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Beyond Reform: Health Care Industry Efforts Hold Key To Access



February 6th, 2013
by Carrie Valiant

Now that the Obama Administration has secured a second term, health reform is a “go”.  Yet, gaps and questions remain, some of them potentially far more substantial than originally anticipated.  While the mandate on individuals to purchase health insurance has survived as a “tax,” states will have much more flexibility to opt in or out of expanded Medicaid coverage without losing all of their federal Medicaid funding.  And there is always the possibility of further cuts.

In the meantime, “wait and see” is no longer an option. With a “cup half full” vision, health reform can be viewed as a basic platform from which gaps can be filled.  How can we make the most of this platform?  How can we connect the people to the coverage offered by the exchanges and persuade people to buy it?  How can we connect the people who buy coverage to the care they will need? And how can we do so in a way that doesn’t break the bank?

Some answers to these questions are offered below.  I also invite you to join us on February 13-14, 2013 in Washington, D.C. at the Health Care Industry Access Initiative’s Access Summit where you can hear more from our experts in a variety of panel discussions about what will and won’t work to achieve access, and how health industry efforts are key to access and, in turn, the success of health reform.

If We Build The Exchanges, Will The Uninsured Come?

Much has been said about state delay and refusal to establish exchanges as a bad omen for health reform.  But even the original Medicaid program adopted in 1965 did not have all of the states stepping up at first, with Arizona trailing the pack until as late as 1982 when it finally adopted a Medicaid managed care system pursuant to a federal waiver.

Eighteen states (including DC) already have filed blueprints with the feds to establish exchanges, and another seven are currently planning federal/state partnership exchanges.  These states include Massachusetts, of course, but also California, where nearly 10 percent of the current uninsured population resides.  Other states may do so later, perhaps in response to a federally operated exchange, or because it ultimately becomes the will of the people.

Politics aside, the success (or failure) of the opt-in states will inform the decisions of the states now choosing to sit on the sidelines. Thus, states that decide to move forward to create exchanges can serve as “laboratories” for health care access strategies.

But, unlike the “field of dreams,” just because exchanges are built does not mean that people will come automatically to buy health insurance.  For some, the pain of the individual mandate penalty may simply not be severe enough to overcome the cost of health insurance.  We already know from previous experience, including SCHIP and the more recent ACA high-risk pool, that many who qualify for existing health care coverage programs don’t enroll in them for reasons including cost, lack of knowledge, the stigma of public assistance, and the simple lack of time.

How can we make the exchanges that are adopted robust marketplaces that promote the benefits and rewards of health coverage effectively?  How can we make it easy for people to demonstrate eligibility and then to choose and enroll in a health plan?  And once they are enrolled, how can we keep people in the system, without inadvertent drops in coverage from reenrollment glitches?

Experiments with in-store kiosks, on-line purchasing, collaborations between insurers and big box retailers, and similar steps to become consumer-friendly are showing promise for connecting people with coverage.  So, too, are technological advancements, including “apps,” that can connect younger, healthier people to insurance coverage.  As a result, companies in technology and retail are becoming health care companies in unprecedented numbers.

Success in health reform will depend on knowing the customer and tailoring products and approaches accordingly.  So what do we already know about the exchange-eligible population?  It is an ethnic, working population largely hailing from Latin American countries that lack a culture of health insurance. They are busy– often working multiple jobs without employer-sponsored health insurance – and have little time to choose among health plan options.  Mass mailings, which worked well for the Medicare Part D senior population, are not necessarily successful with this anticipated exchange-eligible population. Repeated personal contacts, especially by trusted individuals, do work.

If The Uninsured Obtain Coverage, Can They Obtain Access To Care?

Just because people sign up to buy insurance (or qualify for expanded Medicaid) does not mean that they will be able to access health care services. Finding a physician willing to take on new patients is a considerable challenge and will remain so given the work force shortage of qualified health professionals.  Thus, many newly insured will end up in hospital emergency departments for care that is more cost-effectively provided elsewhere.

How do we connect the newly covered population to health care services?  Innovative care models are relying more on non-physicians — indeed, non-health professionals — to reach out to patients to ensure patient compliance with drug regimens and check on patient health status without the necessity of an office visit.  Other models are making health care services more convenient and “user-friendly” — moving beyond “bankers’ hours” care in professional buildings to after-hours care and convenient clinics located where people work and shop. Current experiments with reconfigured old solutions like physician house calls also are showing promise, as are technology-based solutions that can triage patient problems without costly emergency department visits.

How Can Cost Transparency And Wellness Contribute To Access?

Of course, the “elephant in the room” continues to be cost — not only the cost of purchasing health insurance, but the ongoing out-of-pocket costs associated with obtaining health care services. While there was good news last year that health insurance cost increases had moderated, recent reports are showing an uptick in rates.  And as the Massachusetts experience has shown, health reform alone won’t keep people from experiencing financial problems, including bankruptcies, from large, out-of-pocket health care costs.  Health plans available on the exchanges will likely have similarly large coinsurance and deductible consumer obligations as well, making consumer cost a key access issue despite health reform.

How do we take the mystery out of health care pricing so people will know what they are paying up front, not after the service is furnished?  Certainly people will be more likely to get the care they need when they know in advance what it costs. Web sites are beginning to emerge which provide comparative information on health care services, allowing consumers and employers to shop for them.  Insurers and employers both are seeking to provide cost-effective care networks through medical tourism and contracts with centers of excellence.

Ultimately, the question is how do we keep people from needing costly health care services in the first place?  After all, being healthy is not just about obtaining health care services, and healthy people won’t need expensive health care services.  Wellness programs (diet, exercise, smoking cessation and the like) are important, but let’s not overlook public health solutions that have proven effective in third world nations and can work here, too.

Typically focused on a broad perspective well beyond treatment by health professionals and facilities, public health solutions look instead to the larger issue of people’s living environments — the air they breathe, the water they drink — and how those environments can contribute to disease.  Emergency room visits and hospital admissions for asthma complications, for instance, can be radically reduced when mold is removed from housing. Infant deaths from SIDS can be largely avoided when portable cribs are made available to transient families. New organizations are taking on the task of connecting patients to social services that can address the source of their health care problems.

The Health Care Industry Access Initiative Summit.

The next few years pose an unprecedented opportunity for the health care industry to both “do good” and “do well.”  The challenge will be to embrace these fresh ideas for enhancing health care access and scale them to reach the larger population of health care consumers, and to collaborate across the health care industry to do business in a new way that is patient-focused, customer friendly and cost effective.

The Access Summit will focus on these challenges on February 13-14, 2013 in Washington, DC. For more information about the Summit, click here.

The Health Care Industry Access Initiative is a nonprofit, tax-exempt organization dedicated to promoting collaboration across the health care industry to improve access to health care coverage and services in the U.S.  We invite you to join us for a day of strategic thinking in keynote and panel discussions designed to develop and promote best practices for accomplishing health care access and, in turn, success in health reform.  This is an opportunity for senior health care executives to make a difference!  We will record key portions of the Access Summit and publish the results.

We look forward to seeing you!

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29 Responses to “Beyond Reform: Health Care Industry Efforts Hold Key To Access”

  1. Bassem Zeidan Says:

    Variant brings up excellent issues regarding -cost transparency and wellness contributing to access as well as ability to access health care with the increased number of insure. The first issue is important as although the number of insured has increased, it will be more difficult to prioritize care as health providers and services are limited. In order to reduce the number of sick, it may be beneficial to focus more on preventative measures to inhibit or slow down the influx of patients that need medical attention. Focusing on preventative medicine (immunizations and boosters) may be one step in order to prevent the rise of costs vs services with the increased insured. Another method maybe more in depth education programs for all ages and youth as running these would be much cheaper than paying for health services of illnesses that could have been otherwise prevented due to proper education in the long run. Variant also brings the idea of ability to access health care in general with the increased number of insured and limited number of services. One suggestion would be opening up more job sectors in the health field and possibly offering bridge programs for Physician Assistant and Nurse Practitioner to better take the role of General Practicing physicians leaving them for more specialized roles. Opening more lower scale medical jobs run by the government may also be a substantial step in order to aid the increase number of patients.

  2. ruthmartinez27 Says:

    One of the problem that the Affordable Care Act will be bring forth will be how will the health care system handle a large influx in their population and how will these people receive care. The health care system will be expanded to 47 million people that were previously uninsured but the amount of physicians and medical personnel will not increase. There is concern how these people may get access and how efficient consultations can be. One idea is to have more nurse practitioners and physician assistants per clinic therefore increasing the amount of people that can see the patients. Another suggestion is to educate the population with public health issues and preventative practices they can do at home to increase their health and decrease the possibility of illness. The approach of educating individuals will be extremely helpful in rural communities that do not have easy access to any medical care.

  3. Tamara Chin Says:

    Many of my peers have already mentioned the key points of this article, and have brought up many good points. Some of the main themes I see as I’ve been perusing through the responses are proper education, the role of health IT, and the question of whether or not the uninsured population will actual “jump on the bandwagon” and participate in the Health Exchanges and other programs set up to help the uninsured become insured.

    For the point of proper education: I agree that this in particular is key to the success of the ACA. Although it is unfortunate, there is a large population within the United States that is not well-educated about how the current healthcare system works, let alone what the ACA is and how that will both positively and negatively affect their outcomes from both health/wellness and economical perspectives. In order to achieve this, there needs to be easy to understand and easily accessible pamphlets, videos, etc. for Americans so they may do this own their own time. I think Callie’s point of having pamphlets within waiting rooms is a great idea. Although, obviously, there will always be a population who will not want to educate themselves, it is important that we are reaching those who want and need to know more about the changing system.

    As for Health IT — although I agree that modern technology can aid many healthcare processes, especially helping people “shop” for insurance plans, I agree with a point that Keila brought up. User friendly apps and websites may be all the rage right now in most industries, however we need to remember that not everyone has a smartphone and older American citizens, who make up a large portion of our population, may not know how to use these resources appropriately. Thus, I believe it is extremely important to ensure interpersonal contact. Although that may be a more expensive endeavor because electronic tools can be more cost-effective, I believe being able to talk to someone face-to-face about your health insurance will be more qualitatively effective. Many Americans are uncomfortable with the prospect of their private health information being handled completely electronically, thus I believe Exchange programs will go more smoothly with more participation across the country if it can be handled in this manner either exclusively or alongside an electronic option.

    Lastly, although I understand that there is a growing concern whether or not the uninsured will even participate in these exchanges, and whether or not these populations will be satisfied with the quality of care if their primary and acute care needs are handled in health homes and walk-in clinics, as many of my peers have mentioned. I believe we need to remember that we are not talking about the already insured — for these people will most likely stick to the same doctors and providers they’re currently seeing. We are discussing the UNINSURED — the people who have had to pay out of pocket for services or wait until their ailment has progressed so badly that they’ve needed to seek expensive emergency care. I am confident that this population will be grateful for any type of covered care they can receive, regardless of the setting, because it is certainly better than the alternative.

  4. KeilaSole Says:

    This article sheds light on some of the biggest questions that exist surrounding the implementation of the Affordable Care Act. The health care exchanges are imperative, yet not all states have agreed to develop their own state exchange programs. A federal exchange will be implemented in states that refuse actions, however, I believe it would be ideal if all states were mandated to develop their own individual program. Each state has specific needs and would be better able to combine a state and federal programs to encourage purchase from each states local insurance companies. Furthermore, the health care exchanges don’t guarantee that the uninsured will buy health insurance. I believe that the penalty for not buying insurance is too low to fully promote universal insurance, and these taxes should therefore increase every year that an individual refuses to purchase insurance. I further agree with Faith Rialem that greater incentives such as coupons for care should be given to encourage greater participation, and moreover, the use of medical care.

    Technical advancements such as apps and kiosks will help in aiding younger consumers enroll in a health plan, but believe that greater in-person insurance “stores” would help attract participation from other older or minority populations who may prefer a more personable experience. For example, Florida Blue has retail stores where consumers can shop for coverage with the help of an employee, rather than dealing with a stranger over the phone. Furthermore, these types of locations provide in-person customer service for questions regarding coverage or claims, and their accessibility can help retain customers. Also, education will be essential in this implementation because as the Carrie Valiant states there are many citizens that currently qualify for health care programs but don’t take advantage of the opportunities because of factors other than cost including “lack of knowledge, the stigma of public assistance, and the simple lack of time.”

    I agree with Carrie Valiant of the greatest challenges of the Affordable Care Act will be to get newly insured consumers to start using their coverage. This population is unfamiliar with routinely seeking and utilizing medical care, and may not have the same access to care because of their locations and transportation issues. Innovative care models and greater technology-based solutions will help aid these problems and the development of telehealth solutions should be prioritized especially as the shortage of healthcare providers will worsen after millions more obtain coverage. Electronic medical records will improve the quality of care and lower wait times for patients and physicians, and the development of more virtual clinic and health care settings will improve access to those in need.

  5. sofiaoussein Says:

    Carrie Valiant made fundamental points here; however, there are 2 main points that I found extremely relevant. The first point is to make sure that the new people that become eligible for coverage are able to have access to care. The newly covered population will need to be guided throughout the system so they could fully take advantage of the services offered by the health care coverage. According to the article, the ACA offer to reach out to patients to ensure patient compliance with drug regiments, check on patient health statue without the necessity of an office visit, create apps that can connect with younger healthier people, make health care services “user-friendly” and instill convenient clinics located where people work and shop. Although these measures will help the newly covered population, I think the first measure that should be put in place is to educate them about the health care system so they could be their own health advocate and be able to use the system efficiently. Education is fundamental, without it the newly insured won’t understand how to manage their healthcare coverage.
    The second point is about the cost transparency and how it could contribute to the access of health care for the newly covered population. The majority of people chose to be uninsured because of the high and unstable cost of health coverage. Unfortunately now in days, the health care system is run like a business, the insurers are aiming to make money for their own benefit. According to Variant, there are websites available that provide comparative information on health care services so that consumer and employers will be to choose which care is more beneficial for them. The insurers and employers are also participating into the improvement of the health care system by offering cost-effective care networks. Another solution that should be taken in consideration is to have a single payer (federal government) running our health care system. Such measure will decrease the competition driven by the multiple parties’ payers and their physicians; it will reduce the different prices providers have to pay to different health coverage and will provide stability which will reassure consumers by giving them fixed cost.
    Faith Rialem brought an interesting aspect that the author briefly talks about. In order to have a healthier population there is an urge to understand the connection between public health and medical science. Developing new reform to improve our health system is a great initiative; however, the most efficient way to obtain an overall healthy population is to address the root of our problems. What is the point to have an effective health care system if we can’t keep our population healthy? The same amount of effort put to ameliorate our healthcare system should be applied into preventive medicine, and into controlling diseases.

  6. SophiaDekhtyar Says:

    I think the passage contains a convolution of issues which may be circumventing the larger issue, which is elaborated towards the latter portion of the text- the issue of public health and governance.
    As a nation, if we invest in infrastructure, we have the possibility of eliminating many of the leading causes of a necessity for socialized healthcare. Examples such as emergency room visits for chronic respiratory issues due to poor ventilation in public transportation,  T2 diabetes due to lack of healthy food options within public schools, or lung cancer due to urban smog levels exceeding norms of other nations.
    The text highlights a very true and fundamental issue; we are at constant conflict with the lack of information versus the necessity to care for our poor, elderly and sick. The cost of healthcare may be readily available for all to absorb, however that still does not eliminate our necessity for caretakers of our nation to perform their duties, which is the guarantee of life, liberty and the pursuit of happiness.
    The only solution to the everlasting debate on healthcare is to have subsidized funding from a plethora of sources investing within infrastructure, which in a cumulative effect would drastically cut our outstanding health issues. It should come without shock that most sicknesses in the world are due to lack of basic hygiene or contamination of consumption products. If regulation is instead placed into bodies capable of mandating the administrators of the above, I believe we would not have to argue about the cost of health care.

  7. Calie Donnelly Says:

    If the government wants to attract target populations then they have develop other methods besides mailing documents like they did for Medicare. Brochures and information packets should be available in emergency room settings where uninsured populations go the most to advertise health exchange programs. If word of mouth works in communicating the available government options for eligible-exchange populations, other forms of communication can spread among these people.

    Health care services will have to change in the future to meet the needs of the people today who seek services beyond the typical “banker hours”. Healthcare has to meet the demands of the working population. The article mentions there is some experimentation with physician house calls and this is an interesting idea. Doctor house calls could develop into one on one visits with a primary care physician, whom many people don’t utilize enough because its difficult getting an appointment due to standard office hours. If primary care physicians became readily available to people or other healthcare providers like physician assistants, nurse practitioners, nurses, and health aids then the emergency room would not longer be the first option.

    An important point Valiant discussed was how do people prevent needing costly healthcare and one of the ways we have prevented that in the past is through preventative medicine. Preventive medicine and public health has been used for the last century in resolving future disease breakouts, improving nutrition of the population, and taking better care of future generations. I think Valiant jumps to different conclusions when she says wellness programs are important but what about the other programs used in developing countries. Less expensive wellness programs that lead to greater outcomes just have to be incorporated into populations at most risk.

  8. Parth Tailor Says:

    This article is very informative and I feel is knowledge that every consumer in the nation should understand. The ACA is a law, with over 1000 pages, that is going to be implemented and as a consumer, who would want to read all of that? Every law is too long for anyone to read so this highlights the lack of knowledge one would need to realize the effect of any given law. Taking the ACA, knowledge should be readily available for all, highlighting the key aspects to the health reform that we will all be affected by in a couple months. If consumers know how something will affect them and it is presented to them in a fairly concise manner, individuals are more likely to take the time to acknowledge the information. Understanding the ACA and its effect would probably allow consumers to know what they’re in for, and in turn potentially increase the likelihood of a person buying insurance. With this, access to the information is the main concern because if a consumer cannot access the information, they won’t know anything about the health reform. If not already, things such as pamphlets or free programs should be offered to educate the population on how exactly the reform law will affect everyone.

    With the health reform, everyone knows it’s coming but knowing the consequences may not be that severe (not purchasing coverage and paying a penalty, as Carrie Valiant mentioned), consumers are obviously going to consider not purchasing. We should give consumers an even bigger reason to purchase coverage rather than just a fee.

    Regarding health information technology, one solution to developing a cost-efficient health system is the Blue Button initiative, which is an easy way for patients to download their own health information. With this, it can take the burden off providers to see patients regarding certain test results or general follow up appointments. There is going to be a huge influx of consumers come 2014, so if there is a way to ease the stress on the system, why not emphasize it? If patients have access to their health information online, it would allow individuals to improve their own health on their own, rather than taking the time to schedule an appointment with a provider. If consumers know how they can improve their own health, it can potentially reduce the use of the ER, in turn reducing costs to the health system. Even for those who may choose not purchase insurance by 2014, this opportunity should be offered at no cost in order to inform individuals on how to stay healthy. Online tests should be implemented for patients, so they can see where they stand compared to an unhealthy individual.

    Overall, I feel that the most prominent aspect of the health reform is simply the knowledge of it. As long as we recognize and understand how we will be affected, I think it should help convince the uninsured to become insured. Also, technology is rapidly advancing and with new health information technologies, it should be increasingly enforced and available to consumers as a quick and easy reference regarding their own health information. America has a long way to go but the simple steps should be considered first and we will progress from there.

  9. DylanWills21 Says:

    I agree with Faith with the two of the three aspects talked about in the article. Just because ACA is “forcing people to get coverage does not mean people will actually get coverage. There are still going to be people without health insurance, just probably less people being uninsured. It is just like laws in the United States, there are always people who break the law, even though it is a suggestion and enforced for everyone to follow. Just like healthcare, it is suggested and the ACA is saying it will force everyone to have coverage, but there is no possible way to have everyone covered. The second point with shifting power to the public is something I think that is good about the ACA. Just as Faith said, shifting the power to the public forces competition amongst insurance companies, and essential, will force competitive lower costs and better benefits to attract more customers.

  10. Shannen Mincey Says:

    When we speak of health care reform we often speak about the flaws of the insurance companies and of course, the government. Carrie Valiant takes an interesting approach to the question of how can we bring in the uninsured. It has nothing to do with changing policy. The policy is already in place. What we, future and current health care providers, need to do is make it attractive and consumer friendly. She states that the success in reform depends on knowing the customer. I agree with this view. I personally believe that we need to look at the health care industry as a product. We know the ins and outs of the latest iPhone, but not the health care system. Part of the problem is the fact that health care providers make health care extremely difficult to understand, but the other part of the problem is we don’t ask. As Carrie Valiant said, we need to promote health care. We need to promote the benefits and rewards of being covered. We need to find ways to gain the trust of those Latin Americans that are coming into our system. Konstantine had an interesting idea of making Spanish mandatory for those who want to become medical professionals. I don’t agree with making it mandatory but I do think that providing an incentive for medical professions to learn Spanish, or another language popular in their area of work, is something that should be implemented

  11. Jess Herche Says:

    The new Affordable Care Act brings into questions many issues concerning how to lower costs while also covering those who are extremely ill. The best way to combat illness is for individuals to not become sick in the first place. The best way to take on cost and accessibility is to have healthier patients who require less serious medical treatment. Both issues can be tackled simultaneously by finding a solution to severe or chronic illness. This solution is preventative health care. People should not feel obligated to wait until they are deathly ill to see a doctor, regardless of financial status. Unfortunately, if they wait that long, costs will rise and treatment will be more intensive, if even possible in some cases. The only way to combat chronic health issues and their high costs is to ensure those services are never needed. First, the availability of primary care should become a priority. According to the CDC almost eighty percent of emergency room visits are due to a lack of service available elsewhere. Similarly, almost half of the patients seen report they are present because primary care wasn’t available to them at the time of need. Access to primary care needs to be increased. With the expansion of the market with the onset of the individual mandate, the rate of insured individuals should decline. Competition will give consumers more options, leaving fewer people without access to primary care. Hopefully those who are hesitant to purchase insurance will now find more options that financial are plausible for them. Also as the eligibility for certain public benefits expands, more citizens will be covered. By regularly consulting with a primary physician, chronic and long term health problems can be avoided or diagnosed early and treated. Vaccinations, regular screenings, and other preventive measures not only help the health of the individual but also contribute to community health. Other public services should be made available, such as clean water, food options, and pollution control. All of these factors contribute to the overall health of the community. By decreasing the need for emergency care, costs for the health care system itself decreases, regardless of whether the need is due to lack of insurance and desperation or serious illness that could have been prevented. Insurance companies will be spending less by not having to cover as many emergency room visits but will still create revenue through regular primary care appointments. This will also increase income for primary physicians by encouraging new patients, even though prices for service may be lowered. Preventive medicine would prove to be both cost effective for consumers, insurance companies, and physicians and beneficial to individual and community health.

  12. John OByrne Says:

    Health care is, as shown in this article, not a black and white issue. There are many obstacles to overcome such as the lack of insurance, and whether that insurance would ultimately lead to good care. As Konstantine stated, if those that do get insurance don’t ultimately receive the care that they expect to, they will not likely want to have it. This would be a good opportunity to make use of the shortage of physicians. More nurses, nurse practitioners, and physician assistants could be utilized to provide faster and more satisfactory care. This would lead to less stress on the physicians themselves as well as providing quality care to those that need it, and stray from treating the patient as a number but rather take the time to properly treat them.
    The costs associated with healthcare still remain a large issue. As stated health care reform alone won’t result in the elimination of financial problems that are caused by medical expenses. The Affordable Care Act will hopefully encourage more people to shop around for the best deals on insurance, and actually look at what they are getting into. By creating more competition in the insurance market it will make it easier to comparatively shop for insurance, and then figure out which option is best for that individual. Of course, this also ties in with trying to contain the growing cost of care. The government could subsidize businesses that have to provide insurance for their employees, and give financial incentives to doctors that have low readmission and hospitalization rates, and would save money over time.

  13. Shannen Mincey Says:

    When we speak of health care reform we often speak about the flaws of the insurance companies and of course, the government. Carrie Valiant takes an interesting approach to the question of how can we bring in the uninsured. It has nothing to do with changing policy. The policy is already in place. What we, future health care providers, need to do is make it attractive and consumer friendly. She states that the success in reform depends on knowing the customer. I agree with this view. I personally believe that we need to look at the health care industry as a product. We know the ins and outs of the latest iPhone, but not the health care system. Part of the problem is the fact that health care providers make health care extremely difficult to understand, but the other part of the problem is we don’t ask. As Carrie Valiant said, we need to promote health care. We need to promote the benefits and rewards of being covered. We need to find ways to gain the trust of those Latin Americans that are coming into our system. Konstantine had an interesting idea of making Spanish mandatory for those who want to become medical professionals. I don’t agree with making it mandatory but I do think that providing an incentive for medical professions to learn Spanish, or another language popular in their area of work, is something that should be implemented.

  14. Chetna Datta Says:

    This article was informative, realistic and I enjoyed reading it because there is change that is coming about on the health care system that we have in the United States. There were some approachable methods of change in the article that were interesting such as “apps” that are created to connect younger, healthier people to insurance coverage. Technology is a wonderful thing when used in a productive manner and here I feel through technology we can lure the young people to think otherwise of health care and show how important is it to have healthcare and not only young people are tech savvy, the older generation to are affected. The article states that “Success in health reform will depend on knowing the customer and tailoring products and approaches accordingly.” And I completely agree with that statement and it ties in with technology and how it has advanced and progressed throughout the years. It is one medium in which the necessity of health care and “promoting” health care can be effective to the people and this will increase the understanding and knowledge in people.
    The next aspect that stood out was the fact people that have health care don’t use it wisely or correctly simply because they don’t have the proper access to the health care and whenever in doubt the emergency room is the only option that they find. And this was quite amusing when I read it because I haven’t thought of it in that particular way. Shedding light on this aspect is important and increasing the amount of clinics and physicians is vital especially when 45 million are going to be insured according the ACA. Therefore, there should be an effective way in every town, city, or village that there should be a clinic and health professionals available within a certain amount of miles, or some scheme as such in which patients are able to have access to clinics, and various health professional because I feel that anyone who has health insurance is entitled to that facility. I like the idea of physician house calls and this actually has been a system in India many years ago, and it was successful (according to my parents). However, living in the United States I find that hard to carry out appropriately because which physician would be “up” for doing such, very little I feel. I also believe that physicians are people that have a huge work load, whether one is in a clinic, their own private practice, or emergency room, etc and the remaining health professionals which are worthy for so much more are not taken advantage of particularly physician assistants and nurse practitioners, nurses on the other hand are given to much work sometimes. Nevertheless, PA’s and NP’s have a doctorate degree and are capable of diagnosing and NPs are capable of prescribing medications. Therefore the health care system needs to use these professionals more. It understandable that patients have this image of a doctor and whatever he or she says is true, however society in general shouldn’t underestimate the other health professional, and they are as educated as the physician and probably can offer more. If this changes, then we hopefully see an increase in proper and efficient health care.
    The last part of the article that stood out to me was preventative measures people can take to reduce the amount of emergency room visits or even doctor visits. The awareness of preventative measures is significant, there should be a huge demand of classes, or meeting to the general public about anything that one can prevent that can cause harm in on any human being, such as removing mold from homes can decrease hospital visits for asthma patients (as mentioned in the article) or eating healthy, smoking cessations, etc. There is so much that the health care can offer on preventative measures and I feel that a lot time should be spent on organizing effects for people and making them more aware of problems as listed above. Having such workshops and meeting can cause a decrease in national debt and this is cost effective because it primary prevention. If there are people that stop in their tracks in the first place, there would less chronic diseases, and there would be a decreased amount of patients visiting the ER’s. A lot can be done in this field and is the best route to take if the United States wants to improve the health of its people. It’s the single most effective way of educating the general public, raise awareness to various things that they can do to prevent certain diseases and at the same time it would decrease hospital visits, and decrease costs in all aspects.

  15. Konstantine Says:

    As we can see from the article, there are many more questions than answers regarding the new health care reforms. I think questions regarding whether uninsured will seek insurance depends on the question if they can obtain access to care. First, this isn’t a mandate if not every state is obligated to buy into the exchange to help its uninsured gain coverage. I think it would have benefited the country had they broken down the deployment of the mandate and exchanges in parts rather than as a whole. Possibly by starting with the state containing majorities of uninsured, and seeing how it fares with them. This test run would allow for the government to make reasonable changes and improvements in feasible amounts at a time. If the uninsured cannot receive access or attention they feel they need then I don’t see many buying into the program and settling for a fine, if that. Next, we see that majorities of the uninsured are from Latin America, so I think it would make sense if we begin to make Spanish mandatory for those seeking to become medical professionals or at least those specialized in areas which these large numbers of uninsured will flood into. Lastly, I noticed were trying to enforce preventative medicine. Wouldn’t it make sense for insurances to support, to an extent, CAM practices, a dietitian, or physical trainer, depending on the conditions at hand instead of starting the trend of medications that will never end? Time will tell how well these reforms will turn out, with the ultimate goal being a healthier nation.

  16. DylanWills21 Says:

    America’s healthcare system is far from being perfect and there is a reason why America is ranked #37 amongst all other countries in the world. There are costs, quality, and access issues just as Tom22 stated and these problems are which stems our poor system. There are millions uninsured in the United States and trying to get them all some form of health coverage is not going to be the only way to solve this issue. With an increase of people getting health coverage, there needs to be an increase of doctors to take care of these people. There is a shortage of healthcare providers now and spreading the risk amongst the population is going to cause issues with the limited amount of doctors. Having nurses and physician assistants work under the supervision of a doctor in rental clinics, such as CVS or at pharmacies for small health issues, such as colds, checkups, sore throats, pinkeye, and other minor sicknesses, can help balance the distance between the number of new incoming covered Americans and doctors. Although some people might complain about the quality of healthcare they are receiving, similar to what Kelsey and Ryan touched on, it is helping more people get healthcare. This will allow doctors in hospitals and at primary doctor’s offices to deal with more risky and dangerous illnesses, such as broken limbs, severe artery cuts, and other health problems that may need immediate or extensive care.
    Education is probably the best way to aid our healthcare system. Allowing the public to become aware of their health and the choices they make about dieting, exercise, smoking, drinking, etc. are ways to put the authority and blame on the people of America. Obesity and smoking are huge health issues in today’s society and both are avoidable without the assistance of a doctor or through healthcare coverage. If people took more responsibility for their choices on what they ate, drank, and whether they can deal with some stress and not smoke, many health problems can be resolved. If less people smoked, lung diseases and other affiliated smoking diseases could be avoidable and not have to be a cost to doctors and to the taxpayers. Making healthy food/drink choices could reduce obesity and also reduce costs. Implementing wellness programs, just as the article said, could be a solution to keeping health care services and insurance low and ultimately, lower costs for healthcare altogether.
    If third world countries are being successful with their healthcare systems, than why can’t America? America is number one in a lot of aspects and if these smaller, less advanced countries are having success in healthcare, then there is no reason for America to not have success either. We our America, the greatest country in the world and we need to prove that by fixing our healthcare system. Becoming more patient focused and cost effective is what needs to be done, and Ryan hit that right on the head. Hopefully soon, our healthcare system will become as good as it needs to be to supply for the greatest country in the world, no matter what it takes.

  17. Vanessa Moses Says:

    I believe that the future of health insurance will yield designer insurance plans, giving customers the ability to choose how much coverage they desire and in what health care areas. This way, people will have tailor-made insurance plans that will better fit in their budget. The availability for a standard, lower costing insurance plan, for those that can’t currently afford insurance and fall through the cracks, may just be part of the answer we’ve long been seeking. With such a plan available, more people could be covered, even if the coverage is the bare minimum. This would allow the government to increase the penalty for those that opt to be uninsured. If the penalty of un-insurance is higher than the rate of the most standard insurance offered, more people will choose to be insured over paying the penalty, further decreasing the percentage of uninsured. Below, Faith Rialem mentioned shifting market power to the consumers, while keeping the health care market competitive. I believe the more options available consumers, the more power they have in their hands. Also, if consumers are left with the important decision of deciding on a health care insurance plan, it will be a bit of an incentive to get educated. My personal experience with the young and “invisible” that can’t afford insurance has proven that some people nonchalantly accept the fact that they can’t afford health insurance based on hearsay and without any knowledge. By increasing the options available and making it mandatory to choose a plan, more people may feel the need to do some research on what is best for them. With that being said, I believe we also need to keep in mind that it is impossible to get it perfect on the first try and it is impossible to please everyone. While I believe in perfecting the idea as much as possible before implementing it, if we are waiting for a perfect proposal, we will be waiting forever.

  18. AlexandriaDavis Says:

    The gaps may be “filled” if all the uninsured decide to get insurance and not “opt” out of getting coverage and taking the tax. If more states get on board with making exchanges and start to make plans with the federal government to plan the exchanges, then more of the uninsured in those states will get coverage instead of paying the tax. The uninsured that live in a state that make the exchanges will be more likely to get insurance, and if the states expand their medicaid plan, and make it so that more people will qualify for it then more and more people through out the country will be covered in one way or another. If medicaid is expanded there will be some questions though on where the money will be coming from. The article eludes to the possibility of using the money received from the “tax” of those that don’t purchase health insurance after being told to by the individual mandate. This could be a positive, as the states wouldn’t have to add or increase the amount of taxes people already pay which will just make more people unhappy. Some states may not increase the number of people that qualify for medicaid so that they won’t have to think about increasing taxes or finding other ways to get the money to support the expansion. Also, states might not be motivated to increase the number that qualify for medicaid because they won’t lose their federal medicaid funding.

  19. Brenden Gonzalez Says:

    Health Care Exchanges are definitely a step in the right direction; though other states refuse to establish them now, they will quickly do so if these establishments start to succeed. The states which have already began planning out the formation of such exchanges should already be aware that they are basically the “lab rats”, and the future of Health Care rests on whether or not their health care systems flourish. The major problem which we face is definitely increasing the access and quality of care, while decreasing the costs. There will be many ways in which this is accomplished, but a major method will be to move towards the digitalized approach. By allowing people to contact doctors and check medical records through the use of any computer or phone, health care is likely to improve due to an increase of communication and easily accessible information. As for decreasing costs, an important factor will be increasing the access to preventative services. If we can somehow make it so that more people can utilize preventative services, then the need for more drastic and expensive health care will decrease. In reality, everything will come down to whether these exchanges will be able to provide plans which will appeal to the people; if the population doesn’t feel as if these plans are worth the money, then the exchanges will quickly fail out.

  20. BiancaDerrick1 Says:

    This article has brought up some very important points and views that I found very interesting. Carrie Valiant poses some interesting questions right from the start and really had me questioning some aspects of the ACA. Initially, I thought the article was very factual and provided an overall good outlook on some of the positive and negatives of the ACA. In regards to the topic of “exchanges,” states such as California and Massachusetts are becoming the front-runners for taking the initial first step in establishing the ACA for their residents. As a current resident myself of the state of California, I believe that by implementing the ACA, many people have benefited in great ways through the states Medi-Cal plan under governor Jerry Brown. The background research I found on California’s Medi-Cal plan shows that although holes and debt may arise, it will allow for a plan of action to be worked out sooner rather than later. This will therefore set the stage for greater advancements in health reform to take place. It has allowed for better access and quality, while still being affordable to a wide range of the population, with very low tax increase. Valiant brings up a very important point when she explains why people may not want to partake in certain exchanges. Cost, fear of the unknown, the public’s role, and the lack of time are all obstacles towards moving forward. People often times want a quick fix to certain problems, without taking into account the long-term affects. I completely agree with Valiant’s closing state in the first section of the article because in order for this health reform program to be successful, the government needs to know who they are gearing this reform act towards. These people usually include the working, ethnic middle classes who are seeking health insurance. Understanding and knowing who you are working with and what goals you are trying to achieve (lower cost), I believe are key in promoting the ACA.
    Valiant goes on to address the issue of obtaining access to care. After working in a medical clinic this past summer, I could see that many doctors were having a hard time accepting new patients. The medical field as a whole is in a shortage of work, therefore forcing patients to spend a substantial amount of money for a trip to the ER, when they could easily go to a private clinic for much cheaper. How is this fair or taking place in a country that is a leader in innovation and technology? I support Valiant’s idea of creating a way where patients do not have to step into the doctor’s office to receive an opinion or have a medical related question be answered. Implementing stronger technological advancements in the medical field by expanding patient hours through clinics will make a huge difference for these people seeking access to care. The ultimate goal I believe is to make it user-friendly so that it is promoting good coverage at a reasonable price.
    As mentioned earlier, cost is always a huge problem when it comes to health care. Even with small businesses providing care through tax breaks and insurers competing for business to create networks for low cost providers, the cost and increase in taxes poses a great threat. Going back to the state of California, the federal government is willing to pay all costs regarding Medi-Cal expansion for the first three years will promote expansion and reduce taxes. People in general are afraid of the unknown. Not knowing how much something costs is a setback for most people. But not be willing to make a change that can be modified through trial and error? In this way, it is important to educate the public beforehand and make various health care rates accessible so people know what they are getting themselves into before hand. I fully support Valiant’s claim that in order to stop people from paying for such expensive health care, we need to do our own part in taking full advantage of preventative care and free services. I believe that there needs to be a promotion of a cleaner environment for people to reside in and a need for wellness programs to educate the public in the importance of exercise and eating healthy. If we partake in these simple daily preventative measures, we can avoid expensive trips to the ER. In the end, everything falls back on the need for better access and quality of care, in order to reduce the costs that the ACA brings.

  21. kerry.cummings Says:

    After reading this article there appears to be a couple of main issues brought to my attention about the new health care reform. Carrie Valiant made very important points regarding the ideas of the newly insured and their access to proper care and how cost will play out within the future. It is obvious that while the health care reform has many positive effects to come there are a few major downfalls that need to be addressed first. After reviewing this article I chose to do some research on the effects that Massachusetts has had since 2006, when they passed a comprehensive health reform designed to provide near-universal health insurance coverage for state residents. According to the Kaiser Family Foundation report I was able to find that within a year of the implementation the state experienced an extraordinary drop in the number of uninsured despite the countries economic recession. While the United States continues to struggle economically Massachusetts has sustained to have the lowest rate of uninsured residents within the country.

    One of Valiant’s main concerns expressed within the article is due to the lack of health care professionals, will the recently insured patients receive proper access to health care treatment. When assessing the Kaiser Family Foundation report it stated that more adults in Massachusetts have received an increase of preventive care services. Also, as a result of the need for providers Massachusetts has increased the number of patients to provider ratio and expanded medical school enrollment for students committed to primary care careers. Unfortunately, cost has become an issue within Massachusetts. Since the state health reform in 2006 the per capita of health spending is 15% higher than the national average and Massachusetts has the highest individual market premiums in the country.

    Therefor, cost is still the number one concern nation wide with the new Affordable Care Act. From my research on Massachusetts’s it appears that overall the issue is not going to be the accessibility of health care. Our nation will provide ways to obtain more health care providers and help increase providers to patient ratio. As Valiant described through the new electronic systems our providers will spend less time inquiring each patient’s information and submitting their forms. This will allow both more time with the patients and more patients to be seen. I believe that Valiant has very good ideas about providing more preventative care to, in return, lower the overall need for health care. By doing so we will allow the much needed patients to receive the proper care and move towards an overall healthier society. As a result it seems that as a country we need to focus on changing our daily habits and consciously make an effort to live a healthier lifestyle. By doing this we the people can help control the rise in health care costs by lowering the amount of care needed due to unhealthy habits. For example, by living a healthier lifestyle we can decrease the amount of childhood diabetes and obesity therefor removing extremely costly care that would be required for those diseases for the rest of the patients’ lives. Generally all arrows are being pointed to our countries desperate need for preventive care to help reduce unnecessary health care costs due to unhealthy lifestyle habits.

    http://www.kff.org/healthreform/upload/8311.pdf

  22. Faith Rialem Says:

    Three main issues stand out to me from this article, first and foremost the issue of health exchanges and whether or not people will actually use them to purchase health insurance. As mentioned in the article, switching to the practice of buying insurance could be a big challenge especially for a population that has not been doing it before. The ACA pushes for mandatory coverage by implementing a tax to serve as fine; which I agree is not a strong enough push for universal coverage. In my opinion, the ACA should instead provide incentives for participating in the health exchanges, such as a coupon for a comprehensive check up at one of the local clinics. Perhaps this will encourage people to go to the health exchanges and actually purchase insurance coverage in hopes of also receiving the coupon for a check up. The second issue is transparency in costs; something that consumers (patients) should have access to in order to make the best decisions (especially financial-wise) about where they should get health care. Having websites for comparing prices will not only be good for the patient, it might also be a way to shift market power to the consumers as providers may be forced to lower prices in order to remain competitive in the health care market. Using the example of travel websites such as Orbitz, Hotwire e.t.c. that enable travellers find the best deals for hotels and flights, having the option to compare health care prices allows for greater autonomy for patients and will also hopefully create greater awareness among the public about the high costs of healthcare. The last issue is the need for greater public health efforts intended to curb the problems of sicknesses and disease at its roots. There needs to be an acknowledgement of the connection between public health and medical science and how the two can work together for a healthier population. Even as we try to deal with the issues of costs and access, the problem should be addressed from its root causes, and proactive measures need to be taken to lessen the dependence on medical care to fix health problems when they could have been prevented in the first place.

  23. RachelWeber Says:

    One of the most pivotal concerns raised regarding new changes to the health care industry is simply whether or not the individual mandate will benefit the nation as a whole. The concern of whether the uninsured will join the pool of insured citizens is an entire discussion in and of itself. Since the implementation of the individual mandate has become a “tax”, states have been given more leeway in their decision to join the rest of the states who have accepted the mandate. While obliging that everyone purchase health insurance might not be the smartest and most effective way at spreading the risk and reducing costs overall, the ability for individual states to opt in or out of purchasing health insurance isn’t providing much of a benefit either, in my opinion. By doing so, those states that choose to accept the coverage essentially serve as the guinea pigs for the rest of the nation. While those who fail to accept the individual mandate would be penalized by paying a penalty, some agree that the penalty is not large enough or worth it enough to be bribed into purchasing health insurance. Although the original intentions to mandate that everyone purchase health insurance was instilled in an effort to reduce costs overall and spread the risk, there are many barriers even once someone has purchased health insurance. Simply owning health insurance isn’t going to magically prevent everyone from becoming sick or developing a disease at all. The cliché phrase, “You can lead a horse to water, but you can’t make it drink” correlates perfectly with this concern. The government can force everyone to purchase health insurance, but will everyone really utilize this benefit to the fullest extent? Not everyone will go to the doctor for routine checkups to prevent becoming sick in the first place, nor will everyone go to the doctor once they are sick to treat their illness. This is mainly due to lack of access and high costs. The number of chronic diseases will still be on the rise, and out of pocket costs will continue to rise as well in order to pay for treatments. Having health insurance does not automatically lower costs or eradicate the issues that it is especially difficult to find a doctor that will cover a new patient. I don’t believe that forcing people to purchase health insurance will ultimately solve all of our problems. In other words, there are many other measures which can be taken to improve the health of our country and lower costs overall as well as increasing access, some of which are mentioned in this article. I feel that overall people need to become more educated about a healthy diet, exercise, and other healthy lifestyles, as well as public health measures so that we can conquer the quintessential cause of sickness in the first place, and possibly prevent the development of chronic diseases at all. In essence, health care is not the only answer.

  24. Kerri Herbst Says:

    Health care reform aims to strengthen our health care system, yet so many aspects of it are yet to be seen. In the article above, Valiant explores one popular question, “If We Build The Exchanges, Will the Uninsured Come?” I think it is promising that measures are being taken to make the exchanges consumer friendly, such as in-store kiosks and online purchasing. Purchasing and comparing health insurance plans can be confusing, so any steps to clarify the process are positive. This will hopefully make it easier for the uninsured to use the exchanges and purchase coverage. Valiant mentions that in the past barriers such as cost, lack of knowledge, stigma of public assistance, and lack of time have led those eligible for health insurance to not purchase it. It is definitely probably that these same barriers will cause people to pay the penalty tax rather than obtain coverage. Recently, the Centers for Medicare and Medicaid Services published a draft of the list of questions, which will be included in the online application to enroll in the health insurance marketplace. The draft is 61 pages and asks personal information that citizens may be uncomfortable disclosing to the government. Time will tell if the tax penalty is severe enough to make those currently uninsured complete the application process and purchase coverage.
    Valiant brings up the issue of access, which is important because it is yet to be seen if our health care system will be able to accommodate the additional 48 million people, who were previously uninsured. I think it will be crucial for non-physician health care professionals, such as PA’s and NP’s, to play a greater role in patient care. Because of the high barriers in place to become a physician (i.e. medical school acceptance, medical training, and cost), non-physician health care professionals can serve as an alternative to increase patient access. As Valiant mentions, we have seen the emergence of after-hour care and convenient clinics as a way to meet the demands of patients. The growth of these types of facilities will help in increasing supply, as well as the increase use of technology as a way to meet the needs of patients.
    As Valiant refers to as “the elephant in the room”, cost is an issue that cannot be taken lightly with health care reform. How can we pay to bring an additional 48 million people into our health care system? Health care reform is not aimed at saving money, but being more cost-effective. Health insurance exchanges are going to provide options for health insurance plans, but these plans are still going to be costly. The government is providing subsidies and grants to help individuals who cannot afford these plans obtain insurance coverage, however how long can the government provide this monetary aid? The health care reform also encourages states to expand their Medicaid programs by providing the states with funding. It will be interesting to see how the government manages providing the funds, and also how states manage with expanded programs.

  25. Sara Payami Says:

    Due to the shortage of doctors, the 45 million uninsured who will enter the system will have great difficulty accessing healthcare. Our dreams of getting everyone covered will be pointless because having insurance does not mean that you automatically become healthy. Having insurance guarantees that when you do get sick, you will have access to healthcare that will attempt to help you recover, though the effects of some illnesses are irreversible. However, that is a round-about way of trying to raise a healthy population. Instead, we should attack the root of the problem, which is unawareness of the existing preventative healthcare practices. If we increase the education that the general public receives about diet, exercise, and smoking cessation, we can eliminate the root causes of many preventable chronic illnesses, such as type 2 diabetes and hypertension, and lower the amount of people suffering from them. We can then allocate our resources and energy to those who are suffering from terminal illness, with unpreventable and incurable problems. We are all looking for a way to lower the costs of healthcare, when it is right in front of us. Healthy people don’t need to use healthcare, even if they have it. Therefore, with less people in the insurance pool actually using their healthcare, the insurance companies will be able to spread the risk more, and lower the costs for everyone.

  26. Ryan Livshits Says:

    After reading through the article, there are important questions/issues addressed about our new health care system. The first question about the uninsured stated an important point. Even though an individual mandate will exist the penalty may not be severe enough to overcome the cost of health insurance for some, therefore just because the exchanges with the federal government are made it doesn’t mean that people will be running to buy health insurance. Like the article states we don’t live in a, “field of dreams”. Taxing those without health insurance may sound like a good idea; however, if the tax is cheaper than the cost of health insurance why pay more? Another aspect is the people who are eligible; yet they don’t know or don’t have the time to sign up for health care coverage. Well technological innovations will surely help to make that population more aware. Becoming “consumer friendly” will for sure be effective in helping people sign up for health care coverage because they wont consider it a hassle. Also introducing “apps,” is important in connecting with the younger, healthier population with insurance coverage. This will definitely help lower the number of free riders that exist in our population. Ultimately avoiding high health care costs (with chronic illnesses) later on in life.
    Once those who were previously uninsured, gain coverage they will want easy access to a physician. Unfortunately finding a physician to take on new patients is difficult considering the “workforce shortages of qualified health professionals.” The physician shortage may be attributed to the barriers to entry. Getting into medical school is by no means easy, with very few seats available and very few residencies it is extremely difficult to become a qualified health professional. It also takes several years to train a physician; therefore, the shortage cannot be easily overcome. “Thus, many newly will end up in the hospital emergency departments for care that is more cost-effectively provided elsewhere.” Basically this will be a continuation with what we see today, many of those who are uninsured run to the emergency department for care, except now the newly insured will be paying for insurance coverage and still getting the same medical attention as before. I personally think that physician extenders may be another way of helping overcome the shortage and allow the newly insured to more access. Also eliminating need for check up/follow up visits and using technology to make sure patients are in compliance with their drug regimens will save precious time and give attention to patients who need it most.
    Experience from the state of Massachusetts has shown “health reform alone wont keep people from experiencing financial problems.” Taking the “mystery out of health care pricing” will be appealing to many of those that have health insurance coverage. I believe that any person that knows what they can expect to pay for their visit to the doctor will be more likely to get care when they need it.
    With all of these problems, the question of how to keep people from needing costly health care services in the first place needs to be asked. Preventative care is extremely important in answering that question. Teaching people how to eat right, exercise and advising them not to smoke will certainly avoid expensive health care costs. Doing simple things such as fluoridating tap water can help avoid costly dental problems (such as parodontitis) later on in life (this helps to slow/stop tooth decay). As stated in the article, “public health solutions have been proven effective in the third world nations.” So if third world countries can accomplish this I am sure the United States can do the same. I feel that if we do not become more patient focused, and cost effective our health reform will not perform as well as intended in the “field of dreams.”

  27. Cora Neville Says:

    One of the biggest questions today is will the health reform benefit us a a whole and if so, what are the positives and negatives? One suggestion is the expansion of Medicaid, but this also comes with the possibility of further cuts and the loop holes because states have the choice to opt in or out without losing all of their funding. Another viable question is will the uninsured join the pool? Because although it will take time for all states to become insured many states are delaying or refusing to establish exchanges. I believe that we are making progress because most of the states with the least amount of uninsured people are beginning to join. Carrie says that states that decide to move forward with exchanges will basically be a test run for all states on the side line rather its a success or failure. Its a shame that we have to take such big risks, but we need a drastic change in our health care system. We also have to implement ways to increase the enrollment of the people who qualify for these programs because in the past reasons such as cost, ignorance, public assistance stigmas, and the lack of time have greatly effected this. Other suggestions including becoming more consumer friendly and more technological advanced because I believe keeping up with this technology based era will increase access, decrease time and ultimately save money. In the past we haven’t succeeded because we didn’t focus on the patients and tailor products to fit them. Another question proposed is will the uninsured be able to obtain access once covered? And I believe this question will remain unanswered until the shortages in qualified health professionals are addressed. However, we have been relying on non-physcians and making it more convenient to patients by extending office hours and setting up shop in busy neighborhoods. The last question is how do we keep cost down? We know that the health care reform is not the answer to lowering all costs, but we can announce what we are paying up front before purchase by comparative prices of insurance on-line. This will allow consumers to shop around and receive the most cost effective care. Moreover, the ultimate question is how do we keep people from costly health care services and that is through prevention such as public health solutions, in example clean water, and air and keeping people healthy through the encouragement of wellness programs that focus on diet, exercise, and smoking cessation.

  28. Kelsey Hrynyshyn Says:

    My initial reaction to this article is that it is factual and useful in answering many important questions that linger within today’s health care system. The first aspect of the article that caught my attention was where it exclaimed, “Technological advancements, including “apps,” can connect younger, healthier people to insurance coverage. As a result, companies in technology and retail are becoming health care companies in unprecedented numbers.” I thought this was interesting because I never realized how much more easily comprehendible and accessible these applications were to younger people, who are the main target when trying to spread the risk and minimizing free riders. If we are able to get their attention and have them become insured and more knowledgeable, it could be helpful in the long run. Also, in efforts to make obtaining health insurance easier, kiosks and on-line purchasing have been implemented in many areas along with the use of technology.
    Secondly, I think that once we can finally get more people to become insured and take advantage of their eligibility to have health care, they are going to want what they are working and paying for. As explained, there are a shortage of qualified physicians, so after a person obtains health insurance, it isn’t even guaranteed that they will be cared for. This can be a huge roadblock when trying to convince people that becoming insured is more worth it than just paying the tax for being uninsured. This will lead people to end up in the emergency room getting care that is more for primary physicians to take care of and therefore it is not cost-efficient. Also, they mentioned ways to decrease the amount of time physicians take out of their day to see patients in order to decrease spending. I believe that implementation of non-health professionals could work, but I don’t think that the insured would be satisfied and they will want time and effort because they are covered under a health care plan. Although some insured patients may like the idea of having a quick and easy answer, some may not as well because they have more severe symptoms or a more chronic illness. I also agree with the idea of reconfigured old solutions to problems such as house calls made by physicians. As stated, those house calls show promise and although the patient is not getting to see the doctor in an office setting or be physically checked out, it is still a health professional who is giving them answers and they are more knowledgeable on the subject matter rather than non-health professionals. Lastly, I believe that triage patient problems with technology-based solutions could save a lot of time and money, and make health insure useful to more people and be more cost effective.
    Next, the article mentioned that Massachusetts is proof that, even after health care reform, people are still having financial issues with the care they are in need of, which leads me to my last point. I love the idea of preventative measures in order to minimize illnesses and avoidable diseases. In order to assess a patient, it is important to look at their living environments and what surrounds them and what lifestyle he or she lives. Although there are many issues that are genetic and non-modifiable, there are so many cases where a person needs to go to their physician, be prescribed medicine, and/or have hospital visits due to a lifestyle that could have been changed or a bad habit that could have been avoided. The most important aspect that I took away from this article is that unless the ideas are cost-effective and patient focused, they will not be as successful as they could be.

  29. Tom22 Says:

    Cost, quality and access are entrenched problems in our health care system and something must be done.

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