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Fixing The Health Care System In America

1538 words - 6 pages

For the last five years of my life I have worked in the healthcare industry. One of the biggest issues plaguing our nation today has been the ever rising cost of health care. If we don't get costs under control, we risk losing the entire system, as well as potentially crippling our economy. For the sake of our future, we must find a way to lower the cost of health care in this nation.
Last year the average cost of an insurance policy for a family of four was $20,728.00 according to the Milliman Medical Index (2012 Milliman Medical Index, figure 1). The median household income for 2012 was $51,017.00 according to Steve Hargreaves for CNN Money (2013, para. 1). This means the average American spends almost 40.62 percent of health care premiums. This figure is simply too high to sustain. By comparison the median household income in 2005 was $67,019 according to the United States Census Bureau ( Median Income for 4-Person Families n.d.). The average cost of healthcare according to the Milliman Medical Index for 2005 was $12,214 which was only 18.22 percent. (2005 Milliman Medical Index, figure 1). The percentage Americans spend on health care has more than doubled since 2005. If we don't find a way to get the costs of providing health care under control, then this country cannot survive.
One of the biggest contributors to health care costs that I have seen during my time in the healthcare industry is insurance fraud. One example of such fraud came about two months ago. I was taking a phone call from a provider that was upset that one of their claims had denied even though all of their previous claims had been paid. In researching with a partner plan it was determined that the claim denied because this medical provider was not in the HMO network. Since this claim had denied, all of the previous claims should have denied as well. Rather than having the other claims adjusted, the provider insisted that we not look into the matter further because they did not want us to take back any money. Sadly this is just one example of fraud; it is not uncommon to see providers change the coding of claims to get something that they know should not be paid to process for payment. Cracking down on this type of fraud will reduce the amount of money paid out on claims by insurance carriers. Since claims payments directly affect the cost of insurance, this will also help in lowering premiums.
Another issue contributing to the high cost of health care is inefficient use of premium dollars from insurance companies. I am proud to say that the insurance company I work for does a great job of making proper use of insurance premiums. As a company we use on average 8 cents of every premium dollar. This means that 92 Percent of each dollar goes to paying patient's claims and building reserves. Unfortunately this is not as common as it should be. According to Harvard's David Cutler who is among the country's foremost health economists, our...

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