Free Is Too Much

Monday, October 19, 2009
I know I've asked this before, but at the risk of appearing repetitive, What is our Goal? Is it too much to ask that before we completely restructure our health care delivery system and a major portion of our economy, we take a moment and delineate our goals?

There are a few, very few, activists and members of Congress who have the goal of eliminating all private insurance. They view the current legislation as the first step towards a Canadian-style single payer system. It is easy to lump everyone suggesting proposals that might have a negative impact on my business as proponents of "Socialized Medicine". Easy, but very wrong. It is also wrong to assume that anyone not lining up behind a significant overhaul or the "Public Option" is a right-wing nut job probably on the take from the insurance industry.

So let's look for some other goals. One I keep hearing about is that we want to cover the uninsured. Sounds great to me, but before you can cover the uninsured, you have to ask who they are and why they don't have insurance.

We know that a large number of the supposed 47 million are undocumented Americans. The President's big speech put the number somewhere between 12 and 17 million. We also know that a large number are not permanently uninsured, just simply between jobs. Some high earners choose to be uninsured. My favorite was a well known doctor at Hillcrest Hospital. For all I know, he and his family may still be without insurance coverage.

Some of the uninsured have major illnesses. Some are children, eligible for Medicaid, but their parents don't know or haven't bothered to complete the process of enrollment. And many of the uninsured are the working poor. Earning less than 200 percent of the poverty level, often working one or two low wage part time jobs. These people have fallen through the cracks. It is our responsibility to help them get covered.

But there is another group. And this is the group that concerns many of us. There are people of limited means who chose not to be insured, or at least, not today. When they need coverage, due to illness, accident, or pregnancy, they expect to be welcomed like long lost friends by the insurers, doctors and hospitals.

Let me give you an example. Pamela (not her real name) works full-time for a large specialty retailer in a Greater Cleveland mall. She is a healthy single mother in her early 40's. She stopped smoking years ago. Aside from her two pregnancies and her breast implants, she has not had any hospital stays or surgeries. Her older child is on her own. Pamela's teenager is covered by her father. Pam is uninsured by choice.

Pamela's employer has an excellent group health insurance policy. The plan includes an office visit copay, Rx card, and preventive care. Why isn't Pam covered? Why won't they take her? Neither the insurer nor the employer is to blame. The employer pays the vast majority of the premium. The employee portion for this policy is $41 per paycheck, $82 per month. Pam refuses to participate. She would rather spend the money elsewhere, preferably on e-bay.

Who pays if Pamela gets sick or injured? We do. What would it take to get her to participate in the system before she is being wheeled in on a gurney? Should she be forced by implementing a tax (We are supposed to say fees. The President and Senator Baucus love fees.) on people who refuse to buy insurance? Should her employer be required to pay 100% of the premium? Should the government, which is us, just give her free insurance? Obviously the moral imperative of being personally responsible hasn't been a motivator so far.

What happens when premiums increase? There is every indication that premiums will rise with the implementation of the Baucus bill. Will Pam's coworkers drop off the coverage as their disposable income is attacked? There are a lot of Pamela's. Each of these people has a reason why his/her lifestyle is more important than insurance right up until the moment care is needed.

I want to be very clear. I am not talking about people who have lost their group coverage, can't find another job, and have a serious preexisting condition. This year's COBRA extension was only a bandage. Our system has failed too many of these people. The working poor, wage earners struggling to survive, are also not the point of this. At one point the Republicans wanted to give the working poor tax credits to buy insurance. That isn't an answer. Immediate access to Medicaid, a state run program, and an increase in funding (taxes) is the only way I know to help them.

I refuse to believe that people choose to be poor, sick, or disabled. Just as it is our responsibility to help those who can not help themselves, it is our duty to provide for ourselves and our families when we can.

So what are our goals and how are we going to achieve them?

DAVE

By the way: Now that we are getting closer, it is time to assert YOUR Divine right to special consideration. On the October 15, 2009 ABC World News Tonight, Charlie Gibson reported about women testifying on Capitol Hill. The issue was that insurance companies were charging them more for health coverage than males the same age. The injustice! Of course, there was no mention that these same women would pay less than men for health insurance later in life or that their car insurance was less since the day they received their driver's licenses. And life insurance? Women's rates are always less than men's. Poor Charlie. He just didn't have the time to mention any of that.

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