Step Into Karoli’s HCR Complaint Department

Mar 23, 2010 by

Update: The following complaints actually come from Investors’ Business Daily, the same organization that lied to everyone back in July before the disastrous town hall meetings.

While I expect wailing and gnashing of teeth from the right wingers, I do get frustrated with it from the left side of the fence, mostly because that’s the side I sit on. I got a list of complaints tonight that reads like a list of right wing talking points, so I decided to open the complaint department for questions, answers and debunks. There were so many in one post it would take a small book to address them all, so I’ll start with the ones that seem to be causing migraines in fellow liberals.

The Mandate

You are young and don’t want health insurance? You are starting up a small business and need to minimize expenses, and one way to do that is to forego health insurance? Tough. You have to pay $750 annually for the “privilege.” (Section 1501)

Here is a fact: The only way you have universal coverage is to require everyone to have coverage. The only reason this bill isn’t universal? Republicans said undocumented workers did not have the right to purchase insurance with their own money through the exchange, and you get to opt out if you choose to pay a penalty instead.

Sorry, young ‘un, but there is no such thing as health insurance, per se. There are “risk pools”. Risk pools represent a group of people – healthy and unhealthy – who all throw money in the kitty and then take it out when they need it. Insurance companies turn a healthy profit by cherry-picking individual pools for the healthiest in the bunch and booting the rest out. That’s how you end up with stories about people getting sick and being tossed off their policies (like I was) or simply being denied altogether.

This bill, above all else, says people in this country are equal, and deserve to have equal access to affordable health insurance. To that end, the bill has been set up so the guy just setting up his business gets a 50% tax credit in 2014 to offset the cost of buying health insurance. That’s not so bad, for a number of reasons, not the least of which is this: It makes that guy’s small business competitive with the bigger business down the street that offers health insurance benefits.

What exactly was it you expected from health insurance reform? Single payer? Here’s a news flash: Single payer carries a mandate, too, and it would be substantially more than $750 per year to pay for it. For all the positives, a Medicare buy-in for older people was estimated to be around $600/month, as opposed to the $1200 or so a year that a low-income person will likely pay for family insurance.

So you say, the mandate sucks. I say, then don’t opt out. Get something for your money. Hell, the government is covering part of the cost, and there are some serious cost controls built in. The opt-out is silly. You’re betting against inevitability.

Ok, on to the next.

How risk pooling works

You are young and healthy and want to pay for insurance that reflects that status? Tough. You’ll have to pay for premiums that cover not only you, but also the guy who smokes three packs a day, drink a gallon of whiskey and eats chicken fat off the floor. That’s because insurance companies will no longer be able to underwrite on the basis of a person’s health status. (Section 2701).

Boo hoo. Haven’t you been paying attention over the past year? Insurance companies would *love* to underwrite on the basis of a person’s health status. Imagine a slightly different scenario that looks like this:

You are young and healthy and want to pay for insurance that reflects that status. You pay next to nothing for your insurance. One day you come down with what seems like the flu, but it doesn’t go away. You spend the next 2 months trying to find out what is causing your weight loss, fatigue, and stomach pain. Finally, you get a diagnosis: Ulcerative colitis and emergent type I diabetes. You are 20 years old.

That’s a real scenario, my friends. That’s what happened to my son. He didn’t drink a six-pack, eat particularly badly, was athletic and active when he was hit like a ton of bricks. This is the reality: you don’t know when you might get sick, and illness is not always related to lifestyle. That beer-drinking smoker might live to be 95. The odds are not in his favor, but he might. Conversely, you, the young and the healthy, could find yourself needing a whole lot of that pooled kitty long before your time. God forbid, but it happens every day.

Memo to the young: You are no more immortal than anyone else.

What? Unlimited coverage?

You would like to pay less in premiums by buying insurance with lifetime or annual limits on coverage? Tough. Health insurers will no longer be able to offer such policies, even if that is what customers prefer. (Section 2711).

Yes. This is true. Are you willing to put a maximum price on your life? What should it be? 10 million? 1 million? 3.5 milion? Have you priced medical care lately? The whole point here is to actually NOT put a price on life, but to make sure all citizens in this country have the care they need when they need it. This is somehow a bad thing?

Aw, gee. You have to actually get value for what you pay for.

I call the next group the “I live for me and no one else” group. This is the attitude that wants to deny the reality of pooling risk by claiming blazing individualism. Sorry. Repeat after me: Health insurance is really pooled risk. Repeat it again. Then remind yourself that prevention saves money by — remember this one now — reducing overall risk.

Think you’d like a policy that is cheaper because it doesn’t cover preventive care or requires cost-sharing for such care? Tough. Health insurers will no longer be able to offer policies that do not cover preventive services or offer them with cost-sharing, even if that’s what the customer wants. (Section 2712).

News flash: Preventative care saves lives and money. It makes the risk pool carry less risk. It’s the right thing to do. It SAVES money. SAVES. Why would you want to make the costs higher?

You are an employer and you would like to offer coverage that doesn’t allow your employers’ slacker children to stay on the policy until age 26? Tough. (Section 2714).

Wow. Got kids? Mine work for a living, only I have one who is uninsurable. Those slacker kids make things cheaper for everyone as a rule. Some don’t, like one of mine. My other one does, though. The more youngers you keep in the pool, the cheaper it is for EVERYONE. Everyone. Insurance 101, friends.

Do you want a plan with lots of cost-sharing and low premiums? Well, the best you can do is a “Bronze plan,” which has benefits that provide benefits that are actuarially equivalent to 60% of the full actuarial value of the benefits provided under the plan. Anything lower than that, tough. (Section 1302 (d)(1)(A)).

That’s right, because it’s been proven over and over again that anything lower than that is worthless underfunded insurance causing people to declare bankruptcy and lose their homes when they can’t make up the difference. This fixes one of the biggest problems we have today: underinsurance.

Enough with the whining about buying stuff you don’t know you’ll need

You must buy a policy that covers ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care.

Um, yeah. Because you just never know when you might want to get married, have kids, and need a psychiatrist, not necessarily in that order. Are you starting to really understand insurance 101 here? You pay ahead of when you need. Easy as that. No one — not even young, invincible young people — know when fate, love, or catastrophe will strike. No one. And not one of us is immortal.

You’re a single guy without children? Tough, your policy must cover pediatric services. You’re a woman who can’t have children? Tough, your policy must cover maternity services. You’re a teetotaler? Tough, your policy must cover substance abuse treatment. (Add your own violation of personal freedom here.) (Section 1302).

See my note above. Maybe you’re not married now but you might be tomorrow. Maybe you can’t have children but you have high blood pressure. Maybe you don’t drink or do drugs, but you have a problem with obesity. We are all in this life together. We all carry risk. All.

That’s it for this edition of the Complaint Department. I’ll be back with more, I’m sure. Honestly, I’m surprised to see these complaints coming from people calling themselves liberals. It feels a little more like right wing talking points than issues liberals would have, and that’s because they ARE right-wing talking points that didn’t come from liberals. But hey…now you know a little more about insurance pools than you did yesterday, and tomorrow you’ll know even more.

Office hours are 9-5. Post your complaints and questions here, and I’ll do my best to debunk, answer or refer you to someone who can answer them.

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Building a New US Healthcare System: A Look at Best Practices in Western Europe

Aug 1, 2008 by

HealthcareLast month, the Democratic party encouraged ordinary people all across America to hold Platform Meetings in their own communities for input into the document that states what the Democrats stand for in this election. The outcome of these meetings will be reviewed by party’s Drafting Committee as it creates the final Platform.

At the recent BlogHer conference in San Francisco, the MOMocrats held a Platform meeting of our own, at the brunch we co-hosted with the Silicon Valley Moms Bloggers. Ours was a different kind of event, as it included about 40 mothers from all over the country – and not all of us in attendance were Democrats. We had input from a fair number of Republican and Independent women, too.

It’s probably not surprising that the one issue the entire room of mothers agreed upon was the need to improve our nation’s health care system. We may not all see it evolving in the same manner – but we are all dismayed at the rising cost of keeping our own families healthy and the number of families and individuals who do not have access to affordable medical care in our country.

The discussion was led by founding MOMocrat Glennia Campbell, who urged us to think outside the box and to look at what’s been successful elsewhere. By opening our eyes and seeing what’s working in other countries, we might adapt some of the best practices to the unique culture and needs of the United States.

That’s why I’ve been so fascinated by Health Care for All: NPR’s series of in-depth reports on the state of health care in western Europe. If you think (as I did) that it’s all about socialized medicine and higher taxes, you would be wrong (as I was).

Take Germany.

According to NPR, the Germans have enjoyed universal health benefits for over 100 years. Their system sounds actually sounds a lot like ours, as it health coverage is provided by insurance companies, with employers and employees splitting the cost of the premiums. But there is one big difference with the German system: It works.

One reason is that few people opt out of the system. Workers and employers both pay a percentage of their salary. The cost is higher for higher paid workers, but lower for those on the bottom of the economic scale.

For the average worker, this comes to about 8% of salary – which is comparable to what is paid by US workers with employer-provided insurance. However, German employers also pay just 8% of their workers’ salaries into healthcare, while American companies pay an average of 18% per worker.

Germans have a choice of over 200 different nonprofit healthcare companies to choose from. And they receive a very high level of benefits. They have no deductibles. There’s little or no wait for procedures such as MRI’s.

Self-employed citizens must buy private insurance. Most do, and the level of coverage can be even higher.

Costs are kept down through government regulation. Physicians are put on collective annual budgets which amount to a limited pool of money per quarter per region. “Once doctors collectively use up that money, that’s it — there’s no more until the next quarter.”

Administrative costs are also kept low – just 50% of what is paid in the US.

France is a country known for its gastronomic pleasures and haute couture. But in 2000, a World Health Organization survey named its health care system number one. (The United States ranked at #37). It came out on top a few years later in a second survey of 19 industrialized nations. The US was mired right at the bottom.

So what’s so great about the French approach to health care?

For one thing, it’s truly universal. No one in France goes without medical insurance – even non-citizen residents.

The system is made up of several quasi-public health insurance networks, paid for through income and payroll taxes.

Insurance companies and medical unions set doctors’ fees. Hospital charges are regulated by the government.

The national program pays 70% of individuals’ medical expenses. Most French citizens also carry private insurance for the remaining 30% of their health bills. These private policies are usually funded by employers.

Coverage is also needs-based: Residents who contract very serious diseases may find their treatment paid for 100% by the French government.

French coverage is not cheap: French workers pay 21% of their income into the system (however, half of that is subsidized by their employers).

Even though Americans pay far less in taxes, they end up paying more out of pocket for health care expenses. ($6400 per person, compared with $3,300 in France).

If you develop cancer in France, you are eligible to receive any treatment you and your doctor decide upon – even if it’s highly expensive or experimental.

The French take pregnancy and motherhood very seriously. New mothers receive months of paid leave and there are an abundance of free pre-natal and pediatric health clinics, at-home visits, and subsidized day care.

The French health care system is facing some of the same financial problems as other industrialized nations. Their debt last year was $9 billion. Services will likely be cut in the future as the nation figures out how to pay for rising medical costs and aging populations.

Health care costs are low in the Netherlands, partly because of Dutch cultural resistance to treating illnesses with pharmaceuticals. (I find this kind of ironic, given the reputation of cities like Amsterdam, but I suppose their attitude is different when it comes to recreational drugs.)

According to NPR, the Dutch consider it “preferable to endure aches and pains without resorting to medication.” The philosophy there is that most ailments will eventually just go away. This is one reason why Dutch citizens spend half as much on medication per person as Americans.

This extends to pregnancy. The majority of Dutch women have natural childbirths and it is difficult to get an epidural, even if you want one.

The Dutch system is organized like our HMO’s – except that everyone is a member. All Dutch citizens have access to primary health care, 24/7. They must get permission from their primary providers before seeing specialists.

There are still some citizens that do not have access to health care – but in the Netherlands, that figure is just 2% (as opposed to 16% in the US).

NPR reports that “Republican policymakers are abuzz over Swiss-style, universal health care; it comes closest to what they could imagine emerging in the United States.”

Switzerland’s system is a lot like the one in Massachusetts: The country mandates that everyone buy private health insurance, with the government providing a subsidy for those who cannot afford it.

And like our country, there is a confusing multitude of companies and plans to choose from.

The Swiss government restricts private insurers from making a profit on basic comprehensive plans. They do, however, earn profits from plans sold to supplement the basic coverage.

Unlike France and Germany, health insurance premiums are not calculated by income, so everyone pays the same amount. This makes health care costs a bigger burden on lower income families who do not qualify for government help.

The system has been working well, but like those of other countries, is plagued by rising costs – as much as 50% in the last decade. This is reflected both for individuals who are paying for their insurance, and for the government, which subsidizes insurance for the poor.

The final country in NPR’s survey of western European health care systems is the United Kingdom.

When Americans talk about countries with universal health care, the model they are most familiar with is that of Britain’s National Health Service, which insures all citizens and legal residents to a minimum level of coverage. The NHS is an arm of the government, funded entirely by taxes, and it is what has been described as “socialized medicine.” It runs the hospitals and pays the doctors, and treatments must be approved by an NHS council.

Average annual per-person spending: $4,504 (about $2,000 less per person than in the United States). About 75% of this is paid by the government, with an additional 25% coming from  supplemental private insurance, OTC drugs, and direct payments to doctors.
Financing: 95% of funding comes from taxes; 5% comes from user charges, such as co-payments for prescription drugs.

According to NPR, on the the biggest challenges facing the NHS is the fact that the “government doesn’t cover care that it deems cost-ineffective,” and “maintaining a steady source of government funding in the face of increasingly expensive treatments and drugs.”

The following information is personal and purely anecdotal, as I actually do have some experience with the NHS. Both my husband and daughter are dual US/UK citizens, and we visit the family in Wales as often as we can. We’ve interacted with the NHS a few times when our daughter (who was prone to ear infections when she was little) developed a fever while there.

I was afraid the first time this happened – what kind of care would she receive? I should not have worried. We took her to the neighborhood “surgery” (the offices of the general practitioners that serve the area, which was in walking distance of my in-laws’ house) – without an appointment. The wait time to see a doctor was shorter than what I experience at our own pediatrician’s office.

I dug out our passports, my insurance information, my credit cards — for nothing. They never asked us for it, never cared that my daughter and I were obviously not from around there (and when other Brits hear my husband speak after 25 years in the US, they don’t think he’s a native, either) and laughed when I tried to pay them.

Over the years, I’ve observed the kind of care my husband’s elderly parents received under NHS. On my first visit to meet them, BOTH his father and mother ended up going to the hospital (for different reasons). The socialized system of treatment is definitely different from what we are used to in this country. In some ways, it’s better. In other ways, it’s not.

I remember one time when my father-in-law was diagnosed with an anuerism and he had to wait quite a long time for his surgery because there were no beds available at the hospital. But he did eventually get his operation and it was successful.

My father-in-law suffered the first of many strokes a few years later. After the first one, he remained in the hospital for weeks, in a drug-induced coma. My friends and family here in the US were shocked at how long he remained in the hospital; such a stay would have bankrupted most of us, even with the best insurance plan. I remember thinking it was no wonder there was such a problem obtaining a hospital bed… but he emerged from that event with nary a symptom. The care he received no doubt gave him several productive years (he passed away in 2005).

But then there was the time my mother-in-law needed an adjustment in the medication she takes for a chronic condition and the family could not get an appointment with her doctor until her situation became life-threatening. That was frightening and is the kind of scenario that makes Americans wary of a British-style government run health care system.

Yet, according to NPR, “the British say they would riot in the streets if they were asked to adopt an American-style system.”

I urge those who want to learn more about these health care systems to see for themselves here on the NPR website, where you can link to both transcripts and the actual radio reports. They have also summarized a comparison of the systems on a chart here.

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