Boston Gal's Open Wallet

I'm struggling with this insurance issue right now. My husband quit his job and lost coverage for himself and our three youngest children. We applied for BC/BS, and the policy would have come to about $850/month for all of us (adding the kids to my existing policy).

(Sort of) fair enough, but we just learned that he was denied coverage because he has carpel tunnel syndrome in his left hand. Even if he were to get it repaired, the cost would be < $2K, so the insurance company would probably still profit from him during the first year. Still denied. I'm afraid all three kids will be denied too, for various more serious reasons.

Since we live in Oregon, we can be covered by OMIP since my husband was denied coverage. Cost for him and the three kids? $1550/month. Not counting the $335 I'm already paying for myself. Yes, we can pay that, but only by stopping all retirement/college savings, selling a car, stopping the kids piano and language lessons, etc. Just crazy.

 

How nice for her. Unfortunately, the rest of us struggle with the medical debt that she incurred.

 

Sometimes I wonder what planet people are living on... To the previous poster, I don't think it should come as any surprise that you have to pay more because you seem to be high risk. Should a person with 3 speeding tickets be surprised when he is denied cheap coverage and has to take an expensive policy? Your 3 sick children are risks and you expect them to be insured cheap? Maybe your husband should have investigated health coverage _before_ quitting his job...

 

Sad how the subject of health care seems to bring out such mean-spirited behavior ...

 

But getting sick isn't necessarily a choice. The reporter didn't choose to get cancer and some diseases are not preventable nor have controllable risk factors.

 

We don't question public education, public law enforcement, public fire and rescue, public libraries--and yet public health care is somehow painted as something to fear, or to avoid.

It's in the public's best interests--the country's best interests--to have a population that is educated and healthy. It's a national security issue. We cannot be economically, or militarily competitive without these basic, basic safeguards for the common good.

 

"How nice for her. Unfortunately, the rest of us struggle with the medical debt that she incurred."


"Your 3 sick children are risks and you expect them to be insured cheap?"

WOW. Words almost fail, but I am going to try....

The only reason why "we" might have to "struggle" with the debt incurred is because insurance companies choose to make MASSIVE profits on the backs of the entire nation. They could easily afford to cover all of us and our inevitable illnesses except they are expected to make $$$$$$ for their investors.

And guess what? We're ALL going to be sick at some point - mostly due to our genes, although we all want to believe that if we just "make the right choices" we'll be able to die in our sleep in our own beds at age 99. Some of it's controllable, most of it is not.

The insurance industry is denying people coverage for acne, for crying out loud.

I'm sorry to say, but people like you often don't "get a clue" until it happens to you. Unless you are multi-millionaires, you're just one job loss away from being in such difficult situations yourselves.

 

No, she had no control over getting this disease. But she did have control over purchasing health insurance before she got it. The whole premise behind insurance is that you obtain it before you need it and hope you never do. It's not clear why she didn't have it. Maybe she was one of these young invincibles? Maybe she thought it was too expensive? Don't know about MA, but in my state, a healthy 25-year-old can get a catastrophic plan for $53/month. Health insurance should be a priority right up there after rent and food, and before a car, furniture, clothing, social activities, and such.

Believe me, as the owner of an individual plan whose premiums routinely go up 20% a year (and an additional 25% in years in which I change age brackets), I am no fan of the current system. Without a doubt, we need reform. But I can also empathize with insurers (and those who wind up footing the bill, including myself) when it comes to people who suddenly want insurance when they get sick, without having kicked anything into the system while they were healthy. So yes, this woman was very, very lucky.

We can talk about cost control and the medicalization of every little hangnail some other day!

 

"I want it all, I want it now, and I want it for next to nothing."

The average American

 

I used to work in healthcare. Americans want insurance to cover EVERYTHING but do not want their premiums to go up and don't realy want to sacrifice anything for it. How do I know? We processed claims everyday. Why does someone with insurance go the ER during daytime hours for the flu, or an earache or anything that is NOT life threatening and then complain when the ins company denies it because they could have gone to their doctor's office. I worked 14 years in the industry and can tell you horror stories of what we all want at the least price. Something has to give.

 

Last year everybody was bitching about oil company profits, this years its insurance company profits. I suspect once again this is nothing more than a talking point with little fact to back it up. Try as I might I can't figure out what insurance company everybody keeps saying is so profitable ('cause I want to buy their stock ;-) ). Let's look at that big bad boy Aetna http://finance.yahoo.com/q/ks?s=AET profit margin 3.85%. I'm not sure what the whiners think is a big profit but that does not look like one to me... Apple is over 14%... A little help here?

 

Wow - the lack of compassion of some of your posters is truly breathtaking.

 

"The insurance industry is denying people coverage for acne, for crying out loud."

I once had a friend whose daughter had garden-variety acne. A few pimples here and there that most teenagers get, nothing disfiguring. Just needed a little over-the-counter medication and patience, the dermatologist said. Well, the friend wanted nothing of it -- she hauled the daughter into the dermatologist with guns firing, threatening legal action, demanding Accutane, an expensive prescription oral medication meant for people with severe acne, that has some harsh side effects and also requires repeated pregnancy testing in women. The insurance company (and indirectly its subscribers, meaning you and I) footed the bill for that medication and the pregnancy testing and the treatment of side effects.

So ... I could see why the insurers might want to exclude someone with acne. Consumers/patients are definitely a driving force behind some of the problems we now have.

 

The 'lack of compassion' of some
of these posters is simply pointing
out facts. I have no problem paying
the sliver of this person's medical
bill that is my share as a person
who is healthy now, but it's not
free, and that is something not
enough people realize.

 

This story is only half over because Massachusetts is going to go bankrupt. The state expanded coverage without addressing runaway costs. The program was already struggling earlier this year, trying to decide whom to boot off to remain financially viable. It would make a whole lot of sense to watch this small-scale experiment for a few more years before launching a similar program on a national scale.

 

I live in Germany, and everyone here (>99%) is covered, as required by law. The medical care here is very high quality. I wish Americans would wake up to the fact that a public system is definitely the way to go. All of the billing is incredibly streamlined, around 1% of cost is lost to insurance companies and paper shuffling, in comparison to the States at around 20%! I volunteered as a kid at a hospital in the States once, and the ENTIRE basement was full of office and billing personel. Here there are a handful of secretaries, but they are typing doctor's dictations, not messing around with billing. The American system as is is incredibly wasteful and has no conscience, it is only for profit. Here in Europe people just can't understand why many Americans are so against universal coverage.

 

Why is anyone against universal coverage? a poster asked.

I can't speak for anyone but me, but I am against it because I fear that I will not be able to get the kind of care I have now with universal coverage.

What I have now is a high deductible with HSA plan, and every year we pay the "out of pocket maximum" for our plan, which is $5250. We know this from Jan 1, so we put $100 per week into our HSA to cover this. We know we will pay this because I have rheumatoid arthritis and one of the meds I take costs $1538. per month. We pay our deductible by March and the entire out-of-pocket by July. In addition, our share of the premium (the bulk is paid by my husband's employer) is about $160/month.

I have read some about how other countries like the UK and Canada have dealt with RA patients and availability of the new biologic (and expensive) drugs, and it doesn't appear that these drugs are as readily available to those who need them in those countries. I was able to see a rheumatologist within two weeks of the referral from my family doctor and was on the biologic drug within one month after that. The best information we have now is that early and aggressive intervention can make a huge difference for those with RA, and I am endlessly grateful that I got that three years ago. Perhaps my situation would have been no different with universal coverage, but given the accounts of RA patients in other countries I doubt this.

The thing is, you can get great care in this country, but you should not expect it to be free. I agree that something has to be done about pre-existing condition exclusions, tort reform, better competition between insurers, etc. But we should not be so quick to assume that the advent of universal coverage would mean that the health care we each individually receive now would be continued at the same level.

 

But if she'd chosen that catastrophic coverage for $53 a month, say at age 21 when she graduated from college, she would have paid just over $3000 in premiums when she was diagnosed. Wouldn't really have gone far toward that $900,000 bill. No point at being mad at her, most of us rely on our employers to foot the bill for us anyway.

 

Jane,

Have you stopped to think about what would happen if your husband (your source of insurance) lost his job, divorced you, or died? Maybe you are too focused on your own good fortune to care about the misfortune of others. But fortune can change in a heartbeat. What we have in this country today is a total grabfest, with every man, woman, and child out for himself/herself. How sad.

 

Ann,

That's not how insurance works. If all 20-somethings purchased insurance and their premiums are pooled, and only a few of them end up having sky-high medical costs, the pooled premiums should cover those costs. We need to have a mandatory financial education class in high school to get these principles down.

At the individual level, in most states other than MA, that $53/month would have meant the difference between solvency and financial ruin, and between life and death for this reporter.

Glad you are happy to pick up the tab for people who don't purchase insurance just because they think they'll never need it! Because those costs are most definitely passed on to the people who do have insurance and their employers. This is already putting a huge strain on businesses and making us much less competitive internationally.

 

To quote Teddy,

"Health care is a right, not a privilege"

I am embarrassed for my country that so many people think it is OK for this to be a "for profit" business driven by greed. Like education and police and fire personnel, health care is a responsibility of a civilized government.

Period.

 

To those of you who are arguing that universal health care will somehow cost you more, I say that you are very poorly informed and spectacularly ignorant.

Check out the per capita spending for health care of every other developed country. They are all much less than our per capita outlay. Why? In part because of more efficient health care systems, and in part because they require coverage (making the amount paid by those with coverage lower, making the amount paid for total health care costs lower due to better preventive care, disallowing the insurance companies from dropping participants who have paid premiums for years after they get sick).

If you've bought into the argument that health care reform will cost you more, then you've swallowed the insurance industry's lies hook, line and sinker. Sorry, but big businesses like insurance companies hate to be regulated (because it means lower profits for them) and they will spend millions to poison debate and turn more naive people against reform.

Jon @capitalistmaven.com, insurance providers' stock has recently tumbled (check out today's WSJ) BECAUSE of expected reforms. Investors know that the party is over now. A less disingenuous person would have looked at the historical profits, not profits from this year alone, nor from a single company alone. You're a very smug sounding person. I'm ashamed someone who is apparently into economics (like I am) is not interested in the real savings reform will bring, and is instead dedicating themselves to being a sanctimonious scold. Hope that you never get sick, because it will ruin you (I can tell you aren't the sort of person to have a community of supporters to help you in times of need. If you were, you would be more reasoned and compassionate in your responses).

To the rest of you nay-sayers, I dare you to read the white papers and economic write-ups on other countries' conversions to universal health care systems (some single-payer, some not), and see for yourself the saving we could realize. Otherwise you're just going to hear what the insurance industry is paying for you to hear. If you're content to swallow whatever big companies want to feed you, maybe you'd be happier in China.