A Looming Crisis: Where Is America’s Health Care System headed?

(published 2008)

One of the most talked about issues in American society today is health care coverage, and with the presidential election fast approaching, it has become a hot topic for a lot of Americans.

Quality health care that once seemed reliable is quickly being priced out of reach for millions of hardworking, tax-paying Americans. The health care crisis affects every citizen regardless of age, race, or employment.

Everyone gets sick and everyone wants the comfort of knowing that in case medical care is needed, it will be provided and affordable. Yet over 47 million Americans do not have health care coverage according to americansforhealthcare.org, which is over 15 percent of the entire U.S. population.

With nearly 50 million Americans not covered, it is not farfetched that the average citizen may be faced with the dilemma of needing medical services and not being able to afford them because they have no healthcare insurance.

Health care cost increases are growing faster than wages nationally. These rising costs make it difficult for small businesses to provide basic coverage and therefore corporations are shifting the growing burden directly to their employees, leaving many Americans without affordable coverage.

In the past year, wages have increased 4 percent while insurance premiums have increased nearly 15 percent, and the cost of a family premium is expected to reach $14,500 a year, according to citizenshealthcare.org.

In the instance that someone is not covered, the consequences vary depending on the situation. According to Michele Collins of Montefiore Medical Center, a patient arriving at an emergency room with no coverage is different from a patient who is not covered and goes to a doctor’s office for a specific type of treatment.

In the case of emergency medical services such as a visit to the emergency room, a hospital cannot deny a patient treatment if he or she is not covered.

“If you arrive at the hospital needing emergency surgery, of course they will take you right away,” said Collins. “They will treat you and eventually you will be billed for the services provided which is usually an exorbitant amount of money.”

Most hospitals will offer some form of payment plan that would allow the patient to pay it back a little at a time.

However, it differs when someone is seeking medical services from a specialist such as a cardiologist or dentist. In this situation, if the person does not have healthcare coverage, that person can be denied the service, even if the service is deemed vital by a primary doctor. This doesn’t bode well for people who suffer from ailments that require long term extended care such as diabetes or cancer.


Americans who do not receive medical benefits from their employers have realized that there may not be affordable health coverage in their near future. Students who have graduated and not found full-time jobs and adults who have been laid off have quickly discovered that purchasing their own health insurance comes with an exorbitant price tag.

With the vast amount of health insurance providers currently available to the public, choosing which one that works best for the consumer’s needs can prove to be difficult. Among the more popular choices are GHI, Cigna and Empire.

Group Health Incorporated or GHI was founded in 1937 and offers the largest Not-For-Profit services in New York. According to their website they have about 3.4 million members with a variety of health plans, including the 9/11 Health Insurance Group Benefits Program.

Among the benefits of this plan is access to over 130 thousand participating provider locations, including virtually every general acute care hospital in New York State.

With the 9/11 Health Insurance Benefits program, one can see any GHI participating provider, including specialists, anytime he or she requires care for a small co-payment. No physician referrals are required.

GHI also offers Medicare programs with more than enticing benefits and has a plan that offers prescription drug coverage with no deductible, low co-payments, and even a plan with no coverage gap.

Cigna also offers a variety of Health Plans; however, out of its 31 plans, its most appealing is the dental plan. Offered is a program called “CIGNAPlus Savings,” whose dental service network ranges to more than 70 thousand participating provider locations.

According to their website, members save an average of 35 percent off some of the most commonly performed dental services including X-rays, cleanings, root canals and braces.

Two routine cleanings usually cost $153, with CIGNAPlus savings discount fee, customers pay $100. For two quadrants of periodontal scaling and root planning, the usual fee ranges from $300 to $500; with CIGNAPlus customers pay about $232.

Be aware that this is not an actual plan. This means that there are no claim forms, deductibles, age limits, waiting periods, pre-existing condition limitations, or referrals needed for specialty dental care.

Empire BlueCross BlueShield excels at having the friendliest user interface along with its claim that 86 percent of doctors would recommend Empire to other doctors.

EmpireBlue offers 10 plans, including HMO, PPO, and EPO. However what is most notable about each plan is that they all come with what they call “360 degree health,” which is a suite of preventative care programs, wellness information, case management, and care coordination services.

Among these is a ‘Staying Healthy Reminders’ service, in which members receive monthly, semi-annual and annual reminders to schedule important appointments, whether its childhood immunization, adolescent well-visits or flu shots. It also has special offers including cheaper medicine, discount memberships for fitness centers, and 40 percent discounts on all diagnostic testing, among many other offers.

Members who meet a certain criteria are eligible for “Empire’s Systematic Analysis Review and Assistance Program” (SARA). Based on certain test results, doctors can determine if a patient is at risk for a certain condition. According to their website, “The philosophy behind the program is to provide physicians with added support to ensure that you receive optimal care as quickly as possible.”

With the hassle of choosing the correct provider, Brittany Mailing, a feature writer for HRworld.com, offered a few tips on how to make the right choice.

“Do research,” he said. “Knowing the difference between an HMO health insurance and a PPO health insurance is important. The PPO is often more expensive because it offers “choice and flexibility” with regard to choosing a doctor, according to wisegeek.com.

The best way to choose the best health insurance plan is to make a list of priorities. Customers must decide if they care more about premium charges as opposed to customer service. They must also consider whether they would like to retain their current doctor, or if specific illnesses run in their family. Such information is vital to choosing health insurance, said Mailing.

She added that most insurance companies will let customers try out their plans, and after a set period, cancel prematurely. She encourages customers to read the fine print of all policies. “As the refund time, periods usually range from one to six weeks.”

Mailing’s final tip is to consider a health savings account.

“If you aren’t going to be using your health insurance often, this option could save you lots of money,” she said. “The account goes with an insurance policy with low premiums and money you save on the premiums gets set aside and grows tax-deferred.”

There is no precise way to choose the correct health care provider, but reading into them and finding out exactly what they offer is vital in ensuring the consumer that the best possible coverage is the one being provided.


The United States Government Accountability Office founded that approximately 20 percent of college students are not covered for health insurance and that the other

80 percent are covered through private or healthcare from their employer.

This analysis showed that 1.7 million college students were uninsured due to being part-time students, older students, or students coming from a certain racial or ethnic background or from families having low income.

However, most college students are not even aware that their institution even offers health insurance or whether or not they are eligible.

The federal law ensures continued access to health insurance for some, but not all students. Most college students are offered a health insurance plan when first entering the college.

Mercy College offers a health insurance plan to every incoming student, whether the student is a transfer or international student, full-time, part-time or just a commuter.

The health insurance being offered to the students is from Sentry Insurance and is known as, “The Sentry Student Security Plan.”

The Sentry Student Plan is a health insurance plan that is not just particularly for Mercy College, but also represents hundreds of other educational institutions across the nation.

When some of Mercy College students were asked about whether they were informed about this insurance, the answer was an overwhelming no.

“I didn’t even know that the school had insurance available to us, and I’ve been going here for two years now” said Mercy College sophomore Malcom Baker.

The Sentry Student Plan is easily available to students and they are all eligible for it. Any student who is registered and attending a college or university is eligible to enroll.

There are two plans to choose from, but international students are required to choose Plan II only.

At Mercy, students do not have to meet any criteria as long as they are enrolled as a student.

The Sentry Student Plan is immediately effective when a completed application reaches the plan administrator, which is roughly two to three weeks. The insurance is effective until eight months after graduation and four month minimum payment is due with a purchase of any option you choose.

“I am covered through my job, but I also feel it is a good idea to have a back-up coverage in case I am not able to work anymore,” stated Freshman Wilbert Reyes.

The Sentry Student Plan has two plans apart of their benefit options. The plan covers 80 percent of hospital room and board, surgery, non-surgical treatment, laboratory tests, X-rays and ambulance fees. The remaining 20 percent must come out the insured’s pocket.

Along with this insurance plan, students have the option to be entitled to a Dental Plan and a prescription discount card.

“One of the most important things that students need to be aware of is the fact that it is made affordable for college students whether you are full-time, part-time or even if you’re married with a child,” stated Cathy Doe, a Sentry Insurance Agent.

The monthly premium rates for this academic school year are $21 for Plan I and $48 for Plan II if the student is under the age of 24 years old. Anyone over the age of 25 is $26 for Plan I and $67 for Plan II.

“As a college student, I think these rates are very affordable and I am considering signing up for it real soon,” said Baker.

Mercy College students now have the option to affordable health insurance until after graduation.


People have been arguing for what feels like centuries about an all too familiar topic that sees even more air time around presidential elections: healthcare, and most notable, the private health care system against the universal.

America has run with the private health care system for years, and though the argument to make it universal has come into play just about every time there is a presidential election, it seems the private health care is staying put.

Democratic Presidential candidate Barack Obama claimed in Iowa City on May 29, 2007, “My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”

Fellow Democratic candidate Hillary Clinton claims, “If you have a plan you like, you keep it. If you want to change plans or aren’t currently covered, you can choose from dozens of the same plans available to members of Congress, or you can opt into a public plan option like Medicare. And working families will get tax credits to help pay their premiums,” according to her website.

Republican candidate John McCain states on his website that “We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care.”

According to netdoctor.com, the United Kingdom, which is known for their universal health care, is starting to lean towards private health care to solve some of their health related issues.

“The big incentive in the UK of buying private health coverage is that it provides a sense of security that if people become ill or need an operation; they can get treatment promptly and they can exercise choice. A private operation is usually performed at your convenience by a surgeon of your choice and often at a hospital you choose. You have the advantages of unrestricted visiting hours in a private room with TV, and a choice of food. A retinue of medical students will not accompany your consultant,” the website claims.

They go on to claim that with the National Healthcare System (NHS), patients can wait up to a year for what it termed a “non-urgent” operation, however with private medical insurance, that same patient can have it within a few days.

The Connecticut Coalition for Universal Healthcare argues that “The United States is the only industrialized nation that does not guarantee access to health care as a right of citizenship.”

Nearly 30 industrialized nations have single payer universal health care systems, while one (Germany) has a multi-payer universal health care system such as former President Bill Clinton proposed for the United States.

They came up with several conclusions that contradict the common beliefs against universal health care such as the belief that it could take away rights such as freedom of choice and that it would be too expensive with answers such as the following, according to their website: “Single payer, universal health care administered by a state public health system would be much more democratic and much less intrusive than our current system. Consumers and providers would have a voice in determining benefits, rates and taxes,” and “Single payer universal health care costs would be lower than the current US system due to lower administrative costs.”

So with these severely contradicting views on which system is better suited for a democratic society, it would seem obvious that there is no clear-cut answer as to which one is better.