Can We Talk: Insurance Terminology

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Once upon a time there was a country where the people were very concerned about their healthcare. They were understandably concerned – you see, to get a kidney, it  might as well have cost a kidney. The people had a leader who proposed an healthcare change that was nicknamed Obamacare. However, some people rejected Obamacare because they did not agree with the leader’s stance, views, and mentality. Suddenly a new leader arrived, promising to get rid of Obamacare and rallied the opposing side together. Everything seemed fine for the opposing side until they realized they could also loose a healthcare plan called the Affordable Care Act. “How could this be?”, the people cried out in distain. “I liked the Affordable Care Act, just not Obamacare!” And naturally, the gods snickered because Obamacare and the Affordable Care Act were the same thing.

And THIS is why we will be talking about insurance terms this week. Too many of us do not know what is going on or what things mean. Most of us decide what policies we support based on political party leanings and information from the media. This method is not necessarily wrong. But it’s even more beneficial to know what things actually mean – before we develop solid opinions on issues and topics. And with a newly publicized healthcare plan on its way from Bernie Sanders and Kamala Harris (check out the article here), this is perfect timing. So here are some insurance terms that we have heard thrown around for the past few years in the United States. Enjoy!

  • Universal Healthcare/Universal Coverage – According to the World Health Organization, universal healthcare is when everyone in a nation has access to and can afford healthcare. The only stipulation for access is that one proves that they are a legal resident or citizen of the nation. Though many different countries do have universal healthcare, the United States does not. Part of why this is the case is because of the historically individualistic culture of the United States as a whole and different ideologies regarding healthcare as a right or a privilege.
  • Single-Payer System – A single-payer system is a method of executing universal healthcare. The Economist defines it as when “the government provides universal health insurance, but leaves much of the provision of care to the private sector.” Both Canada and France use this method. Under this system, medical bills are paid from a government-regulated budget. All health care providers are paid the same amount as well.
  • Compulsory Insurance/Individual Mandate – The individual mandate or compulsory insurance is another way to execute universal healthcare. This means that an individual is required by the government to buy a minimal coverage insurance. If they choose not purchase this minimum insurance, they are required to pay a fine or tax. This model can be beneficial, according to The Economist, because “…citizens are legally obliged to buy [coverage}, which ensures that healthy people stay in the system, holding insurers’ costs down. The government keeps premiums affordable by pumping in generous subsidies, and bars insurers from rejecting those with pre-existing conditions.”
  • Affordable Care Act/Obamacare – The Patient Protection and Affordable Care Act was signed into United States law on March 23, 2010. It was a healthcare plan that was later nicknamed Obamacare after former President Barack Obama. Some of the highlights of the legislation include an expanded Medicare and Medicaid program, an individual mandate for insurance, and a requirement for all healthcare plans to have certain essential benefits. For a more detailed summary of the Affordable Care Act, click here.
  • Private Health Insurance – This is probably the most familiar term on this list. Private health insurance is insurance offered by a private party, such as an employer. They can use a managed care model to cut costs of healthcare.
  • Public Health Insurance – Public insurance is any insurance program that the government provides. Medicare and Medicaid are the most common examples of this in the United States.

I hope this helped you all and made you a bit more equipped for the continuing debate about healthcare in the United States. It even helped me because my knowledge of insurance was rusty (and by rusty I mean almost nonexistent – guilty). Knowledge is always power regardless of the side of the debate on which you stand. See you all next week!

Peace,

The Neighborhood Bioethicist

 

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HELPFUL LINKS

 

SOURCES

Apr 25, and 2013. “Summary of the Affordable Care Act.” The Henry J. Kaiser Family Foundation, April 25, 2013. http://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/.
Bleiberg, Darshak Sanghavi and Sarah. “Can Canadian-Style Healthcare Work in America? Vermont Thinks So.” Brookings, November 30, 2001. https://www.brookings.edu/blog/up-front/2014/01/22/can-canadian-style-healthcare-work-in-america-vermont-thinks-so/.
Blumenthal, David, Melinda Abrams, and Rachel Nuzum. “The Affordable Care Act at 5 Years.” New England Journal of Medicine 372, no. 25 (June 18, 2015): 2451–58. doi:10.1056/NEJMhpr1503614.
Feb 25, and Jamie Firth. “Kaiser Health Tracking Poll: February 2016.” The Henry J. Kaiser Family Foundation, February 25, 2016. http://www.kff.org/global-health-policy/poll-finding/kaiser-health-tracking-poll-february-2016/.
Klein, Sarah Kliff and Ezra. “Individual Mandate 101: What It Is, Why It Matters.” Washington Post, March 27, 2012. http://www.washingtonpost.com/blogs/wonkblog/post/individual-mandate-101-what-it-is-why-it-matters/2011/08/25/gIQAhPzCeS_blog.html.
Krucik, George, MD, and MBA. “The Most Important Aspects of the Affordable Care Act.” Healthline, August 5, 2015. http://www.healthline.com/health-slideshow/most-important-aspects-of-the-affordable-care-act.
Staff, Investopedia. “Universal Health Care Coverage.” Investopedia, May 22, 2011. http://www.investopedia.com/terms/u/universal-coverage.asp.
“The Expanding Universal: The Fix for American Health Care Can Be Found in Europe.” The Economist, August 10, 2017. https://www.economist.com/news/united-states/21726124-policymakers-should-take-close-look-fix-american-health-care-can-be-found.
“The Fix for American Health Care Can Be Found in Europe.” The Economist. Accessed September 4, 2017. http://www.economist.com/news/united-states/21726124-policymakers-should-take-close-look-fix-american-health-care-can-be-found.
“Understanding Health Insurance-Types of Health Insurance.” WebMD. Accessed September 4, 2017. http://www.webmd.com/health-insurance/tc/understanding-health-insurance-types-of-health-insurance.
“Universal Health Coverage? Why?” Health Affairs. Accessed September 3, 2017. http://healthaffairs.org/blog/2017/07/25/universal-health-insurance-why/.
World Health Organization. “Health Systems Financing: The Path to Universal Coversage.” In Executive Summary: The World Health Report. World Health Organization, 2010. http://www.who.int/whr/2010/10_summary_en.pdf?ua=1.

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