2009-08-16

Healthcare Reform-Let's get real






Let's talk about healthcare and the single payer option. Apparently if we get this option, we will become some New World Order and Obama will become Hitler. I know it sounds horrible. It sounds scary, but what kills me is these people seem to have no option to counter this idea, except rely on insurance companies.

Let me tell you my background in insurance. I have worked for the insurance and prescription drug companies. Companies you are all very familiar with if you have insurance through your employer. Even though these companies tell you they are in the "business of caring", they aren't. My experience as an underwriter tells me that when policies are made, the best interest of the people are not what is in mind when it comes to pricing and developing a group insurance health policy. I can tell you with my experience as a claims manager that the goal is not always to approve and quickly pay every claim. In short, INSURANCE COMPANIES ARE IN BUSINESS FOR MONEY, and sometimes they choose money over people. More often than you care to believe.

Ask me how many policies I created and priced as an underwriter that did not have a pre-existing condition clause? Ask me how many I saw claims denied because of this clause as a claims manager? Ask me how often a medical treatment that is considered mainstream and widely used can be considered experimental under regular insurance policies? When I worked as an analyst dealing with Medicare Part D, ask me how often I saw fraud?

The opponents of this healthcare reform confuse and baffle me, they are scared of socialism, but they partake and use "socialist" policies all the time. If you don't want socialism, never use Social Security or Medicaid. Never drive on roads, never put your children in public schools. If you are in the military, never use the medical care, the GI Bill, military housing, or any other benefits provided to you. Don't use FHA grants for down payments on homes or Pell grants for college. Don't go to a public or state college or university. These are all socialist things paid for by the American people.

If you think the government is full of bureaucracy, which it is, don't ever learn how an insurance company works. Bureaucracy happens in the corporate world too. Ask a person who has a claim to fill out a claim form and how easy it is. Ask an insurance professional what it takes to appeal a denied claim. One asset that is valuable in all areas of insurance is an attention to detail. I wonder how many times an employee has ever actually read their insurance policy and understood it. I wonder how many have read the WHOLE entire thing.

One thing I always think about when people are scared of the government is when Medicare Part D became privatized under the Bush administration as a way to stop fraud and overspending. Medicare Part D is still full of fraud, and it costs more now than ever. Sometimes private companies can't fix the public good. Sometimes the companies in question don't give a damn about public good and sometimes they can't do things better than the government. I know government is bad and horrible, but what makes you think big private companies have your best interest in mind?

Also let's look at health costs in America. It is expensive to get medical care, especially emergency care. I had a visit to the hospital for two nights in April. My bill for those two luxurious nights was $10,000. If I didn't have insurance, I would have been stuck with that bill. As much as I would have liked to shrugged off my medical situation, I couldn't wait until the next day to see my regular doctor. I didn't stay at the Ritz Carlton hospital either. You can go to county hospital, but I hate to break it to you, they will send you a bill, you might not pay for it, but they will send it to you and put a nice little note on your credit report. To have a regular vaginal delivery in a hospital starts at $10,000 and we are not counting pre-natal care or sonograms. Have a C-section we go higher. Don't have a heart attack, or worse yet cancer. Did you know most health insurance policies have lifetime limits, and usually these are pretty low, low enough not to cover the cost of an entire cycle of cancer treatments, which is why folks who have insurance still file bankruptcy for the medical costs they can't pay. I guess if you reach your limit you should just die. To me it sounds like we already have a death panel, it is just the insurance companies and not government doing it.

I know you don't want to government choosing your doctor, but I guess you are ok with your insurance company doing it. I'm going to tell you a secret. Your insurance company does not pay for just any visit to any doctor. You have in network costs and out of network costs. You get penalized for going out of network in most cases, don't get sick in a foreign country, or hell even in a different state, that could cost you 100%, even with insurance. Your insurance company chose your doctor, they just let you pretend to choose your doctor within an "approved" list of doctors. Not to mention I am still looking for that part in the proposed single payer option policy in which the government chooses your doctor for you.

What if you lose your job? You can rely on COBRA, but if you lose your job and pay out of pocket the cost of the insurance premiums (aka COBRA) on your own, you are better than most. When you go from paying $150 a biweekly paycheck for your family's insurance to $900/month, it can get pricey. Individual insurance policies aren't affordable and there is no such thing as an individual policy without pre-existing condition clauses.

What really confuses me is this, if you don't want single payer option, you don't have to have it, you can keep the same old insurance you always have, that is if it doesn't change from year to year because your employer has to renegotiate prices with their insurer each and every year. If you like your insurance, keep it. If you are like others who have lost their job, or work at a company that doesn't provide decent insurance, or that doesn't provide insurance at all, you have an option, because right now for those people there isn't an affordable option. We can't all be poor enough to afford Medicaid, but some of us sure aren't rich enough to afford individual insurance or COBRA.

In terms of Canada, the UK, and all those other countries with "socialized" healthcare, I think they are doing ok for the most part the horror stories there are like the horror stories here. I can tell you at least three or four stories of people dying or having permanent damage because they had to appeal their insurance company on claims they denied for cancer, heart attacks, and kidney transplants. I also want you to know that after 9/11, most insurance policies have a terrorism clause, which means that if you get injured in an act of terror, you are out of luck.

I know that folks are going to say that people cause their own health problems, but I hate to say it, not all problems are caused by the people that have them. Sometimes you have heart attacks due to undetected birth defects. Sometimes there are cancers that you just get. Not all the people in the world who are sick eat too much or drink and smoke too much.

This healthcare debate has in my opinion caused nothing but fear mongering and hate. It is another tactic by the nutjobs to show their distaste in their new President. They got mad about the stimulus, then birth certificates, and now they don't want healthcare for those without heathcare, even if it benefits them. If the right didn't have all these nutjobs and Pat Buchanan screaming from the rooftops incoherently and offered an actual solution to the health care crisis, maybe, just maybe I could take them seriously, right now I can't, because I know what we have now doesn't work, even for those who are insured.

If we can't take care of our own people, then something is wrong. No one should become destitute or file bankruptcy because they get cancer, or have children born with conditions that need lifelong medical treatment, or because their insurance company got mad they got sick and chose not to renew their coverage, or made renewal so expensive people can't afford it.