Tuesday, February 22, 2011

What we're not talking about...

When we talk about health care reform: access to insurance. While many are adamant about being forced to buy insurance, this problem really is trivial compared to the other extreme.
My husband, teenage daughter and I were all active and healthy, and I naïvely thought getting health insurance would be simple.
Why did we even need insurance? First, we wanted to know that, if we had a medical catastrophe, we would not exhaust our savings. Second, uninsured patients are billed more than the rates that insurers negotiate with doctors and hospitals, and we wanted to pay those lower rates. The difference is significant: my recent M.R.I. cost $1,300 at the “retail” rate, while the rate negotiated by the insurance company was $700.
An insurance broker helped me sort through the options. I settled on a high-deductible plan, and filled out the long application. I diligently listed the various minor complaints for which we had been seen over the years, knowing that these might turn up later and be a basis for revoking coverage if they were not disclosed.
Then the first letter arrived — denied. It never occurred to me that we would be denied! Yes, we had listed a bunch of minor ailments, but nothing serious. No cancer, no chronic diseases like asthma or diabetes, no hospital stays.
Why were we denied? What were these pre-existing conditions that put us into high-risk categories? For me, it was a corn on my toe for which my podiatrist had recommended an in-office procedure. My daughter was denied because she takes regular medication for a common teenage issue. My husband was denied because his ophthalmologist had identified a slow-growing cataract. Basically, if there is any possible procedure in your future, insurers will deny you.
The broker then proposed that the three of us make individual applications. Perhaps one or two of us might be accepted, rather than the family as a group.
As I filled out more applications, I discovered a critical error in my strategy. The first question was “Have you ever been denied health insurance”? Now my answer was yes, giving the new companies reason to be wary of my application. I learned too late that the best tactic is to apply simultaneously to as many companies as possible, so that you don’t have to admit to a denial.
I completed four applications for each of the three of us, using reams of paper. I learned to read the questions carefully. I mulled over the difference between a “condition” and “something for which you have sought treatment.” I was precise and succinct. I felt as if I was doing a deposition: Give the minimum true information, and not a word more. I was accepted by exactly one insurance company. So was my daughter, although at a 50 percent premium over the standard charge for a girl her age. My husband was also accepted by one insurer but was denied by the company that approved me.
Our premiums, which were reasonable at first, have increased substantially over the last six years; the average annual increase has been 20 percent. I now am paying premiums that are more than double what they were initially. And because these are high-deductible policies, we still are paying most of the medical bills ourselves.
The new health care reform legislation is not perfect. Nothing that complex could be. But I have no doubt that the system is broken and reform is absolutely essential. If we are not going to have universal coverage but are going to rely on employer plans, then we must offer individuals, self-employed people and small businesses a place to purchase insurance at a reasonable price. [More]
Been there, done that. And I would hazard a guess that anyone who has tried to get individual coverage in the last few years is highly likely to support some form of universal coverage divorced from employment.

Watching the union-busting efforts in WI generates mixed feelings for me. While I am not a big fan of unions, I don't think having an equal-sized opponent to bargain with say, Ford is a bad idea. But ending public employee unions could have a surprisingly harsh backlash for farmers.

I know of several uninsurable, very successful farmers whose wife's teaching job is singularly about health insurance coverage. Any cracks in the benefit packages for public employees could be disproportionately felt in rural areas where small businesses seldom offer coverage, or if they do, less compared to local and state government.

When coverage is lost for any reason, it's amazing how quickly many come to embrace some change from the status quo for health insurance in America. While there seems to be a feeling we can simply mandate insurability and not coverage, the insurance industry cannot tolerate that added expense without new customers.

There are several ways around mandating coverage, and they are looking more credible as the debate intensifies. But stories like the above will resonate with more voters, and like Medicare recipients, their political stances could become more flexible.


Anonymous said...

Wisconsin is trying to rein in union ability to do things I dont feel they should be able to. Public service jobs are already out of proprotion with private sector(read health coverage and retirement). Having neogiated with a teacher union 3 times now I have yet to hear them say what can we give you that will help to better educate the children.

John Phipps said...


I can appreciate your POV, but there are some details emerging that seem to make this look like something other than a budget and education issue.

Furthermore, Walker's approach to cutting taxes for corporations and exempting public service unions that endorsed him is not my idea of valid deficit reduction. It is simply a way to hamstring political opponents.

Finally, the solution to benefit envy is not to make sure everybody has equally poor benefits, IMHO.

Anonymous said...

Yeah but a race to the bottom is what is happening. It is more than benefit envy. A right wing oligarchy has emerged in the US and its members know that there will not be enough to go around. So the business class elite is consolidating its power and control so they get theirs. Little concern is given to the goal of a living wage, a strong middle class, democracy and every other principle that this country fought wars over. One in four counties in the US may be dying as reported in the news but that's just trivial collateral damage. Public education will soon be in short supply too, with limits showing up first in those dying counties. People don't need to know how to spell serf in order to be one. While useful if limited when selfishness, power and greed rule unchecked, civilizations fail. Welcome to the second half of American history.

Steve Hess said...

My point exactly-until public employees feel the pain from health care cost increases(read co-payment)and the stress of funding part of their retirement from their own earnings they are slipping away from the reality the private sector and self employed business have to deal with. Maybe we are creating a 2 class system but it is not the purpose of goverment to redistribute wealth. Do I sound like a big Teapot now?

Chuck said...

I'm in a similar boat to the people you quote. I'm 53, in good health, and can't get private insurance. Why? Because 2 years ago I had an inflamed lymph node that turned out to be nothing.

So I'm hanging on to a part-time job in town because they'll put me on their group health plan.

Unfortunately the current health care reform doesn't solve my problems. Sure I can go into a state high risk pool - if I go without health insurance for 6 months, and then it would cost me and my wife $10,000 a year. Is that affordable? Not even to a member of Congress, I'd say.

Our health care system has problems, and we have a government incapable of dealing with it. What to do? Maybe look outside of the government for answers?