Tuesday, March 9, 2010

Health Care Reform- Why Some (All?) of Us Need It

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I cannot recall a debate as vigorous as the one over health care reform.  Charges of nazism, socialism, communism, death panels, etc. are flying around like I've never seen before.  I know my friends get sick of me talking about it.  One thing I find fascinating, not a single person I have discussed this with- not one has not said that we need to do something about health care in our country.  I have a lot of Conservative and Libertarian friends.  I find this to be pretty surprising.  While I know some who hate what the Democrats are proposing.  Everyone I know agrees something needs to be done.

As a corporate employee for the first half of my career I was shielded from real health care costs as  many people are today.  As a group, as long as we don't pay for something directly, we tend to not think about it. I remember when there were no co-pays.  You just went to the doctor, handed him your insurance card and it was "taken care of".  Then, there were $5 co-pays.  Now there are $30 co-pays and deductibles and the employers are asking us to even kick in on premiums.  It seems that Americans are finally starting to feel the pain.  I've always been conscious of what I spent on health care, even when the bill was going to the insurance company.  Most people I knew back in the good old days weren't so conscious.  They'd run to the doctor for every sneeze and sniffle.  No more.  

I left the arms of corporate American 8 years ago.  I was shocked at the cost of the premiums for my family of four.   The single largest obstacle to making the transition was getting health insurance at a "reasonable" price.    I was paying more per month for health care than I had ever paid for a car payment (and I've had some pretty high car payments).  Health care was my second biggest monthly bill surpassed only by my mortgage.  Over the years I kept tweaking up the deductible to try to keep the premiums reasonable.  Finally about three years ago I bumped the deductible up to $2,500.  But that did not stop Anthem from raising my rates about 30% that year to about $700/month for the family.  I did some shopping, found another company and got a quote for over $500/month.  Done.  The next year, they raised my rates to $770/month.  It was over a 40% increase  They sent me a nice letter assuring me it wasn't based on anything I had done individually. It's all those darn Ohioans who used their insurance so much in the previous year.  My agent told me this was typical.  A company would give you a low quote to get you on board, then jack it up the next year. OK.  Fine.  I paid the $770 thinking now I'd see reasonable increases going forward.  A few weeks ago (about a year after they dropped the over $200 increase on us) we got another lovely letter from the insurance company.  In an effort to control costs they were dropping one of the two provider networks they had in Ohio.  This was going to result in my premium going from $770 a month to about $680.  This, they told me, was good news.  The not so good news, not a single doctor I see, Ty sees or the girls see were on the new plan.  Worse yet, Children's Hospital was not on the plan.  We called our agent and began scrambling again.  Let's look at alternatives. Let's have them apply to our doctors and Children's Hospital to get them in the network.  I figured for the $100/month savings, if I wanted to go see my own GP, maybe I'd pay out of pocket.  Then, we got another lovely letter from them.  The "savings" we had been quoted had evaporated.  Our new rate would be $1,008/month.  Same thing happened as last year. Individually, we had done nothing wrong. But, those darn Ohioans had done it again. Used too much insurance.  So, off we marched to the insurance agent again looking for options.  We opted to go with an HSA. Basically, we're going to self-insure.  Thank goodness the business has been successful and we can afford to set aside $5,000 for our new deductible.   I know that's an option a lot of start up business owners don't have.

I'm sure my agent has heard the bitching and moaning I did a thousand times before.  But, I couldn't help myself.  I was telling her how fed up I am with the health insurance companies holding us hostage.  I have borderline high blood pressure (controlled under medication) and borderline high cholesterol (also controlled under medication).  In the health insurance game, when you're in the individual market and/or a small business owner that's known as two strikes.  With many insurance companies, three strikes and you're out.  IOW they won't cover you.  High blood pressure and high cholesterol are not exactly rare diseases in America where 30-50% of people are impacted with one or both of these conditions.  I'm relatively healthy.  I eat right.  I exercise.  I'm not obese.  Heck, I'm in better shape than most guys I know my age.  No one would even know I have these conditions if it weren't for the fact I actually go to the doctor and medicate myself for them.  Yet, they make me an undesirable candidate for health insurance.  Every time I apply with a new company I wonder if they'll cover me and what they're going to want to charge.  I wonder if/when I'll get that third strike and then I won't have any options left.

My agent then began sharing her story.  She and her husband are small business owners and self-cover for insurance.  She is with the same company I'm trying to leave.  She has MS and a skin condition, both pre-existing conditions that prevent her from leaving the company she's with.  To make matters worse, she and her daughter were attacked last year by a random whacko on the street. So, they needed medical attention.  She got a not-so-nice letter from our company this year.  Due to the fact that she had used her insurance too much, her rates were going up 61%.  As someone who has been screaming for health care reform, I wanted to get her perspective on health care because she and her husband are Libertarians.  I wondered if they would think that the government should stay out and let the market take care of things.  She didn't offer any specific solutions.  But, she was in agreement with me that something needs to be done.  The company she is with now can raise her rates as much as they want, any time they want and there is absolutely nothing she can do about it.

The next day I was talking with a friend who is a Conservative. Her husband works for one of the largest companies in Cincinnati.  I was telling her my health insurance woes and that I was now facing a health insurance payment that was about 50% higher than the mortgage on my first house.  I was complaining about how a person who wanted to start up a small business might not be able to afford $12,000 a year for health insurance (plus co-pays plus a $2,500 deductible) and this situation literally prevents many people from going into business for themselves. Then, I got a surprise.  She and her husband have a $3,000 deductible on their company provided health care.  Wow!  Back when I was working for a corporation we had no deductibles on health insurance.  We were fully covered.  But, now even Fortune 500 companies are sharing the pain with their employees.  I have another friend who works for a small company.  She doesn't make a lot of money and pretty much lives hand-to-mouth.  Her employer offers health insurance.  But, with a $2,500 deductible.  Her son has a congenital heart condition.  What this means for her is every January the clock resets and she has to pay at least $2,500 each year for his medical expenses.  I would classify her as one of the working poor (or at least very lower middle class). She is fortunate enough to have a job that provides benefits.  But, the deductible is one she would never choose for herself because a family that is having trouble paying the mortgage doesn't have $2,500 a year just lying around.

I know two people who have lost their jobs within the last week.  Both came totally out of the blue. One was a VP working for a company that kept promoting him and giving him more responsibility right up until the day the owner of the company called him in and decided he could do it cheaper without him.  What was one of his family's greatest concerns when he found himself on Monday afternoon without the job he had on Monday morning?  How was he going to afford health care coverage?  Asthma, an eye condition that threatens his vision, a diabetic child- all of these conditions are in his family and those things do not look good on a health insurance application.

The health care proposal on the table from Obama and the Democrats is far from perfect.  It's got some really weird stuff like a mandate to get coverage but no public option.  Obama said during his campaign that he was against a mandate.  A mandate where an affordable public option exists at least makes some sense.  But, a mandate that forces people to buy from the very companies that are responsible for a large part of this mess, I'm not so sure about that.  Many Republican ideas have been included in the plan.  But, as soon as an idea is embraced by Obama or the Democrats it becomes anathema to the Republicans.  It's like they've never heard of it before.  

I don't know what the answer is.  But, I do know that the current situation is unsustainable.  If things continue on the trajectory they are on for even a few more years we are looking at a national crisis.  People will be forced to gamble more and more with going without coverage which is a financial and/or medical disaster waiting to happen.  We are all one layoff, one diagnosis or one accident from being one of those who cannot afford insurance or who cannot buy insurance at any price.
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16 comments:

UncleJesse said...

Okay Brian, I'm a libertarian. I'm a limited government, but a fan of sustainable agriculture, renewable energy and more responsible living. First, only is our health care system not sustainable, but the spending habits started by Bush and accelerated by Obama will drive this country into an economic slavery" to other nations such as China, India, and other countries. I recently went to China in December, and was surprised to see an even more free market system than here.
You mentioned problems with the health care bill. It's littered with problems, and just because we change our faulty healthcare system won't mean it will be better. The current HMOs, the FDA, big pharm, frivolous lawsuits drive the price up. I know in Nicauragua there is socialized medicine and privatized. In the privatized system, it's cleaner, you can choose your own doctor, it's fast, and I know someone who fixed their broken arm for $190. The problem in our system is the government bureaucracies driving the price up. The FDA and it's ties with big pharm. Lessen regulation, stop frivolous lawsuits, encourage a free-market system and it will become affordable. Insurance options are also really limited. Co-ops and small communities can form an insurance pot, making it affordable for everyone.

brian said...

Thanks for your comments. I think you touch on some of the problems with our current system. What's wild is that while we can agree on some of the problems, we disagree on the answer. Less regulation (of the insurance industry) is the opposite of what we need. Left to their own devices, they will continue to collude to divide up the market, lessen competition, leave people who are sick uninsured and skim off of the top. We need regulation to limit their profits, increase competition and ensure that everyone has a change to buy affordable health insurance. The problem with our health insurance industry is not enough regulation, not too much.

When it comes to the FDA, that's tricky. The FDA used to get slammed for making it too difficult to bring a drug to market. So, they started fast-tracking drugs. Then, we end up with dangerous drugs on the market and those drugs have to be recalled. Everyone wants good drugs and wants them fast. But, we also want safe drugs.

UncleJesse said...

Great points on the way corporations lessen competition. I agree %100.

"The selfish spirit of commerce knows no country, and feels no
passion or principle but that of gain." --Thomas Jefferson


Our founding fathers were surprisingly anti-monoply.
http://www.wbaltzley.com/Blog/?p=938

Regulation is good, unfortunately the term we need to define is "Corporate Personhood"

The corporate personhood debate refers to the controversy (primarily in the United States) over the question of what subset of rights afforded under the law to natural persons should also be afforded to corporations as legal persons.

When a corporation infringes on the natural free market and people's rights; the government should regulate. Unfortunately our government is inept at that, they give contracts/bailouts to their favorite corporations. (AIG, big banks, GM, Chrystler, Haliberton ect...) This isn't in the people's best interest!

Employers are not given enough choice of insurance agencies, thus limiting healthy competition. With health-care prices so high, insurance companies (with all their flaws) have to raise their rates.

Solution: regulate only when a corporation infringes on a person's life, liberty, and pursuit of happiness; and/or corrupts a free-market system. Instead of limiting profits on big companies, they should be broken up...this will increase competition.

FDA: some good things obviously are done, and some bad. The bad is mixed, some drugs as you say end up dangerous, then other more alternative medicine is overlooked.
Maybe the FDA should be broken up into several 3rd party drug evaluators. This would allow more choices for drug manufactures and people's rights.

MysticBlueRose said...

My son and his wife had a baby December 31st. He was laid off the same week. She will be laid off the end of this month. She has a heart condition, very different than my son's, but needing medication every day. He has high blood pressure. Again, meds. They didn't think, OMG how will we feed ourselves, their first thought was, OMG how do we pay for our meds? Insane isn't it???

LewEllyn said...

I work for the insurance industry as an agent, and I am adamantly for healthcare reform. The theory that the free market will adjust and maintain itself in equilibrium is not holding up. Regulations on the banking industry, ones that would have prevented some of the recent disasters, were dropped in the early 90's and look what those guys did--ran all over us. Insurance companies are for-profit businesses. They are not going to sacrifice their profitability in order to take care of you or me. Not without being coerced. They can't really be expected to take on all risks and keep prices low--not if they're to generate enough income to cover all claims and make a profit. Actually, private insurance will not even insure my family now. I receive no benefits and my husband is unemployed. My husband and daughters have pre-existing conditions and cannot get private health insurance. Fortunately, my husband has COBRA until May and my daughters are on disability plans. I thought I would have no problem getting coverage for myself--I take no medications, am not being treated for any conditions, am very healthy for a 56 year old woman. I applied for a policy with a $5,000 deductible and covering only hospital, emergency and ambulatory care, no doctor appointments, at $310 monthly premium which I couldn't really afford. I was declined! It floored me. Who can get individual health insurance in this country? I'm fighting the denial but probably will get nowhere. Under this new bill, insurance companies may be forced to sell me insurance but what will it cover and what will it cost? I'm sorry current reform doesn't include universal healthcare administered by the government and participated in by private insurance companies. Why are people more afraid of letting the government get involved than of the disaster we're already experiencing with private industry?

brian said...

Yes, Debra, it is insane. I know some people think we have to get the jobs thing right before we move on to health care. But, the two are very closely related. Lose your job, lose your health insurance and your health and your financial security are both at risk. Also, the high cost of health care is a major burden on employers and a consideration when they are thinking about adding to their roles.

brian said...

LewEllyn,

Thanks for sharing your story. I hope for all of our sakes something gets done on this and quickly.

I know why people fear government involvement. There is a perception that everything "big government" does it does inefficiently. Of course that is simply not true. And, the health insurance industry could hardly get any worse than it is now anyway. I hear the people who are against reform saying "We have the best health care system in the world, why risk that with major changes?". First of all, that's only partially true. We have the best health care providers in the world. But, we don't have the best access to health care and we do no have the best outcomes (largely due to lack of access). If you are rich or happen to work for an employer that provides great insurance, you are in a completely different position than someone who is poor or someone who has a pre-existing condition or who is self-employed.

annie said...

good thoughts brian. as you know i've evolved from independent to libertarian (edging toward anarchist LOL). i want the govt to stay out of my business... BUT... healthcare should be provided the same way fire and police protection are. the notion of any industry that makes a profit from the misery of others is noxious. the VA is actually socialized medicine. and it works. any situation where the govt is the payer but not the provider (medicare and medicaid) will send costs skyrocketing. so, my thought is, why reinvent the wheel? use the VA model. i am not in favor of a healthcare bill that INCLUDES the public option. i am in favor of it being the ONLY option. i don't think we need to fear deterioration of the quality of care under such a system, because it will still be ultimately regulated by the people via their public outcry and voting power.

brian said...

Thanks for your thoughts, Annie. Let me make sure I understand. Are you saying you want doctors and hospitals to be government employees and government owned? That's a MAJOR step from where we are. Talk about a government takeover. Your libertarian friends will have a cow over that one!

Personally, the longer this fiasco goes on, the more I think the best answer is single payer. National health insurance. But, leave health delivery private. I guess that's what you mean by the public option being the only option. Just put the health insurance companies out of business period. But, you want to take it a step further, if I understand correctly.

What I'd like to see is a payroll tax similar to what we pay now for social security or medicare. Income based and with a cap on how much you pay. Everybody gets a national health care coverage, period. And, those of us who work pay into the system according to our ability.

jim said...

we need universal health care..not health reform..We all need to be covered no co pays..Just a ID card to show..We are the best country in the world why shouldn't we have the best health care in the world and not be in 36th place and spend more mony on it then any other country..Why settle for any thing less..If this doesn't happen the the Dems are in really big trouble and so is the President.The number one cause of forclosers and bankruptcy is medical expence..I have just been expecting more from our leader.. like full coverage health care for all and a end to the wars just the things he said he would do.

brian said...

Jim,

I don't disagree with your vision. But, we're not going to get there right now. The best we can hope for is major reform. No one's even talking about universal insurance right now.

Darren said...

Great post Brian. I tell you, this whole topic is incredibly depressing, and yet so important. I have one recommendation to you and all your blog readers. Go to your local bookstore or library and read "The Healing of America" by T.R. Reid. It's a fantastic book which I just finished reading. The author covers every major model of health care delivery and visits countries like Japan,Britain, Canada, France, Switzerland and others. He is brutally honest about the pluses and minuses of the various countries. As you read this book, I became more aware of how much we spend and how little we get for it. And its only going to get worse. This book should be required reading by every member of Congress. Sadly, I doubt a single one (or even the President) has read it. If they had, they would know that this current bill does nothing, and would fight for universal coverage even if it meant not getting reelected. As you say, individual mandate combined with the still for-profit, greedy insurance companies just makes them even richer, without lowering the cost we spend on healthcare, or bettering our system. It's an awful idea and we deserve so much better. How is it that our politicians are failing us so badly?

I'm a Ron Paul republican (aka Libertarian), but this is the one area where I disagree with him and other conservatives. Our current system may have worked OK "back in the day" (up till the 90s?), but it's now seriously broken.

The author makes one compelling point though. He says how even now, the proponents are framing it as an economic issue (which is true). But he says it needs to be framed as a moral issue. That's what really hits people. How can a Christian nation allow so many of its citizens to die and fall by the wayside when every other industrialized nation covers all their citizens? In no other developed country in the world can someone go bankrupt from medicals bills. Only in the US. Shameful.

brian said...

Darren,

Thanks for the comment and the book recommendation.

I agree with you wholeheartedly that this is a moral issue, as does my denomination, the United Church of Christ.

UncleJesse said...

We need insurance reform. It's heartless to drop someone because of a job loss. Getting back on insurance with a pre-existing condition is impossible.
I hear what your saying Annie, but the VA hospitals suck. (not just my opinion, but of the veterans I've talked to) Our Veterans deserve better.
We do not have a free-market healthcare system.

There are some real solutions proposed my limited government proponents. http://comments.americanthinker.com/read/42323/344382.html
read all the solutions put forward, #7 and #8. There are ways to take care of our own, yet save the tax-payer money.

in a world of my own said...

Hi Brian -

I just found your blog today, and I look forward to reading into the archives. I just wanted to let you know I blogged about a statement in your "About Me" section. I thought you might be interested in reading it. My blog is http://foundinflowers.blogspot.com/ Please don't let the title of the post deter you. In the second paragraph I explain the origin of the title. I do accept that many Christians will be appalled at the title, but I feel it is a legitimate and honest title that explains the essence of the post quite well, so....life goes on.

Thanks for the great blog you have here!

FoundinFlowers

brian said...

FoundinFlowers,


Thanks for the comment. I read your blog post. I agree with what you say completely. We're taught not to question the illogical, inscrutable nonsense that is traditional Christianity. The more illogical, the more "faith" kicks in. But, for some of us, we can only take so much.

I just started Brian McLaren's new book "A New Kind of Christianity". The first question he asks is what is the overarching theme of the Bible. His answer will probably surprise some of his followers. I'll be reviewing the book here once I finish it. But, more and more people are realizing the things we've believed about G-d being perfect and being mad us for being imperfect (the way He made us) are more of a Greco-Roman pollution of the story than the original Jewish intent.

Peace,
Brian