Tuesday, September 15, 2009

I'm Tired . . . And Sad . . . And Scared

I am so tired of hearing the phrase "government take-over of health care." How many times do people have to be corrected? Or maybe they don't want to hear the truth.

NONE of the proposals for health insurance reform amounts to a government take-over. What they're calling the Exchange or Gateway is a web-based marketplace where all insurers -- all PRIVATE insurers, plus a public alternative if one is offered -- will, for lack of a better word, "advertise" their offerings so consumers can see what plans are available, what they cover, and what they cost. If you've ever tried shopping for health insurance, you know that it's almost impossible to get quotes and find out what all of your options are. The Exchange would allow you to do that.

No government take-over. Just a marketplace.

And the public option would be just that -- an option. There would be all the private insurance plans, and alongside them would be a publicly run plan. Nobody would have to sign up for it. Indeed, President Obama last week said only the uninsured would be eligible for it. Nobody would HAVE to select it -- it would simply be a choice. If you think it's a bad idea, then leave it alone, choose a private plan.

But again, no government take-over. Just an option.

I'm tired of explaining this over and over again, but people don't believe it because they've been sold such hooey by people they're supposed to be able to trust -- elected officials who publicly accuse the President of the United States of lying when it's they who are lying. Elected officials who take hundreds of thousands of dollars from the health care industry in exchange for which they chant the mantra "government take-over, government take-over."

And I'm so very sad that it seems to be working. The public option is all but dead. It can't pass the Senate without Senator Kennedy's vote, and without every other Democrat. And there are plenty of scared Democrats -- scared because people are believing the lies, "government take-over, government take-over."

Don't fool yourself into thinking for one minute that government doesn't already regulate insurance. Individual plans and group insurance plans that are not what's called "self-funded" -- which means the vast majority of plans in the United States -- are regulated by state law. The only difference here is that the regulations being discussed in Congress would be federal instead of state. What would those regulations do? Things even the staunchest of Republicans can't oppose -- elimination of pre-existing condition exclusions, lifetime caps, and the ability of insurers to cancel policies when a person gets sick based on some made-up nonsense about a previously undisclosed pre-existing condition, like the nurse who testified before Congress that she got cancer and her insurance was canceled because of a previously undisclosed case of acne. Yes, acne.

I'm sad that the lies have had their intended effect of killing a public option. Why does a public option matter so much? In the four years since Advocacy for Patients was founded, our insurance has gone up more than 100%. Yup, more than 100%. What makes anybody think these runaway prices are going to end if the insurance companies face no competition? What incentive will there be to lower the cost of premiums? Because I'll tell you where we're going without a public option -- everybody will be required to have insurance, but insurance will continue to cost $1000 per person per month, as it does for our group plan, making it impossible for us to even consider hiring more staff. This will be a catastrophe, with families being fined for not having insurance when there is no affordable insurance for them to buy.

And so I'm scared. The special interests are winning the day. They are eliminating competition, and so doing nothing to control premium prices. They are now so focused on making sure no illegal immigrant gets a penny's help, and no abortion gets a penny's subsidy, that they have taken their eye off the ball and forgotten that the goal was to provide universal, affordable, portable, and comprehensive insurance for everyone. A disgusting outburst from a member of Congress and the Senate Finance Committee spends days crafting provisions to make sure the new system is airtight -- do we really think it's more important to make sure illegal immigrants are shut out than it is to make sure that we get what we need?

I've been saying the same thing over and over. I write about health care reform in our e-newsletter, correcting the outright lies, and people actually unsubscribe at a rate higher than when I write about anything else. People don't want to hear the truth. Or they assume I'm the one who's lying -- after all, would an elected official really lie to them? I suppose, according to at least one member of Congress, only the President is capable of lying, eh?

I'm tired of having to say the same things over and over. I'm very sad that people are buying into the complete fictions that are being put out there. And I'm scared to death of what happens when the lies drive the outcome and we get either a lousy bill or nothing at all. A lousy bill that people will blame on the President, on those who advocated for real change, on people like me.

I hope these blog posts are archived for a long time. I don't want to have to say I told you so, but it looks like too many of you aren't leaving me much of a choice. Jennifer


  1. Jennifer,

    Well said! I am sad that so few people comment here...you're a voice of reason.
    I am a doctor and have seen my fair share of misery arising from the current system. I could write pages of rational argument about the actual diagnosis of the dysfunction (and believe me, it is more than just private insurers, drug companies and lawyers; how about including a significant percentage of doctors, too?), but it falls on deaf ears almost every single time. Truth and rationality will not prevail as long as the vested interests and their politician captives have the bullhorns....and they are amping it to the max! Americans are particularly susceptible to demagoguery and quite willing to hurl themselves into battle without the slightest inkling that they may be wrong. In essence, the people will get what they deserve....good and hard, unfortunately. Tolerance=enablement.

    There is, however, one aspect of this (and neighboring countries) that has been too heavily discounted: ingenuity. If abortion is banned, clinics will erupt in Canada and Mexico, and the backstreet trade will thrive...on cash. Hospitals and related systems will (and are) being planned just across the borders. They will offer policies to US citizens. People will be able to have elective surgeries such as hip, knee, cataract, etc. for a fraction of the price (and premium), by board-certified physicians. There will also be massive telehealth outreach from these centers, who will employ people within the US borders as well. These will include doctors, nurses and others who are US-licensed, but not answerable to any of the vested interests here. Patients will have to waive certain aspects of liability as a condition for insurance. We already ask them to waive jury trial and opt for arbitration in any case. Drugs will be dispensed and shipped from across the borders. Another potential player in the 'flanking run' could be Native American reservations, where you may find hospitals alongside casinos, and where govt. control is minimized.

    My personal, rational choice would be 'Medicare For All'. It has a template, has been around for many years, has a pretty high level of satisfaction, is portable anywhere, has no exclusions and only spends about 5% on overhead. It needs to be more efficient and upgraded, but that is very easy...and will amount to rationalizing care vs rationing it. It accounts for >60% of healthcare expenditure in the USA....universal care!

    We are ranked 37th in the world re: quality and efficiency of care. We spend 100% more per capita and over 15% of GDP on very mediocre care. I know exactly why....and it is a disgrace.


  2. I'm with you almost 100% -- almost!!! Medicare has a 20% coinsurance, and in many states, it's impossible to find a Medigap policy for someone with a pre-existing condition. So I'm not all for Medicare for All, but with that reservation, I'm with you. Thanks for your thoughtful comments. Jennifer

  3. Hi Jennifer, I'm a chronically ill person who is disabled with chronic pain, diabetes, severe asthma, and severe edema and lymphedema in both legs. Because I insisted in my insurance choices through my employer on maintaining my physicians (through 10+ years), they supported my disability applications. I got Social Security Disability and my other disability applications approved. I have to pay $531 per month to continue my health insurance, but I can keep it as long as I want to because of my medical disability status with my employer. My income and my health insurance have been maintained after a tremendous amount of writing, filling out applications, and providing medical detail. Each submission for renewal tears me apart and makes me realize how little of my health is left, but I do them faithfully year after year. At least I still have my mind, my writing ability, and my determination left to me. I am fortunate.

    Every chance I get, in my writing and my interaction with folks on carepages.com, I use the knowledge gained through my illness and through reading your blog. I help others use their health insurance and care more effectively. I also ask the people I communicate with on carepages to dig into the denials that insurers provide and to ask their doctors good questions. I've mentioned your name in postings both on Carepages.com and on Facebook as someone who has an excellent knowledge of health insurance and who helps people solve their problems with that insurance.

    The reason I mention all this is to help you realize you're not alone. I, for one, try to use what you write about, especially about being a patient who advocates for himself or herself. I'll write to my senators and my congressmen asking why there is a 3 year waiting period before insurers have to stop denying insurance coverage for those with pre-existing conditions in the Baucus bill. I'll also ask why there is only the high risk pool solution for those who find themselves uninsured. To me the other key question is why people have to wait until they have been uninsured for six months before they could apply for health insurance. So many chronic illnesses become fatal or out-of-control in six months.

    I think there are many people like me who write their representatives regularly and try to make them think about getting the policy issues right. The reform must improve access, affordability, and quality. Just wanted to let you know that you are a wonderful resource. I can't thank you enough for all you are doing to help those who are very sick and to encourage people like me who are informed health care consumers.

    Here's my other web page:
    Frank Elliott

  4. Jennifer,

    You are correct. However, those Medicare things are fixable. If this govt. finds no problem spending many trillions of dollars bailing out bad bets and prosecuting at least 2 wars, nobody can say that these relatively minor issues cannot be properly handled.

    Cash for clunkers was even enough to fill Medigap problems.....and that saved no money. In fact, it created more debt and the cash is taxable. We need our country back.


  5. Jennifer, FrankLivingFully indicated he has the right to continue his employers plan for as long as he wants and that he is on SSDI. On Thursday night at the CCFA seminar I think you indicated that it is problematic to keep the private group employer plan and Medicare at the same time. I was unclear if said medicare would come after you or if the private insurance would come after you if you kept the private insurance and medicare. I am also wondering about the 20% co pay with medicare and the fact that you said it is a long-shot to get medigap coverage with pre existing conditions. I believe that I too am eligible to keep my employer plan (currently aetna PPO) since I am out of work on disability. Is there anyway to parlay my employer plan period of qualified coverage to cover the 20% gap. I am medicare eligible in December, do I have to eat the 20% copay or is there any course of action you would recommend to attempt to secure medigap coverage? Off topic of this post, but just curious, what do folks do for dental coverage when they convert from employer plan to medicare?

  6. If you are an active employee of a large group plan (over 100 employees), your private insurance is primary and Medicare is secondary, in which case you don't have to worry about enrolling in Medicare right away, although you will pay a penalty for late enrollment eventually. For everybody else, Medicare becomes primary, and your private insurance may require you to enroll in Medicare. If you enroll in a Medigap policy in the first few months after you become eligible for Medicare, it should cover your pre-existing condition. To find out if your current private insurance can be used as a Medigap, you have to call them and ask them if they can be secondary to Medicare. To find out what Medigap policies are available to you in New York, call your SHIP office, 800-701-0501 or 800-342-9871. There's no dental coverage in Medicare. I don't know what other people do, but I haven't had dental coverage in years. I pay. A lot. Jennifer

  7. Hi Nycivan and Jennifer,

    My wife and I both have qualified and creditable plans from large group employers. If I had dropped my plan, I would not have been able to pick it up again during my disability. Also it allowed me to go to almost any doctor or health center in the U.S. It also paid for my very expensive prescriptions. One alone named Xolair costs about $36,000 per year. We also added me to my wife's good plan for about $200 per month. Then we coordinated the benefits between them. The result is that almost 100% of my health care expenses are covered. When it came time to enroll in Medicare I selected only hospitalization and not parts B (doctors and tests) or part D prescriptions. We won't have a penalty when I enroll in medicare when I retire because we have both my wife's active plan and mine (probably) based on active employment. I've also realized that most of the penalties if any will be waived at age 65. So, we have the peace of mind to have most of my health expenses covered for several chronic illnesses. We have removed the possibility of no coverage and potential bankruptcy from the equation. It took a lot of reading and asking questions to arrive at this solution for us. It works because we both have excellent health plans and we've always been frugal and had the money to pay for my coverage at $500 per month and to add me to my wife's at about $200 per month. Spending a few hundred extra dollars took worry and disaster out of the equation.