Prescription Drugs: Access through Innovation

With the shortage of pharmacists and lack of consumer access to prescription drugs, the distribution of medication has become a prominent and controversial topic in pharmaceutical debate. More than ever, the need for quicker methods of safe drug dispensing is critical to the quality of care and increasing demand for medicines by the aging baby boomers. Healthcare providers must find novel ways to protect consumers’ health by providing patients with access to prescription drugs in an efficient and secure manner. With the increasing need for improvement, I decided to venture out into the blogosphere this week to learn more about the discussions surrounding consumer access to prescription drugs. I found myself drawn to two particular blogs that both describe modern day evolutions in consumers’ access to medication and drug distribution by health care providers. The first post was found in an entrepreneurial blog called Springwise, which is one of the first Internet portals that allow spotters to discuss modern day technological innovations. Within this site, I found Anne Rogan’s discussion on InstyMeds' new “Vending Machine for Prescription Drugs” that allows patients to obtain their prescriptions using an automated dispensing machine for some of the most commonly used medications. The second blog comes from Ed Silverman’s Pharmalot, rated one of the top fifty best business blogs by The Times. His post “Behind-The-Counter Debate Moves Front and Center” discusses the implementation of a new category of drugs by the FDA, in which pharmacists will be given the authority to prescribe certain medications. My comments on these posts can be found below.

“Vending Machine for Prescription Drugs”
Comment:
Dear Ms. Rogan,

Thank you for the informative post on InstyMeds' innovative new prescription drug vending machine (see image to the right). You bring to light many of the advantageous benefits of using this product including saving “pharmacists the slow and potential error-prone process of counting out medications by hand” and the possibility to “alleviate [the] growing shortage of pharmacists”. However, I do think it is also important to discuss the potential negative effects of these automated machines. For one, you state that “the machines include several safeguards to insure patients receive the proper medications their doctors ordered”, how can one be sure that the right medicine is dispensed every time and properly stored in the vending machine? Utilizing your link to InstyMeds' website, and reading the company’s description of their equipment’s safety features, I am still not convinced that the majority of people would feel safe obtaining prescription drugs from a vending machine. With no pharmacist present, there is a greater concern for dangerous drug interactions going undetected and a lack of consultation that may negatively impact a patient’s health. You also present the argument that InstyMeds' prescription drug dispensing system may reduce the need for pharmacists and “potentially chip away at ever-growing healthcare costs”. I would like to expand on that by saying that one must take a complete cost-benefit analysis of the implementation of the new system. Even though, the number of pharmacists needed may be reduced, the machines still have their own maintenance costs and doctors must learn to “create prescriptions electronically”. As seen with electronic medical records, many doctors refuse to make this digital change. Nevertheless, even with the controversial issues surrounding this type of system, the product, as you stated, does have a lot of potential. One way of introducing this system which may put more consumers at ease, is to have the vending machines behind the pharmacy counter like the way El Monte Comprehensive Health Center is contemplating doing. This would eliminate the “counting of medications” and allow pharmacists to continue their consultation with patients to double check the vending machine’s success and ensure product safety.

“Behind-The-Counter Debate Moves Front and Center”
Comment:
Dear Mr. Silverman,

I thoroughly enjoyed reading your post this week regarding behind-the-counter medications. The content was very well rounded and enriched with credible resources and opinions from both sides of the debate regarding the “so-called third category of drug”. Before I began reading your post, I was completely opposed to pharmacists prescribing drugs due to the lack of personal relationship and understanding of a patient’s past and present healthcare needs. I agreed with the American Medical Association that a “lack of proper medical oversight could pose safety risks for patients”. However, the statement from Jerry Harrington you site also brings up a valid point that the behind-the-counter system “adds value because it can provide a transition from prescription status to OTC [over-the-counter] status”. This is supported by Tom Greco’s quote, which states “there are a lot of drugs that are available only by prescription that for all intents and purposes really don’t need to be prescriptions”. Overall, I still have my hesitations of giving more authority to pharmacists to prescribe current prescription drugs (see image on the left), but I can understand the desire to create another category of drugs for those that are borderline prescription and over-the-counter medications. I do believe that the questions brought up by Sid Wolfe from the Health Research Group at Public Citizen are very valid and still need to be addressed before the FDA can implement a new class of drugs. Due to the fact that some pharmacists may not have a good understanding of their patients’ needs and we do not have access to universal electronic medical records yet, I hesitate to fully support behind-the-counter drugs due to the greater risk of medical error.

Stress: Is America Working too Hard?

According to a recently published survey by the American Psychological Association (APA), 52% of Americans are “concerned about their current levels of stress,” and one in three are regularly reporting “extreme” feelings of pressure and tension. These statistics are both alarming and troublesome, as they have exhibited steady increases over the past five years. As seen in the chart on the right, the leading causes of stress are work (74%) and money (73%). The strong value associated with productivity and financial gains in America is taking its toll on both businesses and employees, who are incurring large expenses and adverse health effects because of high levels of performance related anxiety. The American Institute of Stress indicated that businesses are losing 300 billion dollars a year due to excess stress in the workplace. The large cost is contributed to employee “accidents, absenteeism, turnover, diminished productivity, direct medical, legal, and insurance costs, and workers’ compensation awards as well as tort and FELA judgments.” A special report completed by WebMd, showed that stress is also manifesting itself as physical symptoms, with 43% of adults suffering from health conditions such as “headaches, high blood pressure, heart problems, diabetes, skin conditions, asthma, or arthritis in addition to depression and anxiety.” These health effects have led to greater medical care utilization, with 75 to 90 percent of doctor visits attributable to “stress-related ailments and complaints.” The merit-based system employed in the U.S. economy has taken a large toll on our nation’s health, where as alternative approaches emphasized in Europe may result in a more balanced lifestyle and improve our country’s health and happiness. Although, European countries such as France show lower rates of productivity, the slower work pace has shown positive impacts on people’s quality of life and America may want to consider adopting European methods of regulating the labor market in order to reduce the amount of work-related stress and greater need for medical care.

Although the APA study indicated that 82% of Americans believe that they are able to deal with stress well, they all report feeling the stress. While some survey respondents are able to use positive coping strategies such as exercise, listening to music, and reading to relax themselves, a large number rely on negative techniques including unhealthy eating habits, alcohol and drug consumption, and spending an excessive amount of time watching television and surfing the net. In addition, over 70% of the survey responses indicated people are experiencing “physical and psychological symptoms” due to stress. As shown in the exhibit to the left, a large number of people described feeling bodily symptoms such as fatigue and headaches. Almost half said they remained awake in bed at night due to stress. Mental effects due to tension were also prevalent and included “experiencing irritability or anger (50%)” and “feeling nervous (45%)”. Even though Americans are showing negative effects from stress, many of them stated that they would not make an effort to change unless they were internally motivated or encouraged by others to do so. Therefore, the imposition of regulations on the maximum number of hours’ people can work and employee assistance programs, like those utilized in France, may give people the needed push or incentive to reduce stress and prevent future health concerns.

The American Psychological Association points out that major causes of stress are work and money, and therefore recommends that companies help their employees improve their well being by offering “flexible schedules, providing assistance with childcare, helping employees with personal financial issues, and providing flexible leave options beyond those mandated by law.” The director of APA, Russ Newman, warned that there are signs of escalating problems with employees’ work-life balance. With advanced digital technology such as online messaging and blackberries, people are being held responsible to respond promptly even after work hours, which can invade employees’ personal time with family and friends. The APA study revealed, “the leading sources of stress at work are low salaries (44 percent); heavy work load (41 percent); lack of opportunities for advancement (40 percent); uncertain job expectations (40 percent); and long hours (39 percent).” Americans are confirming the fact that they need a greater amount of personal time to focus on their health and reduce stress by engaging in activities like exercise, meditation, sleep, and time with family and friends. This lesson may be learned from European countries like France, who place a higher priority on lifestyle.

One study revealed that “Americans aged 15 to 64, on a per-person basis, work up to 50 percent more than their European counterparts”. In terms of work culture, Europeans generally have more time off and a slower paced lifestyle than Americans. In France, businesses are required by law to have a maximum of 35 hours of work per week and a minimum of five weeks of vacation. This is in sharp contrast to the 80-hour work week the U.S. recently implemented for new doctors. The European regulations allow for more personal time and help decrease negative health effects caused by stress at work. Although productivity is needed to make a society function, it is obvious that America needs to re-evaluate the stress imposed on individuals by their jobs and financial compensation. Preventative care must be taken seriously and is an undeniably important part of medical care. Employers must learn how to create a proper work-life balance, which allows people to take care of themselves and reduce healthcare needs. The government and employers must realize the importance of keeping America’s working class healthy and happy if they want to continue to have a highly productive society.

Medicare Part D: Private Versus Public Market Efficiency

Democrats in the House of Representatives’ Oversight and Government Reform Committee released a groundbreaking study on October 15, 2007 that revealed major cost inefficiencies in Medicare Part D. The prescription drug program began in 2006 and now provides insurance coverage to approximately 24.1 million Americans over the age of 64. Unlike other parts of Medicare, Part D is unique in light of the fact that the federal government does not solely control the management of this program. According to Republican Senate Majority Leader Bill Frist, under the Medicare Modernization Act of 2003, the prescription drug program was designed to “allow competitive forces in the private market [to] generate the best savings for seniors.” As a result, Part D is administered by a partnership between private insurers and Medicare officials. Republicans are in favor of this insurance plan, which results in less government control of Medicare, while Democrats fear that “privatizing the delivery of the drug benefit has enriched the drug companies and insurance industry at the expense of seniors and taxpayers.” This has led Democrats to scrutinize the program’s success and release an unfavorable review of its shortcomings, which include high administration costs and lack of drug rebates for Medicare beneficiaries. While both Democrats and Republicans make valid points regarding the advantages and disadvantages of this program, it has become apparent that the federal government must closely monitor and evaluate the success of Medicare Part D to ensure the efficiency of the system for today’s seniors.

Democrats’ evaluated Medicare Part D based on twelve private insurers, including Aetna and Humana, which represent 75% of the current Medicare enrollees. The goal of the study was to determine “negotiated price discounts, rebates, and other price concessions obtained from drug manufacturers and pharmacies by Medicare drug plans; and the extent to which, and the methods by which, these discounts, rebates, and other price concessions obtained by Medicare drug plans are passed on to beneficiaries.” Results indicated that fifteen billion dollars could have been saved in Medicare costs in 2007 when compared to several other federal government prescription drug coverage programs and pharmacy benefit managers. These added expenses were attributed to several weak points as outlined below. First, administrative costs, sales costs, and profits were six times higher than those for Medicaid (please see image to the left). Second, drug spending was more than three times higher than Medicaid spending due to poor negotiated discount rates from drug manufacturers for prescriptions. Even with the smaller rebates from drug companies, Medicare Part D private insurers displayed increased profit-driven behavior by keeping more than their fair share of the drug rebates rather than sharing them with Medicare enrollees. Without any help from insurance companies, consumers who fell victim to the coverage gap or “donut hole” of Medicare Part D, were forced to pay for prescription drugs out of their own pocket . Excessive profit motives and lack of drug price discounts are key arguments that reinforce the need for government oversight. Furthermore the government needs to ensure that the advantages gained in a privatized program remain equitable and perform up to set health care standards.

On the other side of the spectrum, Republicans and President George W. Bush who advocate for the public-private partnership design of Medicare Part D state that the plan has “saved seniors money since it began offering benefits in 2006.” A survey conducted by J.D. Power and Associates further supports the prescription drug plan’s success by showing high levels of satisfaction by Medicare Part D enrollees. The analysis shows that about 75% of beneficiaries are “delighted” or “pleased” with their prescription coverage plans. The two areas that participants wanted to improve were education and communication regarding Medicare Part D plans. As portrayed in the image to the right, most states have over fifty insurance plan options, which can be very overwhelming for consumers. Nevertheless, Republicans and other supporters of Medicare’s prescription drug care plans believe that the overall program has been very successful in this early stage, and will continue to improve over time. Republicans of the House Oversight and Government Committee stated that, “The program operates smoothly and at significantly less cost than expected. As such, the concerns expressed by the majority (Democrats) are relatively minor in scope and not supported by accurate and meaningful analysis.”

With the controversial nature of the potential benefits and downfalls of Medicare Part D identified by the major political parties, it is important the government ensures that the program is staying true to its original intentions. The private sector may be able to generate more price competition that will allow seniors to obtain their prescriptions at lower prices, but evidence currently shows that other public programs are doing a much better job of controlling cost. Therefore, it’s the responsibility of the government to continuously monitor the performance of the various prescription coverage plans by auditing the private companies that manage them. According to a study by the Government Accountability Office, the Centers for Medicare and Medicaid Services (CMS) “has not met the statutory requirement to audit the financial records of at least on-third of the participating [Medicare Advantage] MA organizations for the contract years 2001-2005.” Without any government regulations or incentives, the private sector can slip into a downward spiral, in which financial greed overpowers the desire to help retirees obtain the medications they need at a reasonable cost. The federal government must continually review the cost of these drugs for seniors to protect them from “high and rising drug costs.” With open enrollment beginning this November, it will be interesting to watch the progress of Medicare Part D as a joint public-private venture.

Microsoft HealthVault: The Future of Medical Records

Last Thursday, Microsoft took the lead in fulfilling Bush’s objective to provide an electronic medical record for every American by 2014 with the launch of a new website; Microsoft HealthVault. This service is free of charge and allows patients “to collect, store, and share” their medical history with their doctors and other healthcare providers. With health records saved in one location, patients can manage their own healthcare records by viewing past x-rays, labs and other medical reports from various doctors all at once. This makes Microsoft HealthVault (Please see image to the right) especially useful for patients with serious health conditions such as diabetes or heart disease that need to be constantly monitored by more than one doctor or healthcare professional. These patients can upload their blood sugar, weight, and blood pressure levels on a regular basis to share with medical providers to better monitor their own healthcare. The active participation of physicians and hospitals in the new online system is critical to its success and will give patients the ability to have constant access to their medical files. As stated in the New York Times, “Tighter curbs on medical spending and an aging population with more health concerns are expected to prompt consumers to take a larger role in managing their own care, including using online tools”. By providing greater access to personal health information, Microsoft and other companies hope to take the lead on providing patients with a way to take control of their own healthcare.

Electronic medical records have the potential to create more efficiency in our healthcare system by eliminating paperwork, and creating a single medical file for each patient that can be continuously updated at various locations and times. According to studies reported by Catherine Rampell from the Washington Post, “creating a nationwide electronic medical-record network would save more than $500 billion in medical costs over 15 years”. Nevertheless, due to the novelty of this system, most consumers are apprehensive to use it. Many people still do not trust the World Wide Web, and they worry about the safety of their medical information online. Comments posted on blogs like TechCrunch, reveal that patients do not feel safe putting their personal medical history online with a private company like Microsoft, which has had several security breaches in the past. Microsoft has said that it has made security a top priority for HealthVault, emphasizing the fact that patients control their accounts and no information will be shared without their consent. Microsoft is also a member of TRUSTe, which is a nonprofit organization that builds “trust and confidence in the Internet by promoting the use of fair information practices”(Please see image to the left). Nonetheless, as noted by Peter Neupert, the Vice President of Microsoft’s health group, the company will need to build its reputation in regards to consumer privacy through consumer experience. The ability to make patients feel safe posting their medical information online is going to be one of the most difficult obstacles of electronic medical records.

Another impediment with implementing electronic medical records rather than maintaining paper-based files, is having healthcare providers actively participate in digitalizing their files. It is estimated that “about 90 percent of physicians and more than 80 percent of hospitals still use paper records”. Many healthcare providers are comfortable with their current systems and do not feel like that they have the time or the money to implement a computerized medical database for their patients. According to an interview with Dr. Robert A. Jenders at Cedars-Sinai Medical Center, implementing an electronic database is too much trouble because all of the employees would need to be re-trained and the new infrastructure would cost a lot of money without any guaranteed financial returns. Dr. Jenders states, “Their office practice works very well as it is now and time is money”. Without all healthcare providers working in a computerized database, patients’ information could remain staggered between electronic medical records and paper files leading to inconsistencies and medical errors.

Microsoft was the first big private company to launch a personalized medical record website but it will definitely not be the last. Google and AOL’s co-founder Steve Case, already have plans underway to launch electronic health record services of their own in the near future. With time, I believe that electronic medical records will dramatically reduce administration costs, increase efficiency, and create a single accessible medical record for each patient. However, in order for this to happen, Microsoft and other companies wanting to provide electronic medical record services need to earn the trust of their consumers, and create user-friendly systems that all healthcare providers would want to use.

CDHP: Shifting the Power of Healthcare Management to the Consumer

Would you like to manage your own healthcare? Now you can with a consumer-driven health plan (CDHP). This type of health insurance is increasing in popularity with a growing number of companies offering it every year and an estimated 3.8 million employees already enrolled (See image to the right). CDH plans allow people to participate in their healthcare expenditures by paying lower monthly premium contributions in exchange for higher deductibles and out-of- pocket maximums. Employees are provided with a supplemental healthcare plan and are responsible for managing their own healthcare expenses such as coinsurance and co-pay fees with one of two accounts; health reimbursement account (HRA) or health savings account (HSA). HRA is an account “owned and funded by the employer” while HSA is “owned by the employee and are funded either by the employee or with contributions from the employer”. With either of these accounts, CDH plans have provided a way for employers to reduce healthcare costs, and put more power in the hands of consumers.

With CDH plans, employers will no longer have to contribute to high premiums like those necessary for traditional HMO and PPO health care plans. According to a survey done by Mercer Human Resource Consulting, a higher deductible “reduces the employer’s share of annual premiums down to an average of $5,770 a person, about $1,000 lower than for other plans”. In addition, these plans allow consumers to purchase their healthcare on a need basis, and therefore eliminating what economists would identify as a possibility for moral hazard. Consumers would be able to reduce their costs by paying for healthcare that is suitable just for them.

The CDHP seems like a win-win situation.

Nevertheless, despite these arguments in favor of this plan, CDHP consumers’ survey results show that “44% are not likely to recommend them to others, compared to 19% of those with traditional health plans; 37% are not likely to stay with their plan if given another option (13% for those with traditional plans); and only 37% are very or extremely satisfied, against 67% of the folks with traditional plans”. It is evident that there are still many issues that need to be resolved for the future success of this novice plan design. Although CDH plans provide benefits to both the employers and employees, both groups must be wary of the potential downfalls of the plan design including high out-of-pocket maximums and minimal insurance coverage.

To reduce monthly premium contributions in CDH plans, out-of-pocket costs are increased in order to shift the liability of future health risks to the consumers. However, these out-of-pocket costs must be reasonable for a consumer and their family to afford. One problem, especially with the health savings account (HSA), is that employers can choose not to contribute to the account and leave it to the employee to manage and pay for their own deductibles and out-of-pocket maximums. This can cause a huge financial burden on employees’ with unexpected healthcare costs. In order for this health care plan to work, employer’s need to ensure that employee’s will not be abandoned in midst of a medical crisis.

Many individuals are skeptical about the CDH plan offerings because of the broad range of insurance coverage the plans offer. In a New York Times Article, Fran Hawthorne states, “one way to pay less is to cover less”. Many CDH plans will not provide well-rounded medical benefits including a combination of preventative, routine, and hospitalization coverage so that they can reduce costs. Without any aid from the insurance company, the costs for these office visits and procedures could strongly deter consumers from getting the healthcare that they need. This could potentially lead to even greater health risks and problems in the future. With the strong evidence and support for preventative care and early detection in today’s health care system, CDH plans must encourage employees to get the proper medical care in a timely fashion before their condition becomes life threatening and the cost of medical care is unaffordable.

The CDH plan proposes a new strategy for reducing healthcare expenses, which is desperately needed in light of today’s rising costs. Currently, the United States spends on average $5,283 per person a year for healthcare. CDH plans have the potential to help reduce the per capita cost for healthcare by lowering premiums and reducing unnecessary insurance coverage, but employers and employees must become active participants in their healthcare expenditures (Illustration of a CDHP advertisement can be seen on the left). Employers need to have a good understanding of the medical coverage that their employees need in order to provide comprehensive benefits that will reduce large claim liabilities; and employees must learn how to safely and properly budget their healthcare expenses to reduce their costs. In order to help ensure that this occurs, regulations should be imposed to guarantee coverage of preventative care services and greater price transparency by healthcare providers so that employers and employees can better understand the nature and costs of healthcare. In order for healthcare to progress, everyone needs to have a better understanding of how their medical insurance works so that can use it in a more efficient and effective manner.

Hillary Clinton’s Revised Health Care Plan: Will it be Successful?

According to Kaiser’s Health Tracking Poll in August 2007, healthcare was the most important domestic issue that citizens would like the “government to address and for presidential candidates to discuss”. Understandably, Democratic presidential candidates have dedicated a great deal of their time to addressing healthcare issues and reform including presidential candidate Hillary Clinton; who just last week unveiled her long awaited revised universal healthcare policy in Iowa (See image on the right). Due to the harsh criticism and public failure of Hillary Clinton’s last universal healthcare proposal plan in 1994, I was interested in examining what others had to say about her newly improved plan and began my exploration using the blogosphere. After reading a variety of webblogs, I decided to comment on two very compelling posts. First, I commented on a post entitled “Hillary Clinton Takes on Healthcare (Again)”by Bill Boyarsky, who has taught at several prestigious universities and written four political books. He addresses the need for a “decent system of medical care” and Clinton’s “home field advantage” with her deep understanding of the U.S. healthcare system. Next, I commented on Roger Hickey’s “Hillary Confirms Commitment to Health Care for All”, which makes a strong argument regarding the hardship of implementing a “private-public plan for achieving health care for all”. My comments written to the authors of both of these webblogs can be found below.

“Hillary Clinton Takes on Healthcare (Again)”
Comment:
First of all, I would like to say that you raise some very interesting and valid points in your argument. Although a single payer system proposed by presidential candidate Dennis Kucinich may be more efficient, you are correct in stating that it is a plan that would “probably [be] impossible to pass” and “[t]he health insurance businesses are big contributors who no doubt figure they have bought themselves a place at the table”. I also agree that Hillary Clinton is very knowledgeable in healthcare issues, however, I do not necessarily agree that because she has had the most visible experience, she will implement the best healthcare reform. As you stated, John Edwards proposed a very similar plan before Hillary Clinton unveiled her own. Recent articles have even stated that Edwards’ wife has publicly accused Clinton of copying her husband’s plan outlined in February (See image to the left). There are also strong similarities between Barack Obama’s proposed plan and the other candidates’ healthcare reform as well, except for a few issues such as the mandate that everyone must have health insurance. Although, Hillary Clinton may have the most political experience in dealing with national healthcare issues, many of her opponents have studied the mistakes of her first proposal and have done their own research with expert advisory groups. These candidates may be able to provide a more fresh and objective point of view on healthcare reform.

“Hillary Confirms Commitment to Health Care for All”
Comment:
The conclusion to your post makes a very strong argument in regards to whether or not we will be able to hold insurance companies and drug industries “to a high moral standard” with the willingness to “contribute to the solution to our health care problems”. In order for Hillary Clinton’s plan to work, we need to be able to trust that our private sector companies will follow her new regulations including fair premiums and providing coverage to anyone who applies no matter what their pre-existing condition might be. You statement at the end of your argument saying that we are “going to have to make sure that the political power of the American majority is mobilized to make sure we have the power to enforce that high moral standard” is a bit confusing to me. How do you propose we accomplish this? In that sense, I agree with you that Barak Obama’s plan is much more clear. Due to the fact that anyone who is not covered by private insurance will immediately be enrolled in public health insurance, private insurance companies will hopefully think twice about refusing coverage to anyone because they will lose their business to the public sector.

SCHIP Renewal: Healthcare for Our Future Generations

With children’s healthcare at stake, the renewal of the State Children’s Health Insurance Program (SCHIP) on September 30, 2007 has become a sensitive and daunting task for today’s United States government. In less than fifteen days, both Congress and the President must come to a consensus on the future state of SCHIP for the next five years. Just yesterday, the House of Representatives made progress in negotiating a unified proposal with the U.S. Senate to expand the program by 35 billion dollars. However, not everyone is satisfied with Congress’ plans to increase spending on SCHIP. President Bush has threatened to veto any expansion of the program over 5 billion dollars. President Bush argues, with justified reasoning, that SCHIP is a state and federally funded program intended to help low-income children who do not qualify for Medicaid nor can afford private health insurance. He believes that the program should stick to its original intent before any greater expansion.

In accordance with his beliefs, Bush has added two new regulations to the renewal of SCHIP. First, states must demonstrate that Medicaid and SCHIP cover 95% of the children at or below 200% of the federal poverty level (FPL) before they can expand coverage to all other children. Secondly, children must be uninsured for at least one year before becoming eligible to participate in the program. Although the newly proposed regulations are intended to preserve the State Children’s Health Insurance Program for low-income children, a universal health care program would greatly reduce provider administrative costs and offer healthcare access to all children leading to an overall healthier and more productive environment for the future.

Approximately 8 million children were uninsured in the United States in 2004. As illustrated by the pie chart to the left, 67% of the 8 million uninsured children were eligible for Medicaid and SCHIP, but for some reason, were not participating in these programs. In the past two years, the number of uninsured children has risen to almost 9 million. With so many children eligible for government assisted health insurance programs, the cost of insuring the rest of the nation’s children does not seem so far-fetched or implausible. In fact, in the long run, providing universal health care coverage to children may reduce healthcare costs overall because the majority of provider’s administrative costs would be eliminated.

On the other hand, President Bush’s new regulations could very well cost society a lot more money in the long run because many states which would like to expand their state health insurance programs, like New York, are being restricted from doing so. States will need to reallocate more of their SCHIP funds towards administrative purposes to find and enroll children whose family income is at or below 200% of FPL rather than using their funds to provide healthcare to more children. By implementing a universal healthcare policy for children, the administrative costs discussed above will be eliminated and all children will have access to care.

Many Republicans also argue that by expanding SCHIP to cover all children, there will be a “crowd out” problem. This implies that with more children eligible for health insurance, the more families that will terminate their children’s current private insurance to use public assistance for health coverage because it is cheaper and often times more comprehensive than their current insurance plans. Evidence of the frequency of this phenomena in the past is uncertain, but estimates range from 10 to 50 percent of families eliminating their child’s private insurance for public assistance when available. Republicans support Bush’s regulations on SCHIP because it keeps the program from being over utilized and costing taxpayers more money.

However, these Republicans must take into consideration the hardship of purchasing health insurance for a single family. As shown in the figure on the right, health insurance premiums cost an average family with an income at 300% of the FPL, 19% of the families’ entire income. Due to the high costs of healthcare coverage, parents will avoid buying health insurance if they believe their children are healthy. This type of behavior generally leads to greater medical problems in the future for children and frequent trips to the hospital emergency rooms where nobody can be denied access to care under the Emergency Medical Treatment and Labor Act (EMTALA). This causes greater costs to society due to overcrowding in emergency rooms, which can be reduced by providing universal healthcare coverage for children and more preventative care.

Universal healthcare coverage for children will reduce administrative costs because no child will be denied access to health care. Children will be able to get the preventative care they need such as immunizations to reduce the risk of epidemics in the United States, and may miss less days of school due to illnesses. This will hopefully lead to healthier and more productive lives in the long run for our future generations. If no child should be left behind in education, why should they be left behind without access to healthcare?