Healthcare policies have been reformed, and several analyses and issues regarding those policies are being debated. The United States has one of the most robust health systems in the world as it provides better options for health and healthcare facilities. However, the article in the New York Times newspaper “why health care policy is so hard” (Mankiw, 2017) is insightful as it provides an outline of why it is difficult to have a good healthcare policy. The article started off with the idea that healthcare is a complicated concept, and it is different from other services and goods in the market. The author has highlighted five aspects of why healthcare and healthcare policy is complex services or product. The first and foremost point is that bystanders or what economists call externality affect healthcare service. The two examples quoted are the vaccine and research. For example, if the vaccine is not free someone will not get vaccinated if they are not getting it free. At that point, the government needs to intervene and provide free vaccination programs. The next point which the author has pointed out is the consumer is unaware of the type of goods they need.
If one person goes to an open market, they already know and have planned on what they need from the particular market. But in the healthcare industry, people are often uninformed about the type of service or the products they need with regard to treatment and medications. At that point, other than buyer and seller third party which is a physician or medical specialist use their best knowledge to understand the requirement of the individuals or the patients. Because consumers of this industry are not able to understand their products, Food and Drug Administration (FDA) plays a role to ensure licensing, rules, and regulation. Health is one of the aspects of human life which is unpredictable because you cannot know when someone can have health issues. The planning of other things like housing, transport, and education can be carried out, but healthcare finances are unseen and can have a significant impact on the financial budgets of families. In this case, health insurance companies do play a role in the provision of timely healthcare finances to individuals. However, the article has pointed out that people are misusing the insurance facility.
One of the examples cited in the article is that people tend to overconsume the facilities which are being provided for free. If one person is insured then for even minor issues they will visit the doctor whereas those who are not insured are more likely to visit the doctor only when they have severe health issues. To cater to this problem many insurance companies also have high premiums, deductibles, and limited access to health services. A problem that arises in the insurance markets in the cases of health is adverse selection. Adverse selection is a strategic behavior where insurance companies have more information about the buyers of schemes than buyers themselves. It happens when people who are sicker and are at risk of becoming more sick buy comprehensive insurance schemes as compared to the people who are healthy (Handel, 2013). However, the author of the New York Times article has suggested that adverse selection can result in a death spiral where insurance companies impose the same insurance premium for all people.
This will lead to healthy people being less likely to buy health insurance and will ultimately lead to rising in insurance costs for sicker people. Affordable care act which is also known as Obamacare introduced employer-sponsored health insurance, and because of the compulsion to buy health insurance for the employee now more people are insured (Herrick, 2014). However, the issue with this policy is employees are increasing the deductions from salaries and reducing the raise amount. Also as per the act, companies that have more than 50 employees need to buy health insurance for all their employees, therefore, the companies are reducing the number of employees (Belliveau, 2016). All these factors make health policy more complicated.
There are several counterarguments to the article such as the point of overconsumption can be rebuttable. The idea is that people who get free access to health insurance can overconsume but it is important to understand that people will only go to the hospital and visit the doctors when they are solely in need. In this rapidly developing world, people often find no time to go to the hospital for the slightest twinge. Another point that consumers are unaware of has some fallacies because one of the most important concerns in medical ethics is informed consent and it does not only apply to research but while availing the treatment at all levels. While making decisions insurance companies, physicians, and the consumers (patients) decide and approve the treatment to avoid any malfunctions during the treatment. This means that consumers are also part of decision-making and are not the uninformed parties who are just receiving the end product.
In my opinion, there are other factors that also make policy complicated and are real-life issues such as political influences, issues of health insurance companies, and views of hospital managers, doctors, and practitioners. The political parties and their agendas regarding healthcare are what make healthcare policy law (Bambra, Fox, & Scott-Samuel, 2005). For instance, if access to healthcare is the primary point during the campaign then the work on health will be more, and in this also profit and revenue will be the utmost priority. It is also essential to know that many healthcare and insurance companies invest in the campaigns of political parties therefore upon selection the investors will influence while devising the policies. In other words, while designing a policy the priority is corporate profits, lowering the tax rates comes second on the priority list, and providing affordable healthcare is the least of concern for the policymakers which makes the policy complicated and hard. Therefore, it can be easy to say that health is political because not only healthcare services are politically dependent and require government intervention (Bambra et al., 2005) but also policies can be turned into law only when it is on the agenda of political parties.
As far as insurance companies are concerned, if the insurance companies are offering expensive health insurance, most people have the option not to buy the insurance scheme. But if you are lying in an ambulance the power is not in your hand to decide whether to buy it or not instead you have to buy it regardless of the cost. Also, not everyone can afford health insurance. For example, can a server afford to buy or contribute to a health insurance plan or the bartender can buy health insurance from the minimal salary they acquire? Health insurance can also be considered a luxury for most people. Health insurance is also a complex phenomenon because there are also several stakeholders and cooperative beneficiaries involved in the health insurance industry and for them, the profit is above the health services provided. Another important factor is raising awareness and understanding that health is a basic need and right so considering it as a profitable sector will make the health policy hard and will further have issues with the provision of health services.
In conclusion, the article has presented some insights on why health policy is a complex phenomenon but there are some concerns regarding policy making and health insurance companies that were not taken into consideration in the article. Healthcare policy is complicated and hard because every citizen needs health services and health insurance but not all people can pay for the services and the bigger chunk is left for the government to handle. Health is a basic right but not everyone can afford the health services so government interventions are required which are also influenced by stakeholders and primary focus on revenue generation. Health care policies are business driven which make it difficult to devise a policy that benefits the people who cannot afford health service. ACA act might have benefited the community but it has put more pressure on employers. The government needs to subsidize or provide health insurance and rich people can be helping hand in assisting government agencies in the provision of health insurance to those who cannot afford it.
References
Bambra, C., Fox, D., & Scott-Samuel, A. (2005). Towards a politics of health. Health Promotion International, 20(2), 187–193.
Belliveau, J. (2016, August 18). How the Affordable Care Act Impacted Healthcare Revenue Cycle. Retrieved February 17, 2018, from https://revcycleintelligence.com/news/how-the-affordable-care-act-impacted-healthcare-revenue-cycle
Handel, B. R. (2013). Adverse selection and inertia in health insurance markets: When nudging hurts. American Economic Review, 103(7), 2643–82.
Herrick, D. (2014, June). The Effects of the Affordable Care Act on Small Business. Retrieved February 18, 2017, from http://www.ncpa.org/pub/st356
Mankiw, N. G. (2017, July 28). Why Health Care Policy Is So Hard. The New York Times. Retrieved from https://www.nytimes.com/2017/07/28/upshot/why-health-care-policy-is-so-hard.html
