduces the use of health care, especially primary and preventive services, and low-income individuals and those who are sicker are particularly sensitive to cost-sharing increases.
f) Health savings accounts and high deductible plans are unlikely to substantially increase health insurance coverage among the uninsured.
Choosing a Health Plan
Despite the advantages offered by the HSA, it may not be suitable for everyone. While choosing an insurance plan, an individual must consider the following factors:
1. The premiums to be paid.
2. Coverage/benefits available under the scheme.
3. Various exclusions and limitations.
4. Portability.
5. Out-of-pocket costs like coinsurance, co-pays, and deductibles.
6. Access to doctors, hospitals, and other providers.
7. How much and sometimes how one pays for care.
8. Any existing health issue or physical disability.
9. Type of tax savings available.
The plan you choose should according to your requirements and financial ability.
BIBLIOGRAPHY
1 Questions and Answers about Health Insurance- A Consumer Guide' published jointly by the Agency for Healthcare Research and Quality (AHRQ)and America's Health Insurance Plans (AHIP)
2 http://www.en.wikipedia.org/wiki/Health_savings_account
3 2002 AHIP Survey of Health Insurance Plans
4 "How High Is Too High? Implications of High-Deductible Health Plans" Davis, Karen; Michelle Doty and Alice Ho. The Commonwealth Fund, April 2005
5 http://www.fdhc.state.fl.us/schs/pdf/hsa_tri-fold_brochure.pdf
6 HSA/HDHP CENSUS 2008 by Hannah Yoo, Center for Policy and Research, America's Health Insurance Plans
7"HEALTH SAVINGS ACCOUNTS Early Enrollee Experiences with Accounts and Eligible Health Plans" John E. Dicken Director, Health Care.
8 Thomas Wilder and Hannah Yoo, "A Survey of Preventive Benefits in Health Savings Account (HSA)Plans, July 2007," America's Health Insurance Plans, November 2007
9 Gladwell, Malcolm, "The Moral Hazard Myth", The New Yorker (29-08-2005)
10 2008 Benchmark Survey HAS Bank
11. Employer Health Benefits 2007 Annual Survey, Kaiser Family Foundation
12. Health Savings Accounts and High Deductible Health Plans: Are They An Option for Low-Income Families?Catherine Hoffman and Jennifer Tolbert for Kaiser Family Foundation, October 2006
13. Medicare Prescription Drug, Improvement, and Modernization Act of 2003

I am an ardent reader who also loves to write as well. I am an MBA with specialization in finance.

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A Prescription For the Health Care Crisis

By Alex Lickerman 

With all the shouting going on about America's health care crisis, many are probably finding it difficult to concentrate, much less understand the cause of the problems confronting us. I find myself dismayed at the tone of the discussion (though I understand it---people are scared) as well as bemused that anyone would presume themselves sufficiently qualified to know how to best improve our health care system simply because they've encountered it, when people who've spent entire careers studying it (and I don't mean politicians) aren't sure what to do themselves.
Albert Einstein is reputed to have said that if he had an hour to save the world he'd spend 55 minutes defining the problem and only 5 minutes solving it. Our health care system is far more complex than most who are offering solutions admit or recognize, and unless we focus most of our efforts on defining its problems and thoroughly understanding their causes, any changes we make are just likely to make them worse as they are better.
Though I've worked in the American health care system as a physician since 1992 and have seven year's worth of experience as an administrative director of primary care, I don't consider myself qualified to thoroughly evaluate the viability of most of the suggestions I've heard for improving our health care system. I do think, however, I can at least contribute to the discussion by describing some of its troubles, taking reasonable guesses at their causes, and outlining some general principles that should be applied in attempting to solve them.
THE PROBLEM OF COST
No one disputes that health care spending in the U.S. has been rising dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is projected to reach $8,160 per person per year by the end of 2009 compared to the $356 per person per year it was in 1970. This increase occurred roughly 2.4% faster than the increase in GDP over the same period. Though GDP varies from year-to-year and is therefore an imperfect way to assess a rise in health care costs in comparison to other expenditures from one year to the next, we can still conclude from this data that over the last 40 years the percentage of our national income (personal, business, and governmental) we've spent on health care has been rising.
Despite what most assume, this may or may not be bad. It all depends on two things: the reasons why spending on health care has been increasing relative to our GDP and how much value we've been getting for each dollar we spend.
WHY HAS HEALTH CARE BECOME SO COSTLY?
This is a harder question to answer than many would believe. The rise in the cost of health care (on average 8.1% per year from 1970 to 2009, calculated from the data above) has exceeded the rise in inflation (4.4% on average over that same period), so we can't attribute the increased cost to inflation alone. Health care expenditures are known to be closely associated with a country's GDP (the wealthier the nation, the more it spends on health care), yet even in this the United States remains an outlier (figure 3).
Is it because of spending on health care for people over the age of 75 (five times what we spend on people between the ages of 25 and 34)? In a word, no. Studies show this demographic trend explains only a small percentage of health expenditure growth.
Is it because of monstrous profits the health insurance companies are raking in? Probably not. It's admittedly difficult to know for certain as not all insurance companies are publicly traded and therefore have balance sheets available for public review. But Aetna, one of the largest publicly traded health insurance companies in North America, reported a 2009 second quarter profit of $346.7 million, which, if projected out, predicts a yearly profit of around $1.3 billion from the approximately 19 million people they insure. If we assume their profit margin is average for their industry (even if untrue, it's unlikely to be orders of magnitude different from the average), the total profit for all private health insurance companies in America, which insured 202 million people (2nd bullet point) in 2007, would come to approximately $13 billion per year. Total health care expenditures in 2007 were $2.2 trillion (see Table 1, page 3), which yields a private health care industry profit approximately 0.6% of total health care costs (though this analysis mixes data from different years, it can perhaps be permitted as the numbers aren't likely different by any order of magnitude).
Is it because of health care fraud? Estimates of losses due to fraud range as high as 10% of all health care expenditures, but it's hard to find hard data to back this up. Though some percentage of fraud almost certainly goes undetected, perhaps the best way to estimate how much money is lost due to fraud is by looking at how much the government actually recovers. In 2006, this was $2.2 billion, only 0.1% of $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year.
Is it due to pharmaceutical costs? In 2006, total expenditures on prescription drugs was approximately $216 billion (see Table 2, page 4). Though this amounted to 10% of the $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year and must therefore be considered significant, it still remains only a small percentage of total health care costs.
Is it from administrative costs? In 1999, total administrative costs were estimated to be $294 billion, a full 25% of the $1.2 trillion (Table 1) in total health care expenditures that year. This was a significant percentage in 1999 and it's hard to imagine it's shrunk to any significant degree since then.
In the end, though, what probably has contributed the greatest amount to the increase in health care spending in the U.S. are two things:
1. Technological innovation.
2. Overutilization of health care resources by both patients and health care providers themselves.
Technological innovation. Data that proves increasing health care costs are due mostly to technological innovation is surprisingly difficult to obtain, but estimates of the contribution to the rise in health care costs due to technological innovation range anywhere from 40% to 65% (Table 2, page 8). Though we mostly only have empirical data for this, several examples illustrate the principle. Heart attacks used to be treated with aspirin and prayer. Now they're treated with drugs to control shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty or stenting, and coronary artery bypass grafting. You don't have to be an economist to figure out which scenario ends up being more expensive. We may learn to perform these same procedures more cheaply over time (the same way we've figured out how to make computers cheaper) but as the cost per procedure decreases, the total amount spent on each procedure goes up because the number of procedures performed goes up. Laparoscopic cholecystectomy is 25% less than the price of an open cholecystectomy, but the rates of both have increased by 60%. As technological advances become more widely available they become more widely used, and one thing we're great at doing in the United States is making technology available.
Overutilization of health care resources by both patients and health care providers themselves. We can easily define overutilization as the unnecessary consumption of health care resources. What's not so easy is recognizing it. Every year from October through February the majority of patients who come into the Urgent Care Clinic at my hospital are, in my view, doing so unnecessarily. What are they coming in for? Colds. I can offer support, reassurance that nothing is seriously wrong, and advice about over-the-counter remedies---but none of these things will make them better faster (though I often am able to reduce their level of concern). Further, patients have a hard time believing the key to arriving at a correct diagnosis lies in history gathering and careful physical examination rather than technologically-based testing (not that the latter isn't important---just less so than most patients believe). Just how much patient-driven overutilization costs the health care system is hard to pin down as we have mostly only anecdotal evidence as above.
Further, doctors often disagree among themselves about what constitutes unnecessary health care consumption. In his excellent article, "The Cost Conundrum," Atul Gawande argues that regional variation in overutilization of health care resources by doctors best accounts for the regional variation in Medicare spending per person. He goes on to argue that if doctors could be motivated to rein in their overutilization in high-cost areas of the country, it would save Medicare enough money to keep it solvent for 50 years.
A reasonable approach. To get that to happen, however, we need to understand why doctors are overutilizing health care resources in the first place:
1. Judgment varies in cases where the medical literature is vague or unhelpful. When faced with diagnostic dilemmas or diseases for which standard treatments haven't been established, a variation in practice invariably occurs. If a primary care doctor suspects her patient has an ulcer, does she treat herself empirically or refer to a gastroenterologist for an endoscopy? If certain "red flag" symptoms are present, most doctors would refer. If not, some would and some wouldn't depending on their training and the intangible exercise of judgment.
2. Inexperience or poor judgment. More experienced physicians tend to rely on histories and physicals more than less experienced physicians and consequently order fewer and less expensive tests. Studies suggest primary care physicians spend less money on tests and procedures than their sub-specialty colleagues but obtain similar and sometimes even better outcomes.
3. Fear of being sued. This is especially common in Emergency Room settings, but extends to almost every area of medicine.
4. Patients tend to demand more testing rather than less. As noted above. And physicians often have difficulty refusing patient requests for many reasons (eg, wanting to please them, fear of missing a diagnosis and being sued, etc).
5. In many settings, overutilization makes doctors more money. There exists no reliable incentive for doctors to limit their spending unless their pay is capitated or they're receiving a straight salary.
Gawande's article implies there exists some level of utilization of health care resources that's optimal: use too little and you get mistakes and missed diagnoses; use too much and excess money gets spent without improving outcomes, paradoxically sometimes resulting in outcomes that are actually worse (likely as a result of complications from all the extra testing and treatments).
How then can we get doctors to employ uniformly good judgment to order the right number of tests and treatments for each patient---the "sweet spot"---in order to yield the best outcomes with the lowest risk of complications? Not easily. There is, fortunately or unfortunately, an art to good health care resource utilization. Some doctors are more gifted at it than others. Some are more diligent about keeping current. Some care more about their patients. An explosion of studies of medical tests and treatments has occurred in the last several decades to help guide doctors in choosing the most effective, safest, and even cheapest ways to practice medicine, but the diffusion of this evidence-based medicine is a tricky business. Just because beta blockers, for example, have been shown to improve survival after heart attacks doesn't mean every physician knows it or provides them. Data clearly show many don't. How information spreads from the medical literature into medical practice is a subject worthy of an entire post unto itself. Getting it to happen uniformly has proven extremely difficult.
In summary, then, most of the increase in spending on health care seems to have come from technological innovation coupled with its overuse by doctors working in systems that motivate them to practice more medicine rather than better medicine, as well as patients who demand the former thinking it yields the latter.
But even if we could snap our fingers and magically eliminate all overutilization today, health care in the U.S. would still remain among the most expensive in the world, requiring us to ask next---
WHAT VALUE ARE WE GETTING FOR THE DOLLARS WE SPEND?
According to an article in the New England Journal of Medicine titled The Burden of Health Care Costs for Working Families---Implications for Reform, growth in health care spending "can be defined as affordable as long as the rising percentage of income devoted to health care does not reduce standards of living. When absolute increases in income cannot keep up with absolute increases in health care spending, health care growth can be paid for only by sacrificing consumption of goods and services not related to health care." When would this ever be an acceptable state of affairs? Only when the incremental cost of health care buys equal or greater incremental value. If, for example, you were told that in the near future you'd be spending 60% of your income on health care but that as a result you'd enjoy, say, a 30% chance of living to the age of 250, perhaps you'd judge that 60% a small price to pay.
This, it seems to me, is what the debate on health care spending really needs to be about. Certainly we should work on ways to eliminate overutilization. But the real question isn't what absolute amount of money is too much to spend on health care. The real question is what are we getting for the money we spend and is it worth what we have to give up?
People alarmed by the notion that as health care costs increase policymakers may decide to ration health care don't realize that we're already rationing at least some of it. It just doesn't appear as if we are because we're rationing it on a first-come-first-serve basis---leaving it at least partially up to chance rather than to policy, which we're uncomfortable defining and enforcing. Thus we don't realize the reason our 90 year-old father in Illinois can't have the liver he needs is because a 14 year-old girl in Alaska got in line first (or maybe our father was in line first and gets it while the 14 year-old girl doesn't). Given that most of us remain uncomfortable with the notion of rationing health care based on criteria like age or utility to society, as technological innovation continues to drive up health care spending, we very well may at some point have to make critical judgments about which medical innovations are worth our entire society sacrificing access to other goods and services (unless we're so foolish as to repeat the critical mistake of believing we can keep borrowing money forever without ever having to pay it back).
So what value are we getting? It varies. The risk of dying from a heart attack has declined by 66% since 1950 as a result of technological innovation. Because cardiovascular disease ranks as the number one cause of death in the U.S. this would seem to rank high on the scale of value as it benefits a huge proportion of the population in an important way. As a result of advances in pharmacology, we can now treat depression, anxiety, and even psychosis far better than anyone could have imagined even as recently as the mid-1980's (when Prozac was first released). Clearly, then, some increases in health care costs have yielded enormous value we wouldn't want to give up.
But how do we decide whether we're getting good value from new innovations? Scientific studies must prove the innovation (whether a new test or treatment) actually provides clinically significant benefit (Aricept is a good example of a drug that works but doesn't provide great clinical benefit---demented patients score higher on tests of cognitive ability while on it but probably aren't significantly more functional or significantly better able to remember their children compared to when they're not). But comparative effectiveness studies are extremely costly, take a long time to complete, and can never be perfectly applied to every individual patient, all of which means some health care provider always has to apply good medical judgment to every patient problem.
Who's best positioned to judge the value to society of the benefit of an innovation---that is, to decide if an innovation's benefit justifies its cost? I would argue the group that ultimately pays for it: the American public. How the public's views could be reconciled and then effectively communicated to policy makers efficiently enough to affect actual policy, however, lies far beyond the scope of this post (and perhaps anyone's imagination).
THE PROBLEM OF ACCESS
A significant proportion of the population is uninsured or underinsured, limiting or eliminating their access to health care. As a result, this group finds the path of least (and cheapest) resistance---emergency rooms---which has significantly impaired the ability of our nation's ER physicians to actually render timely emergency care. In addition, surveys suggest a looming primary care physician shortage relative to the demand for their services. In my view, this imbalance between supply and demand explains most of the poor customer service patients face in our system every day: long wait times for doctors' appointments, long wait times in doctors' offices once their appointment day arrives, then short times spent with doctors inside exam rooms, followed by difficulty reaching their doctors in between office visits, and finally delays in getting test results. This imbalance would likely only partially be alleviated by less health care overutilization by patients.
GUIDELINES FOR SOLUTIONS
As Freaknomics authors Steven Levitt and Stephen Dubner state, "If morality represents how people would like the world to work, then economics represents how it actually does work." Capitalism is based on the principle of enlightened self-interest, a system that creates incentives to yield behavior that benefits both suppliers and consumers and thus society as a whole. But when incentives get out of whack, people begin to behave in ways that continue to benefit them often at the expense of others or even at their own expense down the road. Whatever changes we make to our health care system (and there's always more than one way to skin a cat), we must be sure to align incentives so that the behavior that results in each part of the system contributes to its sustainability rather than its ruin.
Here then is a summary of what I consider the best recommendations I've come across to address the problems I've outlined above:
1. Change the way insurance companies think about doing business. Insurance companies have the same goal as all other businesses: maximize profits. And if a health insurance company is publicly traded and in your 401k portfolio, you want them to maximize profits, too. Unfortunately, the best way for them to do this is to deny their services to the very customers who pay for them. It's harder for them to spread risk (the function of any insurance company) relative to say, a car insurance company, because far more people make health insurance claims than car insurance claims. It would seem, therefore, from a consumer perspective, the private health insurance model is fundamentally flawed. We need to create a disincentive for health insurance companies to deny claims (or, conversely, an extra incentive for them to pay them). Allowing and encouraging aross-state insurance competition would at least partially engage free market forces to drive down insurance premiums as well as open up new markets to local insurance companies, benefiting both insurance consumers and providers. With their customers now armed with the all-important power to go elsewhere, health insurance companies might come to view the quality with which they actually provide service to their customers (ie, the paying out of claims) as a way to retain and grow their business. For this to work, monopolies or near-monopolies must be disbanded or at the very least discouraged. Even if it does work, however, government will probably still have to tighten regulation of the health insurance industry to ensure some of the heinous abuses that are going on now stop (for example, insurance companies shouldn't be allowed to stratify consumers into sub-groups based on age and increase premiums based on an older group's higher average risk of illness because healthy older consumers then end up being penalized for their age rather than their behaviors). Karl Denninger suggests some intriguing ideas in a post on his blog about requiring insurance companies to offer identical rates to businesses and individuals as well as creating a mandatory "open enrollment" period in which participants could only opt in or out of a plan on a yearly basis. This would prevent individuals from only buying insurance when they got sick, eliminating the adverse selection problem that's driven insurance companies to deny payment for pre-existing conditions. I would add that, however reimbursement rates to health care providers are determined in the future (again, an entire post unto itself), all health insurance plans, whether private or public, must reimburse health care providers by an equal percentage to eliminate the existence of "good" and "bad" insurance that's currently responsible for motivating hospitals and doctors to limit or even deny service to the poor and which may be responsible for the same thing occurring to the elderly in the future (Medicare reimburses only slightly better than Medicaid). Finally, regarding the idea of a "public option" insurance plan open to all, I worry that if it's significantly cheaper than private options while providing near-equal benefits the entire country will rush to it en masse, driving private insurance companies out of business and forcing us all to subsidize one another's health care with higher taxes and fewer choices; yet at the same time if the cost to the consumer of a "public option" remains comparable to private options, the very people it's meant to help won't be able to afford it.
2. Motivate the population to engage in healthier lifestyles that have been proven to prevent disease. Prevention of disease probably saves money, though some have argued that living longer increases the likelihood of developing diseases that wouldn't have otherwise occurred, leading to the overall consumption of more health care dollars (though even if that's true, those extra years of life would be judged by most valuable enough to justify the extra cost. After all, the whole purpose of health care is to improve the quality and quantity of life, not save society money. Let's not put the cart before the horse). However, the idea of preventing a potentially bad outcome sometime in the future is only weakly motivating psychologically, explaining why so many people have so much trouble getting themselves to exercise, eat right, lose weight, stop smoking, etc. The idea of financially rewarding desirable behavior and/or financially punishing undesirable behavior is highly controversial. Though I worry this kind of strategy risks the enacting of policies that may impinge on basic freedoms if taken too far, I'm not against thinking creatively about how we could leverage stronger motivational forces to help people achieve health goals they themselves want to achieve. After all, most obese people want to lose weight. Most smokers want to quit. They might be more successful if they could find more powerful motivation.
3. Decrease overutilization of health care resources by doctors. I'm in agreement with Gawande that finding ways to get doctors to stop overutilizing health care resources is a worthy goal that will significantly rein in costs, that it will require a willingness to experiment, and that it will take time. Further, I agree that focusing only on who pays for our health care (whether the public or private sectors) will fail to address the issue adequately. But how exactly can we motivate doctors, whose pens are responsible for most of the money spent on health care in this country, to focus on what's truly best for their patients? The idea that external bodies---whether insurance companies or government panels---could be used to set standards of care doctors must follow in order to control costs strikes me as ludicrous. Such bodies have neither the training nor overriding concern for patients' welfare to be trusted to make those judgments. Why else do we have doctors if not to employ their expertise to apply nuanced approaches to complex situations? As long as they work in a system free of incentives that compete with their duty to their patients, they remain in the best position to make decisions about what tests and treatments are worth a given patient's consideration, as long as they're careful to avoid overconfident paternalism (refusing to obtain a head CT for a headache might be overconfidently paternalistic; refusing to offer chemotherapy for a cold isn't). So perhaps we should eliminate any financial incentive doctors have to care about anything but their patients' welfare, meaning doctors' salaries should be disconnected from the number of surgeries they perform and the number of tests they order, and should instead be set by market forces. This model already exists in academic health care centers and hasn't seemed to promote shoddy care when doctors feel they're being paid fairly. Doctors need to earn a good living to compensate for the years of training and massive amounts of debt they amass, but no financial incentive for practicing more medicine should be allowed to attach itself to that good living.
4. Decrease overutilization of health care resources by patients. This, it seems to me, requires at least three interventions:
* Making available the right resources for the right problems (so that patients aren't going to the ER for colds, for example, but rather to their primary care physicians). This would require hitting the "sweet spot" with respect to the number of primary care physicians, best at front-line gatekeeping, not of health care spending as in the old HMO model, but of triage and treatment. It would also require a recalculating of reimbursement levels for primary care services relative to specialty services to encourage more medical students to go into primary care (the reverse of the alarming trend we've been seeing for the last decade).
* A massive effort to increase the health literacy of the general public to improve its ability to triage its own complaints (so patients don't actually go anywhere for colds or demand MRIs of their backs when their trusted physicians tells them it's just a strain). This might be best accomplished through a series of educational programs (though given that no one in the private sector has an incentive to fund such programs, it might actually be one of the few things the government should---we'd just need to study and compare different educational programs and methods to see which, if any, reduce unnecessary patient utilization without worsening outcomes and result in more health care savings than they cost).
* Redesigning insurance plans to make patients in some way more financially liable for their health care choices. We can't have people going bankrupt due to illness, nor do we want people to underutilize health care resources (avoiding the ER when they have chest pain, for example), but neither can we continue to support a system in which patients are actually motivated to overutilize resources, as the current "pre-pay for everything" model does.
CONCLUSION
Given the enormous complexity of the health care system, no single post could possibly address every problem that needs to be fixed. Significant issues not raised in this article include the challenges associated with rising drug costs, direct-to-consumer marketing of drugs, end-of-life care, sky-rocketing malpractice insurance costs, the lack of cost transparency that enables hospitals to paradoxically charge the uninsured more than the insured for the same care, extending health care insurance coverage to those who still don't have it, improving administrative efficiency to reduce costs, the implementation of electronic medical records to reduce medical error, the financial burden of businesses being required to provide their employees with health insurance, and tort reform. All are profoundly interdependent, standing together like the proverbial house of cards. To attend to any one is to affect them all, which is why rushing through health care reform without careful contemplation risks unintended and potentially devastating consequences. Change does need to come, but if we don't allow ourselves time to think through the problems clearly and cleverly and to implement solutions in a measured fashion, we risk bringing down that house of cards rather than cementing it.

Please visit Dr. Lickerman's blog at http://happinessinthisworld.com to read other articles about achieving health and happiness. He can be reached at alickerman@gmail.com.

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Health - Your Most Valuable Asset

By John Mac

Your health is undoubtedly your most valuable asset. So with that in mind how do you protect your health?
Yes you probably have health insurance to look after your health if you become ill and car insurance to take car of you should your health suffer as a result of a car accident. But isn't that paying someone else to look after your health after things go wrong? A bit like closing the stable door after the horse has bolted? What are you doing, or, what should you be doing to look after your health right now?
Do you get regular health check ups? Do you exercise & eat all the right foods that are beneficial to your health? Do you use health care products such as health supplements? Do you smoke, drink or take drugs? Are you aware of how these habits affect your health?
I'm willing to bet that you make darn sure you look after your children's health, making sure that they are not doing anything that is going to cause long term damage to their health? But who is watching your health? Who's making sure you are not doing anything to damage your health?
Health is probably something we all take for granted & only realise how important our health is when we are ill or someone close to us is suffering from ill health. However if we all do nothing in regard to our health now, waiting until we begin to suffer from ill health & then trying to do something about it may be too late as we may have already done irreparable damage to our health. If you could do something now to prevent one of your assets diminishing, such as your bank balance, your home or your car would you? Yes of course you would, so what about your most valuable asset, your health?
Well it's about time that someone took control of your health, and that someone is you! Take control of your health now and make sure that valuable asset, your health, is well and truly looked after. Here are some suggestions that might help you to look after your health:
Get regular health check ups. If you have a good health insurance these are probably insisted upon. After all we all give our cars regular "health" checks, isn't our health more important than the health of our vehicles?
Make sure you eat a healthy diet. Even if you don't need to loose weight the right diet can help to improve your health.
Take regular exercise. 30 minutes a day at least 5 days a week, even if it's just a couple of 15 minute strolls, that's not to great a chore to protect a valuable asset - your health.
If you smoke, stop now! This is probably the best thing you can and ever will do for the sake of your health.
Cut down on your alcohol intake. Stick to the recommended guidelines for sensible drinking - for your health's sake.

John Mac is author & owner of http://www.fitnessdiethealth.com a website aimed at providing help & information for people looking to improve their health

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