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Sick Around America: Half-Assed Health Insurance Doesn’t Work

Posted by Christy Hardin Smith, Firedoglake at 10:45 AM on March 30, 2009.


This infuriates me. And not just because I have a pre-existing condition that would likely have me on the "insurance blacklist."

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This infuriates me. And not just because I have a pre-existing condition that would likely have me on the "insurance blacklist."

It's especially timely because growing numbers are looking for individual health insurance after losing their jobs. On top of that, small businesses, which make up the bulk of South Florida's economy, are frequently finding health policies too expensive and are dropping coverage, sending even more people shopping for insurance....

''This is absolutely the standard way of doing business,'' said Santiago Leon, a health insurance broker in Miami. Being denied for preexisting conditions is well known, but when a person sees the usually confidential list of automatic denials for himself, ``that's a eureka moment. That shows you how harsh the system is.''...

Imagine working your rear end off for a company and having them close down in this recession.  But you've paid into an emergency fund for health care coverage, so you think you've planned ahead and made wise choices.  

Or, if you own a small business (as I have), trying desperately to find affordable coverage for your employees and continually getting quoted insane prices for a relatively healthy group of people that none of you can afford.  It's nuts.

And then, you get slapped with the fine print:

 

Many jobless Americans are shocked to learn that the health plan, either paid for by the employer or deducted from each paycheck, costs so much. The average payment under COBRA can be around $1,200, and much higher if your company had a really good health plan....

$1,200? That's reasonable compared to what you could be paying if you have a pre-existing condition and have to pay out-of-pocket for an individual plan.

Once you are out of the workplace, you have no leverage to negotiate on a group basis for a lower rate. It's just you and your meds, and whatever an insurance company does or does not want to cover.  

In what universe does it make sense that the people who most need regular medical care are the ones least likely to get it?

 

Or that people who are now out of work in their chosen field -- and are turning up at fast food joints or pizza delivery trucks or various other lower wage jobs just to make ends meet -- now have no decent, regular health care coverage.  So communicable diseases they have get spread around the community if not treated.

How does this make any sense at all whatsoever?  

Only in a system where medical care is treated solely as a "for profit" enterprise, and where public health concerns mean nothing. That's where.

The market takes care of its own, and screw the rest of us when it comes to health care.

That has to change. Or we are going to be in an even larger world of hurt if a bird flu or other pandemic hits. Just imagine how far some pandemic disease could spread if no one could afford to go to the doctor and have their symptoms identified until it had been spread through every school and public office and business in your county? And then tell me that health care isn't important.

Frontline has what looks to be a very intriguing documentary airing on this subject tomorrow evening entitled "Sick Around America."

Here's hoping some policy-makers are watching it, even though they still have their government-paid healthcare intact. But to keep it, they have to stay in office, don't they?

Digg!

Tagged as: health, health insurance

Christy Hardin Smith is a former attorney, who earned her undergraduate degree at Smith College, in American Studies and Government, concentrating in American Foreign Policy. She then went on to graduate studies at the University of Pennsylvania in the field of political science and international relations/security studies, before attending law school at the College of Law at West Virginia University, where she was Associate Editor of the Law Review.


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i have no title
Posted by: samanthaseyes on Mar 30, 2009 1:28 PM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Hopefully this is an appropriate place to let folks know about a grassroots effort called "Healthcare Revolution Petition" http://bit.ly/rFpI3 They are about one forth of the way to getting this to Congress. Please pass the word if you like this idea!

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Health Care is Mandatory in Massachusetts.
Posted by: Longdream on Mar 30, 2009 7:21 PM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
A business owner must pay a substantial portion of health care costs for employees who work over 30 hours.

If he can't afford private coverage, he can make use of the reduced rates in a state pool system which is not welfare, but which is supported by the State and taxes.

It's working. Self-Employed individuals may also avail themselves of the pool rates.

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» It is not working Posted by: bthespoon
» RE: It is not working Posted by: Longdream
Health care or Prevention
Posted by: thisizrob on Mar 31, 2009 3:23 AM   
Current rating: 1    [1 = poor; 5 = excellent]
Sadly, I look at the situation of so many unfortunate people who have NO idea that there is a better way to have their health than having a handout from a government or insurance industry who are not interested in your healthy body, only your healthy pocket.

When I tell folks that there is a better way which I myself use but did not believe it had any possibility whatsoever of helping me, they think I have been brainwashed or something worse. I have a quality of life one could only dream about. I see many questionable promises of wonderful miracles that can be performed by so many "wonder pills" but see no results.

I educate folks BEFORE they decide to make any changes to their way of living, They thank me afterwards because now they have a better idea of where they are heading.

My email is thisizrob@ozzienet.net
No one is obligated to follow the information but those who do often contact me back to say "Thanks" for this advanced scientific information. It will be another 10 to 15 years before the medical profession gets to use this program. Fix the cells and you fix the body. Look after your body and you don't need the medical profession. I haven't had to use them for over 9 years. THEN you will be able to get your insurance cover, just when you don't need it but it will be handy if you have an accident. Pass it on to your friends as well. They will thank you as well. Rob

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Face it, folks...
Posted by: QuestionAuthority on Mar 31, 2009 5:27 AM   
Current rating: 5    [1 = poor; 5 = excellent]
Insurance companies are in the business of NOT paying claims. They always have been in that business, not in taking care of your problems. The only difference between insurance from a company and insurance from Vito on the street corner is that the company has a fancy office.

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No, they don't need to stay in office to keep theirs.
Posted by: ratcat on Mar 31, 2009 5:50 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
No, they don't need to stay in office to keep their super-deluxe healthcare coverage.
Once elected, a congressperson gets to keep all of their benefits, including their pay - for life. That includes benefits, and survivorship benefits, for their family, too. Even if they leave after only one day. Even if they are kicked out, or resign in shame, or are thrown in prison. Of course, there is a provision whereby congress can take the benefits away by voting to remove them from someone that leaves in shame, but .. suprise, suprise - they never have! Fact.

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Not to mention absurd doc fees
Posted by: somegirl on Mar 31, 2009 6:27 AM   
Current rating: 5    [1 = poor; 5 = excellent]
i'm not a go to the doc for every little thing but I had to go to my doc to get a splinter out last month...the first time in nearly 50 years i couldn't do it myself. it was tiny, painful, in my heel,just couldn't reach it. i nearly fainted when i got the bill for "in office surgery." i have junk insurance which only gives me the negotiated insurance discount. my price was $196 for a maybe 15 minute visit. is her time really worth $800 an hour? i should have just gotten a scalpel myself and risked the infection. antibiotics would have been way cheaper.

health care in this country is insane.

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The inivisible hand of the market
Posted by: SteveO on Mar 31, 2009 6:35 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Has done its thing.

Time to undo 30+ years of let the "free market" handle it.

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Insurance COMPANIES are in the business of making MONEY.
Posted by: ratcat on Mar 31, 2009 6:42 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Insurance companies are in the business of making money for their shareholders. They are a business. They are required to make as much of a profit for their shareholders as they can. They are corporations (mostly.)
The days of the non-profit healthcare company are over. Around here, that ended in 1992, when Big Blue was given to the execs and became a for profit. Before then, it was a non-profit, and rates were low. Benefits weren't near as bad as they are now. I remember my monthly premium was $29/mo. Everything was covered. Very small deductible was seldom collected.
That's not the way it is now.
The healthcare companies are regulated by the state and federal govt. But most states policies are nearly identical. Not all, but most. NY and California are notable exceptions.
Anyway, the companies profit margin is regulated, sort of...
Around here, their expenses have to account for 65% of their premium.
That leaves just 35% for profit.... er, profit?
And, what is the profit used for? We'll get back to that....
The 65% of the premium that has to be expenses... kind of reminds me of "expense plus contracts." Contracts where after all of the expenses are added up, the price paid to the contracter is increases by a certain percentage. This doesn't give a lot of incentive to keep costs low, because if the expenses are increased - the profits increases, too.
THAT is exactly what happens with the healthcare companies, too. They increases their expenses, in whatever way they think they can get away with, and that increases the $$$ amount of the 35% profits.
So, let's look at what's expensible. Of course, paying the doctors and nurses. And paying for the supplies, like needles, CAT scanners, cleaning crew, all the other staff, sales agents, advertising, exec pay and bonuses, more advertisement, buildings and all of the stuff inside them.... you get the idea - expenses.
So, a very good way to increase the 65% expenses is to spend more on marketing.
Oh, of course a good way would be to pay the sales agents (oh, but they are all rich from cheating their clients - not) and people that cleans up the puke and blood (but they are subhuman - not) - a living wage, but that would be too much like socialism, so we can't have that. The Execs need more money, so we'll spend more on advertising, thereby increasing the 65% expenses and increasing the $$$ of the 35%.
Now, the 35%. It is the profit. Not reinvested profit like in the old days (oh silly, so old fashioned.) Modern up to date profit... that goes to the stockholders. Of course, MOST of the stocks are owned by the Execs, given to them, of course, as part of their salary and benefits.
Remember, increased expenses mean increased profits for the insurance COMPANIES.
(I must state here, that not all insurance companies are set up exactly this way. Some are Mutual Companies. In a Mutual Company the profits go to the policyholders in the form of reduced premium or dividends, but those aren't Health Insurance Companies. Those are LIFE insurance companies. I had to include this so that someone wouldn't confuse the issue by mentioning mutual companies. Remember, mutual companies are mostly Life insurance, with a very few very old health insurance policies.)

So, again, the 65% expenses are increased by increasing expenses thereby increasing the $$$ amount of the 35% Profits. Profits going to the policy holders, which are mostly the Execs.

The easiest way to increase the 65% expenses is to spend it in marketing, which is what they do.

It takes the lawmakers to let them keep the scheme going. To keep the lawmakers on their side it takes lobbying. To pay for lobbying is to increase the 65% expenses.
By spending more on lobbying yields more favorable regulations. In fact the regulations are crazy favorable. I think you see the patern, here.

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rhrandall
Posted by: rhrandall08 on Mar 31, 2009 7:36 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Regarding COBRA: I understand that the President's first stimulus contained Federal monies to assist people paying this program to retain their insurance, and furthermore, it paid a sizable amount for them. Might check it out at the gov stimulus site.

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» RE: rhrandall Posted by: anneliese-nyc
death by design?
Posted by: luzmejor on Mar 31, 2009 9:52 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Our so-called health care is not supposed to work for the underclasses of America.

Of course, the poor, especially females and children, are always being encouraged to die and get out of the way.

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Universal Health Care
Posted by: frank69 on Mar 31, 2009 11:36 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Just one more vivid example why Universal Health Care is the one and only viable solution to our US non-health care fiasco!

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What's The Cure For A Sick System?
Posted by: robigreg on Mar 31, 2009 12:09 PM   
Current rating: 5    [1 = poor; 5 = excellent]
The posts I've read catalog the miseries and sheer injustices, not to mention outright cruelty, of our current for-mega-profit health insurance industry. But what's the cure? The PBS documentary will be on tonight (Tuesday). However, a review I read also catalogs the miseries of our sick country without taking up what we can do about it.

So let me offer one cure that, alas, hasn't received the kind of serious, wisespread consideration--especially in Congressional hearings--it deserves: Single payer. None of the other proposals offers what single payer does: Saving the billions that go into the expenses and profits of the insurance industry by adopting a system that will have an expense rate of less than 5% (it's now somewhere between 20 & 30%). With those billions this country could now provide healthcare for everyone. And that's with no co-pay, no deductions, and none of those sneaky ways of withholding healthcare from people. Single payer is not socialism, and it isn't government providing the healthcare, but only paying for it. Everyone will be able to choose their providers from anyone licensed to do it--something they cannot do now. There are two bills in the House and one in the Senate that are versions of single payer. Inform yourself, cuz you're not likely to have been informed by a media that too often agrees with the insurance industry and its minions that single payer is not "politically feasible," will involve more taxes (people will be less, some a lot, lot less, thru an ability-to-pay tax), will be socialism, yadda, yadda. (Despite saying every proposal was on the table, Pres. Obama had to be pressured by letters and phone to include a couple of single-payer proponents in his recent White House conference.) The legislation in Çongress to look up: S.491 (Sen. Sanders), H.R.1200 (Rep.McDermott), H.R.676 (Rep. Conyers). The California legislature has passed single payer legislation twice, with tons of backers and co-sponsors, and The Terminator has vetoed it--citing disingenuously that it would involve more taxes. It's been introduced again this year. Look it up: SB810. For more info: Physicians For Å National Health Program,
http://pnhp.org.

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I never worked anywher that offered insurance
Posted by: harpy on Mar 31, 2009 1:19 PM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
to anyone except management. I worked full time for over 40 years, and was always on my own. I didn't make enough to do much more than pay the bills and couldn't afford health insurance, but made too much to get any assistance. The working poor make up a large part of the uninsured. Since regular checkups were out, for both health and dental, I and my daughter only went to the doc when we were sick. She's always had dental problems (in spite of the fluoride poison in our water system) and as an adult had to have several teeth pulled.
I recently married, and I and my husband both applied for BC/BS. My husband was turned down because he smoked and his cholesterol was "high" normal. I was accepted, but before I paid the first premium, it was raised! In the 4 years I've had it, it's been raised 4 times. In the past year, I found out I have Hepatitis C and hypothyroidism. Hep C, or "The Dragon", is chronic, and lays in your body for as many as 30 years without a single symptom. It is believed that it will be the next pandemic, as it is estimated that millions of people have it and don't know it. I was absolutely surprised and only found out when I was being checked for hypothyroidism.
Bottom line. If my insurance is dropped nobody will ever cover me. I'm in the same boat as cancer patients.
As far as employers paying for insurance, why should they have to bear that additional cost? If we had universal single-payer coverage, this wouldn't even be a question. Employers wouldn't have to have Workman's Comp, either. Maybe the employer could hire more people or pay them more if they didn't have to cover this cost. Health insurance costs are one of the reasons American car companies are having a hard time competing against foreign companies who have national health programs and don't have that added burden.

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I was hoping
Posted by: westomoon on Apr 1, 2009 6:10 AM   
Current rating: 5    [1 = poor; 5 = excellent]
... that this would turn out to be the beginning of a discussion of how genuinely half-assed our health insurance coverage has become. I mean, what's the use of forcing universality of coverage if the "health insurance" people get leaves them on their own when they become sick?

Some of the comments here have been a good start on the necessary discussion of quality, not just universality, of coverage. But it's strange to me -- we seem weirdly reluctant to actually talk about the cold-blooded killers who run the health insurance industry.

Even our new President, who spoke so movingly during the primary of the hours he spent on the phone when his mother was dying of cancer, trying to convince her insurer to pay for the standard treatments she was receiving, seems unwilling to look into how little actual benefit sick people get in return for their insurance premiums. I have what is generally considered to be enviable health insurance, but I know perfectly well if something major goes wrong with me, it'll ruin me financially. Medical bills are still the primary reason for personal bankruptcies in this country -- and most of those people had what we call "health insurance".

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The bare minimum
Posted by: Aredee on Apr 2, 2009 11:26 PM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Progressives should insist on a single payer health care system, even with the realization that we probably won't get it. Our compromise should be a two-tiered, government system existing parallel to the private one. This option has the insurance companies scared sh*tless, but one that I think is attainable,since Obama has said he favors it.

The insurance companies and HMOs are afraid that it will ultimately lead to all single-payer anyway, since they won't be able to compete.

I say good riddance to them anyway.

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