My family and I have “good” insurance. Oh, sure, I’ve spent dozens of hours fighting our insurer to reimburse us for life-saving cancer drugs that my husband had the temerity to need while he was in Germany, where those drugs cost somewhere between a tenth and half the price that they would have been in the U.S. They didn’t come with the exact same package size or dosage as is standard in the U.S., and so our insurer initially rejected some thousands of dollars in claims. Never mind that my husband saved them some tens of thousands by becoming critically ill while in Germany instead of Ohio. I contested those denials and won most of them. That’s what it means to have “good” insurance.
But yesterday, I just about blew my top on account of the latest hassle from our “good” insurance. On July 1, our employer switched to a new prescription mail plan, Express Scripts. That meant all of us employees needed to set up a login on this mail-order pharmacy’s website. I tried to enter my info, and the screen kept kicking out my email address. I tried setting up a login for my husband – easy peasy. But I couldn’t set up a login for myself.
After about an hour of wrestling with the website and talking with condescending phone reps “patient advocates” – I’ll spare you the tedious details – a supervisor finally informed me that their system wasn’t malfunctioning. Instead, the problem was that my employer hadn’t contracted for dependents to have access to their own prescription information. All my prescription management has to be done through my husband’s ID. All prescription reminders have to go to a single email address; it’s impossible for each partners to get a reminder sent to his or her individual email account.
How is this fucked up? Let me count the ways!
First, this has got to be in violation of HIPAA privacy rights. The Express Scripts supervisor told me that it’s HIPAA compliant. I don’t see how that can be squared with two basic premises of HIPAA: 1) no one but me has the right to access my medical records unless I waive that right, and 2) I have the right to access my own own medical records!
Second, this is just sucky customer service. “Express Scripts” is a wonderfully ironic name. I spend a good two hours dealing with this problem yesterday. (Add another hour for time spent calling physicians offices for old prescriptions that hadn’t transferred and complaining to HR that my kids weren’t on the plan at all).
Third, denying access to dependents decreases efficiency of service and drives up costs for Express Scripts, which will surely be passed along to subscribers. They supposedly want patients to use the website, judging from the message on autoloop played after you’ve dialed customer service and are put on endless hold. But in fact the only way I could access my information yesterday was through talking with a real (and rather snotty) person, who first implied that I must be doing something wrong if I couldn’t sign up for a login.
Fourth, given that the website is the only place where a patient can view her prescription records, lack of access could be medically dangerous. If you’re on multiple medications, they can be hard to keep track of. Plenty of illnesses, from HIV infection to mental health problems, can be exacerbated if you miss a dose.
Fifth, this system is absolutely infantilizing for the “dependent.” I’m 45 years old; I want to be able to manage my own health problems without always having to ask my spouse to do me the favor of forwarding emails, etc. Obviously I know his login and password – I set it up for him, after all, with his permission – but lacking access to one’s own record is structurally and symbolically infantilizing, nonetheless.
Sixth, this system is almost guaranteed to produce sexist effects. My employer’s policy says that when both partners work for the university, premiums for family coverage will be charged on the higher-paid employee. Since the university is the biggest dog in town, quite a few couples are in this position. I’d be very surprised indeed if women don’t make up a strong majority of “dependents” who are also employees in their own right.
And finally, for couples where one partner is controlling or abusive, denying the “dependent” partner access to their own records could subject her (or him) to further abuse. Obviously marriages where one partner tried to control the other through access to needed medications have much, much deeper problems. However, it’s because such marriages (unfortunately) exist that HIPAA privacy protections extend into the family.
Of course I called HR about this. Express Scripts told me that they do offer plans where dependents can access their information. Ohio University could have chosen to include this in their contract with Express Scripts. I asked HR why they didn’t do it. HR will “get back to” me. (Ha.) While I’m waiting for a response, I have plenty of time to ponder how this is just one of many, many ways in which our current system fails to deliver humane, rational, and efficient care and may be driving the need for blood-pressure meds and anxiolytics.
I don’t know if the now-endangered public option will be a panacea. It has the potential to fail, economically and politically, if private insurers are allowed to cherry-pick the lower-risk customers. But abandoning the public option would be even worse, for reasons Robert Reich outlines:
Without a public, Medicare-like option, health care reform is a bandaid for a system in critical condition. There’s no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there’s no way to get overall health-care costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers — thereby opening the way for private insurers to do the same.
(The rest is here. Have I mentioned lately that I adore Reich?)
Yup. Isn’t it ironic that it’s now us liberals who are trying to introduce some real competition to outfits like Express Scripts? And that it’s the conservatives who are terrified of a little competition and cost control?
Update, 8/19/09, 12:30 p.m.: Late this morning I had a good conversation with the HIPAA privacy “team leader” for my region. He impressed me with his thoroughness and professionalism; it was worth waiting for a callback, and far preferable to speaking with an unknowledgeable phone rep. He had to be circumspect because he can’t prejudge a situation, but he basically agreed that there are two potential issues here: the dependent’s lack of access, and the primary policyholder’s access to an adult dependent’s information. The first is not a HIPAA issue if my employer’s notice of privacy practices specifies that we must ask for our personal health information in writing – which my employer indeed does – except that there may still be an issue of discrimination if dependents are treated differently than their insured spouse. On the second point, Ohio University’s privacy notice says: “Unless authorized by you in writing, your health information: (1) may not be disclosed by the Plan to any other University employee or department …” My husband is a university employee, so OU would seem to be violating its own policy on this score.
In short, if anyone is in violation of HIPAA privacy provisions, it’s Ohio University, not Express Scripts (which is guilty only of poor customer service). I’m still waiting to hear back from HR. If I don’t, or if I get an unsatisfactory, I have enough information to lodge a formal complaint. To those critics who complain that the government can’t do anything right and therefore can’t be entrusted with health care: My experience this morning shows that this needn’t be the case.
Patron cat of Kittywampus (1985-2001)
Well, the wingnut wing of the party is mostly terrified that we have a black president, not so much that we might reform health care. And the GOP members in Congress (aside from the true wingnuts like Bachmann (R-MN) are simply protecting their friends in the health-care business.
In fairness, that’s what our “moderate” (opposing the public option that every poll says at least 50% support, if not higher – how the hell is that “moderate”?!) Democratic Senators are doing as well. Can’t touch the industry’s profits that were created by the “free market.” Because to touch those profits would be to touch the campaign coffers of many elected officials, GOP and Democrat.
Rence, the wingnut wing is terrified at a lot of things, but I agree that health care is actually not at the top of their list. Today Amanda Marcotte had an entertaining and I think largely correct analysis of how lots of the guys showing up at rallies with guns are insecure in their masculinity. I don’t think that’s the whole story, either, but it’s part of it.
I am absolutely disgusted with the Blue Dog Democrat. Zack Space, who’s practically from here, is one of them. They are such cowards – partly due to fear of lost contributions, as you say, but also because they’ve got lots of constituents who are swayed by all the “death panel” and “socialism” nonsense. If meaningful reform fails, and I’m very afraid it will, I’ll blame them even more than the Repubs. The Blue Dogs ought to know better!!
Well, the House Dems, Blue Dogs included, aren’t causing too much trouble. The progressive caucus has held strong on the public option being in the bill they pass, and so has Speaker Pelosi, so it’s not them I’m worried about. Mostly, it’s Sens. Nelson and especially Baucus that are causing the problems. There’s already a Senate bill from the HELP committee that has a public option, but it’s the Senate Finance Committee (with Baucus at the helm) that’s screwing the entire thing over. Harry Reid needs to do what Speaker Pelosi has done and say “this is how it’s going to happen” and get his Democrats in line for cloture on the HELP bill. We only need 60 to get the vote, then 51 to vote for it. And I’m sure we can get it.
So basically, my point is, if it fails to include a public option, blame Sen. Max Baucus, Sen. Kent Conrad, Sen. Ben Nelson, and Majority Leader Harry Reid for not having the guts to stand up to his own caucus and get them in line. 3 people are playing around with the health of 100 million people who are uninsured or underinsured, and Reid isn’t doing anything to stop them.
Rence, you’re exactly right on this. I was actually impressed with the progressive Dems in the House, insisting that there won’t be a bill if it doesn’t include a public option.
Yes, Baucus is troublemaker number one. But I’m particularly pissed off at Conrad at the moment. That’s partly because I always feel some responsibility for what North Dakota’s representatives do, even though I moved away from there before I was old enough to vote. It’s also because Conrad’s “co-op” idea seems to be getting some traction. I thought Ezra Klein did a good job of describing the problem with the co-ops – basically, no one knows exactly what they’re supposed to do, and so it’s a pretty meaningless option as long as it totally lacks substance.
Great post. I hadn’t actually considered the sexist aspect of this mess we’re in. I’m really scared of the direction we’re going, and it looks like Obama is wussing out a bit with all the bizarre rumors that are being spread around.
Zoe, I’m nervous about this, too. I’m particularly irked that the administration’s statements over the weekend seem to be tossing aside the public option without any concessions in return! I’m not a particularly savvy negotiator, but I’m pretty sure that’s not how you do it.
Another Reich fan! I thought I was one of the only people who could be that wonky.
I wanted him to run for president. Then I was hopeful he would get a cabinet position. Now I can just turn to him for his usual sharp analysis and wonder why he isn’t making some of these policy decision.
Wonky is good! I like your wonky streak.
I can’t imagine Reich could get elected because he’s not very tall. I know that’s an awful, superficial thing to say – but voters are awful and superficial in that way. I’d sure vote for him. I really, really don’t know why he’s got no official role. I’d hoped for a cabinet spot, too.
Reich’s premise is wrong. There is no effective competition in the health insurance market for the end user of the product.
The reason competition does not exist in the health insurance world can be summed up in two broad statements:
1. After World War II, Congress codified employer-based health benefits through the tax code. This was done to benefit the labor unions.
2. The insurance companies had their markets protected through a law known as ERISA (also passed by Congress), which does not allow insurance products to be sold across state lines.
The result is that there is a lack of choice by the people that use health insurance. Giving the control to choose to the government is really no choice at all. True choice and true competition in the health insurance market will come when these two items are corrected.
BTW, all private insurance will be forced to become identical to the so-called public option in 5 years per HR 3200, so choice and competition will be removed completely. Then what do you do if the government won’t approve the medications?
One serious problem for the end consumer is that there’s so little transparency in this market. You can’t price out your care ahead of time. You can’t “comparison shop” for doctors on the basis of cost; one might quote a lower amount for an office visit but then order lots of expensive tests. Similarly for competing health plans: many people can’t be sure if they’re better off with a high or a low deductible, for instance – assuming they have a choice at all – because they can’t predict their future health.
I agree that interstate competition (your point 2) is probably a good idea. On point 1, though, are you calling for an end to tax subsidies for insurance? It’s *not* true that Congress mandated identical coverage among different employers – but I don’t think this was your point. I’m not sure how you’d want to change point 1, and to what end.
HR 3200 is a mighty big bill. Can you point me to the provision where “all private insurance will be forced to become identical to the so-called public option in 5 years”? That’s contrary to anything I’ve heard thus far, but if it’s in the bill, I’d want to be able to cite chapter and verse. The bill can be read in its entirety here, in case anyone has more time on their hands than I do.
Count me in as fan number 3. I first became aware of Reich when the director of our state labor department went to work for him in DC many years ago. I’ve followed his career with great interest ever since.
Sungold, you are undoubtedly much better educated than most of the country when it comes to keeping abreast of health care “reform”. For those of us who have lagged behind, I suggest you grab a copy of the latest issue of Rolling Stone. Matt Taibbi, who is a fantastic political writer, will bring you up to speed, in a way just about anyone can understand, in no time at all.
After reading it this morning, all I can say is that health care reform ain’t gonna happen in my lifetime…
Well, I haven’t read the whole bill! But yeah, I’m increasingly pessimistic that we’ll see any meaningful reform. I think we’ll get some sort of bill passed, and if we’re lucky it’ll remedy a few of the egregious problems with recissions, lifetime caps, etc. But it needs to contain costs somehow, and without pressure from a public plan with serious negotiating power, I don’t see how costs are going to come down. Insurers haven’t done it yet “voluntarily” and I can’t imagine them starting now.
I wish Rolling Stone were more generous with online content. Maybe Alternet will pick up Taibbi’s article, because I would like to see it.
Hi! Great examples. I’ll have my own up in a day or so. Have you sent this to the white house? All you have to do is copy the text into the contact form. You do have to give your contact information but we need to start pushing back.
Hi Babs! The much more serious examples come from my husband’s (so far successful) fight against cancer, and my subsequent fight with the insurance companies. I think the single largest totally unreimbursed item was an anti-nausea drug (routinely used in the U.S. as well as Germany), which they refused to pay for because the package contained the wrong number of pills. The same drug would have been vastly more expensive in the U.S. We had to eat several hundred dollars on that one.
I didn’t write about that partly because it’s still painful – the financial battles added to the trauma of nearly losing my mate – and partly because I had to vent about the relatively trivial but utterly infuriating run-in I had just yesterday.
What’s the contact form you mentioned? I found a general White House contact form but nothing specific to health care reform.
Judging from your thoughts you would like truthwithzach.wordpress.com
Thanks for the tip, Jason.
What a nightmare!
But what I did not see in your superb post or in the comments was how a public option would be better?
I can recount myriad experiences of similarly hellish, stupid, inefficient episodes in dealing with many government agencies.
So my first suggestion would be to stop using the misleading term “public” option and be more accurate and use the more descriptive term “government” option.
Second, you should file a comlpaint about this under HIPPA because it is clearly a violation.
You should copy your HIPPA complaint to the University.
Then please report back to us how quickly (ha ha) the government responds to your HIPPA complaint.
And then tell us how quickly and effectively the University deals with this problem.
The most likely progress (ha ha) reports will demonstrate that the Government and the University are at least as hopelessly mirred in bureucratic swamps of stupidity and ineffectiveness as is your private insurance carrier.
The solution is not a government health plan, but for employers to give us the money they spend on health plans for us, and to let us use the money to hire and fire our own insurance suppliers.
That would be a free market. Neither the current situation of employer funded benefits, nor Obama’s “government” option are effecient, responsive, nor a free market.
Thanks for your sympathy!
I did try calling the HIPAA hotline. You don’t get a real person; you’re told to leave your number and they’ll call back. I’m still waiting. If the university responds adequately to this, fine. If not, I’ll file a written complaint with HIPAA.
And I’m still waiting to hear back from the university, too.
One problem with the free market solution is that of transparency, as I mentioned above. Another problem is that the industry is essentially structured like an oligopoly. There’s no effective competition, and individuals have no real bargaining power. This is already evident in the present market, where people on group plans pay lower premiums than those who have to buy insurance individually on the open market, and where the uninsured pay much more for a doctor visit (or any other service) because the insurance companies negotiate for lower rates. And finally, as long as insurers’ main goal is to maximize profits, they’ll have a strong incentive to minimize the provision of care.
We’ve all had bad experiences with bureaucracies. I’ve had far worse experiences with insurance companies than even with the INS (my husband is foreign-born). As I wrote in my post, I don’t think the public option is a panacea. But if you look at Medicare, most retirees are basically happy with the care they get. In fact, some of the ire at these town hall meetings is driven by retirees who are afraid of losing their present Medicare coverage! This leads me to believe that a public option can work.
I also spent nine years in Germany, and during that time I was insured through their public, non-profit insurance funds. That system wasn’t perfect, but it is better than what we’ve got in the U.S. Most Germans I know consider the U.S. system barbaric, by comparison.
Amerı1can can’t face the pla1n facts. L1ke anyth1ng else, poor people can (and should) get second rate health care. The US could prov1de perfectly OK second rate care to the poor, and do them a great serv1ve 1n do1ng so, and save money as well. But pol1t1cally nobody on the left can swallow th1s, and the r1ght certa1nly doesn’t care about the poor.
Better del1very of servıces and cost control are what matter.
But 1 could care less, 1 do not l1ve ın the US.
Hey, let’s just return to a Hobbesian state of nature! That’ll show those lazy poor people. They’ll finally get what they deserve.
Mark, I’m getting very weary of you bloviating about ignorance, setting yourself up as superior to everyone else, then making frankly stupid statements, and then saying you don’t really care about the issue anyway. Poor people *do* currently get second-rate health care – by showing up at the ER when their health problems reach a crisis point. This is one big problem in controlling costs in our present system. But if it’s *only* a cost-control problem in your view, then I see no point in discussing it with you.
Since you really don’t care, I’m sure you won’t mind that you’re now banned from further posting here. This is my blog, and you are wasting my time.
Great post! I’m in total agreement that if we’re to have any sort of “free market” we’re going to have to inject some competition into the industry– even if I lost my employer-provided insurance (like you I work for a university), I’d probably still end up with the same insurer, because it’s the only game in town. And I’m under no illusions that my insurer feels any obligation to me. They try to screw me and cut coverage at every chance they get. The only person they are responsible to is their shareholder. At least a government plan would be responsible to the people.
I’m adding your blog to the ones I follow– seems we write about similar things and I like your perspective!
Thanks for your kind words. You didn’t leave a link – do you have a blog? If so, I’d like to check it out.
I don’t know about your university, but we are actually self-insured. Anthem administers the PPO part of our plan; formerly it was Medical Mutual. I’ve found Anthem to be harder to deal with, and for all the trouble I had with Medical Mutual when my husband was seriously ill, by now I’m actually nostalgic for their customer service!
Anyway, the fact that we’re self-insured means that the gaps and problems in our plan can often be traced back to decisions that came from Ohio University, not Anthem. Sometimes that can work to the employee’s advantage; on one occasion, I brought a problem directly to the guy in charge of this at HR, and since he was looking me in the eye, he had a harder time saying no. Most of the time, though, Anthem points fingers at the university, and the university points back at Anthem, and since no one is really responsible, no one has the power to fix anything.
Excellent post. The Dems need all need to fall in line, realize they have enough votes to do what they want and get it done. Medicare and the VA are 2 examples of public health insurance that have worked well and have high rates of patient satisfaction.
Republicans are in bed with insurance companies and want continue to view health insurance as a privilege and not a fundamental human right. We get our police, fire, and public education funded publicly, so why not health care?
What if we had to pay out of pocket for private police protection if a burglar entered our home? Or have to find the best rate on a fire department while your house in burning to the ground? Would there be pre-existing conditions that would disqualify you, say maybe you had too many things plugged in at the same time?
The big irony in all of this is that the public option would create the ultimate competition in the marketplace – something I thought Republicans were for. But because its a “government” entity its taboo for them.
Excellent comment, Rob. You and Rence (who commented above) ought to get together and tell Harry Reid to do his job! This is one of my frustrations with the Democrats: They have such a hard time achieving unity, compared to the Republicans. I know there are lot of reasons for this, but it’s still infuriating.
The view of health care as a “privilege” is precisely why my European friends see our system as backwards. I agree that it’s a basic human right. But even if I didn’t, there are purely pragmatic reasons for wanting the entire population to receive decent care in an orderly way. The current “system” of relegating the uninsured to the ER just drives up rates for everyone else and guarantees that care is provided in the most expensive form possible. Also, as the swine flu may demonstrate (if we’re unlucky), when it comes to contagious diseases, it’s in the public interest to keep everyone as healthy as possible.
Having dealt with some serious diseases in the past five years (two separate cancers for my husband, an MS scare for me), I have to say your fire analogy is spot-on.
And I too appreciate the irony that Republicans are now opposing competition. It would be pretty funny if the stakes weren’t so high.
Did you never spend a morning standing in line at the post office? Never go down to the DMV to get your driver’s license renewed? Have you never dealt with a government agency that gave you the runaround? Apparently, there are a lot of worker bees here who don’t have much interaction with their beloved government on a regular basis. I am laughing my ass off at the thought of a government-sponsored health care run by bureaucrats who actually CARE about you – unlike the folks at those EVIL insurance companies, whose sole reason for living is to prevent you from having everything you want! If you want to know what government-run health care looks like, go down to your county health department or to a VA hospital. You all will be in for a shock! Want to see a dentist? Show up at 7 a.m. and be prepared to stand in line and WAIT YOUR TURN!
Yep, I’ve experienced all of those things, and the INS, to boot! (I’m American and my husband has a green card.) None of that compares to the very special hell of trying to get an insurer to hold up their end of the bargain. I’ve probably lost at least a month of my life to this.
As Rob and I both noted above, Medicare is actually a pretty successful program. Government bureaucrats may be indifferent, but Medicare administrators don’t have a positive incentive to find a pretext to deny care. I don’t expect bureaucrats to love me or care about me; I just don’t want their interests to be opposed to mine.
Contrary to the propaganda in this country, most of the folks in Canada, Germany, France, and even Great Britain are pretty satisfied with their health care system. They may complain abouot particular issues, but very few would gladly trade their system for ours. That’s what we’re aiming for – not some underfunded county health department that’s neglected because hey, it’s only poor people, and they don’t deserve better. (Not my view, but it’s one that’s enshrined in our current services for the poor.)
And that’s exactly the point. The profit motive says they should turn us down for everything they can to raise profits. The government’s interest is to break even, and when your goal is to break even instead of make billions of dollars, a lot more procedures get approved.
And Medicare makes abundantly clear that the government is well capable of running healthcare. Not to mention the quality veteran’s care.
And just as some trivia: Anti-Socialist John McCain is insured three times by the government. Once under Medicare, once as a Veteran, and once as a member of the United States Senate.
Rence, I’m glad you’re sticking around for this. It’s my big day as a big blogger (WordPress featured this post on its front page) and I’m glad to keep seeing a friend here!
Bingo on John McCain’s deal. Where do I sign up to be an anti-socialist?
Re: White house contact info. The regular contact info form, if you chose “I have a policy comment” in the drop down form another drop down form appears below it and that allows you to chose health care as the subject. It is hard for me to get energized because I am conditioned to think that my voice will never be heard but I think if anyone will actually listen and respond Obama will — IF there is enough popular support expressed for this. And the other side seems to have a lot leisure to express their point of view in every forum available.
Re: this co-op idea. Does anyone know of a good resource to explain waht is wrong with this. All I have is my gut and the fact that it changes Obama’s promise that “yes if you like your insurance you can keep it and yest if you like your doctor you can keep that doctor” to “Yes if you like your insurance and keep it you can keep your doctor or if they happen to join the co-op you might luck out.
Thanks, Babs. I think Obama needs to be pushed on this issue. That’s been true all along – he will navigate toward the right unless progressives show that we can’t be taken for granted.
On the co-ops, the Ezra Klein post I mentioned in another comment is a good place to start. Right now, they are a blank slate. If I understood Kent Conrad’s earlier statements correctly, he envisions them as being much smaller – regional or statewide – than a national public option would be. If they’re too small they won’t have much bargaining power, compared to the mega-corporations that dominate the private insurance market.
Wrong on one front: HIPAA allows just about every Tom, Dick and Harry in health care (and their business associates in marketing and elsewhere) to access your personal health infromation (PHI). And if they’re not on the list, the HHS Secretary can add them (there are also five pages of other authorized users too numerous to mention).
I strongly contest your notion that the government can do this better. I’ve never found one instance of the government’s being more adept at any task. I too have dealt with the INS. Disastrous. One INSer insisted I had to fill out a certain form for my spouse. I did and sent it in with the $500 fee. I was duly (several long months later) informed that it was the wrong form, and the INS–by the way–never gives refunds, the letter added as a postscript.
Another instance: I sold a car and filled out all the proper DMV forms. Two years later, I was hauled in for a hit-and-run because I was still the registered owner. After some back-and-forths with the Highway Patrol, I produced a copy of my sales receipt. Several weeks later, I received a voicemail message confirming that the DMV had finally found my record.
My late mother loved Medicare so much that she refused to use it. Fortunately, she had retiree benefits with Kaiser Permanente, which is government care plus one percent–but still one percent better. Without even a death panel, they sent her home to die.
Hi Gary. I’m sorry to hear about your mother’s death.
I wouldn’t hold up Kaiser as a model of how to do it right. Many HMOs in this country offer far less choice than public insurance in other countries. When my sister had cancer, I was shocked at how few choices Kaiser gave her in choosing specialists. My experiences in the German public system were much better than hers in Kaiser. I had very few constraints in picking my doctors there. In the end, she did get competent care, but it really came down to luck.
Nowhere have I argued that government does things perfectly. Remember, we’re not talking about abolishing private insurance. We’re looking at giving the private companies some incentives to do better.
I can’t agree with your sweeping generalizations about the public sector. I’ve worked in government, and I’ve seen first-hand that there’s a mixture of very competent people, some very mediocre ones, and everything in between. That’s been true of every workplace I’ve encountered. Mediocre employees find their niche. It’s important to hold government agencies accountable, because they are working for us. As I wrote in my post, I don’t see the public option as a panacea, but I agree with Reich’s reasons for supporting it.
Thanks for sharing this important perspective. We’re The Albert Schweitzer Fellowship, a nonprofit that works to eliminate health disparities by developing “leaders in service,” and over at our blog, we’ve been weighing in on health care reform, too. A good deal of our Fellows have come out strongly in favor of a public option — thought you might be interested to read what they have to say:
http://schweitzerfellowship.wordpress.com/?s=fellows+weigh+in+on+health+care+reform
Thanks for visiting my blog – I’m honored by your kind words.
I’d like to recommend that anyone interested in the big picture follow that link. I just read some very smart posts, and I’ll read the rest later today. My post was intended mainly to show one relatively trivial – but maddening – way that the current system is broken, and to suggest that we need pressure from a public option in order to see improvements. The Albert Schweitzer Fellows are thinking big about how to fix what’s broken. They’re well worth checking out.
Thank you so much for your wonderful response. As one of our Fellows says on our blog, “History shows us that health reform is a once-in-a-generation opportunity” — it’s terrific to see so many people calmly engaging in discussions about that opportunity here.
I guess feelings are running so high because many of us recognize that this opportunity will be the last for another 15 to 20 years. It’s possible, of course, that the next opportunity will come sooner as the result of mounting economic pressure, especially if this round of “reform” is more of a fizzle.
I’ve been glad that people stayed pretty respectful here, despite some fairly irreconcilable differences.
Truly my one biggest concern about this health care reform public option is where is the funding going to come from? We are already racking up trillions of dollars in debt, this would add yet more. Then it would try to have it taken out of “the rich” which are generally all of our employers leading to more lay offs, and a worse economy. That would lead to even further collapse of the financial sector and inevitably lead to the rationing of the health care for everyone. It really is not a good idea. There have been many solutions from hundreds of very intelligent and reputable doctors that would work much better at allowing a better health care system than that which is being proposed.
“Who will pay?” is an important and legitimate question. I agree that no one has stepped up and explained clearly enough where the money will come from. Please check out the Albert Schweizer Fellows mentioned in the previous comment – they have lots of ideas! One option that Reich has suggested is to eliminate the tax exemption for health care premiums for the very richest individuals. I don’t think that’s entirely wrongheaded.
“The rich” are human beings; raising personal income taxes is on highly-paid CEOs is not the same as raising the corporate tax rate. Taxing Bill Gates, for instance, doesn’t lead to layoffs at Microsoft.
You don’t think health care is already rationed? Try being a poor person who doesn’t quite qualify for Medicaid. Or try taking on a $5000 deductible and then getting seriously ill. Try keeping up with COBRA payments if you’ve been laid off; try purchasing any insurance on the individual market if you have any sort of “pre-existing condition.
We’ve got rationing already; we just don’t call it that.
I think most folks agree that everyone should have access to standard health care to avoid prolonged issues that just get more painful and expensive. It seems as easy as:
To increase competition drop the barriers and allow everyone access to plans all across America.
For those that can’t get healthcare for whatever reason, take the national average monthly cost, for the average coverage plan, and issue a voucher to those people for use for insurance coverage only (can’t be redeemed for cash)… or something along those lines.
Is that too simplistic? The government runs a very efficient plan in medicaid and medicare, but the payouts are way to low and these costs get shifted to the private payer… So I don’t like the government having even more influence over the situation.
Good discussion here… I like debating without all the trolls.
What are you talking about… I’m a troll… and personally I don’t think there is anything wrong with us that a government run healthcare can’t fix.
Mike, you hadn’t arrived here when Barry posted – very sorry that he spoke too soon! That remark got you put on moderation. I banned a troll earlier today – first time ever since I’ve been on WordPress – and I won’t hesitate to do it again, now that I’ve had a taste of blood.
Barry, I agree that competitive barriers ought to be dropped. I don’t know enough about your voucher idea but on the surface it’s intriguing. National averages wouldn’t work if there’s major regional variation, but then you could develop a finer-grained system if needed. This scheme – like any reform scheme – would have to be coupled with major regulatory reform, including a ban on recissions, requiring companies to insure everyone at the same price despite their prior medical history, etc.
That still leaves some major issues, such as the incentive in for-profit companies to deny care (perhaps in defiance of regulations) and the question of how to control costs in ways that don’t compromise quality of care.
Hey, you’ve got me thinking.
Agreed that payouts are too low to be sustainable if we insistuted a “Medicare for all.” This, by the way, is a serious problem in Germany: They have a dual private/public system. Those doctors whose clientele is mostly public have become so squeezed that some have left the profession. My husband’s former family physician – a great doctor who had oodles of poor patients – retired prematurely for just this reason.
OK… I’m tired of the big bad insurance company stories. My wife has MS, was diagnosed 10 years ago with it. Here self injected medication cost is $2000 a month… I have changed jobs three times in the last 10 years… We have NEVER… NEVER been denied health coverage because of her illness which needs to be treated for the rest of her life!
Does our healthcare need fixing… YES! However having a government run healthcare is the worst thing we can do. First off, we are not Canada or Europe… We have the best country in the world built on a peice of paper that acknowledges that government is corrupt… Government is NEVER the answer because they bring more problems. Everyone who trusts Obama with their healthcare is short sighted… Would you trust George Bush with your healthcare? Well guess what… sooner or later that type person will be back in power… Do you still trust our government with your healthcare. Personally I don’t trust Obama with anything…. and you shouldn’t either. He’s a politician!
Mike, I’m sorry your wife is dealing with MS. I had a serious MS scare last winter (and still don’t know what’s wrong with me) so I have an inkling of what MS can mean. I hope she’s doing as well as possible. I *really* hope a cure can be found.
So I also have an idea of how important good health coverage can become. It’s reasonable to fear losing your current good coverage under a new system.
Having experienced denial of claims for my husband’s cancer drugs (!) despite our good insurance, I know that the current system doesn’t always work as it should. That’s an issue alongside those who have no coverage.
We trust government with our schools, police, and fire protection, as one commenter noted above. I trust Obama – mostly. (Still mad at him about FISA and a few other items.) I trust Bush not at all. But no president has complete control over the political process – as we’re seeing just now! – and the idea would be to establish competition, which currently doesn’t exist.
Our Founding Fathers believed in limiting government’s power, not abolishing it altogether. They weren’t anarchists (although anarchists in powdered wigs is an awesome image).
This is one of the big problems with the Republican view of government today – the view is that government can’t succeed, so when they get into power, they work on dismantling the government, causing it to not work even more.
But, despite that, we put all of our grandparents under the government’s care over 40 years ago and, through Nixon, Ford, Carter, Reagan, Bush, Clinton and a crazier Bush, they’ve provided quality care to our seniors. And there’s a president on that list for everyone who wants to not trust a president. A well-designed program can take good care of people, and that’s what we’re asking for from our Congress today. Not some horrible, half-assed program that will fail just on the basis because it was half-assed in the first place.
Exactly. Republicans are determined to make “bad government” a self-fulfilling prophecy.
I just got off the phone with my Scottish friend, who reports that his parents – now in their 80s – are starting to show some wear and tear. But he’s satisfied, overall, with the quality of the care that the NHS is providing them. My own parents have been satisfied with Medicare.
There’s a reason Medicare is a political sacred cow. It works.
There’s another problem with private insurers that you only somewhat addressed – the fact that what the contract states and what their policy states are very different things.
I theoretically have no limits on my durable medical equipment benefits. However, I have been denied for stabilizing orthotics because I do not have diabetes, a low pressure mattress because I do not have bedsores, and several other items that have happened in the same way. I had to fight for MONTHS to get the splints that stabilize my fingers, which they denied multiple times because they didn’t believe they were needed, even though my doctor, my specialist, and my hand therapist all agreed they were absolutely necessary. They set up their rubric for how things should happen, and too bad if you have a rare condition that means you need the same care for different reasons.
I’ve had the same trouble with medications. My contract doesn’t say that they can decide whether or not to approve medications, but the practice sure does! Medications are another area where I’ve had to make phone call after phone call, getting different answers from different representatives, and really getting the run-around.
Frankly, what I’d really like is a health care system that places a higher value on what my doctor thinks is necessary than it does on some outside opinion by a person who has never seen me, hasn’t read my case file, and has no experience with my rare condition. I’m one in a million (literally – Ehlers-Danlos Syndrome is quite rare) and I deserve to be treated that way – with care that is actually tailored to my needs, not to the limits imposed by a bureaucrat.
…not that the proposed revisions would really address that complaint, but perhaps if we start revising we might bring people around to seeing that more changes are necessary than they are willing to make at this point.
~Kali
Hi Kali. There’s a lot that my post didn’t address because it started out just as a vent that strayed into a bit of wonkery. So I’m really glad that you’re bringing in this aspect of the mess – and really sorry that you’ve had to experience so much frustration on top of an already disabling, poorly-understood orphan disease.
Your key statement is this: “Frankly, what I’d really like is a health care system that places a higher value on what my doctor thinks is necessary than it does on some outside opinion by a person who has never seen me, hasn’t read my case file, and has no experience with my rare condition.”
That is just spot-on. My family has experienced the run-around even with relatively routine tests. One example: a breast MRI. I thought we were going to have to pay $3200 for a test my doctors ordered, and it took months to resolve the problem. I can only imagine how much more confusion and ignorance results when your disease is poorly understood even by physicians, never mind the paper-pushers.
By the way, I just checked out your blog. It’s smart and illuminating. I’ll keep my eye on it.
[...] military service and genetic information, but not sexual orientation or gender identity. Why My “Good” Insurance Needs the Public Option – kittywampus.wordpress.com 08/18/2009 My family and I have “good” insurance. Oh, sure, [...]
Hi, Sungold.
Your post eloquently articulates why private sector health insurance needs the the competition of a viable public option.
Thanks, Marcy. Let’s hope it doesn’t turn out to be one of many eulogies for a dead public option!
Please… please tell me what efficient, cost savings programs has our government run?
Do you want George Bush controlling your healthcare? Which, actually might be better then Obama!
Mike, you asked that question above. I and others answered: Medicare. And as for George Bush, I suspect he’s so relieved to be no longer president, he’s only interested in controlling the brush on his ranch.
I’m not willing to deal with people who repeat the same thing over and over, except for my kids. So Mike, that will be your last comment. You’ve worn out your welcome.