Thursday, May 14, 2009

Health Care Reform

I want to continue talking about health care reform proposals. I again want to emphasize that the views expressed here are my own and not those of Cottonwood.

I am disappointed that the Obama administration is rushing health care reform without adequate input from doctors, hospitals, private insurers, and consumer groups. The plan is to get legislation signed by mid summer and I think this is way too fast. The Senate Finance Committee is meeting behind closed doors to consider four different plans none of which includes any possibility of public-private ventures. All the plans are a one size fits all which I think is unwise and may threaten those aspects of our current health care system that do work.

One proposal is the Medicare like plan that I previously talked about in which the government directly competes with private insurers which will after a time drive the private insurers out of business and leave us with a single payer system. Another proposal being considered is no public plan at all which I don't think is being seriously considered by anyone. Another plan would be to allow states to set up their own public plans. This at least gives some flexibility to allow changes and course corrections if things don't work well. The Arizona Medicaid AHCCCS program partially works, though doctors and hospitals can't survive if that is the only plan available. The Tennessee TennCare plan turned out to be a disaster and had to be drastically altered to keep the state from going bankrupt. But at least there was the opportunity for more local self correction.

The fourth plan being considered is a proposal by Senator Charles Schumer of New York. His idea is a Medicare like plan that would have to be paid for by premiums, not tax dollars. The public plan would have to follow the same rules as private insurers, maintaining a reserve fund to cover liabilities as well as having the same consumer protection rules with doctors and hospitals free to participate or not. This is as close to a private-public plan that is being considered and has some merit although it is very unlikely that in practice doctors or hospitals really would be able to not participate.

Overall I am disappointed that these are the only ideas being considered and do not think it is wise to rush to a decision with no real outside input.

Thought for the day

" If anything matters then everything matters".

W.M. Paul Young


  1. I always enjoy reading your blog posts and today I read your multi-part posts about health care reform. You asked for input, so I will give you my point of view. While it may seem that the Obama administration is rushing, I will say our country has been taking its sweet time since the end of WWII. There would be certain immediate clarity on how to design this program/product if our senators and representatives had to live for one quarter without insurance or if they had to try to purchase their own coverage on the open market for themselves and their families. I am a relatively healthy 59 year old female. I have not been hospitalized since the birth of my youngest child 25 years ago. I take one medication for osteoporosis. I am self employed and pay $8400 per year for an Arizona BC/BS HMO policy! Now I find that if I try to apply for a less expensive policy with AZ BC/BS they will treat the newly diagnosed ostioporosis as pre-existing and not cover it or any side effect of same...I am now stuck and guaranteed that my premium will escalate when I turn 60 in October.
    The other issue is this: I am not looking for something free, paid for by the Government, what I want is a program where I cannot be turned down for pre-existing. I am willing to pay the premium, I just do not want to worry about denial. Take for example the person who suffers from the disease of addiction. They start out with coverage, perhaps as a dependant on one of their parent's policies. They seek treatment for their "disease". Now step forward a few insurance and insurance companies deny coverage because they were treated for the disease of addiction. CIGNA says you have to be 5 years post treatment for addiction, HEALTHNET 5 years post, BC/BS 5 years post, HUMANA 10 years! AETNA may consider you after 2 years, but there would be a rating surcharge of 25% and/or pre-existing exclusion. The only hope is to find a job that will provide health insurance, and that is becoming more rare. God forbid you relapse.
    Finally, I am of the opinion that we as a country cannot afford not to act. The stress of not having insurance, worrying about losing coverage, etc...plays havoc with all of our lives. It may not be perfect, but somehow other industrialized countries manage to provide coverage. Why can't we solve the problem. Taking longer to study it will not help...
    We must take the first step...our health, particularly our mental health, depends on it.

  2. Thank you for your comment. You make a very good case as to why reform is needed. I agree that any plan needs to deal with the unfairness of denials based upon preexisting conditions. Again, thanks for the comment!


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