Is It Time For A Change? – The State of Healthcare Benefits in the USA

July 31, 2020

It’s a complex time and subject, but when deliberating a more equitable and just society for all, affordable health benefits must be considered. The struggles are immense for many. The pandemic makes this situation even more paramount. Consider that,

Millions of Americans have lost their jobs and therefore their healthcare benefits
An additional 27+ million USA citizens lack health insurance coverage
The cost of healthcare benefits is predicted to significantly increase for employers and individual coverage
Adequate health insurance coverage is unaffordable for individual plan options
Many in America face crushing medical debt which for many leads to bankruptcy. It is estimated that 66.5% of all bankruptcies in the USA are tied to medical debt. And many of these bankruptcies are Americans who have health insurance.

So, is it time for a change? Is there a win-win option to provide healthcare for all?

Listening to friends from other countries discuss COVID-19 has been quite a different experience than listening to individuals in the USA. Concerns discussed by those in the USA include healthcare costs since millions have lost their employer-based health insurance coverage. Friends in other industrialized countries can’t even comprehend such concerns. They worry about staying safe and well, but not how they would pay for care – or debate if it is worth seeking care as many in the USA do, often waiting until symptoms are more severe or sadly waiting until it is too late for treatment to be effective.

Other discussions in the USA center around when someone will be eligible for Medicare since it’s either better healthcare coverage than they currently have or it’s much more affordable. Either way, since when do individuals, except for teenagers, wish they were older?

A recent quote from an article by the Chair of the Education Committee of Healthcare Justice NC, noted that, “… millions of laid oﬀ workers and their families desperately need insurance, for both Covid-19 related illness and all other health issues. Hospitals and physicians cannot care for them for free. For several reasons, Medicaid cannot handle this new burden. Federal relief is required.” The author suggests a public option be added to Medicare for these individuals and their families. Such an option has been discussed for decades, including having a public option when the Affordable Care Act (ACA), AKA Obamacare, was planned.

Right now, employer-based programs pay approximately 50% of healthcare insurance with government programs (Medicare and Medicaid) accounting for 35% of coverage. The remaining 15% are uninsured or self-insured. However, healthcare insurance is unaffordable for most individuals as well as for employers. Many employees struggle with the financial responsibility for an increasing percentage of the monthly premiums and co-pays. The fear is that more may lose employer benefits and bear the burden of the entire premium cost without receiving an increase in pay to compensate the difference.

Who can afford this? For example, depending on age, a self-insured policy is quite costly, $670+/month for the lowest cost insurance plan available, a healthcare savings account with an $8,100 deductible. That’s $8,052 a year in premiums plus the cost of prescriptions, doctor visits, etc., until meeting an $8,100 deductible. What average working citizen can afford such an astronomical expense? An ACA subsidy helps but only if an individual meets the criteria.

There are also many cases of individuals racking up unimaginable medical debt. For example, according to the Kaiser Family Foundation, the average costs for cancer patients is $150,000. The American Cancer Society noted cancer patients would likely face treatment costs totaling tens and possibly hundreds of thousands of dollars.

In addition, depending on the insurance plan, many others decide to ration needed prescription medications not covered by insurance, and others make decisions regarding whether to fill prescriptions or feed their families.

What makes this situation more dire is that many more employees are potentially at risk of losing their coverage or paying more for less coverage. More employers are cost shifting premium amounts to employees and that is likely to increase in 2021, especially since individual and employer-based insurance coverage is predicted to increase by up to 40% (although some say the increase will never reach that high, with a range of 8% – 38% depending on the type of insurance).

Many are looking for better options. In addition to the movement for Medicare for all, several large corporations are disrupting the system by removing insurance companies from the process and contracting directly with leading health systems. But this still leaves out the unemployed and under-employed.

And none of this touch on the lack of accessible healthcare nor the health and healthcare disparities in the USA. Both are quite shocking and alarming.

How did we get to this point? The brief history is that the first U.S. insurance firm was founded in 1850, offering insurance against injuries received during an accident. Insurance for hospital and medical expenses was introduced in the 1920s. These were affordable prepaid plans offered by individual hospitals and then by employers. The plans were offered for humanitarian reasons but also to ensure a revenue stream for hospitals and doctors. The price was inexpensive and benefitted the non-profit agencies as well as individuals. Today much has changed related to both the business model and the escalating costs. Hospitals are closing and doctors are leaving the profession.

Other industrialized nations ensure access to healthcare for all citizens. Some countries provide a plan similar to our Medicare system, while others provide a government plan similar to our veterans’ plan. Many claim that our healthcare system is better and more affordable than that of any other country; however, research repeatedly proves both to be false. When the USA is compared to other industrialized nations, most providing universal healthcare coverage, the USA spends more than double on healthcare with worse health outcomes.

Many argue against Medicare for all, and yes, it’s complex; however, a solution is needed for the under-insured and the millions without insurance coverage. Currently Medicare in the USA is not considered socialized medicine and maintains a choice of private doctors and hospitals. This plan has been successfully operating for 40 years now with an unheard-of overhead of 2%. There are no wait lists and no rationing of care. By all accounts the program works.

It seems the time is right for change. Accessible healthcare and affordable health benefits must be addressed to destroy inequities over the type of care available and healthcare decisions made based on accessibility and affordability.

An editorial by N Goldberg in the LA Times implored us to consider injustices and inequality. Whether a supporter of Bernie Sanders’ views or not, a few truthful, and haunting quotes noted in the editorial were:

“Not only is it a moral outrage, but it is an … unsustainable situation when three people in America own more wealth than the bottom half of American society.”

“Health care in America should be a right, not a privilege.”

“If you work 40 hours a week, you should not be living in poverty.”

“Our message to the fossil fuel industry, in this country and around the world, is that their short-term proﬁts are not more important than the future of this planet.”

“People in America should not go bankrupt because they have cancer or heart disease. That is a moral outrage.”

So why not insurance coverage – Medicare – for all USA citizens? The struggles are real and appalling. As society and corporations consider a more just and equitable society for all, healthcare for all must be a key component. Many exclaim that our healthcare system is broken. Perhaps it’s only a system ready to evolve to a more just and equitable one. It’s time for serious deliberation to remove barriers and injustices as well as the financial burden and worry.

References:

https://www.amjmed.com/article/S0002-9343(09)00525-7/fulltext

https://www.fightcancer.org/sites/default/files/Costs%20of%20Cancer%20-%20Final%20Web.pdf