Saturday, August 15, 2009

David Axelrod Loves Me!

. . . . because he sent me an email:

From: "David Axelrod, The White House" []

Dear Friend,

We're friends!

This is probably one of the longest emails I’ve ever sent, but it could be the most important.

Across the country we are seeing vigorous debate about health insurance reform. Unfortunately, some of the old tactics we know so well are back — even the viral emails that fly unchecked and under the radar, spreading all sorts of lies and distortions.

So let’s start a chain email of our own. At the end of my email, you’ll find a lot of information about health insurance reform, distilled into 8 ways reform provides security and stability to those with or without coverage . . . .

Let's count 'em:

1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

Oh goody, kind of like I can buy fire insurance after my house has already burned down. Seriously, if I can't be discriminated against because of pre-existing conditions, then I have no incentive to buy insurance until I'm already sick enough that my expenses exceed my premiums. This is guaranteed to drive premiums to . . . infinity?

2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

Why? What if I want a policy that exchanges higher deductibles for lower premiums? Shouldn't I be willing to forego coverage for any medical expenses I can pay out of pocket? This is guaranteed to drive premiums up.

3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

In addition to my criticism above, that these kind of regular checkups are cheap enough to pay out of pocket, are these checkups really cost effective for everybody? Shouldn't I be in an at-risk category to need them? Isn't this just subsidized hypochondria?

4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

I'm pretty sure this is already against the law.

5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

I read somewhere that lifecycle medical expenses for women are about twice what they are for men . . . unless she has children. Then they become three times as high. So this, in effect, becomes a transfer of wealth from men to women. (Or rather, from single men to men with wives. Sorry, guys, sucks to be you!)

6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

This doesn't sound like a bad idea, but you have to pay for what you get. It's guaranteed to drive premiums up.

7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

Why? Shouldn't 22 - 25 year-olds be paying for their own coverage? Isn't this just a subsidy for D.A. and everybody else still living in his parents' basement? Isn't this a subsidy from families who were sufficiently successful at their parenting to avoid this situation to families who weren't. But the bottom line is, you have to pay for what you get. It's guaranteed to drive premiums up.

8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

Isn't this already against the law? Okay, so far I count two redundancies, and six factors that will make private health insurance even more unaffordable than it already is.


Trumwill said...

Not sure about #4, but I'm pretty sure #8 is legal. One of my previous insurance companies maintained policies of time periods no longer than six months, at which point there was a review of your policy and they could decide not to renew. It was considered a given that if you got cancer while you were covered with them, you only had the duration of the term of the policy.

Regarding #7, I think that's for people going to grad school and whatnot.

On #1, isn't one of Obama's plans that everybody must get insurance coverage? Doesn't that kind of address your gaming-the-system (if not overall cost) concern?

Trumwill said...

Also, I think that #3 is a pretty empty gesture. The $40 copay for a doctor visit is not nearly as important to most people as taking an afternoon off work. People up the economic food chain have a higher time-is-money consideration. People down the food chain are more often in jobs with minimal hour flexibility and are less likely to have a stay-at-home spouse.

I suppose it could be more significant when it comes to tests, but in my experience (and maybe I've just had good health plans) the run-of-the-mill tests are mostly covered. Where I get dinged are the second-level tests. The basic glaucoma test was something like $10 out-of-pocket. The tests they ran afterwards when I failed the first test ran something like $200 OOP.

Burke said...

A provision in a health policy that says your insurer can drop you right at the point you need them most kind of defeats the purpose of medical insurance.

All you are really getting, then, is the negotiating power of the insurance company to get lower prices. Which is considerable, but not really insurance. It's like a pre-paid medical plan.

But does this really require legislation? Isn't there something to be said for "buyer beware"? I don't know, I'm just asking the question.

As far as the "individual mandate", that's kind of in that murky category, along with prescription drug price controls, where the answer keeps changing depending on the day and who asked the question. But if we stipulate that there is an individual mandate, then there will be NO SUCH THING as a preexisting condition because everyone will already have insurance by definition. So what's the point?

Trumwill said...

They can't drop you "right at the point"... but they can drop you at the end of your six month policy.

It's not about negotiating power (this was not work-based insurance). It's about avoiding gaps in coverage that open the door for insurance companies to label things you have as "pre-existing conditions" from whenever you weren't insured.

It's basically something you use as a short-term stop-gap in between jobs. I used them twice, I think. This time we're going with COBRA, provided the forms ever get sent out to me.

I think that the point of saying that there will be no discrimination against pre-existing conditions is that it makes a good sound bite. And if there is a mandate, there is something to be said for pointing out "Hey, look, this is something you won't have to worry about anymore."

Burke said...

Yes, I got the bit about the end of the policy term. But really, really bad illnesses last much longer. That's what I meant by still needing the "coverage".

By negotiating power, I mean this: if I have insurance, and receive medical services, the provider bills the insurer for $200. The insurer pays the provider $50, the pre-negotiated price for that procedure (or at least I assume that it's pre-negotiated; I have a file full of these billing statements that show my insurer paying providers pennies on the dollar). By the terms of the relationship between the insurer and the provider, the provider must eat this difference, not come after me for it.

But if I don't have insurance, I can't just decide to pay $50 on a $200 bill; in that case, the balance gets turned over to a collection agency, I get a lien on my house, etc. That's the advantage of having insurance even if it only covers what ought to be routine expenses: it effectively buys me substantial insurer-negotiated discounts on medical care.

I've only ever had work-provided coverage, so I don't know what COBRA is. I gather the issue of pre-existing conditions only applies to individual plans, not group or employer-provided plans. But yeah, getting sick enough to lose your job AND your health insurance at the same time really, REALLY sucks, because then it's too late to purchase an individual plan that covers the illness you already have.

But . . . how many people fall into this category? Do they justify the far-reaching changes that are being proposed? Does the proposal create more problems than it solves, like making coverage more expensive?

BTW, sorry to hear about both you and Clancy being without employment right now. Somehow I got the impression that you followed her out to Cascadia because she had a pretty secure doctor job out there. (Or maybe I was thinking of my brother-in-law.)

Trumwill said...

My theory is that the negotiated rates you're referring to are a big scam. I *always* seem to get better rates when I pay up-front than the rates I see (and pay via deductible) when I am going through an insurance company. My doc in Deseret charged me $120 for a visit before I was insured and then when I was insured I ended up having to pay $200 towards the deductible. My dermatologist similarly had a $130 "rate" but if you paid on the spot it was magically $95. Not sure if that was more, less, or the same as the "insurance company negotiated" rate. Any my clinic back in Delosa charged me $90 and the insurance company $130 for most visits.

Of course, this is largely run-of-the-mill stuff. If they have to break out an MRI machine, it may be a different story. My theory is that when you pay up front, they'll give you a deal because they won't have to submit and resubmit paperwork and then go after you for whatever the insurance company turned out not to cover.

COBRA is a government mandate/incentive that says that if you lose your job, you still have a right to the same insurance plan for a period of time (usually 18 months, but it can be more). You have to pay the full freight, though. So it's expensive, but it's a more comprehensive plan without the provisions like Fortis had that made it practically worthless. I'm not sure how long until they can dump you, but it's at least nine months.

Right now, though, the government is picking up a significant portion of the COBRA tab. 65%. Since my contracting agency was practically picking up none of the tab before, it'll make my health insurance unemployed cheaper than it was when I had a job.

As far as whether or not Obama's plan is worth it, I'm of the mind that it is not. I am/was against it. I am in favor of the government taking a larger role in health care, but not the role that Obama is/was advocating. I can think of a number of ways it could be done better. I'm not sure how politically feasible they would be, but then again The Public Option turned out not to be feasible, either.

It seems that everyone hates the health care system right up until someone wants to change it.

The unemployment was expected. It was a one-year contract after which we knew she would be unemployed. My own one-year contract was very convenient in that I didn't have to be deceptive about how long I intended to be with the company, though it's inconvenient that we both lost our job on the same day. We saved accordingly, though, and there are always ways for doctors to make money in contract work if our funds run dry.