Health Insurance in the United States is a term that is used in describing all programs which have been put in place by the government or other agencies to help the people of the United States in paying for their medical bills. Health insurance in the country can be obtained through private means, through social insurance programs or through a non-insurance welfare programs. The government is responsible for catering for the non-insurance welfare programs through funding the programs. It is used in the country to protect the citizens from illnesses or injuries and it is synonymous with such terms as health benefits, health care coverage and health coverage. Where the term is defined to means any insurance that protects against injury or illnesses, then it only applies to social insurance program and private insurance. Medicare is one of the social insurance programs in the country. Medicaid is one of the social welfare insurance programs. Health insurance also covers such issues as long term nursing, disability and custodial care (Hadley, 2002).
Public health accounts for the largest part of the spending of the government in health in the United States. Public health consists of sixty percent of the entire spending in the health sector. United States is the leading country in terms of health expenditure as a proportion of the gross domestic product of the country. The health system in the United States apart from depending on the government also depends heavily on the not-for-profit insurance and private insurance (Himmelstein, 2005).
Basic Framework of the Health Insurance
Health insurance in the United States is provided through the interactions of various parties which include the government, medical industry and providers, insurers, firms and households. These parties have different motivations and interactions between each other are very important in portraying the fundamental equilibrium which dictates the status of the health insurance in the country. One of the important players in these issues is the government that is involved. The government can be classified as the federal, state and local governments and the government plays a very important in the influencing of the population to attain an insurance status. This is because the government plays a major role in the insurance sector. One of the reasons it plays a major role in the insurance is that it is one of the chief insurer and also acts as a subsidizer the insurance which is acquired privately. It is also responsible for regulating insurance firms and other insurers. The government role in the health insurance status of the country is very vital because it is in contact with all the other parties that are involved in the health insurance status of the country (Davis, 2005).
The government is also one of the direct health insurance providers through several of its programs which include CHAMPUS, Medicaid and Medicare. It is also one of the subsidizer providers through charity and this include many of the public clinics and hospitals found in the country among other programs like Medicaid DSH Payments. With this, the government is capable of crowding out the private insurance and affording other better alternatives to both the households and firms (Hadley, 2008).
The other party that is concerned with the insurance health is the providers of health care and other medical related things like pharmaceutical and health devices. These entities face incentives that affect the patients’ insurance status because the health care providers determine the cost of medical services, other financial incentives and also non-financial incentives. Insurance status of the people will affect the way the people utilize medical care and this will also lead to the effects to the health status of the people. This is a very important factor to look at in relation to the medical providers. It is also important to note that insurance status of the people in the United States will affect many policies which will also affect the medical care providers and other people who provide products and services in the medical field. This means that the insurance status of the people will directly affect the way the medical care is provided in the country. This can be seen in such cases where when many people do not have access to health insurance, then many cannot afford their services and this means that many people will rely on going to the emergency rooms where their bills can be taken care of by the government (Doty, 2005).
Another important party in relation to health insurance is the insurers themselves. There are some health insurances who have taken the outlook of non-profit organizations, yet many of the insurers are in the business to make a profit. The competition in the market that is evidenced within and in between various types of insurers, affects the prices of the insurance and ultimately the people who acquire the health insurance status. There is need to have high competition so that the prices of the health insurance can be accessible to many people within the country. They also need to come up with policies which will ensure that the health insurance is affordable to many people so as to alleviate the rising number of people who cannot access health insurance. These policies should be aimed at ensuring that there are many packages of insurance that people of different economic abilities can choose but the basic and fundamental health insurance should be made available to all citizens (Hadley, 2002).
The insurance firms are also a very important factor in the health insurance issues in the United States. Most of the firms seek to maximize their profits and focusing on this the firms affects the health insurance status of the country because it has to come up with policies and incentives to create new opportunities for making more profits. These when viewed in a macroeconomic perspective affects the status of the health insurance in the country. This is because the firms will come up with a competitive market which will eventually affect the number of people who can access health insurance. Failure to this, the market will be such that the majority of the people will not be able to access health insurance. There are many factors that inhibit the firms to achieve a competitive market and this has brought about the current state of affairs where many people cannot access the health insurance services (Himmelstein, 2005).
The last party to the issues of health insurance are the household themselves. The households’ main objective is to maximize the utility they get from health insurance, non-health consumption and health care. Many of the households are made up of more than one individual and they have to come to an agreement on how to best maximize their utilities in terms of health insurance, non-health consumption and health care. There are preferences and also the economic abilities that are involved in making these decisions. These have raised the number of people who are insured because many households cannot afford the health insurance and yet take care of other non-health consumptions. This can be brought about by many issues but the major one is that there are economical problems or the health insurance premiums are too expensive for them. This has led to the situation where many people cannot afford health insurance and this jeopardizes their health status. Many people who cannot afford health insurance are the most common people who visit emergency rooms (Hadley, 2008).
Many of the people who do not have health insurance and they are employed is because their employers do not offer the benefit of health insurance. Many people who do not have well paying jobs do not have access to health insurance and this has been the case for many people. In this times of financial instability around the globe, many people cannot get well paying jobs and this have brought about the situation in which many people are not insured. This is because they cannot afford health insurance and hence they would rather spend the money on some other stressing things like getting the daily bread, paying rent and affording education for their children. This have brought the rising cases of the people who are visiting emergency rooms because they will have to wait until their health are at dire risks so that they can access medical services. The situation worsens when the employer cannot afford to pay health insurance for them. Many people in the United States rely on their employers to get health insurance and this is sometimes extended to their spouses’ employers. However, many people have lost their well paying jobs and can only be lucky enough to get lesser paying jobs and hence they cannot afford to pay health insurance (Himmelstein, 2005).
There is also a notable decline in the number or employers who can afford to pay health insurance for their employees. This has contributed significantly to the number of people who do not have health insurance in the country. Since time immemorial many working Americans have relied chiefly on their employers to facilitate them with health insurance plans. However, the trend is now diminishing with many employers no able to pay for the health insurance of their employees. Many companies with less than three hundred employees do not pay for the health insurance of their employees.
These companies constitute of a very significant number of the United States work force and this have seen to it that many employees in the United States either have to cater for themselves in terms of health insurance or they will have to do without health insurance. The fact that there is a financial crisis which is acutely affecting the country ensures that many small companies cannot pay their employees handsomely and this have brought about the fact that many of the employees do not have health insurance. This is because many people cannot afford the health insurance when they do not have enough money to cater for other things which are equally more important to them as health insurance. The percentage of the employers who are offering health insurance is diminishing over the time and this have left the country in a situation where many people who are employed can not get health insurance (Davis, 2005).
The current financial crisis have also brought contributed significantly to the rising number of people who do not have health insurance. This is because jobs are very scarce and on the contrary many people are loosing jobs as the major companies and corporations are collapsing. There have been a rising number of companies that are also laying-off some of their employees. Unemployment is one of the major causes of many people not accessing health insurance and hence with the current situation in the financial field, many people cannot afford to pay for health insurance. Statistics shows that the unemployment rates in the currents have hit a high of thirty four years and yet the situation does not seem likely to improve anytime soon. This means that the country is also going to have a high number of people who cannot afford to pay for their insurance (Hadley, 2004).
The insurers and insurance firms are also contributing to this scenario because they have hiked the prices of health insurance. This means that many people cannot afford due to other financial obligations that they have to meet. The insurance firms are hiking this at the wrong time because many people cannot afford other basic things as it is now due to the financial troubles that many people are facing. These have brought about the complication that many people will need to have increased their income base so that they can afford to have health insurance. However, this is a very tricky part because there are no opportunities that exist and no opportunities that can be foreseen in the near future. This means that the companies will need to improve on their premiums so that many people can access the health insurance that is very fundamental in their lives. This can be rooted to the fact that the market is facing lax competition in this field and at the same time the firms are keen on maximizing their profits (Himmelstein, 2005).
The government is also to blame because many people who do not have the basic knowledge as to how to apply and enroll for health insurance. A significant percentage of the people who do not have health insurance claim that they do not know how to access the service. The government is at task here because it needs to come up with effective programs under which the citizens can rely on when seeking information about health insurance. The government also needs to implement policies which will ease the access to information about health insurance in the country. The government also needs to encourage people to seek health insurance and this will only be achieved by the government being able to convince the firms to lower their rates. This will be done by the government coming with new policies which relate to health insurance (Doty, 2005).
There is also an attitude by many people who do not have health insurance that is very negative and that limits the number of people who have health insurance. This attitude is the attitude that they would rather wait and see rather than pay health insurance. This means that the people gambles with their health as well as the health of the people who depend on them so as to save the money that would have otherwise been used in paying for the health insurance. This means that this people tend to visit the emergency rooms more often than other people because sometimes they cannot access the health services when they are needed most. These kinds of people consist of a significant number of the people who do not have health insurance (Hadley, 2002).
Poverty has also been cited as one of the leading cause of the current state of affairs where increasing number of people cannot access health insurance. This is because many people have found paying for the health insurance a heavy burden bestowed upon them by the system. These people are mainly the unemployed or the low wages employees. This group also consists of the non-whites races like Blacks, Latinos and Native Americans. The situation has also been made worse by the fact that the world is facing a financial crisis and this has acutely affected the United States. Many people who cannot access health insurance claim that the reason for this is that they cannot be able to pay for the health insurance. This has led to a point in which many people are relying on government health programs and visiting the emergency rooms often (Davis, 2005).
Many people who cannot afford health insurance qualify for public programs which many people shy away from. There are various reasons why people don’t enroll in the public programs but one of the leading reasons is that many people do not have the information on how to enroll and how to access these programs. This is up to the government to come up with policies and programs which will see to it that everybody gets knowledge of public programs which cater for the health insurance of the people who cannot access private health insurance. Other people shy away because there is a stigma that is associated with people who enroll in the public programs. At this time and age it is very important for the people to know that health is a very delicate issue and simple things like stigma and social status should not prevent one from pursuing a healthy life (Himmelstein, 2005).
The effects of lack of health insurance can be looked at into two aspects. One of the aspects is the health consequences and the other is the financial consequences. In terms of health consequences, various researches conducted throughout the country indicate that lack of health insurance affects the utilization of medical services negatively. People who do not have health insurance are often associated with poor health of varying degrees in terms of acute, preventive and chronic medical services. One of the reasons for this is that the uninsured people do not have access to preventive health services. This means the people who do not have health insurance only go the health facilities when they have a disease and not to prevent it. This is very risky because preventing a disease is always better than treating a disease. Many of the diseases that have claimed a lot of lives would have not have reached to that statistics if they had been prevented. These people also tend to be diagnosed when the diseases are at a very advanced stage and may complicate the healing of the ailment. This means that the uninsured people face a lot of problems when they seek health services and their diseases are at advanced stages. Sometimes, the stages at which the uninsured people seek for medication, their diseases cannot be well taken care of and hence many people end up living with complications or die (Hadley, 2008).
There is also the association of higher mortality deaths of the uninsured than the insured. This is because the uninsured cannot access medical services when they are need most and sometimes depend on the emergency rooms. This means that they depend on the government to pay for their medical bills and this has led to the situation that many people who do not have health insurance die at the emergency rooms of the hospitals. This is because once the uninsured need medical attention and it does not qualify to be taken care of by the emergency services of the country, and then the insured will have to wait until the condition can be taken care of by the emergency rooms of the medical facilities. However, many of the times this comes too late and the patients die on their way to the hospitals or on their arrival at the emergency rooms. This has played a major in role in contributing to the high mortality rate of the uninsured (Doty, 2005).
In the same respect, uninsured patients cannot also access specialized treatment and medical care for complicated cases like cancer and leukemia. This is because they do not have health insurance to cover for such things. This means that many patients live with chronic pain and in many cases die of these fatal diseases. The patients who have such diseases as leukemia, various cancers and diabetes need specialized medical care and attention. However, many of the people who are uninsured and have no money to pay for the services of medical care cannot access this specialized care. This means that the people do without such things as therapeutic care, chemotherapy and other specialized care that they need to survive and alleviate the pain that they may be experiencing. This means that many people who are insured and suffer from these diseases live a very painful life and also die at undue time because they cannot access the necessary treatment and medical care (Davis, 2005).
The consequences are also extended to infants and children who are not insured. They have a higher infant mortality rates than those who have health insurance. Many of the children and infants die because they cannot access such services that are necessary for the well being of the children and the infants. Statistics show that the uninsured babies have lower rates of survival than the insured babies. The same case applies to children (Himmelstein, 2005).
The uninsured people also faced difficulties in getting admissions in hospitals after their visits to the emergency rooms. This is because the medical facilities cannot take care of all the medical bills that will be used on all the uninsured people. In this respect, the people who do not have health insurance are left to cater for themselves and this has led to the problems that after leaving the emergency rooms, they are left on their own and have to go home. This means that many of the uninsured do not have follow up medication and this can result in other complications which can claim the peoples lives (Hadley, 2004).
Poor health resulting from lack of health insurance also results in the fact that these people cannot earn their living. This means that the lack of health insurance is contributing largely to the economical constrains that many people in the United States are facing. This is because when one is not feeling well and at the same time cannot access medication, and then one is not able to work to earn a living. This case is worsened by the fact that many people who are facing terminal illnesses like cancer and diabetes are overly dependent on their families and friends and this only worsens the situation emotionally. It also affects other occupations as well and many of the uninsured people suffer from not performing in their occupations. This can be evidenced by the workers and students who do not perform or beat the deadlines in their various tasks. This can be rooted to the fact that they do not have enough strength because of their health problems (Doty, 2005).
The effects are also related to financial implications. This is because people who do not have health insurance cannot have the opportunity to attain the status of a financial secure person. Researches conducted throughout the country showed that about fifty percent of the families that filled for bankruptcy claimed that medical complications had played the largest part in their becoming bankrupt. Lack of health insurance also contributes largely too many people accumulating a lot of debts related to health services as well as other debts which accumulate because the individuals had first taken care of the health bills (Himmelstein, 2005).
Apart from the effects being on financial and health consequences, there are other effects which are rooted to the social setting of the country. This is because the society will have to take care of the medical expenses of the people who do not have health insurance. This means that the government takes care of the medical bills but in the same respect expects to be helped by the citizens. This is mainly done through taxation and other means of the government getting revenue from the citizens. This put an extra burden to the people and this has the implication that many of the people who cannot afford health insurance depend on the society to cater for their medical bills (Hadley, 2002).
The issue of health insurance is continuing to worry a lot of people in the United States and the policy makers are not left out. This is because more than fifteen percent of the population does not have health insurance and this have brought about a complication in the medical field in the country. This is because apart from endangering the uninsured lives, it is also putting a constraint to the people, the government and other agencies which offer health insurance to the people who cannot afford their own health insurance. The situation is being made worse by the fact that the country is being affected by the financial crisis that has is being experienced globally and this does not help the situation. This means that the policy makers will have to come up with various strategies to rectify this problem which is threatening the health security of the country.
Davis, K. et al. “Health and Productivity Among U.S. Workers,” The Commonwealth Fund, August 2005.
Doty, M. et al. “Seeing Red: Americans Driven Into Debt by Medical Bills,” The Commonwealth Fund, August 2005.
Hadley, J. “Sicker and Poorer: The Consequences of Being Uninsured,” Kaiser Commission on Medicaid and the Uninsured, May 2002
Hadley, J. and J. Holahan. “The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending?” Kaiser Commission on Medicaid and the Uninsured May 2004.
Hadley, J. et al. Covering The Uninsured In 2008: Current Costs, Sources Of Payment, And Incremental Costs. Health Affairs, 27, no. 5 (2008): w399-w415.
Himmelstein, D. et al. “Illness and Injury as Contributors to Bankruptcy,” Health Affairs Web Exclusive, February 2005.