Saturday, October 28, 2006

Health insurance – unattainable or unaffordable

I’m mad as hell, and it’s not good for my health, which is a problem, because in a few months I may not have health insurance.


I was careless enough to have been sick in the past, which, in insurance parlance means I have a pre-existing condition which means that no insurance company in the US will sell me an individual health insurance policy. Not one.


What’s worse is that without insurance, I pay five to ten times more for healthcare than insurance companies. That’s right. I had a colonoscopy without insurance and it cost $5,000. And insurance company would pay around $1,200 for the same procedure with the same doctors and facilities.


That’s the exact opposite of how it should be. If you can’t afford insurance, you certainly can’t afford to pay five times more than insurance companies do. And yet, if you’re “self-insured” (meaning it all comes out of your pocket), doctors and hospitals charge you much, much more.


The only way I might possibly get individual health insurance is through a special “high-risk” group in California, but the cost is almost $1,500 a month, and I literally have to wait for other people in that group to die before there’s space for me to join.


That makes health insurance unattainable.


Anyone who’s ever been really sick knows that without your health you have nothing. Yet this most basic need of its citizens is not only ignored by the government of the United States of America.


This government is more concerned about the corporate well being of insurance and drug companies, than the individual well being of American citizens. That’s the very definition of fascism, which a most famous fascist, Mussolini, called “Corporatism.”


Why haven’t the Republicans, who have been in total power for the past six years, bothered with health care? Because they’re in the pockets of insurance companies, and pharmaceutical companies, all of who are making billions with the current system. Why would they want to change?


Proof positive of this is the prescription drug plan for seniors, a plan so needlessly complex and convoluted that a majority of seniors aren’t taking advantage of it because they can’t understand it. As an example, a senior could accidentally sign up for a certain type of plan that might not even cover their specific prescriptions! Plans cover seniors for a few thousand dollars, then inexplicably leaves them without coverage for a few thousand dollars more, than covers them again. Huh? What kind of insanity is that?


The same kind of insanity that leads lawmakers to write into the law a clause that prevents the government from negotiating with drug makers on drug prices. Medicare can do this. Private insurance companies can do this. But wait, the US government plan for seniors can’t. Who profits? Only the drug companies.


The Republican politicians in power, from the President on down through the Congress and Senate, already all get the best Federal Health insurance. Why can’t these politicians give their constituents the same health coverage they get?


They say, “It’s too expensive.” Really? You could pay for this system simply by raising income tax on the top 2% of taxpayers to the pre-Bush levels. Just 2% of the population. That means people earning over $200,000 a year. That’s probably not you and me, and if it is you, you can afford it.


I’m lucky to have insurance now, and only do because of a government law called HIPAA (Health Insurance Portability and Accountability Act) that forces insurance companies to allow me to buy a policy because my previous group policy was canceled. HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs, or when policies are canceled.


In my case, I had a group insurance policy through a group called the Media Alliance. They offered insurance to their members for 30 years, until last year when insurance companies claimed they weren’t a legitimate group. Even though they had been for the 30 previous years. Bunk.


My current insurance company offered me a choice: I could go from paying $600 a month, to paying $1,400 a month. I guess I was supposed to be grateful to be offered this by the same insurance company I’d paid for three years to the tune of almost $15,000. In return, I’d received maybe $3,000 in benefits. So they’d made $12,000 profit from me, and now would reward me by only charging me $1,400 a month. I declined their offer to earn more profit from me in a single year than they’d made in the previous three.


Or I could take advantage of HIPAA to find another policy for $500 a month, which I did. But HIPAA only protects you for 12 months after which, you’re out in the cold.

What do I do then? There are still some “Professional Associations, Guilds and Societies (groups you can join if you meet certain professional criteria) that offer group insurance. This insurance costs $600 a month, at least until the end of the year, but they’ve announced “major rate increases” that suggest it will cover $1,000 a month.

That’s unaffordable.

So far, after months of research, I’ve yet to find one high-deductible plan in California that basically only covers major medical or hospitalization (and allow me to pay the same “negotiated rates” as insurance companies, not 5 to 10 times more as individuals, as they do now).

I’ve yet to find any group insurance that offers access to a “Health Savings Account,” yet another government law that’s so complex it manages to exclude most of the people who could use it. Why can’t anyone just have a Tax-exempt Health Savings Account without first having to find an insurance company that will accept them? Clearly because the insurance company is more important than you are.

I just want a policy that protects me in case of something major, not everyday stuff. And yet, that’s not an option (or at least not one I’ve found and I’ve been researching this for over two years).

US only industrialized nation not to protect its citizens

You surely already know that the United States it the only industrialized nation that doesn’t offer national health insurance. It is truly, deeply sad (and pathetic) that this country can spend hundreds of billions on a war that was based on lies, but we can’t afford to take care of our own people. In the US, we spend more money on health care than any other country. Yet we do not receive the best health care. What’s worse, almost 50 million Americans can either not get, or afford health care.

According to The World Health Organization “The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance,” The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th .”

The US needs a national healthcare system—and already has a good one—Medicare. But you can only get it of you’re over 65 years old.


  • Medicare operates with administrative costs of just 2.6%
  • The average HMO operate with administrative costs of 25.2%.


That means Government health insurance is 10 times more efficient than private health insurance. That’s good sense and good business.

If the government can provide good, efficient care for 1/10th the cost of private insurance, shouldn’t they be doing it?

It would save the entire country billions, which would, in turn, increase the GNP for business (and, as a nice side effect, help all American citizens with their health care...)

I’ve heard the arguments against a national health system, but my many friends in countries such as the UK, Denmark and Australia, are all happy with their health care systems. They don’t have to worry about it. It’s there.

In Australia, if you’re in an auto accident, not only are all your medical expenses covered, but so is your physical therapy, so is any home care you require (including child care, cooking and house cleaning).

In Australia, if you are in an auto accident, the government makes sure you are properly taken care of. In the US, if you are in an auto accident, you are on your own. Even if you have expensive insurance it may not cover home care and most certainly won’t cover child care, cooking or cleaning.

Based on that—where would you rather get sick or injured?

The US system is most expensive, but not best.

Medicine here is now controlled by insurance companies who tell doctors what they can and can’t do. And by malpractice insurance companies who tells doctors what they should and shouldn’t do. And by pharmaceutical companies that push drugs because they are easy.
I went to an expensive doctor in one of the richest counties in the country. He looked at my blood tests, not at me, and he gave me what I call “medicine by the numbers.” If your blood number is this, we do that.

He didn’t bother to see what other health issues I had or other medications I was taking. He treated me as if I was a machine rather than a human being who might be even slightly different from other human beings.

So we’re in a system where even expensive doctors can be bad doctors, because they are working under so many constraints that they choose the simplest route that will cause them the fewer liability problems.

And a recent study even showed that there are many doctors in this country who still don’t wash their hands regularly between patients!

Doctors aren’t happy with this system that controls and often prevents them from providing the best health care options to their patients. A system that can even prevent patients from being treated as individual human beings. A system where insurance companies pay them too little, while simultaneously charge them so much for malpractice insurance that it can put them out of business.

As for choice of doctors, if you have insurance, your choice is already limited. You can use a doctor who’s in the program and the insurance will pay a higher percentage, or one who isn’t, and if you’re in an HMO your insurance won’t cover it, if you’re in a PPO they’ll pay a much lower percentage (sometimes as low as 20%).

So a national program would actually give you more choice.
It would also give you more protection.

Right now your private health insurance company can stop you from getting treatment. If they don’t think the treatment is valid or cost-effective, they can deny it, which means they don’t pay for it. Every day valid treatment is denied and people have to sue their own health insurance companies to get the coverage they’ve been paying for. This doesn’t happen with national health care systems.

What this country needs:

The right to be able to buy health insurance you can afford, that will protect your home if you get sick. Right now you can go bankrupt paying medical bills.

Every other industrialized nation already does this, so the health of their citizens is taken care of. It’s clearly possible. All it takes is for politicians to put their constituents ahead of corporations. Will that happen? I will if you make it an issue, tell your elected representatives it’s important to you—and most importantly—vote them out of office if they fail to put citizens health before corporate profit.

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