Monday, July 27, 2009

Health Care Reform - Getting the Short End of the Stick

This new health care reform going through Congress infuriates me, and maybe it's just that I don't understand what they're trying to do. Maybe.

But from what I understand, all Americans will be FORCED to PAY a private health insurance company for a policy (or buy a government sponsored policy - but this is still being considered. The private health insurance avenue is the only current option) . I already know that a non-employer sponsored insurance policy for my family of five would cost between $8400 and $12000 - just for premiums.


We could buy a 1700 sq. foot house on a small in-town lot in a neighboring community for what insurance premiums would cost us.

But we can't afford another house.

In fact, if we're FORCED to pay insurance premiums, there's a good chance we wouldn't be able to afford our house.

Then, there's a 20% co-pay for doctor's visits, and a $10,000 deductible *if* something catastrophic happens and we have to be hospitalized or undergo long-term treatment.

When Deus Ex Machina's company cut his benefits three months ago, I looked into alternatives. I didn't like what I found. I didn't like the limited options for plans. I didn't like that the insurance companies didn't have plans for us that would simply cover our visits to the doctors for "check-ups." I didn't like that what I was paying for was the possibility that we might get sick, and then have coverage (after we paid the $10,000 deductible), but in the meantime, the insurance company is raking in thousands of dollars per month, we'd unlikely ever recoup.

The bill before Congress proposes a cap for out-of-pocket expenses. The proposed cap is $10,000 to $12,000 *per year* for families, which does not cover premiums, but can only be applied to deductibles, co-pays, and other costs in that year. Next year, it all starts all over again. So, for a chronic illness, we'd be looking at paying $20,000 per year, just for premiums and deductibles.

I am one of the 45 million uninsured Americans.

But I couldn't be more against this proposed bill.

What galls me is the fact that we will all be FORCED to pay for insurance.

What infuriates me is that our government is negotiating with private insurance companies, who will drop their "preexisting condition" clause and open their doors to everyone, IF the government will guarantee that people like me, who are relatively healthy, are FORCED to buy coverage, too, and, in effect, forced to pay the bills of the people whose premiums and co-pays will never cover the cost of their care.

It will be a law, and if we refuse, we will be penalized with fees.

We're damned if we do, and we're damned if we don't.

As usual, the rich will get richer, the poor with be coddled, and those of us in the middle, will get the royal shaft right up the keister.

Does this not bother anyone else? Isn't anyone else sick and damned tired of the government telling us how to spend our money? It's not enough that we are ALL responsible for the TRILLION dollar debt our goverment has now incurred, but they will also decide how we manage our health.

Other points that bother me about the bill are:

== Mandatory vaccinations (and we all know how I feel about that :). If this bill is to pass, the government could decide *for me* that the risks of Gardisil and the Chicken Pox vax are acceptable and require that I have the vaccines administered to my children. They will even send someone over to my house to give me the shot if I don't go to the doctor to get it done. So much for my right to parent my children or even my right to determine what substances are put into *my* body.

== A central database for storing of medical records. I don't use a credit card, in part, because I don't want anyone to be tracking my spending, but to have my medical records monitored by some central "health organization." Uh, yeah ... not really liking that idea.

The bottom line, for me anyway, is that by forcing us into paying for health insurance, the government is, once again, pandering to BIG BUSINESS (nine of the 100 Top grossing businesses in the US are health insurance companies, and there are also several pharmaceutical companies on the Fortune 100 List, as well). And I have to ask the question: who is benefitting from this proposal?

Definitely not my family.

Of course, there's a chance that I'm wrong about what is being proposed, and maybe there's something in there that I'm missing.

Maybe there's something good there, but from where I'm sitting, it just looks like one more opportunity to stiff those of us in the $50,000 to $125,000 income range. We'd be FORCED to pay between 10% and 20% of our income for PREMIUMS, and that doesn't even include any visits to the doctor. That's just for PREMIUMS, and even if there is something positive somewhere in the other parts of the bill, the points that I can not get around are that our government is proposing that we all be FORCED to pay for health insurance. FORCED.

Does this not bother anyone else?

As an alternative, I propose doing away with all health insurance *period* - including government sponsored programs. No one has insurance.

At the same time, I propose that the cost of medical care be more realistic. As things stand, my doctor charges me $XXX.xx every time I go to see her. If I had insurance, they would pick up 80% of that. Why? Why does the doctor have to charge me so much that I *need* the insurance company to pick-up part of the tab? If it didn't cost so much, I could pay for it myself.

Do away with the insurance companies, and reduce the cost of medical care to more accurately reflect the cost of providing it.

That's the way to handle health care reform and make it "affordable" to all people.

A poll I saw recently indicated that more than half of the American population is AGAINST this current health care reform, and yet, the government is pushing it forward. It was the same with the invasion of Afghanistan and Iraq. It was the same with the 2008 stimulus package. It was the same with the TARP deals.

For once, I'd like to see our government just STOP and actually LISTEN to the people they are supposed to be representing.

I'd love to hear other opinions - especially if you know something about the proposed reform that I'm missing.


  1. Have to agree with you there. I am frustrated and appalled and frightened by this plan - was during the campaign and I am now. It's not very different than any other plan put forth in the past. My body is my body and my children's bodies are their bodies and my responsibility - only I and my doctor - if I choose to trust him - should have any say what happens to me or my children's bodies. One of the major reasons I chose my doctor is because he also does not vaccinate his children and believes in attachment parenting and extended breast feeding. I trust him, but because I choose to trust him, not because the government or an insurance company tells me I must. Is it me or is the CDC in the pocket of the drug companies?

  2. Boy, I don't know. "Health care" in this country is just a mess. I definitely sympathize with you on the objections you list. I don't like mandatory vaccinations, nor centralized record keeping. If we're going to force anyone to do anything, why not also force people to quit smoking, or lose weight?

    One of the biggest reasons I'm in favor of some sort of universal health insurance is that it's just plain IMMORAL when hardworking people without a big savings account or great benefits from their employer go under when they hit the first roadbump of serious illness or injury. Pneumonia or a few broken bones shouldn't make things so dire that a family loses their home. That's just WRONG, and it shouldn't happen in this country. Yet it does.

    I don't think there's any way of getting around the fact that healthy people and rich people are going to end up paying for the health care of the poor and the ill. Either you can cope with that idea, or you can't. I'm ambivalent about it. I've seen first hand how a country like the UK deals with medical treatment, and they're hardly a pinko country. Sure, a lot of Britons dislike their "nanny state" and I see why. Sure, health care over there is rationed by "need" as determined by a bureaucracy. But our health care is rationed by cost, which means the poor don't get much at all. So as I see it, the rationing issue is just a matter of what kind of rationing we're going to have, not whether we have it at all. We've already got it.

    I voted against universal health care when it came up in CA several years back. I'm not sure I'd vote the same way today. I don't have much confidence in anything good coming out of our legislative system, for all the reasons you mentioned. But I think we ought to try.

    BTW, I also worked in a physician's office and dealt with billing. I've got a cousin who finished med school a few years back and has six figures in med school student loans. If health care is to become affordable again, we need to get rid of insurance companies, which provide NO treatment, do not need to carry the huge amount of malpractice insurance that actual physicians do, and basically take your money while attempting to give you as little for it as possible. They screw the physicians too, you know. We also need to make medical school affordable, so that physicians can graduate without leveraging the next 15 years of their income just to break even. Oh, and it would help too if we were a less litigious society that didn't sue physicians for every less than ideal circumstance in their treatment. I know doctors get a very bad rap. I also know they're squeezed pretty hard between forces they don't control. And most of them go to med school because they actually want to help people. No rational person looking at the cost of med school (let alone the difficulty) and malpractice insurance would think that was an easy way of making the big bucks.

    Too long-winded already. 'Nuff said.


  3. I completely agree with everything you have said here. I wonder if maybe the people in congress are a little too concerned with the companies that fund their campaigns and maybe should be more concerned with what the actual people are saying. I am hoping this doesn't pass because I didn't realize their was a stipulation on vaccinations in it, and I am one who is not vaccinating my daughter. For someone else to tell me what I can and cannot do...I thought this was a free country...maybe I was mistaken.

  4. I know nothing about this plan, but I don't see how forcing everyone to pay for insurance is going to help the problem. Isn't the problem that people can't afford insurance now? How is forcing them going to make them be able to afford it?

    I agree, that getting rid of insurance altogether would be the best solution. And no one is forcing me to do anything to my son that I don't agree with. I will not follow a law that I think is unjust.

  5. Does anybody have a link that confirms or refutes the "forced health care" thing? I keep hearing this thrown about, but I can't find any source...

  6. But our health care is rationed by cost, which means the poor don't get much at all.

    I have to disagree with this. There are dozens of programs for people who are poor, and they often get the same level of care as the people who are paying for private health insurance.

    The people who DON'T get care are the ones who make between $35,000 and $50,000/yr (which is not considered “poor” and includes “professionals” like teachers) and don't have employer coverage or have only limited coverage under their employer’s policy. These folks make too much money to be eligible for a government sponsored plan (and even in the proposed plan many of them won't be eligible for the subsidies) and not enough to pay for private insurance, or like was my experience, can only get a plan that pays in the event that something “catastrophic” happens. A broken bone or pneumonia wouldn't even be covered under a catastrophic plan with a $10,000 deductible and a $1000 per month premium.

    The proposed plan will do nothing more than put a greater burden on the shoulders of those people who can already not afford to pay for private health insurance.

    Instead of forcing us all to pay a private insurance company, how about if the government levies a 5% tax on EVERYONE, ALL hospitals and medical practices become government operated facilities, and we ALL sit in the waiting room and are taken on an as-needed basis? That way, the folks in the $30,000 to $75,000 income bracket aren’t paying the lion's share (at 20% to 25% of their annual income just for premiums). That would be more fair, and I might be for that (if they take out the vaccination requirement :).

    Or, we could go back to the "country doctor" model, and some things that are currently treated by "doctors" could be treated by more appropriate care providers, like pregnancy being monitored by a midwife instead of an OB (who is more likely to recommend surgery).

    Or, there could be a shift in focus from taking care of "dis"ease to preventative care and educating the public on the relationship between nutrition and health. I mean, why can't a doctor tell a morbidly obese patient that s/he will DIE if s/he doesn't stop eating Twinkies, and why should *I* have to pay because that person refuses to change his/her habits?

    There are a lot of other options.

    But those things are not what’s being proposed.

  7. Found it - from the BBC, of course....
    The key search phrase is "individual mandate". It'd help if they laid out the cost of the government supplied plan in this case.

    The plan definitely looks like a mess. I wish they'd just stand up to the health insurers. This looks like one of those cases where compromise helps no one.

  8. Wendy, we can argue about who is poor enough to be priced out of affordable health care. But your response basically illustrates my point that some people can't afford it, which essentially rations health care to the rich, and to those you say get a free handout.

    Having worked in the office of one of the few specialists who took state Medicaid, I can tell you that those people got plenty of the runaround and were turned away by many providers who didn't want to take the paltry reimbursements. Basically it was charity medical treatment on the part of my employer. He almost certainly didn't even cover his expenses for office visits, which were reimbursed to the tune of less than $17 in the mid- to late 90s. Believe me when I say that if that's all the money you brought to the table as a potential patient, your health care was rationed. And that's for the poor who were "poor enough" to qualify.

    Oh, and my employers reward for accepting Medicaid patients? Two IRS audits within a 7-year timeframe. Apparently he was automatically flagged by a program that decided a physician in that area ought to be making more than he was reporting.

    "why can't a doctor tell a morbidly obese patient that s/he will DIE if s/he doesn't stop eating Twinkies, and why should *I* have to pay because that person refuses to change his/her habits?"

    Some are told exactly that. It doesn't make any difference to the vast majority of people who are told in that manner. Denial is far too strong. But I think what you're getting at goes to the heart of American individualism. Why should someone else's problem/lack of discipline/moral failings/lack of foresight/bad luck/bad genetics/whatever be my problem? Well, anyone could have a baby born with really serious health problems. Anyone could be in a major car accident, or develop devastating cancer. Should the healthy and the rich let them hang?

    The question is how much we're willing, or not, to be our brothers' keepers. I'm not saying I'm totally okay with it either. Perhaps we should cover the health care only of non-smokers who are within 10 pounds of their optimal BMI. Perhaps we need to place requirements that emphasize personal responsibility for our own wellbeing. But I do feel that too much individualism has not led to good things in our country. I think the much vaunted American individualism is a big part of the reason we have such fractured communities. We will all need each other in the times to come, and that means that sometimes we'll need to support those we're not thrilled to support. They probably won't be thrilled to support us when we need it either.

    So *in principle,* I'm in favor of some sort of universal health care. The devil, of course, is in the details.

    Sorry you opened this can of worms yet?

  9. We're talking apples and oranges here. In our future, if our economy continues its downward spiral to collapse and we have energy depletion, health care is going to be in the form of a local doctor, maybe his nurse (or maybe just the nurse) or in very remote communities a local midwife/herbalist. There will be very few state-of-the-art medical facilities that cost thousands of dollars to operate, and the "specialist" will be the guy that only the very rich see. The emphasis will be on folk medicine with a strong leaning toward self-care.

    Very different scenario than what we have right now.

    But let's be clear.

    I'm not *against* universal health care.

    I am AGAINST the current Health Care Reform proposal that is before our Congress, because nothing I've read in the documentation will "reform" the system we have. Rather it will change the way the care is paid for. It's not who pays the money that's the problem. It's the way the system is set up as an "us" against "them" system with the doctors, hospitals, pharmaceutical companies and insurance companies on one side, and the "people" on the other. We need a system of collaboration, in which health is the objective not "dis"ease control.

  10. Wendy, very thought provoking post.

    Kate, we can't tell fat people to slim down or smokers to stop. Big business drives the dis-ease industry. That's the reason illness is so expensive.

    The real answer is we have to invest in wellness, grow our own food, become responsible for our health.

    At first glance it would seem ludicrous - but I wonder how badly off we would be if our current illness systems collapsed - forcing us into wellness maintenance.

  11. People call is stupid because we wouldn't opt for COBRA when we lost our jobs and insurance we had through them three years ago. The premiums were more than our house note if we'd opted for them, and without COBRA at that point we were told be private insurers we were BOTH uninsurable due to preexisting conditions...period. It hit me like a ton of bricks..and guess what? I had just developed Type 2 diabetes and my sugars were in the 400s. Know what? It'll be folks like me who'll get "managed" right out of healthcare if anyone but I myself make the decisions. After experiencing that and seeing that it required some hard decisions on our part, it forced us to make lifestyle changes to solve the health problem the lasting way...prevention or radical change. And it also taught me that there's a point where we just have to say No. I will not pay a mandatory healthcare premium I do not choose, and to fine me is unconstitutional. How about we distract some of those tort lawyers onto protecting our constitutional right to OPT OUT of FEDERAL CONTROL on grounds of conscience, if nothing else. Same thing with's our choice, OURS. Gosh, who passed around the Koolaid when we weren't looking??

    :) Robbyn