The Pros and Cons of the US Health-Care Model (the Direct-Fee System)

The health-care model in the United States relies on a direct-fee system. Unlike the large majority of Western countries that have national models of health insurance, people in the US have private health insurance plans. In most cases, people can get health insurance through their employers.

In other situations, individuals who are self-employed or work at small businesses without healthcare benefits can purchase subsidized plans on state or federal marketplaces. These plans typically require larger monthly premiums than employer-provided plans. Regardless of the type of plan, policy holders can expect to use healthcare payment solutions for co-payment fees when they visit their doctor’s office.

On top of that, Americans are required to pay out of the pocket for any medical costs that their insurance doesn’t cover. In recent years, there has been a lot of talk about reforming the entire health-care system in the United States and many people hope that all American citizens will one day get universal health care.

According to a poll conducted by the Kaiser Family Foundation in 2020, around 69% of Americans want Medicare for All. However, there are also people who are strongly against any reforms. Since people have started asking for Medicare for All, it’s the perfect moment to analyze the pros and cons of the current US health-care model.

 

The Pros

Quality healthcare services

If you have the money to pay for a premium health insurance package, you will have outstanding medical care whenever you have a health problem. Hospitals across the United States have modern equipment and highly qualified doctors. Healthcare organizations also offer online care delivery via telemedicine applications or virtual hospital services to make patient visits more convenient. Elysium healthcare center, for example, is one of the premier healthcare facilities you can check with holistic help for addiction.

Physicians and surgeons have to go through rigorous specialty and subspecialty training. This allows them to effectively treat even the rarest conditions. In the United States, you can also get the best mental health services in the world provided you can pay for them. If you require home care services, private home care offers patients and their families greater flexibility and control over the type of care they receive. In the United States, this type of home care is typically covered by a combination of public and private insurance plans.

Due to the high costs of medical care under the direct-fee system, hospitals can afford equipment that can help people battle various life-threatening illnesses. For Temporomandibular joint dysfunction, the US healthcare model allows for patients to choose their own path, after considering the pros and cons of tmj surgery vs. TMJ retainers and other options. 

Minimal waiting lists for major procedures

You won’t have to wait a long time to see a surgeon or specialist if you’re in the United States. In a study conducted by the Commonwealth Fund, it was concluded that 57% of Canadians wait more than 4 weeks to get an appointment with a specialist. In the US, only 23% wait longer than 4 weeks to see a specialist.

Although the medical systems in these two countries often get compared, the truth is that it’s much easier to get an appointment or surgery in the United States. Many patients take advantage of this quicker access for specialized procedures such as gynecomastia surgery and liposuction, which can often be scheduled without long delays. In the US, there is minimal wait time even for complex procedures.

Different Medicare options

There are many different Medicare options available that you can choose based on your preferences or the lifestyle you lead. For instance, there are special Medicare Advantage plans for people who travel often or who want extra benefits like prescription drug coverage.

If you enroll in a Medicare Advantage plan, your original coverage will continue being billed directly through Medicare. On the other hand, the advantage plan will be billed through your private insurance company.

Adequate resources

There are many countries across the globe where there are not enough medical supplies both for the workers and the patients. The United States has adequate resources to make sure that every patient with health insurance can get the treatment they need.  Purchasing a medical alert system can help you reach those needed resources quickly.

The Cons

Health-care services are expensive

The biggest issue Americans have with the current health-care model is that medical services are extremely expensive. In case you don’t have insurance or are under-insured, you’ll have to pay medical costs out of your pocket. For instance, going to a dentist just to understand how to clean a retainer can be a costly trip. People who don’t get insurance also have a very limited number of services they can get access to.

It’s worrying that medical debt is the leading cause of bankruptcy in the United States. What a lot of Americans don’t realize is that the standard Medicare coverage isn’t enough to provide the treatment for certain treatments and procedures.

Limited insurance coverage

The majority of Americans get health insurance through their employers. That means that in the event that they lose their job, they can lose their coverage. When someone doesn’t have a job, it can be impossible for them to continue paying for insurance. The fact that you could easily lose your health-care insurance is why most Americans are now in favor of medical system reform.

Lack of transparency

What nearly every medical service available in the US lacks is price transparency. People are not able to shop around and figure out what their most budget-friendly option is. Health-care is what Americans spend most of their family budget on after housing.

In order for the health-care system in the United States to improve, there needs to be price transparency for medical costs. People simply don’t know what to expect when they go to a hospital because the same procedure (even if performed by the same physician) has a different price in each institution.

Today, only 12% of the US population is opposed to price transparency in health care. Meanwhile, hospitals claim that the reason why prices are not transparent is that it allows them to offer discounts to insurance agencies. However, this doesn’t make a lot of sense since the goal of each hospital is to make as much money as possible.

No preventive care

Physicians and surgeons are equipped to handle any type of injury or disease, but they hardly put any emphasis on preventive care. Although they can treat even rare medical conditions, they don’t offer quality follow up services.

Final Thoughts

The U.S. health-care system, while advanced and equipped with some of the best medical professionals and technology, is not without its flaws. The high cost of care and lack of universal coverage create significant barriers for many Americans, especially those who are uninsured or under-insured. For conditions such as Alzheimer’s disease, where early and ongoing treatment can be crucial, the current system’s limitations become even more pronounced.