The Modern Dilemma – National Health Care

National health care is a hot issue all over the world at the moments, but in no country more so than in the United States. As health care is not provided free as a rule, there are major debates regarding affordability and value for money. Fewer and fewer people every year have insurance cover should anything happen to them and as a result society is beginning to deteriorate. Very few people would be able to afford expensive health care and thus fewer people are spending on it and prices rise to recoup lost costs and profits. The medical services suffer as a result.Companies used to provide healthcare as standard in every benefits package, but fewer are now offering it. Instead, they are finding ways around it, like using agency applicants rather than taking on individuals to fill job roles independently. Agency fees are generally lower than those charged by insurance companies to ensure that employees are sufficiently covered. However, as hazards in the workplace increase, the nation’s health is beginning to suffer and calls for a national health care system are growing in momentum and volume. A national health care system has already been implemented in the UK and has proved successful so there is a good model to base a US service on.Health costs in the USA are higher than anywhere else in the world at the moment, which does price it out of range for the average person on the street. However, as other national health care systems have proved, health care that is readily available as well as affordable can improve the economy and improve the nation’s health on the whole!Affording National Health CareIt is not a question of whether individuals could afford national health care because, by its nature, it is whether the government can. There are a number of ways that it could be funded. In most cases, the cost is actually funded via taxes. Nobody pays for individual care but there is a flat rate of tax added on to a bill at the end of the year. It could actually be taken straight from an individual’s pay packet every month so that it is not as noticeable for an individual.If it is deemed desirable to keep health insurance as it is now then it may be possible to offer a flat rate for individuals looking to take out the insurance for a national health care system, with the government subsidising it. This would make it more affordable and health care more widely available without adding a tax. However, what would happen if some individuals did not have national health care insurance? Would they be refused treatment? As a result of this question, there are a number of arguments that pick at the flaws. There is also nothing to say that the overall costs can be lowered.National health care does work if it is implemented correctly and it can dramatically improve the nation’s health as a whole, but there may be problems with initial implementation. As long as health care is made available for all at affordable rates, anything is worth a try!

Focusing on Medical Health Care Concerns

Almost half of the nearly 5 trillion dollars in medical and health care related activities can be accounted for in the US. It is obvious that our country has well trained professionals, outstanding technology and a vast array of medication designed to address health concerns. Yet, why is medical care so costly and problematic for so many individuals to receive?The Growth of Medical CareFor most of the worlds more developed countries the medical field is one of their largest industries. If you count the money generated by medication sales, diagnostics, nursing homes, hospitals, physicians, and other ancillary activities it is quite easy to see why the medical industry accounts for 10-20% of a country’s gross production.In the US alone there are nearly 800,000 medical doctors, more than 5000 hospitals and millions of health care workers. One of every dozen US citizens works in health care now and this number is expected to grow. Still there are not enough workers and facilities to handle the 20 million outpatients that are currently being seen every day. This staggering amount of outpatient visits does not include the average daily count of 4 -5 million hospitalized patients.The vast, complex health care industry in the United States is one that attracts people from around the globe. Switzerland and Germany both have large medical industries, but these countries run their health care differently from the US. Could it be possible that our nation’s health care will soon be undergoing a radical type of change?Answers are Difficult to FindIs the answer to the current health care dilemma as simple as nationalizing health care for all? Will this possibility only make the situation worse? How will the medical resources be allocated among the various segments of our society? These are only a few of the questions that are waiting to be answered.Controversial TopicToday medical health has become a controversial subject among many groups of citizens. There is talk of overhauling the medical system as we now know it. We are also hearing predictions that the government will try to restructure the nation’s health care system. Although much of this rhetoric has been publicized for a number of years it seems that people are becoming more polarized by the possible changes that are now constantly making headlines.The Senior Citizens Have their own ConcernsThe elderly population in the US is keeping a close eye on what is being proposed because health care and medication issues are of great concern to them. Medical and insurance coverage for people 65 and older have undergone many changes since the 1980s. Most senior citizens are very vocal about their displeasure with the way Medicare is addressing the problems, and they are also worried about what the future might hold. The costs of health care and medication needs are extremely high for senior citizens as a whole. Every year they are fearful of having their benefits cut even further, and now they have new worries regarding medical care.Groups at RiskIt has been just a few short weeks since Governor Sara Palin galvanized many citizens with her predictions and comments about “death panels” and nationalized health care. While there were many people who rallied around her statements, the mere possibility of such radical notions began sending shock waves through the nation. This was particularly unnerving to a large percentage of our elderly population. It was also causing concern among advocates for the poor and disabled. Even parents and caretakers of people with physical and mental challenges were becoming alarmed, and feeling threatened.Future Allocation of Health Care Resources?Could it be possible that Medical professionals would possibly agree to form commissions that would allocate health care resources to those they deemed most deserving? This thought was both frightening and “Orwellian” in prospect. A careful review showed that there was no written documentation that actually stated such possibilities, but this did not alleviate the fear and worry of many ordinary citizens. Just the idea that access to hospitalization or medication needs might one day be restricted was enough to generate small scale panic in many communities across the nation.Problems, Problems, ProblemsMedical concerns, health care and affordable medication plans are major sources of worry for everyone today. Insurance coverage is very expensive. There is a growing trend among companies to provide less employee and family benefits in order to cut costs. In some cases this is making it difficult for employees to participate in the insurance plans being offered by their employers. However a growing number of families are too cash strapped to afford health insurance premiums on their own. This is creating a “Catch 22″ type of environment with people unable to afford the cost of becoming sick as well as the cost of being insured.The Answer is CooperationIt is hard to know where the main problems are within the health industry. Some people want to find fault with the high paid physicians and medical specialists and others point the finger of blame at hospitals that seem to be pulling in billions of dollars annually, yet are constantly complaining having too little money. Malpractice lawyers, government regulations and insurance companies have also played a part in today’s health care woes. The answer is not going to be easy to find, and every group associated with the medical industry will need to step up to the plate and help out.

Australian Health Care Benefits

Moving to Australia is an exciting prospect. However inevitably the question of health care is raised. No one wants to become ill or injured while living in Australia and then be left with an enormous bill to pay.Does Australia have free health care?Medicare is Australia’s publicly funded health care system however it does not provide 100% coverage. Medicare provides eligible individuals access to free or subsidised medical, optometrical (eye care) and public hospital care. Medicare does not pay towards ambulance costs, physiotherapy, spectacles, podiatry, chiropractic services, or private hospital accommodation.Medicare also does not cover dental costs, with some exceptions for low-income earners. A nationwide Denticare Australia program may be extended in the next government budget, however the specific details are yet to be announced. Some dental organisations provide interest free payment plans, member discounted services that attract an annual fee, or discounts for regular patients to help manage costs.Individuals can also choose to access private health services that charge for their services, and may choose to take out private health insurance to cover these types of costs.Will I be eligible for a Reciprocal Health Care Agreement?The Australian Government also has Reciprocal Health Care Agreements with some countries that provide ‘restricted access’ to public health care while in Australia. Restricted access usually limits care to ‘medically necessary’ treatments eg. Ill health or injury which occurs while you are in Australia and which requires treatment through a public hospital before you return home.Individuals from New Zealand and Ireland do not get issued with a Medicare card and instead present their passport at public hospitals or pharmacies. Non-hospital care, such as attending a local GP doctor, is not covered. Other reciprocal agreements will pay Medicare benefits for out-of-pocket medical treatment provided by doctors through private surgeries and community health centres. All agreements cover subsidised medicines under the Pharmaceutical Benefits Scheme (PBS).Note: Reciprocal agreements technically only cover individuals if they have come directly from the reciprocal country eg. If you were previously living in another foreign country prior to coming to Australia you may not be eligible, as you have not been recently been part of the health system for your country of nationality. However application of this requirement varies between Medicare staff.Medicare Information Kits for migrants are available in 19 different languages.What amount is subsidised by the government?The benefit (or refund) that you receive back from Medicare is based on the Medicare Benefits Schedule (MBS) for that specific service which is set by the government. Doctors and other health service professionals can choose to charge over the schedule fee or bulk bill. Bulk billing is when doctors bill Medicare directly, accepting the Medicare benefits as full payment for the service. If doctors charge a higher amount the patient wears the extra costs.Many doctors now offer to process Medicare claims electronically at the end of the appointment. Alternatively you can lodge most claims online, visit a Medicare office or post in your claims. Refer also to How does Medicare work?Patients may also be required to pay for additional tests or vaccinations that their doctor requests as part of their treatment.Some benefit examples based on the current schedule (1 Nov 2011) are below:Standard doctor Level B consultation for less than 20 minutes with a GP (General Practitioner) in their consulting rooms: Fee = $35.60 and Benefit = 100% so you receive a $35.60 rebate. Therefore if the doctor charges $65.00 for an appointment you will be out of pocket by $29.40. If the doctor bulk bills they would charge the $35.60 fee direct to Medicare resulting in no out of pocket costs for the bulk billed patient.Specialist doctor consultation initial appointment in a hospital or their consulting rooms: Fee = $83.95 and Benefit = 75% (hospital in-patient) or 85% (out-of-hospital) so you would receive either a $63.00 or $71.40 rebate. Therefore if the doctor charges $130.00 for an appointment you will be out of pocket by $67.00 or $58.60. You will need a referral letter from a GP to see a specialist so will need to budget for both out of pocket costs. Specialist fees can also vary considerably with some charging several hundreds of dollars if they are highly specialised and sought after. It is worth checking fees prior to making appointments so you are prepared for any out of pocket costs.Comprehensive dental oral examination, limited to 1 per provider every 2 years: Note: Any preventive services like removal of plaque and/or stains, or any fillings etc are billed separately and can quickly add up to a sizeable bill even with the rebates: Benefit = $40.50 so if the dentist charges $95 for this item you will be out of pocket by $54.50Medicare concession card holders will usually be charged a lesser rate or receive some services for free.Note: If you are not eligible for Medicare you will have to pay the full appointment fees. However you are also exempt from paying the Medicare Levy and any surcharges (see below for more information on these).The Pharmaceutical Benefits Scheme (PBS) details the medicines subsidised by the government, which must be purchased through a pharmacy. Non-PBS medications will be charged at full price.The government also protects high users of medical services from big out-of-pocket costs through the Medicare Safety Net, and provides pension and health care concessions for pensioners and low income earners. The PBS Safety Net is available for individuals who need a lot of medicines in any year.Individuals may also be able to claim a tax offset of 20% for net medical expenses over the threshold, currently $1,500 for the tax year for eligible expenses.Note: The above protections may only apply to individuals on full Medicare so check further with Medicare before applying.Are there any costs when I use an ambulance?Ambulance cover varies between the different Australian States & Territories.In Queensland and Tasmania, ambulance services are provided free for local residents.In all other States & Territories, fees may be charged. The fees can vary depending on: how far individuals travel by ambulance, the type of transport eg. helicopter, the nature of the illness, whether an emergency or not, and any concession eligibilities.Residents living outside Queensland or Tasmania can insure against ambulance costs, either through membership schemes provided by the relevant ambulance service (in the Northern Territory, South Australia, Victoria and country areas of Western Australia) or through a private health insurance fund (in the Australian Capital Territory, New South Wales and metropolitan Western Australia).Note: Check the details of any ambulance cover provided by private health insurers carefully as it may only be limited to ‘emergency’ transportation eg. not covering trips between hospitals or non-critical call outs. Membership with ambulance services may be more comprehensive.In most cases, local holiday or business visitors to other States & Territories will be covered if they were covered in their home State or Territory due to reciprocal arrangements. However it is worth checking this before travelling to other States or Territories.Do I have to pay anything towards Medicare?Medicare is funded by a Medicare Levy tax deduction taken from your income with the contribution level based on how much you earn. The Medicare Levy is currently 1.5% of taxable income.In addition, the Medicare Levy Surcharge of 1% is levied on high-income earners who do not have private hospital cover. The income threshold for 2011-12 year is $80,000 for singles and 160,000 for couples / families increasing by $1,500 for second and subsequent dependents. The surcharge is designed to encourage individuals to take out private cover and therefore reduce the demand on the public Medicare system.If you are not eligible for Medicare then you may qualify for a Medicare Levy exemption and will not have to pay the Medicare Levy or Medicare Levy Surcharge. You must however complete a Medicare Levy Exemption Form in order to be exempt from the tax.What are the differences between Medicare and Private Health Insurance Cover?The Health Insurance Ombudsman has a good comparison of Medicare and Private Health Insurance.Do I have to take out private health insurance?You do not have to have private health insurance unless it is a requirement of your Australian visa to make arrangements for a minimum level of health insurance. A sponsor could still offer to pay the insurance, however if not the visa holder is responsible. Student visa holders are required to have Overseas Student Health Cover, although students from Sweden or Norway may have special arrangements.However you may still want to consider taking out private health insurance to give you more health care options, to cover items which aren’t covered on Medicare such as dental costs, or if you are not eligible for full Medicare.There are two types of private health insurance: 1) Hospital policies and 2) Ancillary or extras cover for treatments such as dental and physiotherapy. Most health funds offer combined policies.Insurance policies may also have exclusions and restrictions, excess payments and waiting periods for certain claims. Insurance claims may also be subject to annual limits for certain types of claims. Insurers often have preferred suppliers who may offer higher benefits for members.How much does it cost to have private health insurance?The costs of insurance vary considerably depending on what health cover plan and insurer you choose. You should only choose a registered Australian insurer and one way of choosing is to use the many free comparison sites available. The Private Health Insurance Ombudsman website also has excellent information.If you are currently with a recognised international health fund you may be able to obtain an insurance clearance certificate and transfer without incurring waiting periods for some claims. Continual coverage will depend on the old and new policies being similar. Many Australian insurers refer to the International Federation of Health Plans to determine whether a fund is recognised under their transfer policies.Health insurance rates can increase on 1 April each year in line with government regulation and in 2012 this resulted in average increases of 5.06% for new and existing premiums.In addition to the Medicare Levy Surcharge, the government also has two other key private health insurance incentives.Private Health Insurance Rebate – 30% to $40% rebate (not applicable for overseas visitors health cover)Lifetime Health Cover – Additional loadings that increase the later you take out health insurance during your lifetime with a maximum loading of 70%.1 July 2012 ChangesFrom 1 July 2012, the Rebate and the Medicare Levy Surcharge will be means tested. This could result in substantial benefit reductions for high-income earners, particularly singles earning $130,001 or more, and couples/families earning $260,001 as their rebate will drop to zero.You can read more about these changes at privatehealth.gov.au.