Healthcare Reform: It's Your Problem Too

I promised my next post would be a history of cost containment efforts, but in response to what I'm hearing on the news and reading in my e-mails (I've been having trouble with comments here and my blog was blocked for a while, but I hope it is all fixed now), there are an awful lot of people out there who think healthcare reform is for "the other guy/gal" and that there's nothing in it for them but higher taxes. I noted in my blog description that reform is really about "good old American 'what's in it for me' thinking for both the uninsured and the currently insured who could find themselves uninsured at any moment."

I hate resorting to the same hyperbole that has recently framed this discussion, but get real people. Opponents of healthcare reform are using scare tactics to warn off the people––you the middle class––who will benefit most from reform. This isn't about the poor, they get Medicaid, and the wealthy have their gold-plated plans. It's about you and me, from the lower to the upper end of the middle class who are suffering, and if reform doesn't pass, the only winners will be the insurance companies, the politicians they keep in their pockets, and the high income people who have fine healthcare and now won't have to pay an additional penny in taxes so you can have yours. And if you think it's bad now, wait until these companies see no more obstacles in their way.

Or maybe you don't think it's bad. Maybe you are buying into the myth that we have the greatest healthcare system in the world. Well, I hope you are sitting down.

According to a report by Families USA 86.7 million people or 33% of the population under 65 went without health insurance for some or all of the the two year period of 2007-2008.
You've heard a lot about the 48 million uninsured, but they are the "chronically" uninsured. This higher figure includes those individuals who probably didn't think they had anything to worry about. People with employer-paid healthcare plans who lost their jobs. Divorced spouses who now have to pay full cost if they want to continue on the ex-spouse's plan or for whom the COBRA extensions have run out. Employees of small businesses where a spike in premiums left them no choice but to drop their coverage. Employees of large or small businesses that began requiring them to pick up part or all of their heathcare premiums, who, unable to afford it, had to drop their coverage all together.

25% of all uninsured under 65 during that two-year period remained uninsured for 24 months
Twenty-four months is a long time to keep your fingers crossed and hope you won't get sick, especially when dealing with the added stresses of looking for a job, trying to put food on the table, meet your rent or mortgage payments, probably doing more of your own home repairs––climbing ladders, doing electrical work. The mean cost of a hospital stay in the state of Nebraska (home of Mike Snider) is $21,865. That's just the hospital stay. It doesn't include things like rehab, special equipment––wheelchairs, crutches––medications following a hospitalization or for any ailment you might have already had like high blood pressure or even chronic sinus infections. Statistics vary, but from what I can find, the average cost of a visit to a doctor's office runs anywhere from $60 to a few hundred dollars. According to Blue Cross Blue Shield, the average cost of an ER visit (which is where most of the uninsured must go, because doctors don't take people who can't pay––though ERs don't always take them either), is $383.


The percentage of uninsured was highest among 19 to 24-year-olds and 25 to 44-year-olds
Let's say it looks like you're going to make it to Medicare age without going uninsured. Do you have kids? The standard health insurance plan covers children up to age 18 or up to age 23, if they are full-time students. So if you have a kid ready to graduate, chances are they will go uninsured for a good part of their lives. Sure, kids often don't see the long-term value in something like health coverage and turn it down even if they can afford it, but it is often too expensive to afford on the low salaries many young people receive (it costs $165 per month for my daughter), and fewer and fewer employers of young adults provide coverage. Many young people work in jobs that employ them just under the number of hours to be considered full-time. It pays businesses from restaurants to universities (many are now hiring large numbers of adjunct professors) to hire more part-time workers than fewer full-time workers who would be eligible for benefits. It's every parent's fear that a child will have an accident or suffer a major illness, but in this case the fear is two-fold. Most parents would want to help an uninsured child with healthcare expenses, and it could wipe them out.

These statistics showing how easy it is for the average person to end up uninsured at some point in their lives go on and on. You can read them yourselves. What many people don't realize, because it has become such a way of life in this country, is how we are held hostage every day by our current system.

Do you think you'd be more appreciated at Company Y than your current Company X? You'd better not have a pre-existing condition. Employer group plans have to accept everyone, but depending on state regulations, the new insurance plan can exclude coverage for pre-existing conditions for anywhere from three to twelve months. That means, if you have high blood pressure, they would exclude your meds, your doctor visits, and probably your heart attack if it could be shown as connected (which of course it could).

Do you want to indulge that entrepreneurial spirit American politicians so often praise? Be prepared to go uninsured if you have a pre-existing condition or pay higher premiums because of it. A few years ago, when my husband and I were looking for less expensive alternatives to our $1200/month plan, we expected a rate increase for his high blood pressure. We didn't think our daughter's mild dermatitis for which she used an antibiotic cream three years before would add to it as well.

Think your current premiums for individual coverage are too high and you want to look around?
If you've been in your current plan for several years, you'd better stick with it. When you see those people testifying before Congress about losing coverage the day before cancer surgery, you may think the company has a right to flag "fraudulent applications." If you haven't completed an application for individual insurance recently, you may not know that they ask you to list the exact date you sought treatment any time during the past 10 years. That includes colds, flu, sinus infections, prescriptions for seasonal allergies. No one keeps that information. So you fudge it or skip it. The interesting part is, the company doesn't investigate your application immediately. You could go on for years paying monthly premiums and being reimbursed for the usual minor costs. Then, bam, just when you need it most, they terminate your coverage because you didn't mention the time you visited your doctor for poison ivy in 1999.

Are you a divorcee who has met the new love of your life? He'd better have good coverage.
If you are covered under the COBRA provisions of your ex-spouse's plan, they end if you re-marry. If the new spouse doesn't have a plan, or you don't think you'd qualify, you'd better stay single. Often divorced spouses with serious health problems will take health coverage as their settlement. Because of the expense, they rarely get anything else, and, again, forget re-marrying.

We cannot go on calling ourselves the greatest country in the world when we are slaves to our healthcare carriers and when one illness could wipe out a lifetime of savings for hard working people.

Don't fall for their lies this time. It is too important and the opportunity won't come along again.