In response to your peers, highlight in detail and discuss which aspects of healthcare are best regulated by the states and which by the federal government. Define the strengths and weaknesses of pla
Rachel:
Government has an important role in healthcare, especially regarding Medicare and Medicaid. According to one source, the Affordable Care Act (ACA) was enacted in 2010 with intentions to create a bridge between government, employers and individuals by sharing responsibility and providing access to affordable, quality health insurance, however our health insurance in the US is anything but perfect; this model is seriously flawed and has failed to close the gap with insurance rates (THE COMMONWEALTH FUND, 2019). According to one study, it is the government’s responsibility to ensure that the interests of society are protected and advanced, since the market is unable to ensure all Americans have access to quality health care – it is the government’s role to supplement this when there is unfairness or inefficiency (Tang, Eissenberg, & Meyer, 2004).
Health insurance has a huge impact on healthcare delivery. For example, I am insured, however I live in “the middle of nowhere” so the nearest dentist that is in network with my insurance is a 45 minute to 1 hour drive out of town in the summer – you can add additional 45 min in bad weather conditions and since most businesses here are only till 4:30 pm that means I have to take time off work to see a dentist that accepts my insurance. Instead, I visit a dentist in town that is out of network and pay a hefty fee initially, but I am reimbursed months later from my insurance. I still have to take time off work, but the drive is safer and closer. Another way health insurance impacts healthcare is if the service is covered, if it is deemed medically necessary, how it is coded, if it is a pre-existing condition and more. These are all important and can change the course of treatment due to insurance coverage.
In my opinion, one way to maximize quality would be for physicians to stop prescribing unnecessary tests for individuals. It sounds so simple but treat people with the symptoms they present and the treatment they need. I also think preventative education and care would help reduce costs, if people are healthier, then insurance should be lower. That is probably never going to happen, but so many ailments could be prevented with diet and nutrition, but since insurance doesn’t cover a dietitian (yikes) then people don’t get the education they need, and physicians don’t refer patients to a dietitian because they know insurance won’t cover it. A heart attack is preventable (to an extent) with diet and exercise, but most people don’t know that until after they have survived one. If people were just healthier in the first place, they wouldn’t need to be hospitalized so much.
Side note:
As a manager, I typically help my staff through the open enrollment period. Here is a situation that happened in the last year, that I am still blown away by: I had an employee come to me 45 days after her divorce and say “how do I sign up for health insurance for my kid” since it wasn’t open enrollment it would be upwards of eight months. She was not pleased with this, however, once a life changing event has occurred you only have 30 days to make changes to your health insurance. She stated she didn’t even think about it, because she is still under her mom’s insurance as she is only 23, however, because she made the change from CNA to cook about three months ago – her pay increased with her cook position therefore Medicaid dropped her son from insurance. Because of this, her son is no longer insured, and she has missed the window for insurance through our work due to a life changing event. I explained her only option at this point was private insurance, which she stated she cannot afford. With the above situation, I think it is extremely important that individuals are given exact guidelines and fully understand the situation. This employee is young, slightly irresponsible, but now her son suffers. I honestly don’t know how to reduce situations like this, because you cannot make people more responsible and if you open the window for more than 30 days then people will just abuse it.
