If you serve your guests Spam on a silver platter and call it “lobster”, it is still Spam.
If you serve your country overpriced, high deductible, high out of pocket health insurance on a silver platter and call it “Affordable Care” will folks really be any healthier or any less broke?
Rep. Lynn Woolsey (D. CA) has introduced Health Care Reform 2.0, the Public Option. Since the nation’s health affects everyone through high public spending on the chronically ill and disabled and diminished worker productivity, all of us, whether we are 20 or 50, whether we have a pre-existing health health condition or not, should be glad that someone in Congress cares to continue the fight for true health care reform.
http://rawstory.com/rs/2010/0722/woolsey-robust-public-option/ I. Meet Paul and Jane Paul worked at a manufacturing company making a decent wage until his employer closed the plant and outsourced the work to Mexico. His unemployment ran out, and he was lucky to get a minimum wage ($7.25/hour) job in a fast food restaurant. His wife Jane also has a minimum wage job now. Her mother baby sits the nine year old child after school for free. (Lucky!) Their combined income is $30,000 a year. Congratulations! They are some of the hard working Americans who will now be able to say (proudly) “we pay for our
own health insurance.” Unfortunately, their $1250 does not get them much. For instance, Jane has irregular menstrual cycles with heavy bleeding that make her tired and anemic. She used to take hormones to regulate her periods, back in the days when she had insurance through Paul’s job. She has not taken the hormones in over a year. If she schedules an appointment with her gynecologist, he will insist upon doing a Pap Smear and a mammogram and blood work----all of which she will have to pay for out of her own pocket, since her personal deductible is $2000. And she can not afford to pay for gas to get to and from work, much less come up with $2000 extra dollars.
So, she waits. And bleeds. And eventually, she faints on the job and is rushed to the hospital where her hemoglobin(blood count) is 5----less than half of what it should be. She is given a transfusion. She is given all kinds of tests to prove that she does not have cancer. She is sent home with a prescription for iron and the same hormones she used to take. And she now has tens of thousands of dollars in out of pocket expenses that she will not be able to write off even if she declares bankruptcy. Jane will have to flip a lot of burgers to pay that bill.
Too bad for Jane there was no public option that could have provided her with affordable useful health insurance so that she could have saved herself a hospital stay and a blood transfusion. What she does not know now is that the blood was contaminated with a new, not yet identified hepatitis virus. In about twenty years, Jane will have cirrhosis of the liver. Her stomach will swell up to three times its normal size. Her thinking will grow cloudy. She will be in and out of the hospital, and when she is home, she will be too weak to do anything except sit and watch TV. Oh well. By then, she will be on Medicare. You know, single payer federal insurance.
II. Affordable Health Care versus “Affordable” Health Care Before you call me an Obama basher for raining on his re-election parade (“The first president to pass health care reform!”), maybe I should explain the difference between Health Care that is affordable and Health Care that is “affordable”.
Affordable Health Care does not have a 30% mark up to pay the salaries of CEOs. “Affordable” Health Care does. Affordable Health Care does not allow health insurance companies to invest lots of your premium dollars into its claims denial department----and then label that money as health care expenditures on its ledgers. “Affordable” Health Care does.
Affordable Health Care does not charge you $1000-5000 up front to learn if that breast lump is cancer or benign. “Affordable” Health Care does. Affordable Health Care does not charge you a $30 copayment every time you walk into a doctor’s office or a $200-500 copyament every time you go to the hospital. “Affordable” Health Care does. Affordable Health Care does not expect you to come up with 20-40% of the money to pay for your coronary bypass graft surgery before you can be put on the operating room schedule (estimated cost of the surgery $50,000. Your portion---$10,000 to $20,000). “Affordable” Health Care does.
Note that a typical Medicare deductible is less than $200 for outpatient services and around $1000 for up to 60 days of hospital care. You also pay 20% of the bill, however Medicare keeps costs low, so your portion will be small, too.
https://questions.medicare.gov/app/answers/detail/a_id/2260/~/medicare-premiums-and-coinsurance-rates-for-2010Affordable Health Care will be managed by the federal government the same way that it has managed Medicare. “Affordable” Health Care will be managed by the same private insurers who illegally terminate the policies of people who get sick, who routinely deny necessary care and who limit the number of health care providers whose services they will cover. Since “Affordable” Health Care will set up “Nationwide Plans” (to make themselves more “affordable”) they will be exempt from state insurance regulation, which will make it easier for them to 1) cancel policies, 2) deny care and 3) limit access to providers, since they will only have to install one industry friendly federal regulator as opposed to 50 or more under the current system.
III. “Available” Health Care is not the Same as Affordable Health Care The federal government loves to misname things. The Department of War is the “Defense Department”. The “You Can Never Marry” act is called the “Defense of Marriage Act.”
So called “Affordable” Health Care should have been called “If You Have Money and a Pre-existing Condition, You Will Now Be Able to Get Insurance” Act. Hmm. That’s too long.
“Available” Health Care sounds catchier. It is a god send for those who make good money but who suffer from a chronic medical condition such as diabetes or asthma. People who want to quit their company job and start their own business or join a small firm will not have to worry about losing their health insurance. This will give them greater job freedom. If you retired early and are living on a nice retirement income, and the spouse who carried the health insurance dies, the surviving spouse will be able to get his/her own health insurance, even if he/she is 60.
Middle aged folks
with money and anyone with a chronic medical condition
and money should be cheering over “Affordable/Available” Health Care. Their out of pocket expenses if something happens have just gone way down, and they should have no problem affording their premiums and deductibles. If they are smart, the will opt for one of the higher cost plans, in which case their out of pocket will actually be lower if they happen to get sick.
You never get something for nothing. If the well off but uninsurable are going to see their out of pocket medical expenses go down, then someone else is going to pay. The family of three on the other side of town that is struggling to get by on $28,000 a year will now have to pay $1250 a year for some high deductible, high copayment insurance that they will never be able to use. That means $1250 of free money for the insurance companies to put in the bank. If the family can not scrape up $1250 (and how many urban families of three living on less than $30,000 can?) they will pay the federal government $750 a year. That is $750 of free money for Washington. Right now there are about 50 million Americans who do not have health insurance. If all of them either pay the fine or pay for insurance, that is 50
billion extra dollars to be divided between the government and private health care plans. Wee! Free money from the poor to support the rest of us. What could be more American?
The working poor don't vote, you say. Maybe not. But they do get sick.
IV. Meet Tyrone Tyrone has always snored, but recently it has gotten much worse. He does not know it, but he has obstructive sleep apnea(OSA). He is still able to work, but his wife left him because of his erectile dysfunction (caused by the sleep apnea he does not know that he has). She made more money than he did, and she carried the health insurance.
Though he is struggling to make ends meet, he decides to pay for health insurance, as required by law. He opts for the cheapest plan he can get. His deductible will be $2000. Since it is one of the “nationwide” plans, there are only a few providers in his area that accept the insurance, and the only covered hospital is on the other side of town.
Tyrone has been getting headaches recently. And a couple of times, his legs have swollen up when he has been forced to work 12 hour shifts. A neighbor who is a nurse checks his blood pressure and tells him that it is dangerously high. But when he calls to make an appointment with one of the doctors who takes his insurance, he is told the visit will cost at least $80, “And the doctor will probably recommend lab, Xrays and an EKG. Those will cost more. We expect payment at the time of service.” Since he does not get paid until the end of the month, Tyrone puts off making an appointment. And puts off making an appointment.
One morning, Tyrone wakes up and finds that he can not move his left arm. Luckily, the phone is nearby, and he calls an ambulance. He is rushed to the nearest hospital. Turns out, his sleep apnea has given him high blood pressure which caused a stroke.
Four weeks and a lot of rehab later, Tyrone has regained full use of his arm. His employer is understanding, and he lets Tyrone come back to work. His insurance company is less understanding. They want to know why he went to an out of network hospital and saw out of network providers. He keeps getting bills from the hospital, which threatens to turn him over to a collection agency if he does not work out a payment plan.
Tyrone is pretty sure that insurance companies have to pay for emergency care at the closest hospital. But his insurer is claiming that arm weakness was not a life or death emergency. The state insurance board tells him that it has no jurisdiction over a “nationwide” plan. He has no idea whom he should talk to in Washington. When he tries to call, the lines are always busy.
The doctors at the hospital diagnosed his sleep apnea and set him up with a CPAP machine. But it does not fit right. When he tries to make an appointment with a sleep specialist, he discovers that he will have to drive to the next city to see one (he has been told to limit his driving because of his OSA) and the wait is six months. “Oh, and the computer says you have not met your annual deductible yet. That will be $200, due at the time of service.”
Depressed and outraged simultaneously, Tyrone slams down the phone.
V. Hard Working Americans are Falling Through the Cracks “Affordable” health care is good for a lot of people. It is good for
hospitals, who will be able to collect at least 80 cents on the dollar for all the people who have to seek care in the emergency room because they can not pay their office deductible---
But wait! Isn’t health care reform supposed to free up our crowded ERs and get people preventive services that would keep them healthy? No, health care reform is supposed to make sure that hospitals get paid. That is why all those hospital associations were lobbying for it.
“Affordable” health care is good for the
insurance industry which will be able to collect premiums from lots of families which will be unable to use their insurance. Every business loves “free” money. That is why the health insurance industry lobbied so hard for it.
“Affordable” health care is good for
doctors, like neurosurgeons who work at hospitals where they treat a lot of uninsured people. If the next car wreck victim with an open head injury has the cheapest insurance policy around, that can mean tens of thousands of dollars in the surgeon’s pocket. If the next middle aged man with a heart attack has paid his $1250 for the year, the cardiologist will be able to collect at least partial payment for a procedure that he used to have to do for free, as part of the cost of keeping his hospital privileges. More money for specialty doctors. Yeah!
Don’t get me wrong. I am a physician myself. However, it seems to me that “Affordable” health care reform is sealing the wrong cracks. I know a few people who will benefit----those who make a comfortable income but who can not get individual insurance because of their health conditions. People like me and my husband. “Affordable” health care is going to bring down our annual out of pocket health related expenses considerably. Hurray for me----
But I can not help worrying about all the people I see in the office, people who have been laid off from their jobs, people who are too “sick” to qualify for individual health insurance, and so they neglect their health until their little bit of sickness (say diabetes) turns into full blown sickness (say kidney failure). When I see all the misery and suffering that comes from lack of preventive health care, I want to do something about it.
That is why we need a single payer option, to keep the private plans honest, and to give
everyone access to the health care they need.
VI. Four Out of Five Family Physicians Say We Need a Single Payer Option I'm not making this up. Here is a link:
http://www.nhms.org/topics/12-14-2007_a.pdfThat is even more than the 3 out of 4 American health care consumers who want a public option. But go on, call me too left wing. Tell me that I am out of step with Americans. Tell all the folks at DU who want to see health care solutions not health care Band Aids
You are too far left of center and
You will bring ruin down upon the Democratic Party.
Tell me why Tyrone and Jane do not
deserve a chance at decent health.
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