Fixing the Health Insurance Crisis in America

Audrey M. Jones
Medical Provider

The health insurance crisis in America derives mainly from the large number of uninsured individuals in the country. There are numerous reasons why individuals are uninsured, but the end result has been continuous and significant increases in healthcare costs for all Americans.

Opinions Regarding Fixing the Problem

The Patient Protection and Affordable Care Act (PPACA) was passed in 2010. This Act created a system in which health insurance would be offered at affordable prices to more individuals.

Despite the passage of the PPACA, however, there still wasn't a consensus about how to fix the health insurance crisis. In fact, the focus on the healthcare crisis and the division it caused among Congress and the general public resulted in numerous experts providing advice about how to fix the problem. Offered solutions discussed who or what should be held responsible for the crisis, why, and provided advice about how to fix the problem.

Ron Paul, Former Physician and Member of U.S. Congress

Ron Paul states that the healthcare crisis is a government crisis rather than a medical care crisis and that private health care companies are more than capable of providing adequate coverage and care. He also states that there is too much management of the industry as a whole and too much money landing in corporate medical companies' pockets.

To fix the healthcare crisis, Paul suggests giving tax credits for the entire amount of money an individual spends on healthcare and passing legislation that limits malpractice lawsuits. Paul is against a government program providing health care, but opined that if one was created people should have a way to opt out of it.

Providing tax credits, Paul states, allows individuals to be independent in choices pertaining to health care, while limiting lawsuits will eliminate the fear physicians have regarding providing medical care.

William Weldon, Chairman and CEO of Johnson & Johnson

Weldon authored "Fix the Health Care Crisis, One Employee at a Time," published in the Harvard Business Review. The author's recommendations for fixing the healthcare crisis are based on his experiences from instituting a health care prevention program.

Weldon encourages making changes concentrating on prevention. Specifically, he recommends focusing on prevention and developing programs to consider each patient's motive and goals when receiving care. He also recommends that corporations institute changes, for example by having corporate leadership institute a system of health-focused culture.

Not only is working on prevention better than curing or treating diseases, he states, but becoming more prevention-focused leads to reduced health care costs. In his experience, every dollar invested in worker health leads to improved productivity, more than $4.00 per worker in reduced health care costs, and lower absenteeism. Prevention, in his opinion, leads to numerous economic benefits.

Sherry Glied, Ph.D. and Head of the Division of Health Policy and Management at Columbia University

In a recent PBS interview, Sherry Glied states that the people at most risk in this crisis are those with no health insurance at all because of the chances of their not receiving medical care when necessary or treating health problems before they become untreatable. Employers, she stated, are no longer the best medium to solve the crisis, mainly because many employees frequently move between jobs.

Glied recommends establishing a limit between how much wealthy persons and poor persons can spend on care. Essentially, she states that there should be some uniform standard of care provided to all people. Her recommendation for instituting this change is to establish a form of healthcare financing, such as a tax on health care that funds health care. She also recommends that healthcare somehow allow providers to use the best technology available.

This solution, she states, allows healthcare providers to maintain financial stability by using income derived from higher-income patients and those with insurance to pay for lower-income and uninsured patients. More access to technology means higher bills for individuals with insurance and more income, leading to increased revenues for paying for others. She relates her recommendation to an old country doctor who charged wealthier patients more for healthcare and then used that money to stay afloat while treating poorer patients.

David M. Eddy, MD, PhD, Senior Advisor for Health Policy and Management for Kaiser Permanente

PBS also interviewed David M. Eddy, who states that there are two crises: a quality crisis and a cost crisis. The former is related to the fact that type and quality of care provided to patients varies greatly, while the latter relates to the fact that the costs of healthcare have increased exponentially faster than workers' paychecks, making it more difficult for people to pay for healthcare.

To solve both problems, Eddy recommends that hospitals and doctors practice "evidence based-medicine", which is the practice currently used in Switzerland and Germany. This type of medical practice is extremely conscious about the medical tests and other procedures ordered for a patient's treatment.

This solution, Eddy states, enables doctors to decide what tests and type of care a patient truly needs, making care more individualized and increasing the quality of care received. By reducing unnecessary processes, Eddy states, medical costs will be lowered.

Dr. Elliott Fisher, Director for Population Health and Policy at the Dartmouth Institute for Health Policy and Clinical Practice

Dr. Fisher states that the healthcare crisis stems from the unreliable, impersonal, and uncoordinated care provided to patients. The main issue, he argues, is the way that insurance companies bill individually for each procedure and treatment provided to a patient. This process, he states, encourages physicians to do more for patients, even if that "more" is unnecessary.

A solution, he states, is to eliminate insurance companies "fee-for-service" way of charging and switching to Accountable Care Organizations (ACO). According to the Centers for Medicare and Medicaid Services, ACOs are voluntarily formed groups of physicians, hospitals and other healthcare providers who agree to provide coordinated, high-quality care to patients. These groups, the Centers state, allow for spending healthcare dollars more efficiently and wisely. Fisher believes that using ACOs in more or all healthcare circumstances will result in the focus of healthcare changing from "more care" to "better care," leading to reduced costs.

Susan DeVore, President and CEO of Premier Healthcare Alliance

DeVore was also interviewed by Wall Street Journal. She blames the current fee-for-service payment system for the healthcare crisis. This system, she argues, leads to high care costs, lack of coordination, and inconsistencies in the type of care provided.

Her solution is to create a bundling payment method, in which payment for doctors, hospitals, and other provides is provided in one large sum.

Bundling payments, she argues, provides an incentive to provide higher-quality and more efficient care. It also encourages care providers to interact more with patients. The result, she claims, is that care more specific to each patient's needs and a more unified form of care will be provided. The result is reduced costs.

Gail R. Wilensky, PhD. Senior Fellow at Project HOPE and Chair of the Medicare Payment Advisory Commission

Wilensky states that the reliance on employer-sponsored insurance plans doesn't make sense for retired workers. The result, she claims, has been the healthcare crisis because it is retired workers who are too young for Medicare that have the highest medical bills.

Her solution is to ensure that all people have healthcare coverage, particularly those with the lowest income. However, she doesn't say that this coverage needs to be provided by the government or that society should prevent wealthy people from using their money to try new or unique treatment methods. Her proposal is to develop a system that allows patients to question whether they are getting their money's worth for the care provided.

This option, she states, provides more assurance for the sick and worried, allowing healthcare to focus more on quality of life rather than finding cures and treatments no matter the cost.

Dr. Atul Grover, Chief Public Policy Officer of the Association of Medical Colleges

Dr. Atul Grover was interviewed in the Wall Street Journal. He identifies the fact that half of all health care dollars are spent on hospital and physician services. This amount, he says, causes the high costs of healthcare.

His solution is to reduce either the amount of services used or the cost of each service. The latter, in his opinion, is easier and can be instituted along the lines of how Medicare and Medicaid have controlled per-service costs. The former, he states, is more difficult, but will have a larger impact. It can be accomplished by focusing on epidemic diseases that increase healthcare costs.

His answers, he claims, will reduce the overall costs of healthcare. This is because it will decrease the amount of care provided and prevent providers from charging too much for care.

The Future of Healthcare in America

Although each of these experts have different ideas on how to resolve the problem, they mainly believe that health care costs are too high for the often-lacking quality of care provided. Their solutions, therefore, generally focus on:

  1. Increasing the quality and reliability of care provided by hospitals and physicians to ensure that patients receive the best treatment for their needs
  2. Decreasing charges levied for medical care either by reducing the amount of care provided or giving tax credits for medical expenses

Expert solutions, therefore, direct policy makers toward looking at how and what type of medical care is provided to the public.

Fixing the Health Insurance Crisis in America