Although the new administration seems to have gotten the ball rolling as far as changes to policies go, the future is still looking pretty bleak according to many analysts. The number of uninsured Americans right now stands at 45 million people in 2009. If there aren’t significant changes made in health insurance policies, that number will skyrocket to 54 million uninsured people by the year 2019. That would mean that over 17% of our entire population would be without health insurance. In this post, we’ll look at what people are calling for in terms of change, and what members of our government have to say to the President.

What Are the Problems with Current Health Policies?

The increase in the numbers of uninsured would be driven by the costly insurance premiums whose prices rise faster than incomes can keep up with them. If people simply can’t afford to keep paying health insurance premiums, they’re going to let them go and join the ranks of the uninsured. Many health treatments are deemed wasteful and unnecessary, and people pay well over what they should for these services.

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Maoist China during the period between 1958 and 1976 was one of the world’s widest users of public health posters and announcements. It was almost impossible to go anywhere in the country without seeing some form of health poster telling citizens to do a certain thing or not do a certain thing in the interest of public health. Then, unlike now, China had a nationalized health care system. Today, China relies on a variety of health care options, including employer provided coverage (known in China as laobao yiliao) and individual health insurance policies.

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You hear whispers of it on the wind, legends of time where one person saw one doctor, who knew all of their past ailments, and truly cared about their health and well being. This standard has seemed to have fallen by the wayside in the recent years, among all the chaos and hubbub of the current United States healthcare system. Doctors now get paid per patient they see per day, so crammed waiting rooms, curt visits and impersonal service have become the norm, and we have gotten so used to it that we haven’t even considered an alternate way of doing things. But take of your goggles of disbelief, because a more personal, cozy model of health care is being buzzed about.

What is the Medical Home Model?

Three years ago, the healthcare guru’s over at IBM started looking at what they were doing to improve the quality of life for their employees and realizing they were overlooking a crucial component: healthcare. After realizing this crucial change that needed to be addressed, the director of healthcare transformation at IBM, Dr. Paul Grundy, helped found the Patient-Centered Primary Care Collaborative (PCPCC). This coalition of large employers, consumer organizations and medical providers developed the Medical Home model, and its combination of old school patient care combined with the latest in medical communication technology makes this unique and optimistic proposal for healthcare. Under the Medical Home proposition, one doctor would act as a coach for the team of specialists treating one patient, including things like preventative, holistic and wellness needs. More time is spent with the patients in person than you are probably getting from your doctor now, and the doctor is accessible on the phone and via e-mail in addition to extended office hours and coordination of care across the entire medical team.

Advanced Technology and Medical Care

The sharing of a patient’s health information via an EHR, or electronic health record, is an integral part of how the Medical Home model works. An EHR can help to reduce errors, eliminate duplicate tests, highlight drug interactions, improve overall quality of care and reduce costs. This interweb of information can allow a patient to access a web portal to schedule appointments and check their lab results, patient registries and e-prescriptions. With the click of a mouse, information about a patient’s health can be shared across a network of healthcare providers, and patients can always stay in the know about their treatment, doctor recommendations and medications by hopping online or picking up the phone. Instead of wasting precious free time that most of us don’t have, you would be able to utilize the tools readily available to you in the form of your phone and computer to stay in touch with your physician. Doctors would get extra money for being available for the patients in odd hours, and offices can get a little bit more money by implementing the technological changes necessary to upgrade the office. Phone and e-mail consultations would be reimbursed.

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Cost sharing, when you first hear it, might sound like a good thing. Something to help lessen the burden of costs you’re being socked with for your health insurance. Unfortunately, cost sharing in the United States often ends up to the detriment of the consumer, as health insurance companies raise their rates and have to ask consumers to pay a higher portion of what services cost. Sometimes insurance companies have to raise the rates for employers, who then have to turn around and raise the co-pays for their employers. It’s a vicious cycle, but other countries around the world have developed models to help lower and limit cost sharing that falls on the shoulder of consumers, and the United States might do very well to look into these models and implement them here. Especially with things as they are in our current economy, anything that can be done to keep hitting already weighed-down consumers with more costs should be a high priority.

What Exactly IS Cost Sharing in Health Insurance?

There are a few key specific points to understand when looking at the role cost sharing plays in health insurance. Direct forms of cost sharing between consumers and health insurance providers are things like the following: co-payments (what you pay per service), coinsurance (a percentage of the charge that you have to pay) and deductibles (the amount you have to pay out of your own pocket before coverage begins. This can be on all services or you can have a certain deductible on a type of procedure). Indirect cost sharing isn’t typically included in the standard definition of cost sharing in insurance, but they still cost consumers money and come right out of your pocket. These can be things like: charges when you go to see an out-of-network doctor, going to a specialist before seeing a primary care physician and being charged full price for that, any health services not covered by your insurance plan and health care premiums.

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In the past few years, you couldn’t turn on the television without seeing an advertisement for some new kind of drug. Erectile dysfunction, blood pressure, allergies, and restless leg syndrome (yes that is real) are all some of the drugs you may have seen splashed boldly in front of you on the screen. If you have been paying close attention, or just spend hours glued to the television, you may have noticed that drug ads have become less and less frequent throughout 2008. What’s causing this ad-less phenomenon, and is just due to the struggling economy?

Drugs Are Denied More Than Approved

Many drug companies are getting many of their fancy new drugs approved by the FDA and other regulatory bodies, so there’s no point in spending money advertising a drug that no doctor is going to buy and prescribe. If drugs are making it past the rigorous approval process, they are often drugs that target smaller population groups, like a cholesterol drug. There is no sense on spending millions on advertising on a drug that won’t be treating millions of people. According to figures from TNS Media Intelligence, U.S. drug ad spending dropped 6% in the first eight months of 2008, to $3.2 billion. That comes after a 3% dip in the full-year 2007, which had a total of $5.3 billion. Ad spending had generally been upward previously, peaking at $5.4 billion in 2006.

A Change in Media

You may not have realized this, but most of the ad spending done by drug companies is in the form of print ads. I don’t read magazines much anymore but when I did, I would see a ton of different drugs being advertised, varying heavily from magazine to magazine and their target audience. As with so many things, the trend now is headed toward the online world. People want their information in an instant, and web advertising can provide that. While you can easily flip through a magazine and read a drug’s information there, it is so much easier for a consumer to have an ad pop up on their screen, click on it and then read all the information they ever wanted to know about a particular drug. It makes complete sense to funnel money into online advertising (but then again, I encourage everyone to get online, whether it’s for fund raising, communication or shopping). Drug giant AstraZeneca told Dow Jones Newswires that some 20% of its consumer marketing budget was for digital advertising this year, up from around 15% in 2007. 1/5 of a company’s marketing budget going toward making sure online consumers get the drug message? It seems smart to me on the part of the drug companies.

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Where to Go From Here

It may seem like there is no aspect of our country that isn’t an utter mess right now. Big banks are being bailed out, the auto industry is flailing like a car in the river and as we see here, the health care industry is rapidly falling ill to this economic virus. Is there any hope? I feel that there is. We have a new President with new ways of thinking around how health care and insurance should be offered, and while I don’t hang my hat on things changing immensely and immediately after the old administration departs, I do think they are on course to change for the better. How much worse can it get? The road to change has to be one we travel.

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