In this discussion, I will be addressing two major reasons why health care costs in the United States are so high. I will also address two policies that help with cost control. The United States is the only high-income nation without universal, government funded or mandated health insurance employing unified payment system (Cai,2020). Health care costs continue to rise for reason number 1, high preventative procedures and drug costs. In 2018, the national health expenditures reached $3.6 trillion dollars. In the New York Times article the $2.7 Trillion Medical Bill (Rosenthal, 2013), the discussion surrounds the high cost of preventative testing for Americans. The United States has the most expensive preventative testing in the world. The article reviews how Americans receiving basic preventative procedures like colonoscopies, pay double and triple what other countries do for the same procedure. The cost of necessary medications has become almost impossible for working class and low-income families to keep up with. Rosenthal (2013) stated that a simple drug like Nasonex for allergies may cost an American $108, where as in Spain it is $21. Americans with insurance are faced with the continued increase in high deductible plans, and increased co-pays. So even though the preventative procedures may be covered by insurance, patients are still paying a high amount out of pocket. In my opinion, the high cost of healthcare is from the greed of companies that produce and manufacture health care products, ie: drugs and medical technology. The Affordable Care Act has made significant progress in solving the dilemma of long-standing lack of coverage and accessibility, Obama (2016). The ACA is an established policy continuing to reduce bad medical debt and while increasing health care for the American people. The ACA is continuing to help Americans with alternative bill paying, providing health care accounts and bundling payments for a onetime payment option. Obama (2016) states that by expanding health coverage, it increased access to treatment, and provided financial security and health to those who were never insured. Coleman (2021) discusses the policies in making an effort to control rising drug costs. He states that some insurers are in the process of trying to connect common medications that Americans use, with the use of the formal cost-effectiveness analysis. The CEA is a policy already in place, trying to minimize wasteful spending. The downside that Coleman (2021) sees in regards to the CEA, is the continued discussion on how it may be unethical in regards to which medications are chosen to be available at a reduced price, still leaving Americans with a tough decision to make. The second reason, in my opinion, that is driving up health care costs for Americans is fraud & abuse. Shi & Singh (2019) discusses how when fraud occurs from a false billing claim or costs are reported intentionally falsified, this drives up the services that were received for the next patient. Up charging or upcoding is another area within health care that is abusing the health care system. It is illegal for medical personnel to charge more for a less expensive procedure. Fraud and abuse in health care is a legitimate concern and the federal government has established a number of laws to protect the consumer from over utilization of services provided. One policy that is in place to regulate and prevent fraud and abuse is the Stark Law. The Stark Laws prohibit physician self-referral for laboratory or other designated health service (Shi & Singh, 2019). Originally, this law was only established to protect clinical laboratory services. In 1993 it was expanded for 10 other services. Butler (2016) describes in detail how the stark law is established to prohibit a physician from referring a Medicare patient to a designated health services that he or she may be financially affiliated with to receive compensation. The law also prevents unnecessary billing by a physician for their services. Its goal was to prevent an inappropriate financial relationship between provider and patient in the exchange for referrals. Butler (2016) discusses how health care reform legislation passed in the form of Patient Protection, Health Care and Education Reconciliation Act of 2010; or collectively called the Affordable Care Act gave patients the ability to have a Medicare Shared Savings Account. This provided patients with a new approach to health care coordination and cost-effective savings. Teams of hospitals, providers, and other health care members would come together and coordinate high quality care for patients, to ensure patients would not have payments for duplication of services. In my opinion, this is how health care should be for all. References:Butler, K. H. (2016). Stark law reform: Is it time. Journal of Health Care Compliance, November–December, 5-14.Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., … & Kahn, J. G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLoS medicine, 17(1), e1003013.Coleman, C. H. (2021). Cost-Effectiveness Comes to America: The Promise and Perils of Cost-Effectiveness Analysis in Medication Coverage Decisions. Georgia State University Law Review, Forthcoming.Obama, B. (2016). United States health care reform: progress to date and next steps. Jama, 316(5), 525-532.Rosenthal, E. (2013). The $2.7 trillion medical bill: Colonoscopies explain why U.S. leads the world in health expenditures. Retrieved from http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html.Shi, L. & Singh, D. A. (2019) Delivering health care in America: A systems approach seventh edition. Jones & Bartlett Learning.
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