The Health Insurance Dilemma - Part 1
Note: This was posted earlier this week, but in the process of uploading the length of this blog posed a problem. So we have broken it into 2 blogs. This blog focuses on current practices and the second focuses on the position of the candidates and the facts used here. It is up to you, the reader, to decide if which candidate speaks to you, athough we hope you share you thoughts.
After reading Amy Tenderich’s piece on Together RX, I went back to thinking about healthcare and the issues, for about 5 minutes before I needed to go for a run! Health insurance is one way to ignite a fire with me!
Why does this topic ignite a fire? My husband is an insurance broker and I get to see first hand the business of health insurance. My husband worked in fundraising for several years and wanted a place that would use his compassion for people. With insurance, he felt he could offer his compassion and integrity to help clients identify what’s critical for them and the issues they face. To his credit he is doing just that. So many of us crave these qualities and bark at the fact we have so little of it in sales.
He is for universal health insurance, which would make his job harder, but he feels that it would level the playing field between corporate profit and the people who need help the most. But the issue of deciding which candidate offers a plan for you requires understanding the current business and that is complicated at best. The place to start may be looking at the current process of buying health insurance.
Here in Virginia, as a type 1 diabetic, I’m ineligible for individual coverage. My business took out a group policy so that I could have coverage, and I pay through the nose for it! If I lived in Maryland, just 30 minutes away, I could apply for MHIP, a state mandate that gives equal opportunity to have healthcare. Maryland hired Blue Cross Blue Shield to administer the program. The price for an MHIP eligible person age 40-44 in a PPO would cost per month: $311.00 with a $500.00 deductible, $246.00 with $1000.00 deductible, $132.00 with a $2600.00 deductible, or $488.00 for a $0 deductible HMO. Is this a good thing? I think Maryland is a great example of a state run program!
What’s interesting is that different states have different rules about health insurance. Virginia is interested in keeping the cost down, so people can be refused healthcare coverage on an individual basis. Massachusetts is a guaranteed issue state, which means no one is denied coverage. What’s the difference? I took a Blue Cross/Blue Shield PPO policy in Virginia that cost $217.00/mo for an individual with no health issues and compared it to Massachusetts. In Mass, a very similar Blue Cross/Blue Shield PPO policy is almost double costing $414.00/mo, so everyone is helping pay for the burden of providing guaranteed healthcare. In Maryland, MHIP coverage costs the MHIP applicant more, but as a state everyone’s policy does not increase to cover MHIP participants.
Many have blogged about wanting to see universal healthcare here in the US. The advantages are numerous, as are the disadvantages! Anything that is taken over by government looses something in the process. When I lived in England, I got a sore throat and following the protocol for socialized medicine I went to a clinic. I was told to go home and gargle with warm salt water. A week went by and I started to have a raging fever and swallowing had become a problem. I ended up in a private practice, where I was diagnosed with strep and prescribed meds. I paid out of pocket for the office visit, but I got the care I was seeking and it was worth every penny. So socialized medicine had problems, reluctance to offer real medical attention for a simple illness. But it does offer every citizen a place to go no matter what your financial or medical status. At the time I lived there, many in England went to private practices and paid for services out of pocket. I don't know if that has changed.
For those who loved, or hated, Michael Moore’s movie Sicko, what most people failed to understand was that every case he used for showing the failure of the system, he picked an HMO and a patient with chronic illness or health care needs beyond the norm. Not one example of failure was a PPO. HMOs were designed for young, healthy individuals who didn’t need significant health care. I can remember having this discussion with my dad when HMOs were being introduced, and he told me never buy into an HMO because of my diabetes. He should know, he helped set them up in Pennsylvania.
Too often health insurance comes down to price tag. For EMS, firemen and police, their jobs are high risk and HMOs are not designed for serious injuries that require extensive medical care for the rest of their lives. Sicko was a great example of that problem. For me, Moore guided viewers into blaming healthcare companies, namely HMOs, that were never intended for long term care. It would have been better if the movie explained that policies are being sold for the wrong reason: cost, and this has lead to signifigant lapses in coverage for many. Another consideration Moore should have taken was to questions whether people need to rethink an HMO policy after a certain age. Could another answer have been that the city of NY should have considered negotiating a healthcare package that would consider the needs of employees in high risk jobs and, if needed, compensation to help? Moore's answer to the problem was socialized medicine.
Most insurance brokers, and the companies they represent, don’t want the market to change, they make too much money and the perks are tremendous! Free cruises and trips, flat screen TVs, cash handed out weekly for the most policies sold, cash cards for gas, the perks are numerous and unfair to the public whose paying for it. The “reward game”, which is exactly what it is, does nothing more than propagate greed and the business looses site of the people they should be working for.
The bottom line is what currently runs healthcare is greed and until we start to shift away from greedy business practices nothing will change, or government will be the force that steps in. Wall Street is in the midst of a meltdown, which many attribute to greed and government has stepped in. The concern from many members of congress was the potential to bailout the overpaid for the mistakes they made. Wall Street exemplifies my problem with the health insurance industry!
Part 2 will cover points from this blog and the candidates vision for healthcare reform.