More thoughts on Health Insurance

So we're trying to solve a lot of problems at once with all the health care debate. One of them seems to be that people can't find affordable health care. I should have done this a long time ago, but just this morning, I shopped around for health insurance for the first time. A site called ehealthinsurance came up and I no longer believe that it's not possible for people to find affordable health insurance.

Before you disagree with me, let me define a few things. By health insurance, I mean partial coverage for future, uncertain, catastrophic events. In my opinion, this is what insurance was created to do and when we try to use it for something other than it's intended purpose, we will obviously run into some problems.

Insurance wasn't designed to cover events that have already happened. You can't buy home insurance on a burning house and expect them to fix it. And you can't expect us to manage pre-exsisting conditions in the same way that we manage future, uncertain, catastrophic events.

My point is, there are a lot of issues out there and we need to look at each them individually in order to find the best solution.

I'm going to attempt to list out the separate issues that seem to be lumped together when discussing health care reform.

Increased costs
1. Increased costs due to inflation
2. Increased costs due to lifestyle
3. Increased costs due to increased coverage
4. Increased costs due to better care
5. Increased costs due to medical malpractice
6. Increased costs due to medical malpractice insurance
7. Increased costs due to doctor fraud
8. Increased costs due to patient fraud
9. Increased costs due to an increased number marginally decreasingly effective medical procedures
10. Increased costs due to uninsured patients' care
11. Increased costs due to uninsured patients' use of emergency room care
12. Increased costs due to aging and the correlated increased risk of illness
13. Increased costs due to increased out-of-pocket expenses during prolonged illnesses.
14. Increased costs due to a lower risk group subsidizing a higher risk group
15. Increased costs due to increased risk of future, uncertain, catastrophic events
16. Increased costs due to increased cost of future, certain, catastrophic events
17. Increased costs due to increased cost of future, uncertain, normal events
18. Increased costs due to increased cost of future, certain, normal events

Uninsured
1. Uninsured because they don't want insurance
2. Uninsured because of a preexisting condition
3. Uninsured because of the high cost of the desired insurance plan
4. Uninsured because they don't want a cheaper plan with less coverage
5. Uninsured because a cheaper plan with less coverage is not available
6. Uninsured because of citizenship
7. Uninsured because of loss of employment
8. Uninsured because they are no longer covered on their parents plan
9. Uninsured because their policy was canceled
10. Uninsured because their policy was not renewed when it expired

Limits
1. Limits on maximum annual payments
2. Limits on maximum lifetime payments
3. Limits on approved medical tests
4. Limits on covered events
5. Limits on out-of-pocket expenses

I don't think I've listed out every aspect of health insurance, but my point is there is no silver bullet that is going to address each of these issues. Mainly, I'm just frustrated that politicians don't approach the topic of health care in any sort of deliberate or well-thought out way.

None of their proposed solutions are linked back to the problems they are attempting to correct. And none of the politicians give an objective and intelligent analysis of the proposed solution's effect on the issues at hand. If there is a politician that is doing this, please point me in the right direction.

College interns are better at responding to emails than Senators

So, I've been frustrated with my Senators for the past few weeks. There's a lot going on with the new health care proposal, so I thought I would do what I thought responsible citizens did and read the health care bill and write a letter to my senators. So I read the bill, not all of it, but most. There's a big section on how the health care bill will affect the IRS tax code laws and I'll admit that I skipped that part.

So after reading the bill (HR 3962), I felt like I had a much better understanding of what the proposal was. Since most information you get about the bill is usually slightly biased, I'd encourage everyone to at least take a look at the actual bill for themselves.

So I read it and had some questions about some parts of it, so I sent the following email to my senators, Dick Durbin and Roland Burris. The email has 10 fairly straight forward questions. Nothing that I thought would be particularly tricky, especially for someone who's job it is to read and vote on the bill the questions were addressing. And even more so for someone who is strongly in support of the bill.

Well to say the least, I was very disappointed. Bottom line, they sent me a form letter that acknowledge that the subject of me email was health care, but nothing substantial beyond that. What are we paying these guys for? We have over a dozen college interns at my office, and all of them do a better job of responding to my emails than my senators do. I just don't get it.

Now you are probably thinking some they don't have time to do it or his staff responded, not him. I may be the only one, but I don't see how either of these things are valid excuses.

So, here is an open plea to my senators. Please, please, please pay attention to us. We're the people you are representing. We're relying on you to help us govern the country so that we don't have to govern ourselves. Part of me thinks we would be better off with out you guys. Part of me thinks we would be better off governing ourselves. Please, please, please, show me that I'm wrong. Please show me that I can count on you. Please show me that you know that you really are working for us and that you still realize that we are the ones that are paying your salary and that it's ok for us to expect something in return.

My email:

I have a few questions about the public health care option.

1. What will the limits on coverage be under the public option? Since we obviously can't spend an infinite amount of money curing every disease, how much coverage will each person have under the public option?

2. If the premium is less than the expected costs (such as the limitations proposed in section 213 of HR 3962 and section 222.a.3), where will the remaining premium come from?

3. In section 222.a, paragraph 5 and paragraph 3 seem to be in contradiction. Can you please explain this?

4. What is the difference between the Health Insurance Exchange and the Public Health Insurance Option?

5. From reading the bill, it looks like the Basic Plan of the Health Insurance Exchange will offer the same benefits as those outlined in title II. With no limitations on annual or lifetime benefits, how will this type of unlimited coverage be paid for? Will we spend an unlimited amount of money on health care claims? If not, what will the limits be?

6. What problems are the proposals in title I and title II attempting to solve? How will Title I and Title II solve those problems? What are the pros and cons of these solutions?

7. What are the health insurance Cooperatives in Section 310?

8. Section 322.a.1.b.i says that the premiums for the public health insurance option will fully finance the costs? How will individuals that can't afford health insurance benefit under the current systems benefit from a public option that still requires them to pay the entire premium?

9. Section 343 seems to say, basically, that the premium will be lowered depending on the households income. Am I understanding this correctly?

10. It doesn't seem like there will be enough money to pay for this public health insurance plan. Can you explain that part to me?

Dick Durbin's Response:

Thank you for contacting me about proposals to give Americans the choice of a public health insurance option that will compete with private insurance plans.

I believe Congress should work to bring meaningful health care reform to American families. Health care reform should reduce costs for families, businesses and government; protect people's choice of doctors, hospitals and insurance plans; and assure affordable, high-quality health care for every American.

We are crafting a reform bill with these goals in mind. Those who like the health insurance they have will be able to keep it. However, a public option will provide a valuable alternative to today's private health plans for those who do not like their current plan or cannot afford coverage.

Too many Americans cannot afford the health plans offered by today's for-profit insurance companies. A public option will provide competition that will hold private plans accountable and help moderate the price of health insurance. No one will be forced to join a public option - it will be a voluntary choice available in addition to existing plans.

I will continue to work for a reform plan that provides stable and secure coverage, stable and affordable costs, and better quality care.

Thank you again for contacting me. Please feel free to keep in touch.

Sincerely,

Richard J. Durbin

United States Senator

RJD/kg

Roland Burris' Response:

Thank you for contacting me about healthcare reform. I appreciate the benefit of your views.

As your United States Senator, one of my top priorities is to ensure that my constituents have access to affordable, quality healthcare. Today, nearly 3.5 million Illinois residents, 30.8% of the under 65 population, lack health insurance. Those who remain covered face rapidly rising premiums. A Kaiser Family Foundation report found that average insurance premiums have more than doubled in the past nine years, and the New America Foundation projects that, by 2016, coverage costs for an average Illinois family could top $25,000 a year.

In the face of these challenges, I support reforms aimed at improving efficiency and access while reducing cost. A focus on prevention and primary care will help Americans avoid getting sick, saving billions on costly specialist and emergency treatments. Increasing competition in the insurance market, through a public option, will put pressure on insurers to reduce administrative costs, marketing, and high profit margins. This will result in a higher percentage of premiums spent on treatment and a better overall value for consumers. Expanded access to health insurance, provided through affordability credits, will eliminate the $1,200 “hidden tax” that the average insured Illinois resident pays in additional premiums to subsidize expensive emergency care for those who currently cannot afford insurance and bring premium costs within reach for millions of middle class families.

The pending reform effort has received the support of many of the nation’s most prominent medical, consumer, and senior groups. The American Medical Association, the Pharmaceutical Research and Manufacturers of America, the American Federation of Hospitals, Families USA, and the American Association of Retired Persons (AARP) all support reforming our health system, because they know that we face a crisis. As costs skyrocket, more people lose the coverage they need. Patients suffer, and businesses lose productivity. Insurers, hospitals, and doctors lose customers, and the entire healthcare system begins to break down. Currently, 14,000 people lose their insurance every single day. This is not acceptable in America.

A number of groups that profit from the current inefficiencies have spread false rumors about reform. I would like to take this opportunity to correct some of the misinformation.

“Government Takeover”: Some believe that a public insurance option will mean the end of private health insurance. On the contrary, the nonpartisan Congressional Budget Office (CBO) reports that if insurance reform passes with a public plan option, the number of people covered by private, employer-sponsored coverage will actually increase.

Rationing: Rationed care will not happen with reform. In fact, the bill takes a number of steps to prevent insurance companies from making your coverage decisions. Insurance reform will restore your doctor’s ability to treat patients properly, without deferring to insurance company bureaucrats who deny coverage and treatments.

Medicare: Rumors abound that reform jeopardizes existing Medicare coverage. The truth is, cutting waste, fraud, and abuse will assure the security of the Medicare trust fund for years to come. In addition, insurance reform will end cost sharing for preventative care, cut the prescription drug “doughnut hole” in half, and lower Medicare premiums.

Abortion: None of the reform proposals being considered would mandate coverage of abortions. Current federal law preventing government funded abortions; except in cases of rape, incest, or danger to the life of the mother; will remain unchanged. All versions of reform include a “conscious protection” clause, which allows doctors the right to refuse to perform an abortion, if doing so conflicts with their values.

Federal Employees: The Senate reform bill requires all Members of Congress and their staffs to enroll in the public insurance exchange. I fully support this proposal, as I believe that we Senators should have a personal stake in the reforms we propose.

Cost: President Obama has repeatedly stated that any reform must not increase the federal budget deficit and must control growth in medical spending. The Senate reform bill reduces our federal budget deficit by more than $100 billion over the next ten years, and takes important steps toward paying for quality, not merely volume of service, in our healthcare system.

Investing in reform now will ensure stability in coverage. President Obama has made very clear that reform will protect Americans’ right to keep their current health insurance policy, but changes will slow the rate of increase in premiums, offer protection and options for those who lose their jobs, and help those who cannot afford insurance.

I will continue to listen closely to what you and other Illinoisans have to say about matters before Congress, the concerns of our communities, and the issues facing Illinois and the nation. My job is not about merely supporting or opposing legislation; it is also about bridging the divide that has paralyzed our nation's politics.

Sincerely,

Roland W. Burris
United States Senator

As you can see from their responses, it's clear that they didn't read my email. I'm not sure, but they could have used the same approach when they decided to support HR 3962. It's frustrating that nothing in their response makes me confident that they have actually read the bill that they support.