Monday, March 31, 2008
The repo man comes along and takes the car back. Heck, we even had an insurance carrier get into the "take back" game by repossessing a bionic arm.
But now the car lenders have a new device to protect their interest should you decide to stop making payments.
They zap your car so it won't run.
A light on the plastic box flashes when a payment is due. If the payment isn't made and the resulting code punched in to reset the box, the vehicle won't start. The next step is a visit from the repo man.
This is not good.
So what does this have to do with insurance?
Nothing really . . . yet . . .
But let's just say . . . you have a medical emergency and require immediate care. The ER, hospital & docs are obligated to treat you regardless of ability to pay under EMTALA guidelines.
You do not have insurance.
The providers agree to bill you and even work out payments.
Then something comes along and rather than making payments on a medical bill you decide instead to buy a new SUV.
Then the light on your body begins to flash. Unless you catch up your payments the hospital sends out the repo man to take back the pacemaker . . .
OK. Maybe a bit far-fetched but hey, it could happen.
We keep hearing about 45, 46, 47 million uninsured. But the press rarely gives us details.
Readers of InsureBlog know that this is an issue addressed almost ad nauseum. But sometimes it is worth repeating.
Six years ago, Evelyn Reinthaler’s face smacked against the windshield of her Geo Prism during an Interstate collision. The accident sent her to the hospital, where she racked up an $18,000 bill.
This winter she broke into tears when she was hit with a $100 bill for flu medication.
The 25-year-old Omahan, a part-time student, is among the more than 13 million young adults nationally who lack health insurance.
Even though older Americans often are the focus of concerns about health care costs, people ages 19 to 29 are one of the fastest-growing groups without insurance, according to a report by the Commonwealth Fund.
A small percentage of my business is comprised of people in this age bracket. Most have plans selected by and paid for by their parents.
Even though they comprise just 17 percent of the under-65 population, young adults account for 30 percent of the nonelderly uninsured
Carriers are introducing new plans to appeal to this generation but the marketing effort is falling on deaf ears.
The Georgia legislature is looking at ways to make health insurance more affordable by providing tax breaks to employers & individuals who buy HDHP (high deductible health plans).
As a Georgia resident and agent, this is something that is now on my radar.
In addition to exempting these plans from premium taxes, there are tax breaks.
Small employers under the bill would get a $250 tax credit per enrolled worker, and individuals buying them would get a tax credit.
Tax breaks. Gotta love it, right?
So what's the problem?
The premium tax in Georgia is a whopping 2.5% of gross premium. Eliminating taxes paid by carriers on these policies may generate some savings, but not anything noticeable.
Many who are uninsured do not pay taxes. Others (the young invincible's) pay taxes but see no need for buying health insurance.
This is a step in the right direction but like most other proposals, does nothing to control health care costs.
On a scale of 1 - 10, I give it a 5.
Sunday, March 30, 2008
Under this scheme, “patients will not be given money directly, but will decide themselves how to spend sums normally administered by the NHS.”
The U.K. health secretary notes the generation now reaching retirement expects "more control over chronic health conditions that affect four adults in 10." Of course, there are differing opinions. One source of controversy is that some service providers (who at present are paid directly by the government) fret that patients will not welcome the “extra burden” of deciding for themselves where they prefer to obtain treatment. But overall, this scheme seems to me yet another remarkably original, creative, and imaginative idea from the British National Health office. Don’t you agree?
And yet, reading about this scheme . . . I sense something . . .a presence I’ve not felt since . . .
Oh shucks that sensation is probably just deja vu all over again. Won't it be interesting to see how this scheme plays out, over there?
Friday, March 28, 2008
Thursday, March 27, 2008
And we believe most docs are competent.
But are all docs up to speed on all medical situations and treatment?
After all, even specialists treat multiple patients and multiple conditions and each treatment protocol is different.
So what is a patient to do?
Consult Dr. Web.
14 years ago Todd Small was diagnosed with M.S. (multiple sclerosis).
For 14 years Todd took a daily 10mg dose of Baclofen. His doc told him that was the maximum dosage.
Granted, that was years ago and perhaps when Todd first started on Baclofen 10mg was the maximum.
To Todd's surprise, he discovered patients taking up to 80mg daily.
There are a little more than 7,000 Todd Smalls at PatientsLikeMe, congregating around diseases like Parkinson's, multiple sclerosis (M.S.) and AIDS, all of them contributing their experiences and tweaking their treatments. At first glance, the Web site looks like just any other online community, a kind of MySpace for the afflicted. Members have user names, post pictures of themselves and post updates and encouragements. As such, it's related to the chat rooms and online communities that have inhabited the Internet for more than a decade.
There are plenty of resources available to anyone with internet access. As the Yellow Pages used to say, let your fingers do the walking.
Finding "baby Daddy" is a staple of daytime talk shows. I am still amazed at the number of folks willing national TV and reveal what most would consider deep, dark secrets.
So if you are not into public humiliation (although I have yet to see any signs of embarrassment), help is on the way.
For $30 plus another $119 to process the results, you can know the father without a live audience whooping and hollering "you, you, you, you . . .".
What fun is that?
The kit costs $29.99. It contains cotton swabs for taking cells from inside the mouth. The swabs are sealed in plastic bags and sent with a consent form and a $119 fee to a lab. In three to five days, results can be accessed online. Rite Aid has ordered 10,000 more for all its stores except those in New York, where state law requires a court order or medical prescription.
So what's to stop New Yorkers from crossing state lines to buy the kit?
Sure beats hearing Maury say, "You ARE the daddy"!
Wednesday, March 26, 2008
OK. That was cheesy.
But the WSJ has revealed something I have known for some time. Some folks who work for the federal government do not have health insurance.
I have several clients who are employed by government agencies who either have no health insurance, or have a very limited benefit plan.
A few weeks ago a lady from the CDC called. She was referred by a co-worker who is also a client. Seems she had emergency surgery a few months ago and the health insurance paid less than $1000 on a $14,000 bill.
Covering the uninsured is a central issue in this year's political campaign. Yet while politicians debate how best to cover the growing ranks of the uninsured, the federal government -- by outsourcing service jobs -- quietly is adding to those numbers.
To save money.
Considering it is taxpayer money, such moves are commendable.
The problem is, the contract workers are offered health care benefits that are akin to putting a patch on an old pair of jeans. Many of these workers are semi-skilled and usually do not understand how poor the benefits are . . . until they need to use them.
By then it is too late.
Under a 1965 law, called the McNamara-O'Hara Service Contract Act, most contractors with service contracts of more than $2,500 are required to pay locally prevailing wages, plus fringe benefits or the cash equivalent -- $3.16 an hour this year, under a government formula.
$3.16 per hour for fringe benefits.
That's $526 per month per employee working 40 hour weeks.
But not all contract employers offer health insurance as part of the package. If they do offer health insurance, it is usually a limited benefit plan.
By diverting all or some of the $3.16 to wages, they are able to offer employees a wage that is higher than the "prevailing market wage" and attract workers.
And some contractors don't even comply with the law, and pocket the government allowance.
"A lot of contractors are playing games," says Al Corvigno, a Smithfield, Va., consultant who trains contractors and Labor Department employees on the McNamara-O'Hara Act. He estimates that 40% of service contractors may not be providing the required benefits or cash, or paying the right amount.
No government oversight or accountability meets greed.
Yeah, I am shocked too.
In fiscal-year 2007, the Labor Department initiated more than 650 investigations under the statute and found that in 80% of those cases, the employer failed to pay proper wages or benefits or both. Employers who violate the law may be required to make cash payments to employees and may be barred from government contracts for as many as three years.
80% failed to comply with the law.
Looks like contracting with the federal government is Easy Money.
Tuesday, March 25, 2008
Over at Distractible Mind, Dr Rob muses on a case gone horribly wrong, and the lessons painfully learned from it. Recommended, but heartbreaking.
Monday, March 24, 2008
For more than six hours on Monday, the Oklahoma Highway Patrol classified Zack Dunlap as the state's 610th motor vehicle fatality of the year.
Troopers removed Dunlap's name from the list the same day after learning he showed signs of life shortly before his organs were to be harvested for transplant.
This is a truly amazing story no matter what your faith may be.
For an update on Zack's recovery, click here.
Friday, March 21, 2008
Some will read this account and say it is just another coincidence. Others will define it as luck.
But some who want to believe in miracles will see this story in a different light.
If you don’t believe in miracles, then you didn’t read of Greg Bugher’s heroism on the front page of this section. The Russiaville man and his family witnessed the horrific accident on Interstate 465 Easter morning – the one that took the lives of Joy Edwards and a motorist who was driving the wrong way on the highway.
Bugher risked his life to save those of Branden, Courtney and Kristin Wade, and their friends, Alex Stang and Chase Parker.
After the violent impact, Edwards’ van was on its passenger side. Fire burned from the engine.
Bugher first pulled Courtney from the wreckage and ran back to the burning van.
“I looked over at my wife and Courtney and, at that moment, I realized I might not be coming back,” Bugher told us last week. “My family, I knew they were safe and God was going to protect them. But, if I don’t go do something to help the kids in the van, they weren’t going to live.”
One by one, Bugher and a passer-by extricated the children – even as the fire crept closer to the van’s fuel cell.
“When Branden came out, the flames were at the second seat,” Bugher said. “Thirty or 40 more seconds and he would have been burning. By the time we got him away and turned back, it was engulfed and there was nothing anyone could do to stop it.”
It is a miracle those five children were saved.
It is a miracle that Joy Edwards veered to the right just before the impact, saving the life of Courtney, who was sitting up front.
It is a miracle that selfless folks like Bugher and his wife, Dianna, were there to help.
It is a miracle the Bughers were even on the road.
“I’m in the passenger seat and was just starting to fall asleep,” Greg Bugher said. “[Dianna] asked if I wanted to get gas at this exit. I said no, go to the next one.”
As children, many of us are taught that God has plans for us – that our lives have purpose.
Easter morning, Greg and Dianna Bugher fulfilled a bit of theirs.
Peace and blessings.
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Seems the folks in Massachusetts are at it again. So much so we just had to blog on it. They are such an easy target . . .
The state's new subsidized health insurance program will cost "signficantly" more than the $869 million proposed in the governor's FY2009 budget just two months ago, the state's top financial official said today.
In case you missed it, the Massachusetts plan has been a favorite target at InsureBlog. You can find our refresher course by clicking here.
The budget gap looms despite steps taken today to hold down state costs -- approval of a tough contract with insurers, and increased premiums and copayments for about half of the 176,000 people enrolled.
Budget shortfalls in spite of increased premiums and copays.
The premiums will go up 10 percent on average. For example, people with incomes between $21,000 and $26,000 who are now paying $70 per month, will pay $77
$77 per month. About $2.50 per day. Yeah, I can see how this is a burden.
This is what happens when lawyers decide to meddle in something where ignorance of the dynamics of risk management is rampant.
Thursday, March 20, 2008
One of the great things about HWR is the opportunity to find previously undiscovered blogs, and this edition is no different. David Hamilton runs VentureBeat, and has some cool news from Aetna, which now offers some new web-based care management tools. Recommended.
91% of whites rated their care as excellent or good. That percentage fell for most ethnic groups, with the lowest ratings recorded among Chinese-Americans, 74%; African-Americans born in Africa, 73%; and Vietnamese-Americans, 72%.
Note the differentiation for blacks. "African-Americans born in Africa."
This would seem to indicate the dissatisfaction has more to do with culture and/or language.
When it came to getting an appointment, about 63% of whites were able to get an appointment on the same day or the next day after they became sick or injured. That percentage dropped to 42% for Cuban-Americans and 39% for African-Americans born in the Caribbean.
Again note the separation. "African-Americans born in the Caribbean."
This distinction is not referenced for Asians or Cuban-Americans, only blacks.
About three-quarters of whites reported that their doctor listened carefully to them. That percentage fell to 62% for Korean-Americans and 58% for those from Central America or South America.
So the conclusion is?
the Harvard study also showed that there are steps that health care providers can take to improve patients' perceptions, such as resolving language barriers. She said health care providers should incorporate translation services into their practice.
So doctors should pay to have a translator on staff.
Why can't those for whom English is not their primary language bring along a translator?
Wednesday, March 19, 2008
I've been thinking about one of the "givens" in the universal coverage debate, and wanted to share some of that with our readers. We operate under a few assumptions here at IB and, although we obviously don't think in "lock step," I'm pretty comfortable in stating that, for the most part, we all agree that:
■ Mandatory benefits impact premiums
■ Personal responsibility and accountability are desirable
None of the legislative initiatives currently on the table substantively address these issues. Which is not to say that there's nothing of value to be gleaned from them.
Tuesday, March 18, 2008
"Women have been telling me this for 25 years," says Elizabeth Lee Vliet, a women's health physician with offices in Tucson, Ariz., and Dallas, Tex., who notes that her patients often speak of feeling "fuzzy-headed." She takes detailed blood tests and typically prescribes 17-beta estradiol, an FDA-approved estrogen replacement. "They come back a couple weeks later and say 'It was like someone turned a lightbulb on my brain! I can think again!'
Like turning in a lightbulb.
Does Estradiol work on blondes?
OK, I am going to hear about that one . . .
Primary care physicians are battling to save their practices by looking at new ways to increase revenues. Some have converted to cash only services, other are peddling nutritional supplements. And a few have gone to concierge services.
Doctors who charge an annual fee to patients in exchange for customized care including house calls are drawing the ire of some health insurance companies.
Now it seems that some carriers are rebelling against the concierge docs.
But United Healthcare and Cigna both say the concierge model violates their contracts, and United Healthcare is dropping four Texas physicians because of the practice. Insurers say that doctors may charge patients for co-payments or co-insurance, but not additional fees
I tend to agree with the carriers.
MCO contracts signed by physicians prohibit the doc from balance billing for covered services. In other words, once the patient pays their portion the provider is prohibited from charging more.
To do otherwise defeats the concept of the copay (or coinsurance).
It seems this practice may be running afoul of the TX DOI as well.
Jennifer Ahrens, the Texas Department of Insurance's senior associate commissioner for life health and licensing programs, said Texas law is explicit for health maintenance organizations and preferred provider organizations. Physicians associated with HMOs or PPOs agree to discount the fees they bill insurers for specific patient services, but doctors who enter into these discounted-fee contracts can only charge patients related co-payments or co-insurance and not additional fees.
Concierge services is still a new concept so this battle may take a while to come to a head if it ever does.
Still, it is something worth noting.
(Thanks to Matt Horn for the tip on this story line).
Monday, March 17, 2008
How about 302.79? Maybe you participate in a bit more risky things such as 302.4, or 302.3.
Help may be on the way.
The U.S. House has passed a mental health parity bill that is on its' way to the Senate.
"It's a civil rights bill for people with mental illnesses and chemical addiction. It forces insurance companies to treat them as they treat others."
Carriers have long resisted covering psychiatric disorders as any other illness for two primary reasons.
In many cases, diagnosis is an inexact science. Psych disorders usually cannot be diagnosed from an X-ray or other testing used for physical conditions.
Depending on the condition, treatment is palliative but may not have a cure. Treatment can go on for years without improvement and can be quite expensive.
According to the NIMH it is estimated that 26.2% of the U.S. population suffers from "a diagnosable mental disorder."
This would include those who have 302.89.
It's enough to make one 303.00
Sunday, March 16, 2008
[Welcome Industry Radar readers!]
An article in Thursday's Wall Street Journal reports on a few inexpensive health insurance plans that are now being marketed as a solution to the serious problem of the uninsured.
Although this insurance is quite affordable, the article properly acknowledges that the cost is sensitive to the rising cost of health care – specifically that more services are now available and more people are willing to take advantage of those services – as examples, the article cites hip replacement and cataract surgery.
The coverage sounds OK, if unremarkable – deductibles are available between $50 and $125 and the coinsurance is 80% to 90% depending on the options you choose. To keep costs down, very strict medical underwriting applies, and there seem to be three different levels.
First, the insurance company will not issue a policy if certain health problems already exist. (Oddly enough, having a bladder stone problem is one of the reasons reported that can result in refusal to issue a policy.) Other specific pre-existing conditions that “manifest” within a 30-day look back period following policy issue are automatically excluded – and, if the insurer rescinds the policy at that point, the first month’s premium is refunded. Still other pre-existing conditions are insurable subject to limitations. Message here is - watch out.
Wellness assistance benefits are available as add-on coverage, but the coverage is not all that generous - the insurance pays as little as 40% and some wellness regimens such as special diets are not covered.
The premiums run anywhere from about $350 to $480 per year. Oh, and I forgot to mention. This is pet insurance.
Saturday, March 15, 2008
Friday, March 14, 2008
This post will contrast the difference in two clients.
Let's just refer to them as Client #8 and Client #9.
Client #8 is a long time client who has grown to trust my advice.
Client #9 is also a long time client, but somehow doesn't feel satisfied with the work we do.
Client #8 appreciates the long hours of devotion and care we give.
Client #9 believes we should do more.
Client #8 is pleased with all the money they save and is socking it away for future needs . . . perhaps in an HSA.
Client #9 is also pleased with the money he saves, but rather than saving his money, he chooses to spend it on expensive toys.
Client #8 values our advice and does not see a need for seeking outside counsel.
Client #9 also values our advice, but perhaps not to the same extent as Client #8 and feels a need for a second opinion.
Client #8 will remain a client for years to come.
Client #9 will most likely terminate our relationship before too long and move on.
We wish only the best for Client #9.
The money in your HSA can not only be used to pay CURRENT medical expenses, but also for those incurred after you turn age 65.
According to Fidelity Investments, "the average 65-year-old couple retiring this year will need about $225,000 just to cover their medical expenses once they stop working."
Where can they get that money?
How about from excess contributions (over and above current medical needs) to their HSA?
What a novel idea.
(Warning. Shameless self promotion follows.)
You can learn more about HSA's and other "Bare Bones" plans by visiting this site. Interested readers may also want to read an interview conducted by Golden Rule about agents who promote the HSA concept.
The clamor for lower cost health insurance is being heard in the hallowed halls of carriers all over the country. United Healthcare (through its' subsidiary Golden Rule) is one who is responding.
Saver options within each type of Golden Rule plan feature the lowest premiums. The “Savers” provide customers with protection from the more costly medical expenses that can break a family’s budget, like hospital stays, outpatient surgeries or CAT scans. Premium costs are lowered by limiting the amount of coverage for more routine expenses, such as doctor visits.
(The Saver plans have been around for a while but folks in S.D. are just now able to purchase them).
I suppose Saver plans have their place, but there are trade offs.
Saver plans limit the amount of coverage offered to a policyholder. Copay Saver plans allow 2 doctor visits per year.
That is fine as long as you are not sick.
If you need more than 2 visits the additional visits are not repriced, nor do they accrue toward the major med deductible.
Saver plans do not cover brand name meds. You can get a discount, but not as great as you would have under a plan that includes Rx cover.
Again, no big deal until you get sick.
Since the meds are not a covered expense, they do not accrue toward the deductible and your Saver plan will NEVER reimburse the cost of meds even if you breach your major med deductible.
Sick people know exactly how much meds can cost. Just ask them. Spending $400 per month on one med is not uncommon. Some can run as much as $8,000 per month.
Just how much can you save?
A family of 4 in Atlanta would expect to pay $542 for a Copay Select plan with a $2500 deductible and full coverage for doc visits, Rx and lab work.
A Copay Saver plan that only covers 2 doc visits and no coverage for brand name Rx is $371.
Saving $171 per month can be attractive. As I tell my clients, the Saver plan is a great plan as long as you don't get sick.
On a major claim, the Copay Select limits your out of pocket under the major med portion to $4500 (the $2500 deductible plus coinsurance up to a max of $2000).
There is no limit on out of pocket for the Saver plan since brand name meds are not covered.
A better choice would be an HSA plan from Golden Rule with a $3850 FAMILY deductible for $434. Or opt for a higher family deductible of $5800 for $351.
If you are buying insurance to protect your assets, the Saver plan is not a wise decision.
Thursday, March 13, 2008
In a few months an estimated 26,000,000 families will lose coverage. This could effect well over 60,000,000 Americans.
A new government mandate will affect households all over the country. Old, young, rich, poor . . . this law is merciless and indiscriminate.
But a taxpayer bailout is on the way. Without this assistance, many will be denied access to even the most basic services.
Yes, I am talking about the law that goes into effect on February 17, 2009 when TV sets that receive their signal over the air will go black.
Without a converter box, households of the poor and wealthy alike will be unable to view local programming. Of course those who are privileged enough to receive their signal on a new, digital TV as well as those who have cable or satellite service will not be affected.
Once again the wealthy have privileges that separate them from the rest of us.
Watching TV should be free. It should be a right of every American.
If you are going to lose your service next year you can ask the government to give you a coupon to help you purchase a converter box.
Personally, we think Americans should ask congress to repeal this discriminatory practice. Otherwise, those who live on the borders to neighboring Canada or Mexico may be forced to receive their services from other countries where TV services are free.
We should have the same privileges as residents of other countries where TV is free. Despite spending $1.5 billion in taxpayer dollars, we believe this program will fall short. Citizens will find that the coupon falls short of covering the full cost of a converter box. Unless congress authorizes more coupons there will be countless numbers of Americans who miss out on this lottery.
Wednesday, March 12, 2008
Need health care reimbursement? How about meds?
Learn the rules of the game.
Be prepared to deal with things like medical necessity or cost effective alternative.
This is especially so with medication.
For some illnesses, there are only a few meds that work. If you have one of those illnesses, be prepared to do battle to get your claim paid.
Eric Stoner has cystic fibrosis (CF). His maintenance meds run $60,000 per year by his own account.
Last November, I spent weeks politely jostling my inept doctor's office and insurance provider to get one of my prescriptions filled. Nobody seemed to take me seriously or put any priority on my case, even as I stressed that I was quickly running out of my medicine.
I ran into this earlier, except on a much smaller scale.
When I tried to refill a prescription for one of my wifes meds in January I discovered that the doc needed to reaffirm the prescription. Fortunately, she still had a few days supply left.
Still, we had to contact the docs office, give him a phone number and secret code so he could reaffirm the prescription he had written 6 months earlier and was already approved by our carrier.
But this was a new year and a new PBM (pharmacy benefit manager). Even though there are no alternatives to this med, there are less expensive meds (which do not work for my wife) that can be tried. Her dry eye condition has no cure, is not life threatening. It is more of an inconvenience than anything.
OTC meds don't work for her.
The process we went through to renew her medication was annoying but necessary.
I spoke with a friend who is a lawyer. He was eager to take action. "I'm always ready for a good fight," he reassured. "We can send them a nastygram," he explained, which would put pressure on the company to resolve this before it gets ugly.
A nastygram. Gotta love it.
Some folks seem to think they can buck the system by being a bully. Rather than frustrating everyone by trying to rewrite the rules, learn the rules and play be the game.
Of course in this case, you know what is coming next.
Health care should not be subject to the whims of profit-hungry corporations. It must be recognized as a universal human right.
Wonder if Mr. Stoner, who works as a writer, gets to make his own rules in his work? Does he have deadlines, or assignments, or does he just do things his way and send a nastygram when he doesn't agree?
Perhaps jobs should be a basic human right.
Tuesday, March 11, 2008
In teens . . .
A 12-year-old boy weighing 300 was hospitalized for a heart attack. His weight exacerbated irregular breathing and underlying heart disease, said Dr. Scott Lazar, who treated the boy at Memorial Regional Hospital in Hollywood.
A 14-year-old girl weighing 290 struggles to walk and has signs of impending diabetes and heart disease. Her West Palm Beach cardiologist, Patricia Scherron, said: "I told her, 'When you look around and see people with their limbs amputated, that's going to be you some day.' We need to get through to her."
A 13-year-old boy weighing 350 has been on blood pressure medicine since age 9, Scherron said.
This blows me away.
One-quarter of obese children ages 5 to 10 have early signs of heart disease, and one-tenth of teens have fat deposits in their arteries that can lead to heart attacks
And this . . .
The American Academy of Pediatrics urges physicians to start screening children for weight, cholesterol, blood pressure and diet at age 2, but many don't
Where are the parents of these kids?
"Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms [almost 40 pounds!]. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada."
So she did what an increasing number of ailing Canucks are doing, and headed for the border: Pontiac, Michigan. There, she had the foot-long tumor removed by a skilled American surgeon, and just in the nick of time: a few more weeks, and she faced the failure of multiple organs. Yikes!
But it gets worse: because she didn't cross all the t's and dot all the i's, the Ontario Health Insurance Plan refuses to cough up the $60 grand to cover the potentially life-saving procedure. The result is that her life savings are now depleted, and she faces huge medical bills and further treatment.
But hey, it's free!
Much has been made of rationed health care in countries where taxpayer funded, single payer plans are the norm. Those who support single payer dismiss the idea of rationed health care as a myth.
Seems you don't have to travel too far to find an example of what happens when health care is free.
Dave Boggs (age 25) has a digestive problem and needs corrective surgery. But he doesn't have health insurance and he doesn't have the money to pay for the surgery.
To ease the pain of his condition, he has been on a liquid diet for the last 2 months.
He is waiting his turn for free care.
Because there are so many people like him waiting for free care, Boggs said, he's been told it will be months before his turn comes.
"They told me it could be a year," said Boggs, who is part of the Lexington Rescue Mission's Life Renewal program for recovering substance abusers.
As in Kentucky.
Although there are several clinics available that provide free or reduced-cost care to those in need, it isn't always easy to get in to see a doctor, and continuity of care can be a problem.
And where are those who say nationalized health care is the solution to all that ails us?
"There's a big gap for people that have no insurance to have primary care,"
This still baffles me.
Primary care is the least expensive to deliver, yet we have an entire generation of people who think it should be free or at the least, a nominal copay.
Medicaid exists for those who are truly needy. But we have middle and upper class Americans who share this same mindset. They complain about having to wait to see a doctor.
Wonder how loud they will scream when health care is free?
Monday, March 10, 2008
I have been in this industry for a long time. Over 30 years. Insurance can be complicated, confusing.
I understand that and go to great lengths to paint with simple, word pictures.
Avoiding words like copay, deductible and coinsurance (except when necessary) I use analogy's to make a point.
One example is explaining what happens to premium dollars you pay to the carrier. Let's face it. Most folks don't have big claims, and certainly not on a regular basis. It doesn't matter if you have a $1000 deductible or a $3000 deductible. Chances are, you will not hit the deductible during the year.
Recently I talked with a couple who has a newborn. They pay $800 per month for a plan with a $1500 deductible and a bunch of doctor visit copays. Their premium is increasing in May by another $150.
After gathering a lot of data on their current plan, how often they use it, expected future needs, etc. I proposed a plan that would provide everything they need, nothing they don't need and still saved them over $300 per month vs. the current premium. (And $450 vs. the renewal premium).
They stalled. One of their children was having ear problems and was going to require tubes in the ears. We agreed to postpone the change until the surgery was complete.
Last week I followed up to see if the surgery was complete and they were ready to move forward.
Again they balked.
After talking it over, they decided to keep the plan they have because they have already met the $1500 deductible.
The new plan has a $3500 deductible.
The projected premium savings (factoring in the rate increase for the existing plan) is over $3000.
They have phantom insurance.
The extra $3600 they will pay over the balance of the year is (most likely) money they will never see again. When you overpay for coverage, you do not get a refund. The carrier does not send flowers or even a thank you card.
They keep your money and send you a renewal rate increase.
Insurance premiums are not a savings account. You do not get extra credit when you pay for coverage you don't need. The carrier wins, and you lose.
Some folks just don't get it.