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What is Health Care Reform?

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Question: What is Health Care Reform?
I've heard a lot on the news lately about health care reform, and how the healthcare system in the United States needs to be reformed. What is health care reform, and how could it affect my career in the medical field?
Answer: Health care reform is a complex issue, consisting of many different aspects. If you've worked in healthcare for a while, particularly as a provider or an executive, you probably understand this. If you are new to the health care industry, or if you have never worked in health care, this may help you to understand some of the basic points of the health reform issue.

Many people, including politicians, government officials, healthcare professionals, and citizens, feel that the health care system in the United States needs a complete overhaul. Others feel that there is definitely room for improvement, but the health care system does not need to be completely transformed.

The primary objectives of health care reform include:

  • Provide healthcare coverage for all (currently uninsured) Americans universally
  • Decrease the costs of health care services and coverage
Sounds like a great idea, right? The United States has extremely high health care costs, and we also have millions of people who are uninsured. So it seems obvious that we need to provide coverage for all, and decrease costs. However, those two objectives do not necessarily coincide.

Most people who are insured are insured through their employer, with a company health insurance policy. Some employers pay for this coverage fully, while some employers share the costs with employees. Some people who are self-employed or unemployed must pay for their own health care insurance policy by paying a monthly premium. People over the age of 65 qualify for a government health care plan called Medicare, which is paid for mostly by taxes and other government funding. Medicaid is another government funded program that insures those who are too poor to afford their own insurance. Additionally, there are government-funded state plans and children's plans to cover yet more citizens who otherwise would not be able to afford health insurance coverage. However, there are millions of Americans who do not qualify for any of these insurance plans.

Many people feel that providing healthcare coverage to the millions of people who are currently uninsured would cause the health system to be overloaded, resulting in long waits and overworked clinicians.

Decreasing costs of health care services is another major endeavor. The United States does have costly health care, but also has some of the highest quality of healthcare. Treatments and technology in America are very advanced, and that comes with a cost, not the least of which is research and development, such as clinical trials and lab testing. Reducing the cost of healthcare would be a very good thing, but not if costs are reduced at the expense of the clinical providers, or of the companies who develop the cutting edge drug therapies and technology we enjoy in the United States.

Many factors contribute to the high cost of healthcare that people do not often consider. For example, medical malpractice laws in some areas can contribute to high health care costs. In litigious areas, rising costs of malpractice insurance cut into the bottom line of physicians and hospitals, who must then pass those costs on to the patients. In addition to rising malpractice insurance costs, fear of being sued prompts many physicians to order unnecessary tests to cover themselves. These additional tests also contribute to the high cost of healthcare. If a doctor makes a careless mistake, he or she should pay for it; however, sometimes malpractice suits are filed frivilously or unnecessarily which contributes to the higher health costs.

So how do we reform healthcare? One way is to try to make it more efficient. Perhaps implementing EMR is the answer to making all of healthcare more efficient. EMR can help, but there are costs associated with developing, implementing, and maintaining an EMR system that works effectively. In 2009, President Obama has mandated the use of EMR in physician practices to get the ball rolling in this area. Many politicians and government officials are trying to figure out additional ways to make health care more efficient, thus decreasing its costs.

Increasing coverage to the millions of uninsured presents a challenge as well. The Obama Administration is currently working on offering an "optional" public health care insurance plan to cover the uninsured. Some fear that this optional plan would soon become the only plan, and then we would have only one option - the government. At that point, we would then have a system similar to those in Europe and Canada. Many feel this would be a good thing for America. Others feel that this would cause the quality of care to decline (as it has in many areas where national health care is provided), and cause very long waits (six months to one year) for medical care.

The above considerations are just a few of the most prominent issues that are involved in health care reform. So if health care reform is implemented, how would it affect your health career? That depends on what exactly is implemented. But most agree that healthcare reform would result in an increased workload in a number of ways, due to both the increased regulation and the additional patient load from the millions of people who would suddenly become insured.

If the optional public health care plan puts the private insurers out of business, then basically all physicians and medical providers would then be working for the U.S. government at that point. Obviously, that would decrease your options for employers, because the government would be then be controlling all of health care, as it does in Canada and Europe, where all physicians and health care workers now work for the government.

As you can probably see by the above issues, health care reform is an enormous undertaking that is multi-faceted and there is most likely no one simple solution.

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