Health Care

OK, how many years have I been saying this? Health care needs to be divorced from employment. It just does. I understand how we got here, but it’s no longer a model that’s working.

Now, changing that won’t be easy. But we need to.

But now that this economic landscape is making this fact obvious to many people, I fear it’s leading (or we will be lead) to universal, government-supplied health care. And that freaks me out. And I don’t think it’s the answer.

We can still have private health care. Just not tied to employment. And while we’re at it, how about if we remove the requirements on what must be covered? In a competitive marketplace, those requirements will not be necessary. If our family want to seek insurance that doesn’t cover mental health, we should be able to. If a couple of gay men, or a couple in their 50s, or single men, or even married young couples or whomever – wants to seek healthcare that excludes maternity care, they should be able to.

I think we’ll see costs come down (competition is great for this) – not only for health insurance premiums, but for the cost of health care. Maybe, just maybe, we’ll also see consumers finally shopping around for health care.

Curious what bothers me about government-supplied health care?

– if there’s no cost to the consumer (patient) or the cost is very low, it encourages overuse.

– you know how we get tax deductions on mortgage interest because the government wants to encourage home ownership? or how the federal government just withholds federal highway money from states if they dare to exercise their Constitutional right to enact laws as they please – or to not enact laws? i think the government will wield similar power with its health insurance. specifically, I’m thinking about vaccines.

– as I’ve said before (though apparently not on here?), I don’t think that government health care is the ticket to better maternity care and better deliveries. The countries who have largely midwife attended births, yes, also happen to have government health care. But as Henci Goer says in her book, just because two things coincide, doesn’t mean that there is a causal relationship. IMO, those countries have such a large number of midwife (or home) births because that is their culture. If you ask them, they can’t imagine why Americans use hospitals and OBs. But this is not OUR culture. And can you IMAGINE the response if the government health care would pay for an OB only if there was an actual medical need, as  is the case in some other countries? Ha. (Plus, there’s no way our midwife community could possibly take on that workload. In Des Moines, that’d leave us with fewer than 10 providers, if you cound the lay midwives and bring everyone out of retirement.)

– it’s really not the federal government’s job. I’ve read the constitution. Health Care is just not in there.

.

OK, I’ll say it. I’m going to sound mean and judgemental, but I don’t care. In the paper today is a sob story of a woman who lost her job in the fall and struggles to pay her COBRA so she can get her needed insulin and supplies. I feel bad for her. But the story doesn’t address why she hasn’t found another job with health benefits, or why her “self-employed” husband can’t get a job with health benefits. I realize that perhaps she wants a job that she doesn’t feel is below her college education, or perhaps he wants to pursue his dream of self-employment. But when it comes down to it, families sometimes have to do things they don’t want to do in order to get through tough times. I know several places that are hiring full time staff, cashiers or stocking or the like, that have health benefits. And from personal experience, a college degree really doesn’t prevent someone from taking a job in retail or similar. Even if it’s not your dream job, it’ll get you by.

Unless she’s done the math, and she’s better off financially on unemployment and COBRA, in which case she has no business complaining to the paper.

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5 responses to “Health Care

  1. Very few retail jobs come with benefits, and that woman in the paper has a pre-existing condition (type I diabetes). Good luck getting a private insurance company to cover her.

    My brother is self-employed and does pretty well but still can only afford “junk insurance”–that is, health insurance with a high deductible that would cover some catastrophic problem but don’t cover basic preventive care or prescription drugs. So, he pays through the nose for his health insurance and pays almost all of his medical expenses out of pocket.

    I have friends who tried to buy private insurance when they were between jobs. The wife has a thyroid condition, and they literally were not offered any policies–it’s not that the companies wanted to charge them more or even that the companies wanted to exclude coverage for any thyroid issues. They simply wouldn’t sell my friends a policy. Fortunately, her husband now has a job with benefits, but what if his small company goes under?

    Private insurance companies have very high overhead (usually 20 percent). Medicare’s overhead is only 3 percent. Single-payer health care would be far more efficient than requiring every individual to purchase a private insurance policy–even if you could get private insurers to sell everyone a policy.

    Talk to people who work in a doctor’s office about how much time is wasted on paperwork for the insurance companies, compared to paperwork for Medicare.

    Also, I know doctors who are sick of wasting time on the phone explaining to insurance company employees (who have no medical training) why this or that procedure is medically necessary. I’m sick of private insurance companies practicing medicine in this country.

  2. Hm, Joanns had health benefits for full time employees. That’s retail, right? I haven’t worked retail anywhere else, but Joann’s isn’t really known for their fantastic employee benefits.

    You’re still locked into the CURRENT private insurance model. Private insurance right now is not a very workable product, because MOST PEOPLE get their insurance thru work. Again, if you divorce work from health insurance, you’ll end up, thru market force, with better private policies that cost less. It’s called competition.

    However, you will still have people with expensive conditions being charged more – AS IT SHOULD BE because their care costs more. I didn’t see anyone jumping up to offer to pay for the $3000 external version I had last year, I paid for it. (No, insurance did not pay for it. However, the amount charged was more than the conracted amount allowed, so I didn’t have to pay the full $3000.)

    With government paying for all of it, it will still be super expensive, but we’ll all get to pretend like it’s free, because we won’t see “health insurance” deducted from our taxes. Those without jobs won’t see any expense because those with jobs will be footing the bill for them, too. Just like with everything else in this country. (It’s scary how much I’m like Jan M from WHO – I’d totally go for If You Don’t Pay Taxes, You Don’t Get To Vote.)

    The (evil, I know) health insurance company I used to work for had highly trained medical personnel on staff to make the decisions about what we would and would not pay for. It was originally a doctor, but over the years got scaled down to a few nurses because of costs, but it’s not like Joe with his high school diploma is making those decisions.

    You’re sick of private insurance companies practicing medicine, but the federal government doing the same thing is OK with you? At least when it’s a private insurance company, you can fire them. (for example, we switched to BCBS from Coventry because BCBS would pay, in theory, for a homebirth. turns out, in practice, it pays after i meet my out of network deductible, so I’d need to have like 10 babies before that would kick in, but still.)

    (ps, my point with the woman in the article was that she had more options than just go without her medicine or pay for COBRA. She could have gotten another job. Her husband could have gotten a job. They have options that they seem to have not explored. I personally think it would have been better to explore those options before going running to the paper.)

  3. There was just a study on COBRA showing that it is prohibitively expensive for most unemployed people:

    http://www.washingtonpost.com/wp-dyn/content/article/2009/01/09/AR2009010903350.html

    The cost of buying health insurance for unemployed Americans who try to purchase coverage through a former employer consumes 30 percent to 84 percent of standard unemployment benefits, according to a report released yesterday.

    Because few people can afford that, the authors say, the result is a growing number of people being hit with the double whammy of no job and no health coverage.

    In 1985, Congress passed legislation enabling newly unemployed Americans to extend their employer-based health insurance for up to 18 months. But under the program, known as COBRA, the individual must pay 102 percent of the policy’s full cost.

    “COBRA health coverage is great in theory and lousy in reality,” said Ron Pollack, whose liberal advocacy group, Families USA, published the analysis. “For the vast majority of workers who are laid off, they and their families are likely to join the ranks of the uninsured.”

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