Confusion Remains in Difference Between “health care,” “health care access,” and “health care insurance”

With the roll-out of the GOP plan to “repeal and replace” Obamacare, terms thrown out by both sides of the aisle use terms interchangeably that are different and should be used as such.  Both Republicans and Democrats use the terms “health care,” “health care access,” and “health care insurance” interchangeably, as if the terms are alike and have the same meaning, when the terms are different and cannot be used interchangeably.  This incorrect usage of terms has caused confusion among much of the public resulting in fierce defense of Obamacare and dissent against the unconstitutional GOP health care insurance plan being dubbed “Ryancare.”  Interchanging these terms and causing confusion among the public is immoral, irresponsible and political in nature.

In order to understand the issue of “repeal and replace” Obamacare and understanding of Obamacare, one should know the definition of the terms used to confuse the public into thinking either Obamacare or “Ryancare” somehow equates to attaining health care.

Health care, by definition, means, “the prevention or treatment of illnesses by doctors, dentists, psychologists, etc.”; “field concerned with maintenance and restoration of the health of the body or mind”;  “act of taking preventative or necessary medical procedures to improve a person’s well being”;  and/or “the maintenance and improvement of physical and mental health, especially through the provision of medical services.”

Health care access means the “ease in which an individual can obtain needed medical services”;  “helping people command appropriate health care resources in order to preserve or improve health”;  and/or “ability of an individual to receive health care services.”

Health care insurance means a type of coverage plan that pays for medical and surgical procedures incurred by the individual as a result of sickness or injury.

Obamacare, as well as “Ryancare,” is health care insurance.  It has nothing to do with health care or health care access.  Neither plan guarantees provision of health care or health care access nor does either plan guarantee payment for medical services.  So, why are politicians, including the president, using these terms interchangeably?  It is to confuse the public on what is actually occurring with the legislation and guide citizens into thinking that no one will receive or have access to health care services without a government controlled insurance plan.

Most communities have several physicians in general practice, some physicians who specialize in specific areas of medicine, a hospital, a health department, and individuals who provide ancillary services, such as dentistry, optometry, mental health, etc.  These are accessible by individuals in the community in order to preserve or improve their health.  In communities near large cities, individuals may choose to receive services from medical entities there or may be referred by a local physician for specialized care if unavailable in their community.  All of this is considered “health care” or “health care services.”

Individuals who have no transportation, are elderly without family members close by, or live in extremely rural areas may have difficulty obtaining needed medical services.  This goes to “health care access.”  The services are available;  yet, the individual has difficulty accessing the system due to their personal circumstances.  On the flip side, many communities may not have services that would meet the needs of the individual and large cities are considered “too far away” for a person to reasonably rely on that city for access.

Health care insurance provides for payment of medical and surgical procedures incurred by the individual because of illness or injury.  However, insurance plans may not cover all services needed, may have specific criteria that an individual needs to meet before the plan pays for services, and/or may not cover all providers in an area or community accessible by the covered individual.  This means an individual would need to seek a provider the insurance covers in order to receive appropriate health care, which could present a problem for an individual without transportation or who cannot access public transportation.  The individual may have insurance but not have the means to attain medical services.

Just because one has insurance to cover health care expenses, it does not make accessing the system any easier.  Some areas do not have all the medical services an individual may need in order to maintain or restore their health.  Despite having the insurance, the lack of providers or facilities does not change, meaning the insurance does not make access easier.

The following experience should demonstrate the point attempting to be made.

When I was a practicing registered nurse, I worked for six months on an Indian reservation in Arizona.  The hospital was located in the main city on the reservation with lesser towns having small clinics.  Each town possessed general practitioners who provided for the medical needs of the Indian population.  The reservation was comprised of vastly rural, sometimes isolated areas, meaning some individuals lacking transportation had to walk to receive care from a medical provider.  The population there was covered for services under different insurance plans overseen by the federal government.

Several individuals, some elderly, walked for days to be seen by a physician at the hospital outpatient clinic, receive dental services, have prescriptions refilled, or access emergency care.  One individual rode his horse to the clinic to see a physician.  In one instance, a patient, who had walked for days to receive care, suffered irreparable damage to her hand as a result of scaling a barbed wire fence to avoid an abusive husband, because of the transportation situation.  The insurance she had paid for the visit and what treatment could be rendered.  However, it did not increase the ease with which she could access services by resolving the transportation issue.

Specialty medicine clinics, orthopedics, podiatry and cardiology, were operated once  per month.  It was not unusual for these patients to have at least a four month wait time for an initial evaluation at a specialty clinic. Every Thursday morning, intravenous therapy was provided for individuals receiving treatments through IVs or who received injection therapies, such as Humira.  While these individuals had government controlled insurance, their access to receive certain health care services was limited to the services available at the hospital clinic due to the facility schedule.  However, if the need to be seen by a specialist was pressing or urgent, the facility scheduled patients with the appropriate specialist who was usually located hours away and outside the boundaries of the reservation.  Transportation was secured through an additional provider.

So, when any individual claims, “Obamacare or ‘Ryancare’ is needed to provide individuals with health care service,” it is patently false.  Neither plan has to do with provision of services, but payment for those services.  Just like the Indians on the reservation, the plan they had did not provide them services, only payment for services rendered if the service rendered was covered.

Likewise, when any individual claims, “Obamacare or ‘Ryancare’ is needed to allow individuals access to health care services,” that claim is patently false as well.  The plan does not address personal circumstances that might prevent access to facilities nor does it address the problems with lack of providers in extremely rural areas.  Again, like the Indians on the reservation, the access to specialists was limited by availability and facility scheduling.

Neither plan employs medical personnel to provide services nor does it construct and staff facilities in rural areas to ensure ease of receipt of services.  All Obamacare and “Ryancare” do is provide insurance individuals purchase to assist with payment of medical services rendered if the service is a covered service.  Even then, it does not guarantee payment.  Since most insurance plans rely on “networks,” providers within a specific geographical location, to provide services, certain services may not be contained within the geographical network and has to be attained outside of it.  Insurance plans may or may not pay for services outside of the network unless the insurance company authorizes out-of-network service.  Then, the reimbursement rate may not be enough to cover the service needed, establishing an additional barrier to access and/or attainment of services.

When individuals who support either Obamacare or “Ryancare,” claim those who do not support the plan want to deny health care to others, that can be proven to be false based on the true understanding of all the terms and how those terms are being incorrectly used.  The opposition to these government controlled plans centers around government interference into the health care and health care insurance industries.  Because of the politicians’ misuse of definitions to sway public opinion, the bill presented is skewed as some sort of provision of health care and/or increase in access.  Neither is appropriate.  All these bills and legislation do is offer health care insurance — nothing more and nothing less.

Despite the government controlling the health care insurance of every individual in America, there will still be individuals who do not have insurance, individuals who do not want to purchase insurance at this time, individuals who cannot afford it, and limitation of services based on individual demographics.  Moreover, the plans include the use of taxpayer money to subsidize insurance premium payments for some at the expense of others.  And, the Republican plan, like Obamacare, is being established to fail in order to usher in government-controlled centralized social medicine.  Neither solves the problems of out-of-control prices for health care services, areas having a limited number of providers, or the availability of specialty services within a reasonable travel distance.  Add to all of these dilemmas that any intrusion into health care or health care insurance remain outside the authority granted to the government by the Constitution.

Advertisements

About Suzanne Hamner

Former professional Registered Nurse turned writer; equal opportunity criticizer; politically incorrect conservative;
This entry was posted in Constitution, General, health care, Uncategorized and tagged , , , , , , . Bookmark the permalink.