Insurance World

About 50 years ago, health insurance started to be an attractive incentive offered by employers to attract and keep good employees. Overall, group plans tended to be inexpensive for employers, with employees contributing a small amount of money or none at all to secure health insurance for themselves and their families.

It was more expensive for individuals to pay for non-group policies, but coverage was fairly affordable. Then medical costs started to rise, people started to live longer and the medical profession became adept at curing various diseases and saving and prolonging the lives of people with serious injuries and life-threatening illnesses. Health care and insurance prices started rising much more quickly than annual incomes and premiums began taxing both employers, who were paying the lion’s share of premiums, and for employees, to whom businesses often passed on costs through larger deductibles, greater out of pocket expenses and higher premiums.

According to a recent report by the MSNBC News Service, 41 percent of Americans whose income ranges from moderate to middle had no health insurance for at least part of 2005. In 2001, that number was much lower—28 percent. Additionally, more than 50 percent of uninsured Americans in 2005 found it difficult to pay their medical bills. Another alarming statistic—28 percent of Americans in 2005 had no health insurance, while 24 percent had none in 2001.

So, what should a person do if they don’t have any health insurance or if they have a choice between a cheap discount plan that does not cover core expenses and an affordable plan that may cost a bit more but also provides much better coverage? According to data from the U.S. Centers for Disease Control and Prevention, the majority of people who are not covered for important screening tests, such as a mammogram, colon cancer screening or a PSA test, will not undergo those exams. Also, close to 60 percent of people without health insurance missed treatment or did not buy medicine needed for a chronic condition.

All of these figures point to one thing—people who lack health coverage for essential services are often unable to pay for those services, putting them at greater risk for developing new or exacerbating existent health conditions.

What should you look for in a health insurance plan, especially when cost is an issue? It’s important that you get the best coverage you can afford. Skimping on premiums can save you money upfront, but the result can prove to be penny-wise and pound-foolish. Sometimes people can’t afford coverage and sometimes they believe because they are healthy that they simply don’t need it. However, healthy people get ill or are involved in serious accidents all the time. You never know when you’ll need coverage.

Some people opt for “catastrophic” insurance, which usually covers only major medical and hospital expenses above a specific deductible. Under such a plan, the insured pays for routine doctor visits and prescription drugs. With this type of plan, you’ll pay a low monthly premium but will also have a high deductible and limited coverage. Deductibles start at $500 per year but can be considerably more. If you purchase an inexpensive policy with a $10,000 deductible and you undergo surgery that costs $8,000, you must pay that $8,000. If your surgery costs $12,000, you would owe $10,000.

One insurance company offers a plan that costs $29 per month for a 21 year-old, non-smoking female. There’s a yearly $250 deductible and $2,500 in out of pocket expenses that the insured must pay before the policy kicks in. Hospital, surgical and x-ray expenses are covered but other costs, such as doctor visits, prescription drugs, maternity care and mental healthcare are not included. There’s a lifetime maximum of $1 million.

It’s certainly a bargain, if you don’t plan on going to the doctor very often. To enroll in a plan that will cover doctor visits, prescriptions, maternity expenses and more could easily cost $400 per month—a jump of $371 every 30 days for a total cost of $4,800 per year!

Group health insurance plans, which you can usually enroll in through your employer, union or guild, are the best buy. Individual plans, especially those that offer comprehensive coverage, can be crippling to many people’s pocketbooks. When buying health insurance, it’s important to shop around. Your choice of what type of plan you purchase will be determined by what you can afford and what you need as far as insurance is concerned. There’s no right or wrong choice when it comes to health insurance but at the very least you should have catastrophic insurance.

There are basically three types of plans—Fee-For-Service, Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). Fee-For-Service plans offer the most choice regarding doctors and hospitals but they often involve quite a bit of paperwork and are the most expensive. If you’re willing to give up some or a lot of choice, do less paperwork and save some money on premiums then either a HMO or a PPO is for you.

A HMO offers the least amount of choice, involves co-pays, has the least amount of paperwork and is the cheapest of the three types of insurance. A PPO combines some elements of Fee-For-Service and a HMO. You’ll have more choice than you would with a HMO but less than you would with a Fee-For-Service plan. It tends to be more expensive than a HMO but less expensive than Fee-For-Service. All three types of insurance have some aspect of Managed Care—which determines how much health care you can use—attached to them, with Fee-For-Service having the fewest restrictions and a HMO being restricted the most.

When shopping for health insurance ask the following questions—

* How much is the premium?
* What services are covered?
* What are the total deductible and out of pocket expenses per year?
* How much are the co-pays?
* What is the maximum lifetime benefit?
* How much freedom will you have when choosing doctors and hospitals?
* What are the pre-approval procedures for seeing specialists, undergoing a procedure or being given a test?
* What prescription drugs are covered and to what degree?
* Is mental health covered and to what degree?
* Is dental covered and to what degree?

As you begin to narrow down your choices, you can look more closely at specific plans that seem to fit your needs and determine which offer you the best value for your dollar?

America has one of the finest healthcare systems in the world and one of the most complex health insurance systems across the globe. Often, they seem to be at odds with one another, unable to communicate and work together. That can be one of the most frustrating parts of anyone’s foray into the world of healthcare professionals, hospitals and health insurance companies. For this reason alone, it’s important that you carefully and thoughtfully choose your healthcare benefits provider.

As Health Savings Accounts grow in popularity, there is growing fear among those who want to nationalize healthcare that they will not be able to put the cat back in the bag. There are already over 3 million HSA owners, and by 2010, the Treasury Department estimates as many as 45 million Americans will be covered by HSA plans. They will have billions of dollars invested to cover future medical expenses, and by then it will be politically impossible to take that benefit away.

If you currently have a high-deductible health insurance plan, you can invest tax-free money in a Health Savings Account. You get to choose the type of investment – anything from savings accounts or money market funds, to a full brokerage house. If you invest wisely, you could have well over $500,000 in the account when you retire. You will be able to use that money to pay for your healthcare in whatever way you please, tax free. You can go to the best surgeons, or the least expensive doc-in-a-box. If you decide to treat a condition with acupuncture, homeopathy, or psychic healers, you can do that too. Whoever offers you the service you want with the best combination of quality and price should get your business. And since you are the one paying, it will be completely your choice. You have healthcare freedom.

If proponents of a single-payer system were to ever have their way, you would be at the mercy of a government bureaucrat when it comes to your healthcare. To see what this may look like, all one has to do is look at the state of health care in Canada, England, New Zealand, and the parts of Europe that have not yet abandoned single-payer systems.

Proponents of a single-payer system tend to point to Canada or England as countries that cover all their citizens with quality healthcare, while spending less money per person than the U.S. But if we look a little more closely, we see that these publicly financed health insurance systems are breaking down, the quality is low, and the costs can be quite high. Here’s what Canadians have to deal with if they need medical care:

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Long waits. Hundreds of Canadians go to Detroit and other U.S. cities every year for procedures like CAT scans, which they can obtain treatment in a matter of days. In Canada, the wait is typically six months. Currently 876,000 Canadians are on waiting lists for medical procedures.

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Difficulty in getting life-enhancing procedures done. If a Canadian is having a heart attack, they will be treated right then. But if the surgery is considered “elective” (meaning that possible death is not eminent), the wait could be months or years. Average wait for cataract removal is 18 months. Average wait for a knee replacement is one year.

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Increased risk of dieing. The average Canadian waits eight weeks to see a specialist, and another nine weeks before getting treated. This is even the case with conditions that are likely to get much worse if there is any delay in treatment. For example, the median time for a mastectomy is 14 weeks, enough time for the cancer to spread to other parts of the body. In fact, 28% of those diagnosed with breast cancer in Canada die from it, while the mortality ratio in the U.S. is only 25%.

Things don’t look any better across the ocean. Each year the British National Health Service cancels 410,000 surgeries because of resource shortages. According to the London Sunday Times, there are currently over 1 million Brits awaiting elective surgery. Thomas Cook, a British travel agency, is even considering offering “sun-and-surgery” packaged trips to Indian hospitals for British citizens fed up with low standards and long waiting times for surgery.

The British and Canadian governments have the power to make healthcare “free”, but they are unable to control its costs. So the costs become longer (and potentially fatal) delays, and fewer innovations.

Its not surprising when you think about what is happening. Universal health insurance systems always encourage over-consumption by patients, and such over-consumption always leads to financial crises. The result is inevitably broken promises about universal access and quality care. Because there are always limited resources, single-payer systems tend to overspend on primary care for the healthy, while denying more expensive specialist care to those with serious medical problems. This is because most people (voters) are healthy most of the time, and the sick and dieing are less likely to be able to organize into a political force.

What makes the United States such a great country is the “freedoms” we enjoy. Though our freedoms seem to be constantly under attack, there is still no nation in the world that has the freedom of the press, freedom of religion, freedom of association, or the free markets that we have in the United States. As anyone who understands even a smidgen of economics knows, free markets encourage competition and innovation, which lead to lower prices and better quality.

Though the U.S. system of health care can not really be considered a “free-market”, it is certainly much more free than any single payer system. Some of the benefits we see as a result of our current healthcare system include:

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U.S. medicine produces the best outcomes for virtually every patient, from premature babies to elderly cancer patients.
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American companies are the chief source worldwide of new treatments and procedures which each year are used to save millions of lives.
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U.S. medical training and research facilities are the best in the world.

Though Canadians might have to wait a year or two for hip replacement surgery, they can get the same operation done on their dog in less than a week. This is because veterinarians are competing for that business, finding innovative ways to deliver service more quickly and less expensively. Another example is laser eye surgery, a procedure that is rarely covered by insurance, so laser eye surgeons must compete on the basis of cost and quality. While costs for most medical procedures have been going up every year, the cost for this procedure has dropped by 80% over the past decade.

Unfortunately, U.S. healthcare policies still tend to limit competition, restrict consumer’s freedom to choose, and discourage consumers from shopping for value. Thus, there are too few choices and there has been little attention paid to price and quality of service. The answer is clearly not more government intervention, but instead letting competition and the power of the marketplace drive down prices and increase quality and access to care.

Health Savings Accounts are the Solution

There is increasing recognition that third-party health insurance payers are actually a major cause of escalating medical costs and the decline in the quality of service. The increasing adoption of HSA plans has already begun to cause greater transparency and competition in the medical marketplace. There are now physicians available by phone, medical kiosks setting up in malls, doctors that accept only cash (and who charge significantly less), and others competing directly for the consumer’s healthcare dollar.

Don’t be fooled by the politicians who advocate a single-payer system, claiming their only concern is the uninsured. If a single body (such as a government bureaucracy) controls healthcare, they control one seventh of the national economy. And everywhere in the world that central control of the economy has been tried, it has been a colossal failure.

As public policy reforms centered on individual choice continue to gain wider footholds, the result will be greater prosperity, greater choice, and a better value for all. The culture of dependence and entitlement will begin to fade, as millions of individuals demand further policy reforms that will reinstate the values of freedom and personal responsibility that helped establish this great nation.

As more consumers turn to health savings accounts, the market will respond. Innovative providers will begin to compete more on price and quality of service, and those that provide the best value will get wealthy doing so. And all consumers will benefit.