Healthcare Series

So, What is Healthcare? Part 5: Trump Healthcare

After the Affordable Care Act was put into action via the Obama administration, many people were unhappy with the changes that took place. As a result, the drive to change or repeal the new system in favor of other structures gained support. One of the platforms that fueled President Trump’s campaign was the promise to alter the existing healthcare system and undo the changes that were making some of his voters unhappy.

Make note that the plan for the Trump administration and various republican supporters to repeal and replace the Affordable Care Act was seen as a difficult strategy to achieve, even from members within his own camp. As a result, the goal of the administration to change the healthcare system became to simply repeal or alter the current system, as no replacement was widely supported. Additionally, the political requirements to pass such changes were not strongly advocated for amongst the majority, leading amendments and changes to the existing system as the most feasible option. The changes are outlined clearly by CNBC and will be detailed here today.

What changes were proposed to take place in the reported bill to be passed through our legislative branch? According to CNN Money “American Health Care Act goes a long way to fulfilling the Republicans’ seven-year pledge to repeal former President Obama’s landmark health reform law.” The original bill passed in the House of Representatives would have removed the subsidies paid out to enrollees based on their income, a new initiative of the ACA mentioned in last week’s edition of “So, What is Healthcare.” Rather than just ending governmental support of all kinds for enrollees, the plan was to change the support by offering tax credits based on age instead. Additionally, the plan is to remove mandatory enrollment and making health insurance optional. Mandatory coverage was one of the biggest changes instituted by the Affordable Care Act and it has been a hot topic of debate since it’s inception. This would also remove the requirement for businesses to require health coverage to their employees, outsourcing insurance programs or leaving enrollment up to other avenues once again. These changes alter the basis of availability of plans and the requirements for enrollment. Other changes alter the structure of health insurance policies and coverage plans.

The proposal originally set out to allow insurers to offer plans that don’t include all of the elements mandated by the Affordable Care Act. These plans would be limited in the scope of coverage, allowing people to opt out of mental health coverage or maternity care. The idea is that people will have more flexible options when choosing an insurance plan that fits their lifestyle and the potential costs could be kept to a minimum for people who do foresee the need to have comprehensive coverage of these areas of treatment. The flip side of this is that it would make comprehensive coverage harder to access, and there is a potential that coverage could be more limited or less protective for people with pre-existing conditions. This is especially true because the proposed system would allow insurance companies to change their premiums based on pre-existing conditions. Limiting care for people with pre-existing conditions is a direct contradiction to Trumps goals of ensuring access to this population.

The proposed changes would also affect Medicaid by providing set allowances of funding per state. The idea is that this gives states more rights and control of the programs in their state and ideally allows for more resources and flexibility. There would be a per-capita cap limiting the amount of money each state has for the Medicaid program and the amount of money allotted for each enrollee. The concern here is that the shift in funding moves primarily to the individual states that not have the ability to support these programs without adequate federal assistance. This would cause a shortage of funds, leading to changes in requirements for Medicaid enrollment, difficulties in payment or benefit distribution and access, and reduce the amount and quality of care for patients using Medicaid.

2 weeks ago, the Senate was planning on voting on the latest version of he Republican health care bill. The perception of the bill at that time was that it would not have enough support to pass through Senate due to the opposition by democratic representatives and division amongst representatives of the republican party. After a number of delayed votes, the Senate rejected the proposal.

Want to check back on the previous parts of the series? Great! Check them out here: Part 1, Part 2, Part 3, Part 4

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Healthcare Series

So, What is Healthcare? Part 4: Obama Healthcare System

The goal of this post series is to educate and outline the healthcare system and the current debates surrounding accessibility to healthcare and health insurance. While I am not an expert in this field, I will hyperlink reliable sources that can offer further information about the topics at hand. Please leave your political stances, charged/accusatory/emotional comments, or closed mind at the entry to the site and approach these topics with an understanding that health care will never be a topic of uniform opinion. Regardless of the direction our country takes in regards to it’s own healthcare system in the next few years, there will always be some who are dissatisfied with the changes, and there will always be people with opinions different from your own. Here, I hope to shed light on the basics of the healthcare system with the goal of forming a ground of mutual understanding. Not everyone has to agree, but we should all be well informed.

Last week we discussed the various structures of healthcare systems around the world. I provided a basic outline of the American system, as well. However, it is widely known that this system underwent numerous changes in 2010 with the implementation of the Affordable Care Act. Now, the ACA may undergo some more changes or, perhaps, be dismantled by the Trump administration. Today, I will outline the changes created to the US healthcare system by the ACA and the continued changes we might see in the future.

In March 2010, the Affordable Care Act was signed into law, effectively changing the direction and composition of American healthcare. This act came about due to the high cost and poor coverage of the healthcare system in place at the time. At the time, more than 60% of bankruptcy claims were due to healthcare related costs, and almost 15 million people in the country lacked healthcare insurance coverage. The concern at the time was that this created a health disparity in which millions of people lacked reasonable access to medical care simply due to cost. The system was divided so that those who were fortunate enough to afford care or the costs of insurance could access healthcare, and those who were enrolled in government plans, such as Medicare, Medicaid and CHIP could access care. This left a margin of people in between these two groups that could not afford insurance coverage from private insurance companies but were not eligible for coverage through a federal program. An additional concern for private insurance companies was that it left gaps in coverage, so someone may be able to afford some appointments or circumstances, but not others. Spotty coverage (or lack thereof) leads to people neglecting their health because of cost. The ACA’s aim was to reduce these problems by creating a system that provided universal coverage, hopefully providing an effective solution to improving America’s health.

So, what changes did the ACA make to the previous system? First and foremost, it requires all Americans to have insurance coverage. To help make healthcare insurance an affordable, subsidies and other financial breaks were used. Additionally, the number of businesses offering insurance coverage to employees was increased by requiring all declared businesses with more than 50 employees to offer insurance plans. Another previous concern was that many Americans that lacked coverage were because they could not obtain coverage secondary to pre-existing health conditions that allowed existing companies to deny their applications. Thus, ACA made it illegal for health insurance companies to deny coverage to people with pre-existing conditions.

The Affordable Care Act did not go through implementation and successive practice without challenges and changes. Before its passage, the largest concern was that a universal system would lead to increased taxes or create financial burdens for families that were happy with the existing system. Dissatisfaction continued after the ACA’s implementation. The plan required insurance plans to provide coverage for birth control, a controversial issue for businesses and conservatives that wanted to refuse mandatory coverage to birth control on the grounds of personal beliefs or business reputation. Other changes that were made to the ACA include extending the age of dependent coverage to 26 years old, extension of coverage to people with pre-existing health issues, including children, extension and changes to coverage for early retirees, and new policies for preventative care. The implementation has not gone smoothly. A few challenges include: healthcare.gov experiences technical difficulties, concerns about distribution of insurance subsities were heard in the Supreme Court.

While this program has undergone many changes since its initiation, nothing compares to President Trump’s plan to redesign, or even repeal the act all together in order to replace the existing system with a new structure. We will cover insurance plans and the proposed changes by the Trump administration in the next edition of “So, What is Healthcare?”

To learn more, check out the other posts in this series: Part 1, Part 2, Part 3, Part 5.

Healthcare Series

So, What is Healthcare? Part 3: Healthcare Systems

So last week we discussed the organization of the healthcare system in regards to providing patient care. Feel free to brush up by reading “So, What is Healthcare? Part 2: Public Health and Healthcare Tiers.” This week, we are going to break down healthcare systems by mode of business structure. Although there are hundreds of healthcare systems around the world, they all fall into the same basic 4 categories. Each system is tweaked to meet the needs and abilities of each individual country, but they all carry the same goals: to provide healthcare to people and to reduce costs. An ideal system keeps people healthy and prevents illness.

The Beveridge Model– In this system, health care is provided and financed by the government. The government funding is garnered through tax payments. The goal of this model is to provide universal, publicly financed health insurance as a means of providing access to healthcare. This model is commonly referred to as the “socialized medicine” model. Interestingly, this model came about through a report created by Sir William Bevridge in the United Kingdom in the 1940s, following a period of economic depression. The goal of the report was to improve the financial and business structure of the healthcare system because it is integral to the people’s capacity to join or continue their participation in the workforce. Overall health and preventing illness was not the primary focus of the report. The function of this model is largely through government avenues, however there is opportunity for privatization. Hospitals and clinics can be either government run or privately owned, just as physicians can either work as government employees or charge the government from their private practice. The foundation of this model still lies in that the government is the sole insurer and the only payer of insurance. This model of care is found in countries like Great Britain, Spain, parts of Scandinavia, and New Zealand.

The Bismarck Model– contribution-based, employment-related social security. This model is financed by both employers and employees through payroll deduction. The insurance plan does not generate profits and all people are covered by insurance.This model is found in Germany, France, Belgium, the Netherlands, Japan, and Switzerland.

The National Health Insurance Model-This system is a mix of the Beveridge and the Bismarck models. The physicians and healthcare providers are part of the private business sector, but they are paid through public funds. The government runs an insurance program that is funded by the people’s taxes. This insurance plan is what pays the doctors. This system also does not generate any profits. This is the system used in Canada.

The Out-of-Pocket Model– In countries that utilize this model, the people pay for insurance out of their own pocket , hence the name. Therefore, healthcare services are only accessible to those who can afford to pay for it and hence only a luxury of the financially well off. This system is used by most countries that are not highly developed because they lack the infrastructure and resources needed to maintain a national healthcare insurance system.

For further descriptions of the models above, please refer to the webpage hosted by Physicians for a National Health Program.

The model used by America contains elements of all of the systems outlined above.Our system utilizes a mixture of private insurance plans, out of pocket payments and federally funded programs to provide healthcare. Before 2010 there was no national insurance plan and the 3 systems in existence had a complex relationship with each other. As a result, the USA paid more for healthcare than any other nation, and the level of coverage varied considerably from one program to another. Inconsistencies in insurance coverage, costs of care, and payment methods. Physicians can work in a solo practice or group practice, and can charge fee for service or be employees of the government, businesses, or hospitals. Hospitals and clinics can be government owned, non-profit, or for-profit facilities. In this system, people can obtain insurance through their employers or directly buy insurance plans from insurance companies. People also have the option to utilize more than one insurance program. Additionally, enrollment in health insurance of any kind is optional. As a result of this structure, the system runs more like a business and has limited oversight and regulation by the state and federal governments. The amount and cost of coverage can vary widely from one plan to another.

This system underwent numerous changes with the enactment of the Affordable Care Act by the Obama administration in 2010. These changes, and the proposed changes by President Trump, will be addressed in the next edition of “So, What is Healthcare?”

Interested in learning more? The other parts to this series can be fond on the blog! Access Part 1, Part 2, Part 4, Part 5 here.

Healthcare Series

So, What is Healthcare? Part 2: Public Health and Healthcare Tiers

The second edition of “So What is Healthcare?” series will focus on public health and the organization of medical care.

The goal of this post series is to educate and outline the healthcare system and the current debates surrounding accessibility to healthcare and health insurance. While I am not an expert in this field, I will hyperlink reliable sources that can offer further information about the topics at hand. Please leave your political stances, charged/accusatory/emotional comments, or closed mind at the entry to the site and approach these topics with an understanding that health care will never be a topic of uniform opinion. Regardless of the direction our country takes in regards to it’s own healthcare system in the next few years, there will always be some who are dissatisfied with the changes, and there will always be people with opinions different from your own. Here, I hope to shed light on the basics of the healthcare system with the goal of forming a ground of mutual understanding. Not everyone has to agree, but we should all be well informed.

The United States has undertaken several campaigns and public health goals since its inception. There is a notable list of accomplishments of public health that accounts for the top 10 of these endeavors. You may be surprised to note that most of these accomplishments are concepts included in our education, media, and often a part of political campaigns. The reason here is simple: a simple change can affect a great number of people, making these goals cost effective and a matter of public interest. The CDC lists these accomplishments on their website. The are:

1. Immunizations

2. Motor Vehicle Safety (aka Seat belts)

3. Workplace Safety

4.Control of Infectious Diseases

5. Reduction in Heart Disease and Strokes

6. Food Safety

7. Improvement in Maternal and Baby Health

8. Family Planning

9. Fluoridated Drinking Water

10. Recognition of Tobacco as a Health Hazard

Public health generally applies to populations of people, although the campaigns and implementation of the projects may affect individuals. The programs are often preventative in nature and are aimed at improving the health of many, with a lasting impact over time. On the other hand, the practice of caring for individuals and a reactive care model are the basis of our health care system, which is when we go to a doctor or a specialist for illness or chronic condition management.

The healthcare system can be divided into 3 subdivisions based on the level and type of care provided. The function of each level and the type of patients seen at each level further differentiate these care levels and create a more organized healthcare system. These levels are primary care, secondary care, and tertiary care

Primary care: This level of care consists of what most of us think of as our “regular doctor.” Primary care physicians include pediatrics, family medicine, internal medicine, and occasionally obstetricians/gynecologists. These specialists’ scope of practice focuses on the main health problems in the community. Their clinics are often located within the community they serve. They are often the medical care level that has an interest in promoting health, preventative care, and is the basis of many referrals to other specialists or healthcare providers. These specialists have an interest in promoting healthy diet and exercise, good sleep practices, and family planning. This area of care is also largely where the clinical implementation of public health efforts take place. This includes immunizations, education, and other elements of basic care. As opposed to other specialist positions, these physicians see a diverse range of conditions not limited by problem origin, organ system, or diagnosis.

Primary care is the point of first patient contact and is often the central locus of their care plan. Many patients see their primary care provider (PCP) for a new, undiagnosed condition or for continuing care for unresolved diagnoses. This physician is also usually responsible for providing continuity of care. They play an important role in ensuring that medical care is coordinated between all the providers involved and is dealt with on any long term basis, if needed. It is also important to note that your PCP should be your first choice of care for any symptom or condition that is not emergent.

Now is a good time to take a break in order to outline the difference between emergent and non-emergent states. Emergent care is designed to treat medical emergencies. This includes threats to life, limb, or eyesight. These are the emergencies we think about when we see an ambulance drive by or when we watch NCIS. Gun shot wounds, car crashes, profuse bleeding, appendicitis, drug overdoses, etc. These are things that cannot wait for treatment and can be life threatening without medical intervention. Urgent conditions are states that require care within a timely manner due to discomfort or possible worsening. These are, of course, great candidates for urgent care centers or stand alone clinics which are able to see patients with conditions not warranted for the ER, but still in need of medical care. Some PCPs are able to see patients the very same day, allowing for their office to also be a place of urgent treatment. Routine care is the condition most suited for primary care offices because they are long standing, stable conditions or illnesses that may resolve on their own (common cold, ear infection, etc).While this may sound like a simple differentiation, it is important to know that miss-attribution of a condition as an emergency when it is not one can end up costing time, resources and money for both yourself, the medical facility, and others in need of emergency services.

Secondary care: Medical care provided by specialists who have specialized medical training focused on specific organs and diseases is secondary care. These providers offer care through referrals from primary care physicians and often treat a patient base spread over a larger land area. While primary care physicians are located in each community, secondary providers service the district and county levels. They include cardiologists, gastroenterologists, oncologists, endocrinologists, etc. For many people, these specialists are located in offices in hospitals or health clinics.

Tertiary care:This is medical care given by providers in a specialized medical facility, often provided by subspecialists and sub-subspecialists. These physicians use advanced, complex procedures and treatments with state-of-the-art technology, tools, and facilities. They also see patients on referrals from primary and secondary care providers. This can include pediatric subspecialties such as pediatric oncology, pediatric neurology, pediatric cardiology, etc.

The basis of the healthcare system is its medical structure. The division of pulic healthcare from medical healthcare creates a dual system for addressing the needs of the people. The medical system is further divided into 3 tiers: primary, secondary and tertiary care. How this system is utilized by patients can be affected by the rules and regulations surrounding the system, as well as the financial attributes of the government and insurance agencies. These topics will be covered in later posts.

There are more posts in this series that you can read on the blog! Links here: Part 1, Part 3, Part 4, Part 5

Healthcare Series

So, What is Healthcare?: Part 1- What is Health and Disease

So, in light of the political debates and governmental changes that have affected our healthcare system over the past few decades, and most notably over the past few years, I have decided it is necessary to shed a little light on this area on the blog. Let me be quite clear when I state that I am not presenting a political position, nor do I think that it is appropriate to approach an area of education with a hidden agenda. The goal of this post series is to educate and outline the healthcare system and the current debates surrounding accessibility to healthcare and health insurance. While I am not an expert in this field, I will hyperlink reliable sources and other resources that can offer further information about the topics at hand. Please leave your political stances, charged/accusatory/emotional comments, or closed mind at the entry to the site and approach this topic with an understanding that health care will never be a topic of uniform opinion or understanding and that there is always more to learn. Regardless of the direction our country takes in regards to it’s own healthcare system in the next few years, there will always be some who are dissatisfied with the changes, and there will always be people with opinions different from your own. Here, I hope to shed light on the basics of the healthcare system with the goal of forming a ground of mutual understanding. Not everyone has to agree, but we should all be well informed.

Today, I would like to delve into the concept of “What is health and disease?”

The World Health Organization (WHO) defines health as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Therefore, being in a state of health is something above just being “not sick.” It is a well rounded concept that encompasses more than the scientific definition of a disease and includes our social situation, interactions with others, and even our perception. The various areas of health, social, mental, and physical aspects, are all linked to one another. Poor health in one area can negatively affect health outcomes in another.

Social health is the development and maintenance of supportive relationships with other people. This also includes balancing your social life with your work life and home life. Forming relationships with others includes establishing trust, support, and creating an environment that improves your self esteem and helps you try new skills. A good social network provides for emotional resilience, reduces stress, and builds empathy. These relationships can be formed with family, friends, or a romantic significant other. Signs of good social health include being yourself in all situations, being respectful and engaging with others in the community, maintaining friendships, having clear, respected boundaries with friends and family that foster support, understanding, and conversation, and having healthy conflict management that uses assertive skills, not passive or aggressive actions.

The US Department of Health and Human Services states “mental health includes our emotional, psychological, and social well-being.” Mental health affects our perception of ourselves, others, and our environment as well as our coping mechanisms. This area of health allows us to participate in society, reach our full potential, and become productive individuals. Mental health affects children and adults alike. Approximately 20% of all children under the age of 18 have a mental disorder. Mental health and its associated diseases can be managed through the assistance of a medical professional or trained specialist in the mental health field, but it can also be assisted by your own personal habits. Things such as these include good sleep habits, regular exercise, and maintaining social interactions with others.

Physical Health is commonly called physical wellness. This is the health of the physical body, and it includes sleep, exercise and diet. Some tips to maintain physical wellness include engaging in physical activity everyday for at least 30 minutes in total, eating healthy, well balanced foods, with controlled portion sizes, and maintaining a sleep schedule and get between 7-9 hours of sleep every night. Most of these tips sound like common sense, but good personal health hygiene are the foundations of healthy living.

On the other hand, the definition of a disease is a bit harder to define since what we categorize as diseases has changed over time . What defines someone ill is mostly due to symptoms or a recognized deviation from the normal status quo. An infectious disease is defined as an illness caused by a microscopic pathogen that is contagious between people, and sometimes can be exchanged between humans and animals in the case of zoonotic diseases. Zoonotic diseases are spread from animals to humans through direct contact, waste, or through vectors , which are organisms that can transmit diseases between humans and animals. Examples of vectors are mosquitos, fleas, ticks, and snails. According to the WHO “Every year there are more than 1 billion cases and over 1 million deaths from vector-borne diseases.” These can include things such as malaria, Zika, and Lyme disease.

Other types of diseases include many other types of conditions. For example foodborne illnesses as I have outlined in a previous post are a type of infectious disease caused by bacteria in food. Non-communicable diseases are conditions that are not caused by infectious agents. These are often genetic abnormalities or lifestyle diseases.

While most diseases we consider are physical ailments, any area of health can be affected. This includes mental illness, which is categorized as any disorder that affects your mood, thinking, or behavior. This range of diagnoses are just as broad as the types of physical ailments identified. Additionally, this category is among one of the most changing fields in health and disease, as evident by the Diagnostic and Statistical Manual of Mental Disorders, which is in its 5th edition.

The fundamental elements of healthcare are the concepts of health and disease. The conditions categorized as abnormal and in need of medical treatment are the basis of the function of medical professionals. Although this first part of my Healthcare series may seem to only skim the surface, it is integral to have a solid understanding and foundation for us to continue to build out discussion of the healthcare system.

Parts 2, 3, 4, and 5 can be found on the blog!