One would think I would be a fan of the recently passed, so-called health care reform. I have a need for regular medical care and I’m the walking-talking definition of “pre-existing condition.” I know the value of health insurance first-hand and reaching my lifetime limit is a legitimate concern.
The fact is, I am not, but not for the reasons you might think. There is no question in my mind that reform of some sort needs to take place, but I’m afraid that this solution is not the answer.
There are fundamental differences in the way many see the role of government and who should be footing the bill for such grand endeavors. I’m not even going to get into those arguments. The issues below are based more upon personal experience with medical insurance and medical care than on philosophical political differences.
Health care is a profit-driven industry.
• I have a private policy with Anthem Blue Cross, whose parent company is Wellpoint. When I first signed up for my policy in 1990 my premium was $27 a month. My most recent monthly bill was for $542. Starting May 1st, I’ll be up to $748 per month. Yup, a 38% increase in just one year. I’m one of the Californians that Anthem Blue Cross feels they aren’t making enough money on. You read that right. It’s not that they are taking a loss, they are just not making ENOUGH money.
Wellpoint CEO, Angela Braly claims the company lost $10 million on individually insured Californians last year, which may very well be the case. She argued that in this economy, of those with private policies, only sick people (ie: those who file claims) are keeping their insurance. Of course that’s what’s happening, premiums that rise at ridiculous rates drive out healthy subscribers. However, those of us with individual policies make up only about 10% of those who are insured by Anthem Blue Cross. In fact, Wellpoint reported profits of $4.7 billion in 2009. (That’s billion, with a B.) And while a $10 million (with an M) loss on the privately insured may sound like a lot, somehow Braly neglected to mention Wellpoint spent $27 million in 2007-2008 on executive retreats.
Anthem covers more than 8 million Californians, including about 800,000 who buy their policies directly. It is on those individually covered people that Anthem has proposed rate increases of up to 39%. While state Insurance Commissioner Steve Poizner is investigating the company’s plans, his office is largely powerless under California law to stop the rate increase from happening.
• In my previous post, I shared the story of my $70 x-ray that cost $800. Exact same images, just at different facilities. My co-pay on the $800 x-ray was more than the fully billed amount of the $70. So much for coverage. Medical providers can charge whatever they darn well please, with insurance companies only picking up the “negotiated” amount, leaving the patient with a large chunk of the tab.
Access to coverage doesn’t mean access to care.
As previously mentioned, I have pretty decent medical coverage. However, even with my level of coverage, I’m limited as to which tests I can have and what medications I can take. I have a pretty complex medical background and am fortunate that I can be seen at some of the top institutions around. Even so, my insurance has refused to cover certain medications, forcing my docs to come up with less effective alternatives. Because I’ve been heavily treated, I’m also at a much higher risk of developing long-term complications, such as secondary cancers. My docs and I have been trying for the past two months to get my insurance company to approve a standard screening test. Even though I meet their guidelines and had the same test the past two years, they continue to deny me. Does anyone believe that someone with a lower level coverage will get these tests or meds? It’s more likely that access is going to be even more difficult.
When you rush, you make mistakes.
This legislation was rushed and pushed through without a thorough analysis, or enough outside input. (Granted, trying to get politicians to work together is like trying to push a glacier while on roller skates, but reform of this size needed more cooperation. Instead of fighting with the Democrats, Republicans should have been fighting to be a part of the conversation. And Democrats should have been more interested in getting it right, rather than getting it done quickly, for fear of losing their hold on both houses of Congress.) Something of this magnitude should have been vetted much more thoroughly. There is already push-back from the insurance industry regarding coverage of kids with pre-existing conditions. The White House promised that all children with pre-existing conditions will be covered within six months. Not so fast. Turns out, they may not have to be covered until 2014, according to two White House agencies. The legislation was so poorly worded, that it doesn’t even say what was truly intended. Does anyone really think that this is the only poorly worded or ambiguous section? (CBS is my source on this.)
So, what?
So what does all this have to do with my argument against this health care reform legislation? Bottom line, it was rushed into and does nothing to address the primary issue: health care is an excessively profit-driven business. For the most part, all that matters is the bottom line, not the well being of their subscribers. And despite mandating coverage for all, there are apparently no checks and balances in this legislation to control costs and protect consumers.
I understand and agree that businesses should make a profit. Otherwise, why would anyone even be in business. Unfortunately, the health care industry has become too profit-driven. Wellpoint’s CEO argues that, “Insurance industry margins are dwarfed by the margins of others in health care.” For comparison, Wellpoint had a profit margin of 7%, the pharmaceutical industry had a profit margin of 20%, and biotech’s was 29%. True, Wellpoint’s was smaller. But these other two industries actually produce products. They have research and development costs. They are literally trying to cure cancer. All the insurance industry does is collect money from a whole bunch of people, then fight like hell to avoid paying it out.
I may be naive, and I am clearly not an expert, but there seems to be some common sense components that are not a part of this legislation:
• Allow insurance companies a reasonable profit, but with a cap.
• Permit competition across state lines for insurance companies.
Many times just getting something done is better than nothing. I hope I’m wrong, but I have a very bad feeling that this reform package is not one of those times.
Additional source: New York Times
Coming next: My favorite resources that explain the health care reform legislation.
