Odds Are Against Major Healthcare Coverage Overhaul

Discussion
Oct 08, 2007

By GMDC

It isn’t streamlined, it isn’t logical, but America’s cobbled-together system of paying for medical care does cover 85 percent of the population.

And despite the chorus of pleas for a sweeping redesign of America’s medical insurance system as the 2008 presidential race heats up, a top-to-bottom makeover seems less likely than a series of reforms that aims to fill in gaps in coverage

The calls for a far-reaching redesign of the health care system are as loud as they were in 1993, when a newly elected Bill Clinton tried to persuade Congress to enact a form of national insurance – the last time a president took on the issue.

Whether the new president is a Republican or a Democrat, a redesign will be difficult to pull off. Insurance companies, pharmaceutical firms and medical device makers, all of whom have a vested interest in averting radical change, are big campaign contributors and are strongly represented by lobbyists in Washington. That helps explain Congress’ reluctance to do more than tinker with a system that left an estimated 44 million Americans without health insurance last year.

Many of them did not require medical care, but a survey by the National Center for Health Statistics found that six percent of the population, or about 18 million people, reported that they were unable to get needed care due to cost at some time during the previous year.

The current patchwork system of paying for medical care results in disparities, with some low-income people going uncovered and affluent retirees having more coverage than they need. Most of these individuals turn to over-the-counter (OTC) treatments for treatment. For individuals with access to flexible savings accounts or health spending accounts, many of the OTC health expenses can also be reimbursed.

Most at risk are those who don’t have adequate medical insurance because they are not poor enough to be eligible for the “safety net” Medicaid program and yet can’t afford to pay insurance premiums. Often the only jobs they can get are ones with scanty or no health insurance benefits.


Discussion Questions: Does the impact of insured/non-insured consumers affect the sales of typical self-care categories such as OTC health care products, durable medical products, diabetes products, etc.? How has the impact of Flexible Spending Accounts and Health Spending Accounts affected these product categories? Do you see further government support and reimbursement for these product categories?

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5 Comments on "Odds Are Against Major Healthcare Coverage Overhaul"


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Mark Lilien
Guest
14 years 7 months ago

When a prescription drug is approved for over-the-counter sales, such as Prilosec and Plan B, volume soars. The increase comes from people who have no health insurance or drug plan AND from people who are well covered, but don’t want the delay, extra cost, and inconvenience of getting prescriptions. A huge proportion of prescriptions are written at the specific demand of the patients who already know what works for them as well as the right dosage. The extra cycle time and expense to get a prescription, particularly renewal prescriptions, is often just more overhead waste in the health care system.

Richard Housman
Guest
Richard Housman
14 years 7 months ago

There are two separate and distinct issues. One is coverage for the 15% of the people you mention that have no insurance coverage. The second is the out of control costs of the existing patchwork of systems that in time will force that 15% number higher as employers cut back even further. Bring control to the second issue and I think funding of the first will be easier.

Jane Sarasohn-Kahn
Guest
14 years 7 months ago

There is momentum among Americans, shown in the latest WSJ/Harris poll on health reform, to ensure that government provides access to some basic benefit plan for those “uncovered.” See my blog from yesterday at http://www.healthpopuli.com. As we muddle through our fragmented health ‘system,’ we Americans project-manage our health through cobbling together individual approaches through a variety of products and services–some that fall under the strict definition of medicine and health care, and others that blur into health-enhancement. The latter can include food, exercise, tourism (medical and otherwise) and other categories that aren’t included in the 16% of our GDP allocated to health care. While those without health insurance coverage do spend more on OTC, we’re all spending more on lots of product categories that aren’t, per se, “health care,” but positively impact our health. Traditional health stakeholders–hospitals, physicians, and insurance companies–are starting to understand this, but they’ve still a long way to go to get more consumer-centric.

Ed Dennis
Guest
Ed Dennis
14 years 7 months ago
Truly a sad state of affairs. The American Consumer is being damaged by a system that discourages risk reduction and and is becoming more rigid, instead of becoming more flexible. Why would our health insurance system prevent me from buying insurance anywhere I wanted? It’s because each state has the ability to license insurance companies and uses this “power” to limit consumer choice. While states regulate who practices, they do little to regulate the practices of the insurers. They do not require insurers to reimburse doctors and hospitals for services in a reasonable amount of time. I know of one physician who is regularly approached by a major insurance company and advised that they will cut him a check today if he will settle for $60,000 of the $100,000 they owe him. If he doesn’t settle, they withhold payment for months (to teach him a lesson). Insurance companies force up the cost of medical care by increasing overhead of the care providers. But insurance companies have lobbyist and your congressmen and senators are in love… Read more »
James Tenser
Guest
14 years 7 months ago
Clearly the U.S. health care system is broken. Beyond the 15% of the population who are uninsured yet ineligible for government safety nets, there are untold others inadequately insured. For these people–working poor, children of working poor, and self-employed–our system is harsh, not compassionate. Some face draconian exclusions for “preexisting conditions,” others can insure themselves but not their families, and many cannot afford both their premiums and their prescription medications. A nationalized health care system is not the answer, in my opinion. But a few fundamental changes might help re-engineer what we’ve got. Here’s my Utopian checklist: 1. Nobody can be excluded or canceled. Sick or well, young or old. Make it a Federal law that no individual willing to enroll may be turned down for health coverage and nobody can be discontinued from their plan if they get sick. 2. No individual may opt out. Make basic health coverage mandatory for all adults and children, just like we do for auto insurance. 3. Minimum benefits/maximum premium. Federal law must require all health insurers to… Read more »
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