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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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The Need for Changes in U.S Health Insurance

Allan Schwartz, LCSW, Ph.D. Updated: Nov 13th 2009

two doctors in operating roomThe United States House of Representatives has passed a health care reform bill for the nation. Now, the bill goes before the Senate for debate, modification and passage or rejection. That there is a need for health care reform no one seems to question. However, the nature of the reform is being hotly debated once again, as it has for many years.

Kaiser Health News, (unaffiliated with Kaiser Permanente health insurance company), publishes a monthly newsletter named, KHN. This month, in conjunction with the LA Times, they discussed the serious issue of health care in the United States. What they had to say was sobering indeed. What they pointed out was that there is not much difference between those who are uninsured and those who are.

How is this possible?

The answer is multi faceted. For example, 1. many people who were insured have lost their jobs, throwing into unemployment without any coverage. In other words, they join the ranks of the uninsured.

Those who remain employed or who find new jobs, discover that their coverage is grossly inadequate if they or an immediate family member develops a catastrophic illness. These are people for whom medical bills are covered by their policy only up to an allowable limit. Because medical costs today far surpass that limit, they find themselves quickly in debt as a result of the illness.

I expect some readers to protest that these people should have saved and invested their money so that they could have paid the balance of their bills. The answer is that many of them did just that thing, paid all their medical bills until the bank account was empty with no further ability to pay.

2. Many others are finding themselves caught in the web of co-pays. As the cost of medical treatment has risen, insurance companies have increased the amount of the bill patients are expected to lay out before they will reimburse doctors and hospitals. At one time, a copy pay for an office visit might have been five dollars per visit. Today, many co pays are as high as twenty to thirty dollars per visit. When you add to that the fact that prescription drugs require another co pay, the entire venture becomes quite expensive. If their is a chronic or catastrophic illness, such as cancer, the results can and do ruin peoples financial well being. By that I mean that people in this category find themselves unable to pay their mortgages and find the banks pushing them into foreclosure. Remember, these are not people who speculated when they bought their homes, nor are they people who became trapped by questionable mortgage companies so that they purchased a house they could not afford. The loss of their homes is due to the advent of a serious medical problem and inadequate insurance coverage.

3. Yet another problem is that, the way the medical system works today is that, if someone has been hospitalized for surgery or some other procedure, the doctors who provide these services send their bills after the hospital charges are paid.

The problem is that this catches many families by surprise. Given a hefty bill from the hospital and having their insurance reimburse for the charges, these people believe all their charges have been paid. Suddenly, they begin to receive bills from doctors they never heard of or whom they incorrectly believed, had been paid. These charges often come to thousands of dollars. Like it or not, these patients remain fully responsible.

Will their insurance pay? Not an easy answer. Here is why:

1. The bills from these doctors must be submitted before a deadline set by the insurance company. If the bill fails to be submitted on time, they will not pay.

2. If the doctors are not in the network of the person's insurance company, the insurance company that the patient has may pay part or none of the bill, depending on how their policy is written.

As KHN and the LA Times jointly point out, the problem is not that these people have no insurance. The problem is that they have inadequate insurance.

In my very humble opinion, I believe we need universal health insurance so that every citizen will be able to feel certain that their illnesses will be treated without the threat of being driven into bankruptcy or homelessness.

What is your opinion?

I want to make two final statements:

1. I invite those who agree and disagree, to submit their points of view. In no way am I attempting to impose my views on those who may disagree.

2. I also invite those of our readers who live in other nations to participate in what I hope will be a good discussion. Our audience extends well beyond readers in the U.S. Therefore, I want invite those who live in other nations and have different insurance systems, to discuss their experiences. Many, but not all of these people come from the UK and Canada. U.S. citizens regularly refer to these two countries when discussing the U.S health care crisis. I am not sure that we in the U.S. have an accurate view of what happens there. Of course, there is also France and many other countries that have medical systems that vary from that of ours.

So, I invite everyone to weigh in on this important issue.

Allan N. Schwartz, PhD



Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
Discuss this issue below or in our forums.

But, But, But - Cathy - Nov 16th 2009

Well, let's go with argument that someone brought up that they shouldn't have to pay for health care for someone else.  I don't have children in the local school or the community college so if I don't have to pay that tax amount, I can put that toward health care.  Also, I will probably never be able to collect social security or I should have an option not to pay into the system and just save up my money for retirement or go ahead and buy health insurance with that.  Before insurance really entered the picture, health care was affordable.  When I was a child, the 60's, my dad had a policy that amounted to only major medical and even on a factory worker's salary and one parent working, we never had a problem paying medical expenses or affording medications.  In the crappy little town we live in, the only good paying jobs which pay nearly twice the normal starting wage here are with the insurance companies that process claims - see, they say not everyone is cut out to do the job because the reward is in denying the claims.  Someone I know whose husband works there (he is from England) cannot believe the claims that he must turn down.  Another friend said her husband was laid off from there and hasn't found a job yet but it was the best thing that could have happened for their family.  The US has only two areas anymore for jobs and that is the prison system and the medical system - that is where the money is spent and made.  I saw that special about health care in Europe where if you are sick, you just walk in and get care at no expense - I thought, can you imagine the burden that would lift if you knew that tomorrow, no matter how ill you or a family member were, that you could walk into the clinic and not have to worry about losing your house or ending up filing bankruptcy?  The proposed system by Obama is to support the people - insurance companies - that played a major role in getting him elected.  There are so many older people where I live and they go without some of their medications so that they can afford to pay for food or utilities.  What a sick and selfish nation this is.  Constantly we see those little cans set up in the store or maybe a fund raiser at one of the local fire stations for someone's very ill child because the parents can't afford the care.  Too, too much money is going into the pockets of the insurance companies and too much is being paid to the employees to turn down claims that should be paid.  When we had insurance they always turned down the claims at least 3 times before paying - it took 8 months for them to pay for a thyroid test that cost $60.00 and I probably spent 6 hours over that time talking to either them or the lab trying to get the bill paid.  I met someone from Canada and asked her about the system there and she said that often you had to wait for services but I said "At least you know that you will get them eventually."  Maybe if Congress worked at creating real jobs we wouldn't have to force people to buy insurance in order to have jobs in this country.  I agree with the idea of universal health care for the reasons stated by A. Swartz but in my thought process, it is only right that all should have access to health care.  All those who would just let Little Johnnie die because their parents could not make enough money to pay for insurance because they washed the dishes and waited the tables for their family, drove their children to school,  chased their dog and took it to the pound for safety, the clerks at the super store who rang up their purchases, or maybe cleaned their big house - well, if you eliminate these people or they all get high paying jobs, you'll be doing all your own dirty work.  I just get so tired of those that have being critical of those they are actually using and making money off of. 

We don't need "universal" health care, we need medical cost reform. - - Nov 14th 2009

Why does everyone think someone else should pay for thier medical bills?

Because that's exactly what "universal health care" means for all of us - we will all pay for everyone via our taxes. And if you don't pay taxes, well, I guess you get a free ride.

What we need is medical cost reform. If the insurance companies would be allowed to compete across state lines that would allow for better rates for coverage purchasers. If insurance companies would not force doctors to take an "adjusted" rate (read: greatly reduced rate) for thier services the doctors would be able to offer thier patients reduced rates. If the medical goods and services providers would reduce thier "greed factor" and not have a 500% markup (Example: wheelchair purchased online for $200, exact same wheelchair billed to Medicare: $780!! I experienced this myself.) more people would be able to meet their financial obligations for the medical goods and services they have received. If our society wasn't so litigious (the doctor made a mistake, I'm going to sue) we wouldn't have such high costs now. Everyone forgets that medicine is not an exact SCIENCE so we expect perfection from our doctors and punish them severely if they make a mistake.

I understand many medical goods and services providers (specifically pharmaceutical companies) use profits for research.

Legislating more social responsibility on the part of medical providers might be a good start. (similar to windfall taxes on oil companies.)

What's needed is a change in paradigm - Monica Birsen LPCC - Nov 14th 2009

I'm a therapist at a public agency and I think there is too much emphasis on the immediate, but superficial result, and not enough emphasis on self-care as preventative and curative care.

Depression, obesity, high blood pressure and particularly diabetes are long term expensive illnesses to treat, at least the way we are going about it.  In my opinion, antidepressants are far too often used as a first resort, and these medications cost hundreds, sometimes over a thousand dollars a month.  On top of that, if you do a search of the literature, there is abundant research that shows antidepressants to be of less than impressive efficacy. The pharmaceutical companies have their ways of cherry picking subjects and publishing only those experiments that show favorable results.    And when you take into account that many psychiatric medications, such as Serquil, have such a high prevalance of precipitating diabetes and obesity, the actual cost to our health care system goes exponentially higher.   We really need to be encouraging self-care and psychotherapy first, and using antidepressants as a last resort. 

That's all I have to say about that.


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