Protecting a Lousy, Overpriced Product

by: Natasha Chart

Fri Jun 05, 2009 at 10:45


The 'trigger' debate on a public option is sickening.

Legislators who don't get that the healthcare system is already broken when 22,000 Americans can die for lack of coverage in a single year, or where 78 percent of healthcare-related bankruptcies involved people who had coverage when they first got sick, such disinterested aristocrats are hardly proposing a good faith effort to fix the situation. They can't even see a problem with what we've got now.

Sen. Ben Nelson (D-NE), for example, doesn't want to come down against the popular public option, but doesn't want one that will 'erode the current system.' In previous statements, he's declared opposition to any competition with private insurance, which presumably means no price competition or improvements in quality of coverage.

So Wednesday, I called an insurance agent in Pennsylvania to find out what I was eligible for under this system Sen. Nelson is so enamored of.

Natasha Chart :: Protecting a Lousy, Overpriced Product
I'm a single woman of 34, with a history of migraine but not currently taking any medication. The costs for the six plans I was quoted over the phone before medical underwriting, where they check a database to see what you've been diagnosed with and prescribed over the course of your life, ranged from $175-$349/mo.

If I wanted a HealthAmerica PPO plan with some out-of-network coverage, the plans were generally more expensive. A hospital stay would either set me back $200/day to a maximum of $1,000 (the most expensive plan), or the full $3,000 deductible (the cheapest plan). None of these PPO plans covered either maternity or childbirth costs.

To get coverage for having a child, which would be of concern for some women my age, I would have had to go with one of two Aetna plans, both HMO plans, where some HMO bureaucrat in Connecticut would reject any costs incurred from out-of-network healthcare. The out-of-pocket for hospital stays was either $400 or $500/day, to a maximum of 5 days, with yearly deductibles of $4,000 and $5,000, respectively.

I could have called for a quote from UnitedHealthcare, the company called out by Elizabeth Edwards in a recent Daily Show appearance. But just last week, I was talking with a self-employed hair stylist who owns his own salon, and he canceled with them because he found it too expensive. As an added insult and months after the fact, he recently got a letter from them denying the one doctor's visit he made while he was covered.

I could also have looked in my own mail. Just last month, I got a letter from UnitedHealthcare, the coverage I'd had for a year through my brief tenure as a student at George Washington University, rejecting a $319 claim for a diagnostic test which my doctor considered medically necessary. Some UnitedHealthcare bureaucrat in Minnesota thought they knew better than my doctor, and I'm sure they're hoping that I'm too disorganized (they may be right) to attempt to get them to pay this bill before the collection agency starts sending me nasty letters and calling several times a week.

And if I should prove to be as disorganized as they're hoping, I'm past caring about threats against my credit rating. If I have money, I'll pay them, if I don't I'll tell them to try back next month. I've hit "the number", my credit is utterly destroyed already, and it doesn't matter any more.

Sallie Mae, a student loan provider so stingy that they don't even include return envelopes with their bills, stopped giving hardship deferments last year. So did Nelnet. My total monthly income is about $2,000, my cumulative monthly debt payments to all lenders from the time when I was a student are about $1,400. I stupidly thought there'd be jobs or something when I got out of school.

As to the remaining $600, give or take, I can't function without a phone, or at least I'd rather not. Occasionally, I like to buy food, maybe see a movie or have a drink now and again. Where I'm going to come up with $200-300/month to pay for insurance, I don't know.

(I'm confident that I can fix this situation, but if I get sick in the meantime, I'm going to be so, so screwed.)

People are naturally not supposed to complain about this sort of thing in public. I'm supposed to feel so ashamed of the crime of being unable to pay my bills and have a reasonable standard of living afterwards, that I should just stfu. Screw the thousands of dollars of dental bills I'd racked up from years of not being able to afford a dentist or the costs of moving thousands of miles in an attempt to make something of my education. It's my fault for not predicting that I'd have fewer economic opportunities as a college graduate in 2008 than I did as a high school graduate during the 1998-2005 timeframe.

In fact, this mentality that blames people ground down under the economic system of which healthcare is only one facet, is so entrenched that people will blame perfect strangers for deciding to have children and then losing their income. As chances at the American dream recede for ever more families, such shaming becomes increasingly absurd.

Nelson and the 'moderates' in Congress want to wait until more people have ended up in poverty or died because of our deeply broken economics, where a public official is unashamed to say in front of God and everybody that they're more concerned with the health of the insurance industry than the health of American citizens.

A majority of American households included a member who delayed or went without healthcare last year. The cost of all that delayed and foregone care went to insurance companies as profits, extracted almost literally from the bodies of their customers. This doesn't happen in Costa Rica, not even in poor, rural farming communities in families whose yearly income is around $4,000 per year.

Insurance companies make a lousy product that kills people and leaves Americans with lower life expectancies than people in 49 other countries. Their interests should stop mattering more than those of the people whose lives they wreck and whose entrepreneurial spirit they stifle.

Update: I'd love to mix it up with y'all down below, but I can't get the comment features to work on my computer. It's probably a Windows Vista thing, no one else seems to have this problem. Anyway, thanks for sharing your own stories.


Tags: , , , , (All Tags)
Print Friendly View Send As Email
This business about people being satisfied with their current plans is a bit outdated. (4.00 / 6)
Yeah, I'm quite satisfied with the plan I had five years ago but I don't have that plan anymore.  Instead I have the version with the $2,300 deductible - the one I had to switch doctors to stay in-network for.  Corporations all over America are working HARD to reduce the benefits they provide and shift costs onto their employees.

"The current system" is not a static plan that isn't changing.  It's being undermined by corporate America every day.  It would be nice of some of these "Democrats" would acknowledge that fact and actually, you know, take it into consideration when formulating public policy.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


I know what you mean... (4.00 / 2)
I used to love my BCBS plan... PPO... Free... $200 deductible... it was great.   NOW, I'm on an HMO... I hate it... its a pain in the ass to have to get referrals for everything.  I pray for the public option... Obama appears to be pushing it hard.   I will never give a dime to any Senator or COngressperson who votes against the public option... I don't care if control of the Senate is at stake.

[ Parent ]
Public option (4.00 / 4)
I simply have to have the public option.   I've survived a couple of cancers and am healthier than a lot of the younger kids who work with me, but if I couldn't get insurance through my job, I wouldn't be able to get it at all.   No private insurance company will even talk to me, and I'm stuck in a dead-end job until Medicare kicks in.  

All I really want is the same kind of insurance that I'm having to help buy for Senator Nelson.   He gets government-run health care. He's happy with it.  He just doesn't want to share.


[ Parent ]
Agreed (0.00 / 0)
While I'm not so sure your basic statement is statistically true (I actually think it is not), it should be obvious to all that the status quo will destroy in current plan one still has.

For myself, I had the option to move to a "cheaper" plan that really sucked.  (I use quotes because it didn't cost any less then a good plan only a year or so ago.)  I decided to keep with the old plan, but it went up something like $100 a month this year.

My good plan is an HMO, which I know many others hate.  I didn't even look at what the non-HMO plans cost, other than to note it was much more.

And this is me with a good corporate job, good health and so on.  In other words, I'm pretty sheltered from all this.  If even I notice the problems personally, they really effect everyone directly.


[ Parent ]
Which statement of mine do you find to be not statistically true? (0.00 / 0)
As for HMOs - ever since an HMO doc diagnosed my wife as a hypochondriac when she actually had a brain tumor - I ain't goin' there again.  HMO's are great, until you need them.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

[ Parent ]
Statistic (0.00 / 0)
I was commenting on your Subject line:

This business about people being satisfied with their current plans is a bit outdated.

I've seen some fairly recent polling (within the year, at least) that show most people want to keep their current health care plan and are happy with it.

But I think you are correct about general trends.  The number is going down, I suspect, and each person who changes his or her mind has a story.


[ Parent ]
Thank you (4.00 / 4)
Progressives have not challenged this idea, and it is a crucial part of the insurance industry's attempt to maintain their death grip on our system.

That said...that charge, and most of those in the diary, would apply equally well to most of the push for the public option, no?

National Nurses United (AFL-CIO) is America's RN union, representing 150,000+ nurses from all 50 states.


[ Parent ]
I am not sure I agree with you about the public option. (0.00 / 0)
Yes, I agree true single payer would be better, and a "crippled" public option wouldn't be any good at all.  But a "decent" public option that provided real competition could make a difference.  

I know that the private insurers have played games in Medicare, but they still had their non-medicare business to keep them afloat.  With that endangered too, I suspect that the worst private plans would begin to go under and there would be momentum toward the government-provided option which would be better.

Why, do you think, are they trying so hard to weaken the public option?  I liken it to Lincoln's prewar plan for "stopping the spread of slavery".  The slaveowners weren't fooled.  They didn't want a slow death any more than they wanted a fast death.

In any event, I think we are going to see where the bottom line is drawn in the next few weeks.  But hey, if we can get single-payer, great. I still just don't see it happening.  In any event, all pressure is good pressure here.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.


[ Parent ]
It's a complicated debate... (0.00 / 0)
And as you agree with the merits of single-payer, it's more of a discussion....

But one of the ideas here is that the public option will leave untouched most of the problems in our healthcare system.  For example, today's PNHP study showing that most medical bankruptcies were by people who did have healthcare.  Also, the problems within hospitals wherein the delivery of care is distorted by the irrationality and intransance of insurance companies.  Also, the well-known tendency for insurers to cherrypick via adverse selection, which may well end up with a two-track healthcare system, with the poor and sick on the public dime and the employed and "desirable" generating private profits.  Etc etc ad infinitum.

So, if this is our healthcare moment, that's a lot to not be addressed.

Nonetheless we are hopeful in terms of the obvious effect we're having on the debate, from Baucus' backtrack to next week's Congressional hearing on single-payer to the increase in media coverage.  I would offer that up to pessimistic progressives who at the beginning of the debate accepted Washington's parameters on what's possible.

be well, all.

National Nurses United (AFL-CIO) is America's RN union, representing 150,000+ nurses from all 50 states.


[ Parent ]
cost of childbirth (4.00 / 2)
I have had two midwife-attended hospital births with virtually no interventions (no IV, no pitocin, no induction, no epidural, no c-section, no episiotomy, etc.) I was out of the hospital less than 48 hours after each birth. The total bill from the hospital each time was something like $5,000, which did not count the $3,500 my midwife charged for prenatal care and delivery. My insurance covered most of the cost, but good luck if you're uninsured.

If a woman has an epidural, add at least a couple thousand to the cost. A cesarean will add around $10K to the cost, and in many states the c-section rate is 30 percent.

Even a home birth with a less expensive midwife will cost you $2,500 to $3,500, and most insurance (including Medicaid) won't cover any of those costs.

Natasha, are you eligible for Medicaid? You should look into that if you haven't already.


Join the Iowa progressive community at Bleeding Heartland.


morbid (4.00 / 1)
It seems to me these folks would rather folks die than go into poverty. If you hung around just in poverty, then they'd have to figure out some ways to help at least a little bit but if you were dead then they don't have to worry at all.

Bingo! (4.00 / 2)
Sad but true. I was talking to my dad (on Medicare) and they won't cover his heart medication at ALL which is so expensive that if he didn't have other coverage, he would die. When I asked him what are you going to do if you get laid off and he said, die...that's what they want, otherwise why else not cover it.

[ Parent ]
Ouch! What a story (4.00 / 2)
I'm a retiree and pay $96 monthly for Medicare, which is deducted from my Social Security check, and another $96 to Blue Cross for prescription drug coverage and Medicare supplemental. I gave that example in my calls to some senators this morning. When you look at OpenSecrets.org for large donor groups, retirees are right up there, esp. to Obama and Clinton in 2008. So, all retirees you know - ask them to call as well.

I plan to contact the Democrats who haven't come out for a government-funded option. I started this morning with MoveOn.org's group. I told the staffer who answered for Baucus, 202-224-2651, that retirees want reform. Calling Bayh, 202-224-5623, I left a 4-minute message. Cantwell's staffer at 202-224-3441 said she was for a comprensive plan but was studying how to fund it. Carper's staffer at 202-224-2441, took my zip code and said he'd pass on my message. Conrad's staffer at 202-224-2043, said he couldn't speak for the senator, but would take my comments, so I gave my story again. Patty Murray, 202-224-2621 had a message that invited you to call back later or send a fax or e-mail with your comments. Feinstein's answering machine message couldn't take my comment and Bill Nelson's line was busy! Spoke with 4, left 2 messages and 2 strike outs - not bad for my efforts this morning.

I'd like to share a resource posted at Health Justice by Ken Koldewyn, Top Ten Enemies of Single Payer. Thumbnail stories provide good ammunition when calling should your own experiences not be sufficient! How likely is that?  


My MD mom considers United to give the worst coverage out there. (0.00 / 0)
Quite a race to be winning.

Credit Rating (4.00 / 3)
What's "the number" to hit? I know mine is awful to the point that threats to it are laughable. It's rather liberating in a way.

Product liability is indeed the issue (4.00 / 1)
When an unscrupulous insurance contract left me and my family owing over $40,000 (really!) in medical costs, I sent an urgent complaint to our state regulatory agency about the practices of of the insurance provider (MidWest National Life). Some of my argument was based on an article by Daniel Schwarez from the William and Mary Law Review that stated:
"Just as firms that make defective products must pay for resulting injuries, insurers that issue defective insurance policies should have to provide coverage to insureds . . . . Products liability law offers important insights into how courts can efficiently correct failures in insurance markets by encouraging effective disclosure to consumers and appropriately setting penalties so that insurers take an optimal amount of care in drafting policies."

Of course, the response to the complaint was that the state regulation authority had no "legal authority." However, as a commercial liabilty insurance professional informed me, if it had been a commercial insurance contract, the burden would have been on the policy provider to show that there was understanding about the contract obligations. So the nutshell: medical insurance providers don't have the restrictions that other consumer or commercial providers have.

thanks for the post (0.00 / 0)
my situation isn't any better...

I'm supposed to feel so ashamed of the crime of being unable to pay my bills and have a reasonable standard of living afterwards,

don't feel ashamed, that's for the ben nelsons of this world

I can't understand how people can look for how to make money from the health-care needs of others, and not on how they can help them meet those needs money be damned. I don't understand how can there even be question.


ps (0.00 / 0)
two thumbs up on the youtube clip!

[ Parent ]
Health Insurance in Pennsylvania (0.00 / 0)
And keep in mind that Pennsylvania has the best coverage for the least money. People move here from other states for the health insurance!

Donate to Open Left








Friends of the Earth thanks the OpenLeft community for the ideas you generate and your contributions to the progressive movement.

As an anti-spam measure, there is a 24-hour waiting period after registering before new users can comment.
blog advertising is good for you
blog advertising is good for you
SEARCH

   

Advanced Search