The cost of health care in the United States is expensive and is escalating. A majority of Americans cannot afford the cost of medicines, physicians’ fees, or hospitalization without some form of health insurance. Health insurance is a contract between an insurance company and an individual or group for the payment of medical care costs. After the individual or group pays a premium to an insurance company, the insurance company pays for part or all of the medical costs depending on the type of insurance and benefits provided. The type of insurance policy purchased greatly influences where you go for health care, who provides the health care, and what medical procedures can be performed. The three basic health insurance plans include a private, fee-for-service plan; a prepaid group plan; and a government-financed public plan.Private Fee-For-Service Insurance PlanUntil recently, private, fee-for-service insurance was the principal form of health insurance coverage. In this plan an individual pays a monthly premium, usually through an employer, which ensures health care on a fee-far-service basis. On incurring medical costs, the patient files a claim to have a portion of these costs paid by the insurance company. There is usually a deductible, an amount paid by the patient before being eligible for benefits from the insurance company. For example, if your expenses are $1000, you may have to pay $200 before the insurance company will pay the other $800. Usually the lower the deductible, the higher the premiums will be. After the deductible is met the insurance provider pays a percentage of the remaining balance.Typically there are fixed indemnity benefits, specified amounts that are paid for particular procedures. If your policy pays $500 for a tonsilectomy and the actual cost was $1000, you owe the health care provider $500. There are often exclusions, certain services that are not covered by the policy. Common examples include elective surgery, dental care, vision care, and coverage for preexisting illnesses and injuries. Some insurance plans provide options for adding dental and vision care. Other common options include life insurance, which pays a death benefit, and disability insurance, which pays for income lost because of the inability to work as a result of an illness or injury. The more options added to the insurance plan, the more expensive the insurance will be.One strategy insurance companies are using to lower insurance premiums and out-of-pocket costs to the consumer is the formation of preferred providers organization (PPO). A PPO is a group of private practitioners who sell their services at reduced rates to insurance companies. When a patient chooses a provider that is in that company’s PPO, the insurance company pays a higher percentage of the fee. When a non-PPO provider is used, a much lower portion of the fee is paid.A major advantage of a fee-for-service plan is that the patient has options in selecting health-care providers. Several disadvantages are that patients may not routinely receive comprehensive, preventive health care; health-care costs to the patient may be high if unexpected illnesses or injuries occur; and it may place heavy demands on time in keeping track of medical records, invoices, and insurance reimbursement forms.Prepaid Group InsuranceIn prepaid group insurance, health care is provided by a group of physicians organized into a health maintenance organization (HMO). HMOs are managed health-care plans that provide a full range of medical services for a prepaid amount of money. For a fixed monthly fee, usually paid through pay roll deductions by an employer, and often a small deductible, enrollees receive care from physicians, specialists, allied health professionals, and educators who are hired or contractually retained by the HMO. HMOs provide an advantage in that they provide comprehensive care including preventive care at a lower cost than private insurance over a long period of coverage. One drawback is that patients are limited in their choice of providers to those who belong to an HMO.Government InsuranceIn a government insurance plan the government at the federal, state, or local level pays for the health-care costs of elgible participants. Two prominent examples of this plan are Medicare and Medicaid. Medicare is financed by social security taxes and is designed to provide health care for individuals 65 years of age and older, the blind, the severely disabled, and those requiring certain treatments such as kidney dialysis. Medicaid is subsidized by federal and state taxes. It provides limited health care, generally for individuals who are eligible for benefits and assistance from two programs: Aid to Families with Dependent Children and Supplementary Security Income.

Is Health Care Reform New? As somebody who is very interested in the progress of health care reform as a taxpayer, private consumer of health insurance and services, and as a professional, I have been trying to follow the current health reform debates. I am getting a little frustrated with the lack of progress on either side of the aisle, and also by some of the knee jerk reactions by politicians and their groupies.. You would think that the current administration, and its political adversaries, had just invented health reform or the cries of outrage that sound against it.I decided to do my best to outline some of the highlights of the health reform attempts, failures, and progress in the past 100 years or so. I am not a professional historian, by any means, so some may feel as if I left out important things or took them out of context. I am trying to be balanced, but take all the blame if I neglected something you feel is important.Teddy Roosevelt In the 1910′sTeddy Roosevelt ran on a very progressive platform in the early part of the last century. His campaign promises for 1912 included protection for workers safety on the job women’s right to vote, and a national health care program. He was president of the United States, by the way, from 1901 – 1909. But he lost the election of 1912 to Woodrow Wilson. It is interesting to note that this Roosevelt was a Republic. Wilson was the Democrat. Never assume that American party politics are set in stone.Early Models of Current Health Insurance and Cries of SocialismIn 1929, Baylor Hospital in Dallas, Texas came up with a pre-paid program for a large areal teacher’s union. This is considered one of the earliest models of health insurance. Now here’s the irony. A few years later, an Oklahoma doctor formed a farmer’s association with a pre-paid plan. Members of the association would pay into the plan, and then get services covered. The American Medical Association called this doctor’s plan socialism!Despite this, pre-paid hospital and doctor plans continued to grow in popularity around the US. However, they usually left out the unemployed and elderly.The New Deal in the 1930′s Another Roosevelt, FDR, also wanted to implement national health reform. He wanted to include it as part of social security legislation. That did not work out, but even Truman wanted to set up a national fund. for health care. He figured everybody could pay in, like we do for social security, and then it could make sure that people’s most severe health needs were met. All of this was left out of the New Deal, and the AMA continued to criticize it as socialism.Post World War II By the end of the second world war, it became a lot more obvious that there was a big gap between health care costs and what mos people could afford. Congress did pass a bill to build a lot more hospitals. They also required hospitals to provide charity care. They had a clause to forbid discrimination on race, religion, etc. But they did allow separate but equal care, which did not always turn out to provide equal care to everybody.In the 1950′s, labor unions began adding health benefits to their collective bargaining agreements. This really formed the basis for the group health insurance many people enjoy at work today. So group health plans became more popular, and in 1954, Congress voted to make this benefits tax-exempt.The 1960′s JFK fought hard for national health care, but again he was met with cries of socialism. But Medicare and Medicaid, regarded as American institutions now, did emerge despite this. Medicare is the US national health plan for seniors and disabled people. Medicaid is the national health plan for very poor people.Despite the fact that millions of Americans had heath insurance coverage for the first time, in the 1960′s, health care spending and costs were beginning to rise.The 1970′s – Nixon and Carter President Nixon, a Republican, worked for health reform. He proposed a bill that would require employers to provide minimum health insurance coverage. Under his administration, money was allocated for the development of HMOs and managed care to contain costs.Carter ran for president, and national health care was a large part of his campaign platform. Even though he won, the severe recession put these plans on hold.The 1980′s and COBRACOBRA is the national law that requires some employers to extend group health benefits to terminated employees for several months.The 1990′s and The ClintonsProbably the most famous previous attempt to dramatically reform health care was under President Clinton. Hillary Clinton, then first lady, spear headed this work. You will probably not be surprised to learn that political critics of the pan delighted in calling it socialism. Experts contend that the plan failed because of partisan politics on both sides. The drug and insurance companies, and the American Medical Association (AMA) also spent a lot of time and money getting the Health Security Act defeated.CHIPS – I cannot leave the 1990′s without mentioning CHIPS. This is the state and federal children’s health insurance program which covers millions of children from lower and moderate income families.21st Century Health ReformI have to credit George Bush, a Republican, with passing the Medicare Prescription plan in 2003. This is also known as Medicare Part D, and it helps fund prescription insurance for Medicare beneficiaries.Obama ran on a platform that included health reform. It seems like it is as tough to pass now as it was during the time of Teddy Roosevelt, FDR, Truman, and Bill Clinton. Politicians are still making deals behind closed doors, and of course, people are still shouting socialism.But some things have changed. The AMA now supports health reform. Many businesses are concerned about spiking costs of covering employees, and representatives have admitted they would like to see some reform that would help them. Even insurance companies have said they will cooperate.Hopefully, we can see some progress. I have no idea what will (or should) happen next.