1a: The two common strategies that health insurance companies in the U. S. apply to maximize their profit is by increasing cost and decreasing coverage. The U. S. maximizes cost by increasing cost of prescription pill and charging for malpractice insurance. U. S. charges ten times more for prescription medication and One-hundred time more for malpractice insurance than other developed countries. (Reid 2010). The U. S is also maximizing profit by decreasing the number of people eligible for coverage through a “patchwork” system.
For instance, those with preexisting conditions will be refused coverage since they’re already ill. Another method is through the “medical loss ratio” and it refers to the loss that insurance companies will face when treating a patient (Reid 2010). That is why insurance companies spend approximately 60-65% towards coverage and the remaining 30-40% toward profit or administrative cost (Lo 2017). 1b: The Affordable Care Act has implemented some changes that have affected the deployment of the strategies above.
The ACA has expanded coverage to approximately 20 million people by not cherry picking e. g. pre-existing conditions, making it an individual mandate, and by providing government subsidies (Lo 2017). These changes have affected the insurance companies since they are now covering 20 million people that they didn’t have previous and they no longer deny patients based of preexisting conditions (Reid 2010). In all, more people insured the more the insurance companies can profit from, but this will be a process. 1c.
If the ACA had been passed before Sheila’s diagnosis she would have received the care she needed early since the ACA covers pre-existing conditions and will less wait time. With ACA, she would have continued her chemotherapy and perhaps attend to the tumors instantly rather being able to remove them after they had spread. Women who are diagnosed, but uninsured are twice as likely to die of breast cancer (Vo 2012). Sheila was part of this statistic once her husband lost his job.
In this situation Shelia’s could have utilized the ACA in helping her get the treatments needed if it was passed before her diagnosis. a: Our employment based health insurance system is not in line with the policy recommendation that was discussed in the article. The two-policy recommendation that Phelan and his colleagues (2010) is to reduce resource inequality and have interventions towards dealing with contextual risk factors. It’s difficult to reduce resource inequality when there is already a misconception of how much resources are being distributed amongst different classes. The top 20% has access to over 80% of resources, but American believe that number is just below 60% (Lo 2017).
Annual income matters in what kind of resources one has access to and that cannot be altered without resistance from the government officials and the top earners in the U. S. , therefore it’s not lined up with the policy recommendations. The other policy recommendation is the intervention of reduce individual risk created by structural factors (Phelan et al. 2010). For instance, those in lower SES who tend to live in areas with limited access to healthy food causes them to consuming harmful products that results in chronic diseases (Lo 2017).
People from lower SES do not receive similar health insurance as the upper class, therefore they have limited access to even getting proper treatment. 2b: Class is a “fundamental cause” for health disparities because it affects resources, the kind of lifestyle one can have, and the control over that life. The resources that Phelan et at. mention are power, prestige, knowledge, money, and social capital (2010). People with lower SES have an unequal distribution of these resource provided to them which makes it difficult for them to prevent, protect or even treat health issues.
In contrast, those with the resource can utilize them when need to maintain health and prolong their life (Phelan et al. 2010). Lower SES also means having a different lifestyle compared to upper class. People with higher incomes can live in an area with better quality air, better neighborhoods, and have more options to healthier products. On the other hand, those with lower income tend to suffer more from asthma because they tend to live in a city that consists of most the air pollution, neighborhoods that are unsafe that prevents them from activities e. g. unning, and tend to be near liquor stores (Unnatural Causes).
The amount of control one has in their jobs has tremendous impact on health and 1 in 5 men have a high demand, low control job (Unnatural Causes). Lack of control over a job or your own life is stress producing therefore it can increase risk of health issues. Class is a fundamental cause for health disparities because of resources and structural conditions produce restraints for lower SES and not the upper class. 2c: Sheila’s family exhausted all the resources they had within 6 months after her husband lost his job (Vo 2011).
Her husband losing his job lead to less power, prestige, and social capital than they had previously acquired. This became an issue because later Sheila could not receive Medicare as quickly because of her class status resulting in delayed treatments. Sheila’s case is an example of the middle-class is being squeezed pushing them down the ladder that’s contributing to a growing working class (Lo 2017). This an ongoing concern because the income gap is widening and it’s benefiting the upper 20% of the population.
The continuous growth gap is resulting in even more of an unequal distribution of resources and health disparities amongst different classes. 2d: The three race-related flexible resources are prestige, beneficial social connections, and freedom. Phelan and Link, define prestige refers to the honor that someone has in society, beneficial social connection is related to the neighborhood effect, and freedom, is the control own life (2015). Implicit biases and racial stereotyping are lowering the level of prestige for blacks than whites.
Doctors view black patients to be less intelligent, get involved in risky behavior, and follow less of medical advice than whites (Lo 2017). The white population isn’t dealing with segregated racism either enabling them to have a wider range of beneficial social connections. The black population tend to live in neighborhoods with lower socioeconomic resources in result limiting beneficial connections that can lead to higher paying jobs, getting admitted to college, or access to political power holders (Phelan and Link 2015). Mass incarceration of black males also lead to the unequal distribution of these resources.
Between 1965 and 1969 imprisonment of black Americans was 9 time more than whites (Phelan and Link 2015). This lack of freedom connects back to prestige and power and it’s evident that black population has disproportionately less of these resources than whites. 2e: Yes, she did. Sheila’s case was to be significant enough to be featured in front page of the New York times where she later got the attention of a doctor that helped her. Her story was published because of the beneficial social connections that came with living in the neighborhood that she did.
Sheila could get noticed for panhandling on the streets because it must’ve been uncommon to do that in her neighborhood. Being published also allowed others to reach Sheila’s story and reach out to help her family by paying for their home and food for about a year. This allowed them to have the freedom to continue living the neighborhood that they did and not have to sacrifice their home for financial support. 3a: Three major mechanisms that help control the cost in the German system are non-profit insurance system, competition, and transparency.
Having a non- profit system cut cost since they can take care of people before they get chronically ill and it’s cheaper than treating people once they are sick. Growth in sickness funds are important in Germany because it increases employment and prestige as well. This system maximizes competition between non-profit insurance companies which cuts down on spending because sickness funds compete for members therefore, claims and care don’t get denied. Transparency in the also help control cost.
This is mainly in the administrative cost and since 90% of German population are in the same system so there is no extra cost to hire people to do the paperwork and figure out what plan the individual’s fits (pbs. org). 3b: First, the ACA has expanded coverage to approximately 20 million people. Second, it has addressed the issue with pre-existing conditions by not allowing insurance companies to cherry pick member, provided government subsidies so that low-income families could have health insurance, and made it an individual mandate requiring people to purchase health insurance (Reid 2010).
Third, it has limited the medical loss ratio from 60-65% to 80-85% providing more treatments and coverage (Lo 2017). When it comes to cost medical control, the ACA has failed to address the issue with administrative cost which is 17% of GDP. Second, they failed to address the high price malpractice insurance that insurance companies charge. Lastly, the insurance companies are still for profit which means they deny any claims which is leading to more medical bill for people (Reid 2010). 3c: Yes, the healthcare system in the U. S. needs to change.
One key lesson that the U. S. can take away from Switzerland and Taiwan is looking at other examples of healthcare systems. In Taiwan, they looked at the healthcare system from six industrialized countries and decided what improves economy and social welfare. They chose to apply the Canadian model, but modifying that it’s not funded through general taxation, but through people paying through individual payments on health insurance (Reid 2010). In Switzerland, they applied the Bismarck Model that Germany and France follow resulting in more insured people.
The U. S. could view other nations to compare what is economically and socially beneficial for everyone. This is to gain some knowledge and understanding that we are spending far too much of administrative cost because is not efficient in helping people and it’s resulting in more health disparities. This is in the hope that if the U. S. will gain more understanding of the ineffectiveness of the healthcare system leading to the two-political party to unify and decided that Universal Health is not only good for social welfare, but economically beneficial and effective.
