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Source: Mass health
Health For All is a must!
There is no doubt USA is looked at as a nation that can take good care of its ill and debilitated. After all this is one of the three countries in the entire world that soft-landed a probe rocket on the moon. It has the funds and infrastructure to take care of the ill.
According to the New England Journal of Medicine, however this is not the case. This is one of the quotes I managed to collect from a very informative text.
" Our health care system is failing. Tens of millions of people are uninsured, costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms succeed only in exchanging old problems for new ones. It is time for basic change in American medicine. We propose a national health program that would (1) fully cover everyone under a single, comprehensive public insurance program; (2) pay hospitals and nursing homes a total (global) annual amount to cover all operating expenses; (3) fund capital costs through separate appropriations; (4) pay for physicians ½ services and ambulatory services in any of three ways: through fee-for-service payments with a simplified fee schedule and mandatory acceptance of the national health program payment as the total payment for a service or procedure (assignment), through global budgets for hospitals and clinics employing salaried physicians, or on a per capital basis (capitation); (5) be funded, at least initially, from the same sources as at present, but with payments disbursed from a single pool; and (6) contain costs through savings on billing and bureaucracy, improved health planning, and the ability of the national health program, as the single payer for services to establish overall spending limits. Through this proposal, we hope to provide a pragmatic framework for public debate of fundamental health-policy reform," (N Engl J Med 1989; 320: 102-8).
Coverage is a panacea if....
"Everyone would be included in a single public plan covering all medically necessary services, including acute, rehabilitative, long-term, and home care; mental health services; dental services; occupational health care; prescription drugs and medical supplies; and preventive and public health measures. Boards of experts and community representatives would determine which services were unnecessary or ineffective, and these would be excluded from coverage. As in Canada, alternativeinsurance coverage for services included under the national health program would be eliminated, as would patient copayments and deductibles.
Universal coverage would solve the gravest problem in health care by eliminating financial barriers to care. A single comprehensive program is necessary both to ensure equal access to care and to minimize the complexity and expense of billing and administration. The public administration of insurance funds would save tens of billions of dollars each year. The more than 1500 private health insurers in the United States now consume about 8 percent of revenues for overhead, whereas both the Medicare program and the Canadian national health program have overhead costs of only 2 to 3 percent. The complexity of our current insurance system, with its multiplicity of payers, forces U .S. hospitals to spend more than twice as much as Canadian hospitals on billing and administration and requires U .S. physicians to spend about 10 percent of their gross incomes on excess billing costs.1 Eliminating insurance programs that duplicated the national health program coverage, though politically thorny, would clearly be within the prerogative of the Congress.2 Failure to do so would require the continuation of the costly bureaucracy necessary to administer and deal with such programs.
Copayments and deductibles endanger the health of poor people who are sick,3 decrease the use of vital inpatient medical services as much as they discourage the use of unnecessary ones,4 discourage preventive care,5 and are unwieldy and expensive to administer. Canada has few such charges, yet health costs are lower than in 1he United States and have risen slowly.6,7 In the United States, in contrast, increasing copayments and deductibles have failed to slow the escalation of costs.
Instead of the confused and often unjust dictates of insurance companies, a greatly expanded program of technology assessment and cost-effectiveness evaluation would guide decisions about covered services, as well as about the allocation of funds for capital spending, drug formularies, and other issues, " (N Engl J Med 1989; 320: 102-8).
Unsolved Problems
"Our brief proposal leaves many vexing problems unsolved. Much detailed planning would be needed to ease dislocations during the implementation of the program. Neither the encouragement of preventive health care and healthful life styles nor improvements in occupational and environmental health would automatically follow from the institution of a national health program. Similarly, racial, linguistic, geographic, and other nonfinancial barriers to access would persist. The need for quality assurance and continuing medical education would be no less pressing. High medical school tuitions that skew specialty choices and discourage low-income applicants, the underrepresentation of minorities, the role of foreign medical graduates, and other issues in medical education would remain. Some patients would still seek inappropriate emergency care, and some physicians might still succumb to the temptation to increase their incomes by encouraging unneeded services. The malpractice crisis would be only partially ameliorated. The 25 percent of judgments now awarded for future medical costs would be eliminated, but our society would remain litigious, and legal and insurance fees would still consume about two thirds of all malpractice premiums.23 Establishing research priorities and directing funds to high-quality investigations would be no easier. Much further work in the area of long-term care would be required. Regional health planning and capital allocation would make possible, but not ensure, the fair and efficient allocation of resources. Finally, although insurance coverage for patients with AIDS would be ensured, the need for expanded prevention and research and for new models of care would continue. Although all these problems would not be solved, a national health program would establish a framework for addressing them, " (N Engl J Med 1989; 320: 102-8).
Massachusetts Health and the nation-wide Affordable Care Act-ACA
I come from Massachusetts and when it comes to insurance I fall under the below 65 year old eligibility criteria which places me under MassHealth.
Simply put, in Massachusetts, Medicaid and CHIP (State Children's Health Insurance Program) are combined into one program called MassHealth. Qualified MassHealth members may be able to get doctor visits, prescription drugs, hospital stays, and many other important services.
The Commonwealth Health Connector, provides education on the new health care reform law. The site features specific information about health plans in MA, including price information. Consumers can also enroll online.
MassHealth is not acting in isolation but it is an answer to a wider acting Act known as the Patient Protection and Affordable Care Act of 2010 (also known as the ACA). This was signed into federal law on March 23, 2010, creating the biggest expansion of health care coverage, making health insurance accessible to millions of people who currently are uninsured.
Get enrolled, get covered
Coverage
Source: The White House
The big deal
That is the value and incentive that got me all worked up. As a medically trained person,I am aware my health benefits both I and the larger society. I do want to have a better health. I do want to preserve my life.I do want to take care of myself. I have to have more control of situations where I need to afford both a life that would not make me vulnerable. But, in case I am vulnerable,I wanted a situation where my providers would be accessible, affordable and appropriate for me.
I looked up "Affordable Care Act" online following a short talk introducing to us insurance and need to enroll. I made it a point to set aside a day understanding all the literature I could lay my hands on. I thought I would understand it better in broken down blocks. The blocks are: what this insurance is about; benefits; what is in it for government and general public health; what it takes to enroll.
Being that I am from Massachusetts I looked for a specific site.
The stop was the Commonwealth Health Insurance Connector website: This website provides education on the new health care reform law. The site features specific information about health plans in MA, including price information. Consumers can also enroll online.
Affordable Care Act- ACA
Are all three true?
See results without votingThe Services
- The first service is the 'Prescription Advantage', administered by the Executive Office of Elder Affairs, is a prescription drug insurance plan that is available to all Massachusetts residents age 65 and older, as well as younger individuals with disabilities who meet income and employment guidelines.
- The next is to serve the health information needs of elders 'SHINE.' This is a health benefits peer counseling service which uses trained volunteers to assist elders on questions about Medicare, Medicare supplements and Medicare Health Maintenance Organizations.
- The third in line is the catastrophic illness in Children Relief Fund 'CICRF.' This reimburses eligible families for medical or medically-related services or expenses associated with the care of children with special health care needs and disabilities that are not covered by a child's medical insurance. For more information call 1-800-882-1435 or click on the link above to go to their website.
- Resources for Health Care and Insurance
- Health Care Resources for Veterans
- Medicare Prescription Drug Coverage where everyone with Medicare, regardless of income, health status, or prescription drugs used, can get prescription drug coverage.
Tel. 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048
- Worker's Compensation
- Health Insurance Products in Massachusetts information on individual and group insurance products and consumer guides from the Massachusetts Division of Insurance.
- Continuation of Health Coverage-COBRA gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events.
The ACA Provisions
The Affordable Care Act expands affordable Medicaid coverage for millions of low-income Americans and makes numerous improvements to Medicaid and the Children's Health Insurance Program (CHIP). Browse this section to learn more about the provisions of the Affordable Care Act related to Medicaid and CHIP.
Population to be covered
Patient Protection and Affordable Care Act of 2010 (ACA) will provide health insurance coverage to some 32 million uninsured people over the next 10 years.
It is a recognition of the needs of low- and moderate-income people.
People in these lower-income groups have been the most affected by the nation's inability to enact comprehensive health reform until this year, 2013.
Most people in the U.S. have health insurance through an employer, the chances of having job-based benefits decline dramatically with income. Nearly two-thirds of the 45.7 million uninsured people under age 65 have incomes that are less than 200 percent of poverty, or about $44,100 per year for a family of four (Exhibit). In addition, of the estimated 25 million under insured adults—those who cannot afford their out-of-pocket medical costs despite having insurance—more than half have incomes under 200 percent of poverty.
Obama Care
The Political Prospects
"Our proposal will undoubtedly encounter powerful opponents in the health insurance industry, firms that do not now provide health benefits to employees, and medical entrepreneurs. However, we also have allies. Most physicians (56 percent) support some form of national health program, although 74 percent are convinced that most other doctors oppose it.24 Many of the largest corporations would enjoy substantial savings if our proposal were adopted. Most significant, the great majority of Americans support a universal, comprehensive, publicly administered national health program, as shown by virtually every opinion poll in the past 30 years.25,26 Indeed, a 1986 referendum question in Massachusetts calling for a national health program was approved two to one, carrying all 39 cities and 307 of the 312 towns in the commonwealth.27 If mobilized, such public conviction could override even the most strenuous private opposition," (N Engl J Med 1989; 320: 102-8).
Get Covered
ACA is for all our good:
1. It ensures that you and I who are low to middle income earners can afford a provider.
2. It provides information on available services
3. Through it providers are encouraged to practice beneficial medicine.
4. Individuals, families and communities are empowered to take care of their life at a primary level.
5. The points of care are accessible and affordable
6. The regular checkups provide timely and appropriate diagnosis and management and stop complications.
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