Diabetes Under Various Health Insurance Proposals
In part 1 of this blog, I looked at current practices for buying health insurance. For part 2 of this blog, I took pieces from the McCain website and the Obama website to look at the changes they propose and asked myself whether this was change I could live with.
Senator McCain is for a free market, doesn’t that leave us in the same place we are now? What would be the dramatic difference? At JohnMcCain.com, I pulled up his healthcare outline. The total pages of information, three, count’em 3, which is not enough information to really know what he stands for. I felt this was an effort to look like change, but it contains little substance. I’m just going to pick out pieces that are relevant to this blog. In the McCain plan:
1)“ An important part of this plan is to use competition to improve the quality of health insurance with greater variety to match people’s needs, lower prices and portability. Families should be able to purchase health insurance nationwide, across state lines.”
My comment: We have competing companies, but it has not lowered the price! There is ample variety to match people’s needs, but the problem becomes what they can afford, and education on the part of the broker. Often the brokers are too quick to get the job done and they sell clients policies they don’t understand. So why does he think this is a change from the current crisis? McCain and Obama both share the same view on this issue, but I’m not sure their decision to push for more companies to compete will bring down the price, smaller companies can't offer the range that large companies do. For example, my husband represented a company that did not include coverage for colonoscopies and mammograms in any of their plans, but the larger companies do. The larger companies have multiple plans to choose from because of their size.. unfortunately.
2) “While still having the option of employer-based coverage, every family will receive a direct refundable tax credit-effectively cash of $2500.00 for individuals and $5K for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.”
My comment: Both my husband and I love this idea! But McCain doesn't offer much to small business owners in the way of helping them cover their employee benefits with tax incentives for taking on the responsibility. NPR did a piece on healthcare and the campaigns. NPR asked healthcare advisors for McCain and Obama answer questions from small business and individuals, which simply confirmed what I was finding for myself. As a matter of fact, I couldn't find anything for the small business owner! Another place to understand the Obama attack ad about the tax credit is politifact.org
3) Another feature of the McCain plan is HSA, Health Savings Accounts- HSAs are gaining popularity. The outline reads: “When families are informed about medical choices, they are more capable of making their own decision and often decide against unnecessary options. Health Savings Accounts take an important step in the direction of putting families in charge of what they pay for.”
My comment: The health insurance industry is so messed up that an HSA is the best option to control your costs. Most HSA policies for an individual start with a $1000.00 deductible, families are $2200.00 deductible. All medical and pharmaceutical costs come from your savings account until you meet the deductible, then the HSA kicks in to cover medical and pharmaceutical costs at 100%, only one had a weird nickel and dime set up. Catastrophic coverage is anywhere from $3 to $8 million dollars. An HSA is not as cheap as HMOs, but are often less than PPO plans, and they do offer you the choice to see any doctor like a PPO. People with chronic illness can participate in an HSA and be well covered, unlike the limiting HMO network care. What many people get hung up on are copays. In their mind, copays mean better health insurance coverage. The reality is you are paying for the copay every month and often paying more money than what you would use in a year for office visits, prescriptions etc. An HSA would allow you to set up funds toward those visits and if you don't use it, it rolls over for the following year and you can either continue to contribute the same amount of money, or cut down on your contribution to the account. An HSA is tax free and interest is deferred unless used for qaulified medical expenses and then the interest is tax free. At age 65 you can use anything left in the account for out of pocket costs that medicare doesn't cover like prescription drugs. You may withdrawl the money at anytime, but over 65 pays income tax and under 65 pays a penalty and income tax. So I agree with McCain that more people need to understand an HSA option, but he is NOT presenting something new, he is merely supporting existing programs.
4) McCain’s plan for the uninsured is Guaranteed Access Plan. The site states “ As President, John McCain will work with governors to develop a best practices model that states can follow- a Guaranteed Access Plan or GAP- that would reflect the best experience of the states to ensure these patients have access to health coverage. One approach would be to establish a non profit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.
My comment: All I can say to this is uh-oh! Guaranteed Access Plan, sounds very similar to Guaranteed Issue State! Please reread the state plans above. In this plan I don’t see change from where we are now, and isn’t the heart of this issue about those who don’t have adequate coverage or coverage at all because they can't afford it? Additionally, who is going to oversee the non profit? Government? Non profits are not exempt from issues. I have many concerns about this, as I don't see enough details.
To note, the Obama site had a 5 page outline and a 13 page detailed plan. Grab a double espresso and plan to read slowly! Obama's plan has more options and versatility, parts of the plan are similar to McCain's ideas, but it has many layers which makes it difficult to know how he will get it approved through congress!
Many have said that Obama wants universal insurance and healthcare. Government run health insurance is questionable to me. When thinking government, think HIPAA! That was a great piece of legislation that causes me to have to sit on the phone in order to connect the dots and reconnect the dots so the dots can speak to each other to clarify a billing error!
In fact, Obama advocates for a system set up like the federal government and my friends working for the government like their insurance coverage. This could be a good thing!
1A) From the Obama outline: “Obama and Biden will make available a new national health plan to all Americans, including the self employed and small businesses to buy affordable health coverage that is similar to the plan available to members of congress.
1b) The Obama-Biden plan will create a national Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The exchange would evaluate plans and makes the differences among plans, including cost of services, public.”
My comment: Lawyers love to verbally abuse us! So here’s my suggestion take a look at the OPM homepage for the fed program: http://www.opm.gov/insure/. If this is what he intends to mimic for everyone, this program is like any other that you get from a large employer. For small companies this maybe the PPO to offer. Would it cost more, I'm betting that it would because we have to cover everyone. I don't know how he intends to make it less money unless we pay for it through taxes.
2) Lowering Cost by increasing the Insurance: “The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. There have been over 400 mergers in the past 10 years, and just two companies dominate a full third of the national market. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed by over 87 percent. Barack OBama and Joe Biden will prevent companies from abusing their monopoly power through unjustified price increases. Their plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. Their new National Health Exchange will help increase competition by insurers.”
My comment: I like pieces of this section. For example, the National Health Insurance Exchange would allow me to buy what I want. I like the fact that he would like to prevent companies from abusing their monopoly power through unjustified price increases. Like McCain, Obama feels that competition will drive prices down. My feeling is that the companies need to figure out how to cap their overpaid execs and trim the “reward game”. When Obama and Biden launch into controls by government, the system looks potentially bogged down in bureaucracy, and would members of congress fight the salary and compensation packages of the execs? They haven't so far. How are they going to change that "Hill" practice?
Quite frankly, I think the health insurance industry needs to rethink their business model, but neither presidential candidate has a Harvard MBA. Oh wait, our current president is a Harvard MBA, so why didn't he take charge of this business problem?! Is this the problem with a C+ student becoming President?
McCain fans claim that Obama will change the system to universal care, which doesn’t work. And Obama fans claim that McCain’s plan favors big business and no change. For me, Obama’s plan has some new thinking, but my concern is that the plan is burdened with many layers and how will Congress pass it? While I love the McCain tax credit for individuals and families, he does not offer help to small businesses and overall McCain’s plan doesn’t seek to curb corporate problems enough for me to believe that he will break the current problem. An organization called Intelligence Squared U.S. held a debate on this subject: Is the Government Responsible for healthcare? Well worth reading!
With our current grim economic situation, I don’t feel that Obama or McCain will be able to reform healthcare in the next 4 years. So what options do we have? Can we correct the problems with the current system? Reorganize the health insurance industry, capping salaries and redirect the business to be more equitable and customer service based like it should be? Why can’t the National Governors Association be given a role in making state to state changes, that allows the portability piece and the coverage needs to be decided among the people who understand the issues personal to their state.
Some comments have been left on other healthcare posts about France and Scandavian healthcare systems. While I agree they are good, and better than Canada and England, becareful what you think is free! Medicine: Who Decides?, by Paul Krugman, Commentary, NY Times. And if that isn't enough: Sweden's single payer Health Care system.
What is most important is educating yourself on healthcare. Go to the website of the candidates, look at socialized healthcare in other countries in order to compare someone like Obama who is presenting something new. Many of us have made choices without doing the homework. The more you research healthcare the more confident you will be in your choice for president.
If you are not exhausted by now, here is more food for thought:
The Voice for the Uninsured, an AMA proposal to the healthcare crisis.
Obama Ad Targets McCains Health Care Plan : NPR