Abstract

As healthcare costs rise insurance companies are reforming medical insurance plans for their customers. New plans are offering lower amounts of coverage for a higher premium and an even higher deductible. Insurance companies are shifting the cost of healthcare onto American citizens, expecting them to be able to pay for the large majority of medical care treatments out of their own pockets. American’s invest in insurance to avoid falling into lifelong debt from a surprise illness or medical need. Through shifting the hefty cost of medical care onto American citizens, insurance companies are negatively impacting the level of care being provided by medical professionals. Everyday Americans might not be able to afford the cost of their medical treatments when the insurance that they pay for suddenly no longer covers most of the bill. Some patients have to forgo treatments altogether or try cheaper solutions that are not as effective as others because it will be impossible for them to pay for otherwise. The quality of healthcare in America is facing a roadblock because insurance companies are not offering comprehensive medical coverage to citizens.  

How Insurance Companies Impact Healthcare in America

Medical care has been a prevalent force in lengthening the lifespans of people across the globe. As technology advances, medical care becomes increasingly more comprehensive. Diseases that have previously deemed fatal are now treatable and patients have multiple treatment options available. While preventive care and treatments have surpassed what once seemed impossible, the ability to receive care without incurring a monumental amount of debt has become staggeringly low. Inflation has caused the wages of medical providers such as doctors, respiratory therapists and nurses to increase thus creating a direct relationship in price of care being provided. Healthcare costs have skyrocketed, and insurance companies are not reevaluating healthcare plans so that their customers can receive the care they need. Instead of creating new comprehensive health insurance plans to adjust for the change in costs of healthcare, insurance companies have resorted to higher premiums for lower coverage and higher deductibles on any care necessary for a patient. Insurance companies are businesses looking to make substantial amounts of money from their customers. By charging more for an insurance plan that will not offer extensive coverage for any medical treatment insurance companies are guaranteed to make money, thoroughly protecting themselves from the rising costs of healthcare. Without quality insurance being offered to consumers the costs of medical treatments are shifting into the pocketbooks of everyday Americans thus negatively impacting the ability of healthcare providers to supply proper and comprehensive treatment to patients.

The cost of healthcare in America has increased exponentially in the recent years, and Americans are suffering from the inability to afford vital care without becoming laden down with massive amounts of debt from their medical bills. Even patients with insurance can expect large bills to arrive at their doorstep with their insurance companies covering only a minimal amount of the cost. In a study conducted by the Organization for Economic Cooperation and Development (2010), it was revealed that Americans pay over twice as much for healthcare administration and insurance costs compared to countries such as France, Canada, Switzerland, Germany and New Zealand. With such high costs for healthcare, hospitals have become increasingly adamant on receiving payment before providing care so that the risk of losing out on substantial amounts of money are lowered. In Maitland, Florida a woman by the name of Susan Bradshaw was brought into the emergency room and in desperate need of surgery to remove her appendix. Yet, while Bradshaw was being wheeled into the hospital on a gurney she was told that she would need to “make her $1,400 insurance payment before the surgery could proceed” (Andrews, 2016). Expecting Americans to be financially capable of paying large sums of money before a receiving health care is preposterous, as insurance companies have shifted the cost of medical care on to their customers they have also effectively forced hospitals to place patients in a position where they either drain their bank accounts or have to refuse care. Washington University’s Law Review shared that “the United States is the only economically developed country where a slip and fall and a trip to the emergency room could spell financial ruin or bankruptcy” (Washington University, 2007). In a country of extraordinary comprehensive care, insurance companies have placed American patients in a state of choosing between financial distress, or the care that they need. With the shift in healthcare cost to patients, the burden of medical debt is weighing down the pockets of everyday consumers. As more debt is placed upon American people from medical bills they begin stressing about paying back momentous sums of money as opposed to focusing on fully recuperating. The nature of medical bills that patients are often marooned with are confusing and arduous to sort through, making it even more complicated for patients to pay off.

Peering into the complicated systems of hospital billing and medical care costs often results in confusion surrounding the validity of expenses incurred while a patient was receiving care. Washington University shares that there is an “opaque and a la carte nature of medical bills, such as the unanticipated facility fees that may be added to a physician's fees for outpatient care” (Washington University, 2007). Hospitals have been accused of overcharging for simple care, which in some sense is reasonable. Walking into a local emergency room can cost a patient near three hundred dollars...not including any supplies or services provided. Three hundred dollars however is just a base price, for John Elfrank-Dana, a man who slipped, hit his head, and then had to have emergency surgery the price for his trip totaled up to over one hundred thousand dollars even after his insurance had paid their part. The reason his bill was so expensive was because “some of the physicians who treated him were out-of-network” (Washington University, 2007). Elfrank-Dana couldn’t tell the doctors that were out-of-network for his insurance plan that they couldn’t operate on him because he was incapacitated, but because his insurance did not want to cover certain doctors the man was left with no choice but to pay bills that there was no way in knowing that he even incurred. Receiving bills with exorbitant fees for care that a patient was not aware of incurring, and had no say or power over is shocking for everyday American citizens. Medical bills can easily reach hundreds of thousands of dollars, to what extent is a patient responsible for extra fees they weren’t aware of incurring? Like Elfrank-Dana, patients across the country want to receive the best care possible and healthcare providers most often want to give patients care that will heal them quickly. George Lundberg, former editor for the journal of the American Medical Association, faculty member at Northwestern University in Illinois and at the Public School of Health at Harvard speculates that both “patients and physicians now seem caught in a new system of health insurance coverage that neither group likes” and that “both are keenly aware that insurance itself does not guarantee good patient care” (Lundberg, 2000). A majority of healthcare providers strive to give the most comprehensive care to their patients as possible, focusing not on the price of the treatments but instead the wellbeing of their patients. Insurance companies are preventing medical care providers from supplying the necessary treatments to patients in fear that they will not be paid for their services. Patients want and need the best care possible so that they can return to work to pay for the care they receive and their insurance. By reducing coverage and increasing the prices for consumers insurance companies have taken American patients focus off of healing and onto their overwhelming medical bills. Medical bills are costly and it may be hard for insurance agencies to keep profit up as the price for healthcare continues to rise.

Insurance companies are businesses, and have to make money in order to continue to provide stable coverage for their customers. However, in recent years medical insurance has begun to negatively affect the health care being provided to patients across the United States. Healthcare should be streamlined from the provider to the patient and then the insurance agency. Researcher Mark McClellan (2007) shares in an article that medical insurance “coverage that shifts costs to beneficiaries without lowering overall costs—or perhaps increasing them—does not increase efficiency”. Raising the cost of insurance while not offering better packages with more value is creating inefficient medical care for patients and providers alike. Insurance companies are failing to create comprehensive healthcare plans to offer modern and comprehensive coverage both for treatments and preventative care. For North Metro Medical Center (NMMC) the shift in payment responsibility from insurance to patients has “required a shift in process, technology and training for NMMC” (PR Newswire, 2018). Hospitals like NMMC now have to shift focus and resources away from patient care and onto how they are going to collect payment from their sick patients, all due to insurance companies falling behind in providing inclusive coverage for their customers. Insurance companies are raising deductibles as a way to protect themselves from increasing healthcare costs. According to a survey by the Kaiser Family Foundation “Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year” (Andrews, 2016). Washington University found that “deductibles have more than tripled in the past decade from $303 on average in 2006 to $1221 in 2016” (Washington University, 2007). The response to an increase of price in healthcare that Americans are seeing from insurance companies is to merely just charge more for the same, if not worse coverage. One has to take into account that insurance companies are trying to make money off of the plans that they offer. But where does the business end and the moral obligation begin? According to a survey by the Doctor-Patients Rights Project “as many as 53 million Americans...may be in jeopardy by insurance providers who deny coverage for their treatments” (Worthy, 2017). When American citizens have to choose to forgo treatment because their insurance providers are denying coverage for illnesses then the situation needs to be reevaluated. To a certain extent there is a moral obligation to insurance companies customers to aid in treatments for their illnesses. The health of American citizens is decaying, not because of healthcare providers or patients’ faults, but because of insurance companies inability to provide comprehensive medical insurance policies.

While insurance companies are denying or not providing adequate coverage for their customers, they have also found a way to save money by adjusting their customers treatments and medicines as prescribed by their doctors. There are two main approaches insurance companies often take in order to save money on medical care, as outlined by David Grasso in his study “Insurance Companies Are Rejecting Doctor’s Orders To Save Money”. The first tactic is called ‘prior authorization’ which requires that a doctor has to ask the insurance company if it is alright to prescribe treatments. The second common practice is named ‘step therapy’ in which doctors are instructed to prescribe cheaper medications that might work instead of one that may be more expensive but work better (Grasso, 2017). Insurance companies should not be in the way of medical treatments being prescribed by a trained medical professional. Doctors attended eight years of training to diagnose and treat patients, insurance companies do not have the medical knowledge to have influence on how a patient will be treated. Lundberg (2000) again weighs into the issue of insurance companies having a say in how patients are treated by stating that “insurance coverage decisions should be made by the medical profession and by a fully informed public” and that “the profession should be responsible for restraining the overuse of expensive medical services, and proven preventive measures should be available without question”. While insurance companies do pay for some treatments they should not have influence over what and how a patient is going to be treated. Health care professionals are trained to prescribe and suggest treatments they should only offer different solutions that may also be viable options if they deem it necessary. Even then it is up to the patient to decide if they would like a cheaper treatment alternative. In an article posted by Psychiatry MMC, real doctors answer questions in regard to providing care for patients who struggle to pay. In any situation the article stresses that “the doctor must remain mindful that the standard of care...is determined by a patient’s clinical needs, not by the patient’s finances” (Psychiatry MMC, 2009). When insurance companies are influencing standards of care provided by healthcare professionals the standard of care being given to the patient is lowered. As it is no longer wholly dedicated to what is best for the patient, but what is best financially for the large corporation that will end up paying part of the bill. Insurance companies are subtracting from the quality of care being provided to American patients by holding potential profit over the wellbeing of their patients. American citizens’ health are being jeopardized because insurance providers are failing to provide comprehensive coverage for customers.

The quality of healthcare being delivered to American citizens has the potential to be the most advanced in the world. However, with the rising costs of healthcare is not being accounted for in health insurance plans American citizens are opting out on the care that they need. Insurance companies have the opportunity to provide comprehensive plans for customers that will increase profit margins and will also give patients care that will help to prevent and treat illnesses.