U.S. Health Care System - Essay Example

Outline I Introduction II Medicare. General knowledge and problems. III The Blue Cross and Blue Shield Association (BCBSA). Why it is better IV BCBSAtoday. BlueCross BlueShield Insurance Billing vs Medicare Billing Thirteen years ago Bill Clinton became the president of the USA mostly because of his promises to do something with high and rising costs for health care. Clinton's chances of reforming the US health care system were quite convincing and good at first glance but his efforts soon ran aground. The absence of other politicians desire to resist the insurance and other lobbies very easy destroyed the Clinton efforts. temporary remission in the increasing health care spending as HMOs was a good try to limit increasing of cost. But at the same time the general attention of a nation is focused first on the problem "how to get rich", then on the problem of terrorism. All these factors have kept the problem of health care off the top of the day. Today there are several popular health insurance programs. Let's look through them briefly. Medicare is the name of a health insurance program which is administered by the government of USA. It covers people who are 65 and older, or people of some other specific criteria. It was added into law signed on 30th of July in1965 by President Lyndon B. Johnson. It was the amendments of Social Security legislation. At the ceremony of bill-signing President Johnson registered former President of USA Harry S. Truman as the first Medicare beneficiary. Then Johnson presented him with the first Medicare card. And that was the beginning. Medicare is financed partially by payroll taxes which are imposed by FICA (The Federal Insurance Contributions Act) and the Self-Employment Contributions Act. Concerning to employees, the payroll tax is equal to 2.9% (1.45% withheld from the worker and a matching 1.45% paid by the employer) of the salaries, wages and other compensations connected with employment. Until the 31st of December, 1993, the law gives a maximal amount of wages, salaries etc., on which the Medicare payments could be imposed each year. In the beginning on the 1st of January in 1994, they removed the compensation limit. Concerning to self-employed individuals, the payroll tax is 2.9% of net earnings from self-employment, and the all amount is paid by the self-employed individuals. Medicare is facing continuing financial issues. In annual report to Congress in 2006, the Medicare Board of Trustees reported that the hospital insurance trust fund of the program could run out of money by 2018. Such projections trustees have made in the past, but this time that was colder than the perspectives reported even one year ago. The main problem is that the ratio of workers paying taxes for Medicare to retirees drawing advantages is shrinking and at the same time the payment of services of health care per person is increasing. Today there are 3.9 workers paying taxes into Medicare program for every older American receiving their services. Under forecasts by 2030, as the baby boom generation retires, that figure will drop to 2.4 workers for every beneficiary. They expect Medicare spending to grow by about 7 % per year for the next ten years. Some part of the cost of Medicare is a deceit, which auditor of government estimates to cost Medicare billions of dollars per year. The Government Accountability Office lists Medicare as a "high-risk" program of government in need for reformation partly because of its vulnerability to deceit and partly because of its long-term financial problems. Popular opinion reviews show that people convinced that Medicare's problems is serious, but not so immediate as other concerns. In January 2006, the Pew Research Center found that 62 % of the people said that government must give to Medicare's financial problems a highest priority, but the government still put this problem behind other priorities. Reviews suggest that there is no consensus between people behind any specific strategy to solve this program. A study by the Government Accountability Office estimated the quality of responses that were given the Medicare contractor customer service representatives to questions of provider. The evaluators made a list with number of questions, which were asked during a casual sampling of calls to contractors of Medicare. The rate of accurate, complete information given by Medicare customer service representatives was only 15 percent. In 1929, J. F. Kimball (Justin Ford Kimball) started his career as the vice president of Baylor University in Dallas, Texas. He was an experienced and talented administrator. He graduated from the College of Medicine, School of Nursing, College of Dentistry, and the university hospital. Soon after taking the job, Kimball thought up and developed a new health plan that guaranteed teachers 21 days of hospital care for $6 a year. This health plan was extended to other groups of employee in Dallas, and then similar plans began to spread all over the nation. The Blue Cross and Blue Shield Association (BCBSA) is a national organization that consists of 38 independent regional companies of health insurance in the USA and Puerto Rico. It was formed in the 1982 merger of the Blue Cross Association and the National Association of Blue Shield Plans. These two organizations started their histories to plans of health created nearly that time in two different parts of the U.S.A. The progress and evolution of managed health care in the USA is intimately connected to that of the Blue Cross-Blue Shield plans. Now from year to year more and more people turn their minds to this health plans because they have very significant benefits. Blue Cross and Blue Shield Associations (BCBSA) are the Servicing Agents for the State Employees' PPO Plan. The State Employees' PPO Plan covers most major medical expenses and gives access to employees to vast net of providers as well as a number of special services, benefits and different additional programs. All these include Healthy Addition prenatal program of education, information and health related resources, and also there is out-of-state health care coverage with the Blue Card Program. The State Employees' PPO Plan is to cover most major medical expenses for covered injuries and illnesses, including physician and hospital services. Participants will be responsible for any co-payments, related deductibles, admission fees, coinsurance, and non-covered services as well. In addition, members are responsible for charges above and over the allowed quantity for non-network services, amounts above the PPO Plan limitations, and compensations which are associated with non-network not certifying hospital admissions. With the State Employees' PPO Plan, one has the opportunity to visit any hospital or doctor from BCBSA wide network of providers. There are no claims to file, and no referral authorization requirements, also there is any balance billing. So, one is really free to seek care when and where it is needed. BCBSA benefit package is flexible and detailed, and strong competitive. Even in difficult and hard times, with all of the issues that were focused on the costs rising of pensions and healthcare, BCBSA were able to give a big specter of benefits, such as healthcare and transit checks, which can be tailored to meet the needs of employees and their families. Medical coverage of BCBSA gives protection against the high costs of healthcare. As a BCBSA employee, one can choose between 3 medical plans: Traditional PPO, HMO and a high deductible PPO with an option of healthcare savings account, or one can choose of all medical coverage altogether. A Flexible Spending Account (FSA) allows employees to avoid pre-tax earnings to pay money for chosen medical and dependent care expenses. BCBSA employees can postpone up to $3,000 annually for a Health Care FSA and $5,000 annually for a Dependent Care FSA. Due to their costs benefits BCBSA has a strong popularity in U.S. More and more people come to conclusion that BCBSA could be a good decision in The Heals Crisis. The Blue Cross and Blue Shield Government (BCBSA) is a spread Service Benefit Plan, also known as the Federal Employee Program (FEP), found more than 133,000 new members during only the 2006 year open registration season -marking the program's 22nd consecutive increase of members. Both Basic and Standard Options continued to increase registration this past season with Standard Option increasing by nearly 1.5 % and Basic Option by approximately 12 % over enrollment of last year. Starting in year 2007, retirees and federal employees were offered a new FEP vision product, named FEP BlueVisionSM. This product was made as a result of the Federal Employee Dental and Vision Benefits Enhancement Act of 2004. FEP now covers more than 59 % of all retirees and federal employees who receive their health care benefits with the FEHBP (Federal Employees Health Benefits Program). Subscribers of FEHBP with their families receive health coverage through their local Blue Cross and Blue Shield Plans across the whole country. BIBLIOGRAPHY 1. Can We Say No The Challenge of Rationing Health Care by Henry J. Aaron and William B. Schwartz, with Melissa Cox 2. Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Kinga Zapert, Jordon Peugh, and Karen Davis, "Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries," Health Affairs Web exclusive, November 3, 2005. 3. Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R. Waters, "Health Spending in the United States and the Rest of the Industrialized World," Health Affairs, Vol. 24, No. 4 (July/August 2005), pp. 903-914. 4."Medicaid: A Lower-Cost Approach to Serving a High-Cost Population," policy brief by the Kaiser Commission on Medicaid and the Uninsured, March 2004. Read More