An Example of Why We Need Health Care Reform

Submitted by Lawrence Rafferty-Guest Blogger

 

With the recent news of an appeals court decision that struck down the individual mandate portion of the Health Care Reform act, the problems with our Health Care system is on the front page again.  While we hear politicians claim that the market place should decide all health care cost and access issues, millions are without coverage and the costs Americans pay for health insurance is staggering.

When I opened my business last Fall, I was shopping for affordable health care coverage.  My wife teaches in a middle school here in Illinois and we eventually went with her School District’s cheapest family coverage.  We joined a HMO which required us to change the doctors that we had both been going to for 20 years, but the cost concerns were overriding.  Our cost for the coverage is approximately $550.00 per month for the two of us.  Now, imagine my shock when I read that Florida Governor Rick Scott and other State legislators pay $30.00 per month for family coverage!

“Scott is among nearly 32,000 people in state government who pay relatively low health insurance premiums. It’s a perk that is available to high-ranking state officials, including those in top management at all state agencies. Nearly all 160 state legislators are also enrolled in the program that costs just $8.34 a month for individual coverage and $30 a month for family coverage.   Brian Burgess, a spokesman for Scott, confirmed the governor and his wife are enrolled in the state health insurance plan, but refused to discuss why Scott signed up. He called the governor’s health care coverage “private matters.”  The health insurance coverage provided to Scott used to be free for top state officials until 2010. Rank-and-file state workers pay $50 a month for individual coverage and $180 a month for family coverage. Married couples working in state government also pay the same amount as Scott and legislators.”  Miami Herald

As you can see from the Miami Herald quote above, Gov. Scott is paying the same rate that state legislators pay for family coverage.  I have no problem with an employer like the State of Florida paying for a nice health care insurance plan for its employees, but when the politicians on both sides of the aisle piggy back on that system and sometimes pay even less than full-time state employees, and then turn around and vote to deny other people the opportunity to obtain quality care at a reasonable cost, the morality alarm goes off in my head.  (My morality alarm consists of visions of the good Benedictine nuns chasing me down a hallway with a yardstick in hand.)

You may remember that Gov. Scott has made a name for himself by refusing Federal Affordable Health Care Act funds for his state in the past.  First Coast News  Those are funds that would provide health care savings and access to his Florida residents who don’t have coverage, but what is good for the goose, is not good for this politician gander!

After reading the Miami Herald article it seems clear to me that my wife and I need to move to Florida and run for the State legislature and then present a bill to make every Florida citizen an employee of the State and maybe then Florida can get affordable coverage for all of its citizens without that evil individual mandate.

Submitted by Lawrence Rafferty-Guest Blogger.

72 thoughts on “An Example of Why We Need Health Care Reform”

  1. A lot of people focus on insurance companies and their “obscene” profits and salaries. Accepting that this is a problem, I wonder why people are not looking at the doctors as well. I see enough news reports about doctors making huge, dare I say obscene, salaries and profits on sales of services to lead me to conclude that doctors are taking advantage of us.

    I’ve seen news reports showing that some doctors have billed Medicare millions of dollars a year. Unfortunately, the law gives these doctors a shield of privacy so we don’t know their names only that they exist.

    How much profit should an insurance company be allowed? How much should an insurance company executive be allowed to earn? How much should a doctor be allowed to earn in a year? If a doctor is employed by a corporation, should the amount she earns be restricted, say to the same level that the insurance company executive gets? Inquiring minds want to know.

  2. rafflaw & Jay S.,

    I’m paying well over $800 a month. I did choose the most comprehensive coverage offered by the town that I worked for in Massachusetts. I’ll be applying for Medicare soon.

    *****

    Dr. Selkin,

    “And second, let’s make Medicare available to every American.

    “As a nation, we’ve allowed healthcare to be co-opted and doled out by for-profit companies. And for this, we should be truly embarrassed.”

    I agree. It’s a great shame what has happened to the cost of health care and medical insurance in this country.

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  4. Sorry for the double post, I mistyped the link above.

    Raff,

    I am very impressed by this thread; no one has resorted to name calling, none of the stuff you see on less worthy blogs, you know things like:

    Rick Scott is Lord Voldemort!
    Rick Scott is Skeletor!
    Rick Scott is Lex Luthor!
    Rick Scott is Gollum!
    And my personal favorite 🙂
    Rick Scott is Bat Boy!

    https://secure.wikimedia.org/wikipedia/en/wiki/Bat_Boy_(character)

  5. Clarification: The medigap is for two of us, me—and my bride of 55 years.

  6. I am older than raff by several years. I have Medicare and a medigap policy through AARP. The medigap policy runs over S400/month and is well worth it. When I go to the doctor I do not have to pay anything unless we wanted something not covered like vanity plastic surgery or something Medicare regards as unnecessary.

  7. Jay S.,
    you must be new. I am 60 years old and my wife is 59 years young. Our policy is an HMO and not a PPO. It sounds like you might have a PPO which is more expensive here as well.
    Nice link Woosty!

  8. Holy mackerel – only $550 per month for two? You must be very young. It costs us almost three times as much for a mid-level private policy in MA.

  9. Otteray Scribe’s opinion is that the Medicare model should be used for all of us. I wrote a comment about Medicare in response to that idea.

    Elaine –

    I was unfamiliar with Medex, but if I can trust the internet, one of its products is Catastrophic/Stop Loss Coverage (i.e., private insurance). (I’d be glad to hear if it is something else.)

    Because your mom is paying for insurance in addition to her Medicare, I don’t think that is fully germane to Mr./Ms. Scribe’s idea. Nevertheless, it sounds like the government system (Medicare) is great, provided that you also buy private (or quasi-public) insurance.

    Shano –

    How old do you suppose I am?

    Medicaid (in my state) uses what appears to be the Swiss model as you describe it. While I can’t speak to bankruptcy, I can say that people are routinely denied services that their doctors have found medically necessary.

    And yes, Medicaid is better than nothing (unless of course the treatment your doctor prescribes is not covered), and I acknowledge that the current system needs to be improved.

    I am addressing the question of how to improve the system. I read comments that, to me, sound as though if the government takes over as the single payer, then our problems will solved. But because there are problems with how the government provides health care now, I don’t accept that putting the government in charge will fix things.

    One problem with Medicaid is that it is a form of insurance, not medical treatment. I’d rather see a focus on treating people as opposed to creating or modifying forms of insurance. One method would be to use clinics. I understand that some (big, bad) corporations are trying to use that approach, only to have the AMA object.

    Dr. Selkin –

    I posted this link on the thread “Court of Appeals Strikes Down Individual Mandate.”

    http://scc.lexum.org/en/2005/2005scc35/2005scc35.html

    When I read that other industrial nations have consistently better outcome than the US, I find that hard to square with the Canadian Court’s opinion as to the outcomes in Canada, which found that “Waiting lists are therefore real and intentional.” See paragraph 39; see also paragraphs 112, 113, and 114.

    As to the profits of corporations: did you work for free? Is there a maximum that a doctor should be allowed to make each year? How much have you made these last 38 years?

  10. We should never be having this debate. While other industrialized nations treat health care as a moral or ethical issue, the US treats health care solely as an economic issue. We should take advice from those other nations: they spend far less on health care than we do—and they have consistently better outcomes.

    I’ve got two suggestions about Medicare: First, get rid of the unconscionable supplements to all Medicare Advantage plans. Medicare Advantage costs every taxpayer 14% percent more per beneficiary than traditional (government) Medicare. And they don’t have better outcomes.

    Getting rid of those supplements will certainly bring costs down—and will pay for all Medicare patients to see whichever physician they choose.

    And second, let’s make Medicare available to every American.

    As a nation, we’ve allowed healthcare to be co-opted and doled out by for-profit companies. And for this, we should be truly embarrassed.

    And by the way, for the past 38 years, I’ve been a physician in private Ear, Nose, and Throat practice. I also have a law degree.

  11. Shano said: “We could evolve into a system something like the Swiss: they use private corporations, but the profit margin is capped at 5 or 6% and there is still competition for good service, efficiencies, etc.. That is reasonable and denies them the avenues of abuse that denies health care to people and drives people into bankruptcy and penury.”

    Except for the cap, that’s what the US does. Medicare claims submitted to the SSA office are forwarded to Medicare. Some doctors submit directly to Medicare. The actual claims are processed by insurance companies like Aetna and Blue Cross. In each state, some private company has the contract to process Medicare. One company handles all Medicare claims for Railroad Retirement Board beneficiaries.

    Ross Perot made his fortune processing Medicare claims. His company got the contract for a lot of states after he contributed six figures to Richard Nixon.

  12. Also, mahtso, even when Medicaid was not all that great in your experience, it is better than having nothing, which is what many many Americans have- nothing at all- and bankruptcy after an illness.

    Nice to know you can get health care in this nation even if you have to live under a bridge after they manage to cure you.

  13. mahtso: hahaha, take your chances with the private market? Lets see, when you turn 50 they will write you out of most of the coverage you will need in the future and then raise your premium every year after that. They will find a way to drop you altogether when you turn 60.

    People need to realize one reason we even have Medicare is because private insurance corps would not insure this group! I think we should go to a Medicare for All system, having younger and healthier people paying into Medicare will drive costs down.

    Insurance corporations ADD NO VALUE. They only push papers around. The only way they can increase profits is to deny medical expenses.

    We could evolve into a system something like the Swiss: they use private corporations, but the profit margin is capped at 5 or 6% and there is still competition for good service, efficiencies, etc.. That is reasonable and denies them the avenues of abuse that denies health care to people and drives people into bankruptcy and penury.

  14. mahtso,

    My mother has been covered by Medicare and Medex for nearly three decades. Her most recent stay in the hospital last year was completely paid for–as were her other stays in the hospital and all of her doctor’s visits over the years. Lots of people on Medicare pay for supplemental coverage like my mother. She currently resides in a nursing home/rehabilitation facility in Massachusetts. She has lived there for more than a year. She never had to pay $11,000 for a 100-day stay. Maybe the situation is different in other states.

  15. To find out more about Medicare, I went to Medicare.gov, which provides:

    “Medicare Part A (Hospital Insurance)
    * Helps cover inpatient care in hospitals
    * Helps cover skilled nursing facility, hospice, and home health care”

    The write-up on Parts B and D also used the words “helps cover,” which to me implied that Medicare will not be covering all of a person’s bills. At webmd, I found that

    For hospital stays, “for the first 60 days, you pay a maximum of $1,132 and Medicare pays the rest. After that, the longer you stay, the more you pay. You pay $283 per day for days 61 through 90. After that, you pay $566 per day until the 60 days of “lifetime benefits” run out. After that, you pay all the costs.”

    And there are similar limits on skilled nursing facilities (100 day max payment with member paying $11,000 for a 100 day stay.

    If this is single payer, I’ll take my chances on the private market.

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