Thursday, August 27, 2009

The Universal Health Care Debate

There are a lot of folks who disagree with the current proposal for health care reform. Many think we don't need reform at all. Others simply dislike the terms of the current proposal - or perhaps they dislike the terms that the extreme right-wing media has convinced them are in the proposal, even though they are not (there is no “death panel” for example). I am not here to argue the details of the plan. Those can and will be tinkered with over the years and certainly there is room for debate about how we should provide health care for our citizens. But in my view, we should not be debating whether to provide some form of basic health care for all of our citizens. We should just find a way to do it.

Here are some things to think about before you pooh-pooh the idea of universal access to basic health care:

Do you know how much it costs to buy private insurance? Or does your employer provide it for you? If your employer provides it for you, you may pay a portion of the premium, anywhere from $1 to $500 per month, say (and you likely complain every time your contribution to the plan is raised). According to the National Coalition on Health Care, the average employer-sponsored plan premium for a family of 4 costs $13,000 per year. And employers generally get a discounted group rate!

So if you are complaining about paying $400 per month for your health care plan this year instead of the $300 per month you paid last year, just stop it. Instead, thank your employer for paying the lion's share of the premium for you, and be thankful you don't have to pay the entire $13,000 per year yourself. Also thank your employer for providing your insurance. Many employers do not, particularly for part time and lower-paid employees.

Now imagine yourself in the position of someone whose employer does not provide insurance. Suppose you are working a job that pays minimum wage. Or even $12 per hour. That would be $24,000 per year if you work full time. This amount likely is high enough that you are not eligible for any federal or state income-based health coverage. If you need to provide health insurance for your entire family, and assuming you could get a policy with the same coverage at the same rate your employer pays (on average, $13,000 per year), that would be more than half your income for the year - and likely about two-thirds of your take-home pay!! Could you afford to pay 2/3 of your take home pay for insurance? I thought not.

Suppose you are one of the few very lucky minimum wage (or thereabouts) or part-time laborers whose employer does provide some sort of health insurance plan.

What if you wanted to change jobs? What if you got laid off? Imagine that you have applied for several different positions but the new job offers you are able to obtain do not come with health insurance, either because the company is small and thus exempt from the requirement to provide it, or because the position is part-time, so the company is exempt from the requirement to provide it. Thus, to take the new job, you will have to absorb the cost of insurance yourself. Will the new job give you a raise of more than $10,000? Those of you earning upwards of $100,000 or more per year will find a raise of $10k (approximately 10% of your current salary) to be within the realm of possibility. But if you are earning $10 per hour ($20,000 per year), the chances of finding a new job that comes with a 50% pay raise are between slim and none. And the reality is that most lower paying and/or part-time jobs do not come with health care. So if you are merely unhappy with your new job, it's hard to financially justify changing jobs, and if you’ve been laid off, you will probably have to take one of the new jobs and simply go without insurance.

OK, you say to yourself, but if you are buying your own insurance, you don't need the fancy plan your employer provides. You would be willing to settle for true insurance against disaster instead of the fancy, full-coverage-for-every-mosquito-bite HMO (health maintenance organization) or PPO plan your employer provides. You might see ads from Blue Cross for policies for $50 per month that will cover catastrophic health problems and you might think, "Great! I can afford that!" But that would be for an individual, with no pre-existing health issues. The family premium would be substantially higher - often $400 to $1000 per month. That’s a large chunk of change for a person earning minimum wage or thereabouts.

Now suppose you or a family member have a pre-existing health condition. Perhaps you had cancer, or your spouse has diabetes, or your child suffers from food allergies, asthma, or a skin condition. Any private policy you obtain likely will charge a substantially higher premium than it would for "healthy" policy holders, and will preclude coverage for the pre-existing condition for at least a year. If you were previously covered under your employer's health plan and are seeking a new policy due to a job loss or change to a new job, the federal Health Insurance Portability Protection Act likely will apply, and will prevent the new insurer from excluding coverage for the pre-existing condition. But it won't stop the new insurer from charging huge premiums for coverage. You will be quoted a premium price that is far more than the $13,000 per year your employer was paying for your coverage.

Even assuming you can find coverage for your healthy family at a rate you can afford while working at your minimum wage job, private insurers often raise premiums yearly, even for their healthy policy holders. What happens is that insurers bundle policy holders into “groups.” Then, as the members of the particular group of policy holders start using the coverage, it costs the companies more to run the program. Companies are not allowed to drop policy holders (unless they fail to pay the premium), but nothing stops them from raising the premium costs substantially. So they raise their rates. Then the healthy policy holders seek out and find a new insurer that will charge them less. The less healthy ones cannot find a less expensive policy, so they stick with the initial policy. But now there are fewer remaining policy dollars to cover the remaining health problems among the remaining, somewhat-less-healthy policy holders. So the insurer raises the rates again. And more of the relatively healthy members seek and find other coverage, dropping the current policy. And then the insurer raises the rates again...

.... which means that if you get a private policy that costs you $200 per month for your family this year, and then you or any member of your family develops any sort of health problem, in 10 years you will likely be paying substantially higher premiums (perhaps $1000 per month or more), and may be unable to find new insurance at any price due to the pre-existing health issue.

Now suppose you don't have health insurance, and you are working at your minimum-wage job, which is the only employment you can find in this economy despite your college degree. And suppose your child develops a sore throat, cough, and a fever. You know you cannot afford a “quick trip to the doctor” to make sure it isn’t strep throat. So you give her an over-the-counter medicine and hope she gets well soon. Probably she does. But suppose that cough just won't quit. Do you pay the $200 or more to take your child to the doctor? If so, how will you pay the rent (or the mortgage, if you were able to obtain one) this month on your $1000 per month take-home pay?

Suppose you take your child to the doctor anyway, figuring you will find the money somehow or beg the landlord for leniency, and that cough turns out to be asthma or bronchitis or something worse, like lung cancer. How will you afford the bills to treat these expensive conditions? If you cannot afford the $500 to $1000 per month for private insurance, I can pretty much guarantee you cannot afford the medical bills to treat cancer or diabetes or even somewhat less deadly but still debilitating conditions like asthma.

And now how will you ever obtain affordable insurance for your child? You won’t. She now has a "pre-existing condition"!!

* * *

The current system provides fantastic health care for the wealthy and those covered under their employer's group insurance plans, and no care at all for the vast majority of the working poor (those on welfare generally are covered by state medical plans). It strikes me as hugely unfair that the wealthy, who can afford fantastic health insurance at a discounted rate through their high-paying jobs, will often have expensive elective procedures covered by their insurance, such as fertility treatments, vasectomies, and reconstructive surgery after an accident, while the less wealthy, whose employers do not provide insurance and whose salaries are so low they cannot afford expensive private insurance, cannot even obtain necessary medical treatments for non-emergency, yet serious, conditions such as cancer, bronchitis, asthma, or even the flu.

I agree we should not take away the option of purchasing private insurance that covers a huge range of elective and necessary medical procedures, for those who can afford it and wish to pay for it. I also think we should keep in place the option to pay privately any doctor who is willing to treat you for whatever medical treatment you and your doctor deem necessary. In a country that allows and even values income disparity because it is an incentive to work harder, better, more intelligently so as to raise your income, there will always be some disparity in the quality and amount of health care available to folks with more, or less, income. Some folks will be able to afford vasectomies (and vasectomy reversals, too!) and try every experimental and cutting-edge cancer treatment known to mankind, along with the more traditional treatments. Others will have to settle for using condoms and being provided with only the tried and true, proven-to-work, more widely available, and thus less expensive cancer treatments.

But I ask you this: Shouldn’t access to basic and decent health care - the proven-effective cancer treatments, for example - be a right for every citizen in this wealthy country of ours, rather than a privilege for only the lucky (or wealthy)? Just as it is critical to our national security and national well-being to provide a free basic education for our citizens so that they can become productive members of society, isn’t it just as critical to ensure that our citizens are reasonably healthy so they can be good students and become productive members of our society?

There is room for debate about what things should be covered and how the coverage should be provided. Reasonable (perhaps income-based, on a sliding scale?) co-payments should be charged for services to discourage truly unnecessary doctor visits and to help defray costs.

But is it really fair to tell a sick child, “sorry honey, I can’t take you to the doctor because I chose to buy food and shelter instead of medical insurance this month”?

Is it fair that a working class man cannot afford treatment for his prostate cancer because his employer does not provide health insurance, while a wealthy stockbroker can have a vasectomy paid for by his employer-sponsored health plan?

(Note: I’m not saying the vasectomy shouldn’t be covered if the private insurer wants to cover it. I’m sure the vasectomy is less expensive for the insurer than paying for any pregnancy and childbirth that might result if the man didn’t have the vasectomy. I’m just saying that the cancer treatments should be covered somehow, too!).

We need to find a way to make decent health care available to every citizen in this country. It’s just the right thing to do.


Green said...

Thanks for writing out all these scenarios. As someone who doesn't understand exactly what's being proposed and is overwhelmed and doesn't know which articles are fair assessments, I really appreciate when people I "know" and already believe to be smart write things like this.

I think a big part of the problem is that a lot of people think this way: "Sorry that McDonalds worker doesn't have health insurance but if he wanted it, he should have worked harder in school to go to college like I did. College wasn't easy for me either, but I forced myself through and did it. He should have done that too. He chose an easy job slinging fries and now he has to live with the consequences."

It's mind-blowing how removed from it that some people are.

SkylersDad said...

I have a slightly different problem, a son who has a disability. I hit my max on my policy of 1 million dollars long ago, but I was very lucky to go to work for a company that provided high quality health care that didn't care about the previous condition. So Skyler has coverage, but still it doesn't cover a lot of things for him. But at least he can go to the doctor.

I know several families who are not as lucky as me, and their children with disabilities are completely uninsurable.

Peggy said...

Loved your views. To me, it comes down to everybody in this country should have access to good healthcare. But I think we need to fix what's broken but keep Gov out of the equation. We should open up competition and develope a plan for people that don't have company healthcare. I don't know what that plan would be, but I do know that neither side does either.
OH...and please could we have someone that can explain every aspect of the plan with all of us.
Finally... please send back our congressmen to DC and make them read any plan, cover to cover. Not too much to ask!

Nan said...

Nicely said.

Peggy, we can't keep government out of the equation because they're already in on both the state and federal level. All health insurance is subject to regulation now. It's more a question of how much more (or little) involvement would be most effective and/or efficient in the long run than it is of keeping government out completely.

Raine said...

Great post!! So well said and understandable. I am going to send some people over here who are having a hard time understanding the propositions.

And I agree COMPLETELY! :D

Quilter422 said...

Do we need national health care? Yes.

Do I think that Obama's plan is optimal? No. But then, neither would a different Democrat's or a Republican's plan be optimal.

There are no good answers. Any plan put in place is going to have multiple problems, bureaucracy being the least of them. Any plan put in place is going to be subject to eternal revision and "fact finding" inquiries by Congress, complaints by citizens not covered by the plan, and complaints by citizens covered by the plan.

But you gotta start somewhere...

Raine said...

I left you an award!

Candy's daily Dandy said...

Amen, Legal!