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Medical insurance system is collapsing

If we don't fix it now we're going to be in a whole lot of pain.
People I know who have to buy their own medical insurance -- self-employed or employer doesn't provide insurance -- are paying $300-$400 a month for one person! One health care activist who has studied this told me recently that he expects buy-it-yourself medical insurance to be up to around $500 a month in a couple years. Very few can afford that.

I'm on the Oregon Health Plan, Oregon's expanded version of Medicaid. Due to the state budget crisis and a dysfunctional legislature, benefits -- dental, mental, drug treatment, vision and prescriptions -- have been cut for most of us on OHP. I'm just thankful that I can get by without any of that, but, at 63, for how long? Most major illnesses require expensive prescriptions. I fear for those on OHP who need prescriptions to survive. Also for the mentally ill, whose outpatient treatment has been eliminated.

As for all those lucky people who are getting insurance through their jobs, premiums have been rising at double-digit percentages every year, and your employer will eventually pass some of that on to you. In other words, here comes a pay cut. Is it worth it to you to keep paying the grossly inflated overhead of the medical insurance companies? Government medical insurance programs like Medicare have a much lower overhead than that of the insurance companies. No profits, high CEO salaries, etc.

If you have medical insurance through your job you will lose it every time you get laid off. So you have no security. Better not get laid off and have an expensive illness at the same time. I've been there.

If you're young and have a good deal now, be aware that by the time you hit your late 50s you will probably have a life-threatening, very expensive illness. The way things are going, by then there may not be any medical insurance system to pay your bills. The system is slowly collapsing, and we need to change it now.

People in this country without medical insurance have a higher death rate than those with it. Health care in this country is rationed by income.

And no, you can't just go to the Emergency Room. Their job is to stabilize you and get you back out onto the street, ASAP. They are not set up to provide the long-term treatment needed for chronic, life-threatening illnesses.

It's a myth that people in other countries with socialized medical insurance have it worse than we do. Canadians are NOT flocking across the border to get medical care. They much prefer their system to ours. They may have to wait for elective care, but they will not be denied it for lack of money. Don't believe the lies shoveled out to you by the corporate news media and medical insurance companies. Those lies could kill you.

homepage: homepage: http://www.hcao.org


This is just plain wrong 12.Feb.2003 15:36

James

Lynn, what you've written is simply just plain wrong.

First, it is only $400/month for very good medical insurance for people in the highest age bracket (55+). For most other folks, good coverage is not more than $200/month.

Yes - the cost of healthcare is rising faster than inflation and wage growth. That particular problem, however, can be dealt with almost entirely by tort-reform. Baby Bush's tort reform doesn't cut it: What we need is a system where, in civil suits, juries can enter 1 of *3* verdicts:

a) Guilty
b) Not Guilty
c) Frivelous

If a claim is ruled frivelous by a jury, the *plaintiff* should be forced pay any and all legal bills incurred by the defense. This would nearly single handedly end all frivelous lawsuits, and hence, drop medical premiums a huge amount.

Secondly, YOU DO NOT LOSE YOUR HEALTH INSURANCE IF YOU GET LAID OFF.

That's rediculous. There's a little law called COBRA in this country which prevents exactly that. After you get laid off, you have 60 days to take over payment of the premium on your health care plan. You pay the /group rate/ not the individual rate. If you're a student, or fit other qualifications, the period is extended to 18 months.

At the end of the 9 months, you have the option to get an individual health care plan with the same provider DESPITE ANY PRE-EXISTING CONDITIONS. The provider CANNOT disqualify you based upon any pre-existing condition you may have. The premiums will certainly go up w/ the individual rate, as opposed to the group rate, but you cannot lose your health care.

Canadians also have private healthcare. All Canadians who can afford it use private healthcare. The only people who use public healthcare are those who can't afford it. Because the quality of public healthcare in Canada is not very good.

The bottom line is that socialized healthcare will be no better, and is simply stealing from the rich to cure the poor. A noble cause, but probably wrong.

Response to James 12.Feb.2003 17:19

Lynn Porter

James,

You are wrong on just about all counts. I can only assume you have little experience with the medical insurance system.

I know people in their early 50s who are, as I said, paying monthly premiums of $300-$400, and these premiums are going up every year in big jumps. I don't care what younger people are paying, but even $200 a month is more than working-class people can afford. Once you have a serious illness on your medical record you can only buy your own insurance by going through the state high risk pool, and you will pay the highest premium to do it.

As for "very good medical insurance," that is the only kind worth having. If you get insurance with a yearly $1,000 deductible, and you are trying to live on working-class wages, you will not be able to afford preventive care. My sister, who cooks in a nursing home, has that problem.

And by the way, working-class people are the only ones I care about. "Working-class" has been defined as having a yearly gross household income of under $30,000.

Another common problem with lower quality insurance is that you are required to pay 20 percent of all the bills. Most serious, life-threatening illnesses are very expensive to treat. My last 6 months of chemotherapy for leukemia cost about $26,000. I've heard that brain surgery can run over $100,000. Most of us cannot afford to be stuck with 20 percent of that.

The insurance companies play all kinds of games to reduce what they will have to pay if you get sick. And you probably won't pay any attention to what your insurance benefits actually are until it comes time to use them. Check out the move "John Q" for an example.

No "tort reform" will cut it. Malpractice suits are not the main force driving up health care costs. The main causes are high prescriptions costs, new medical technology, high insurance company overhead, an ageing population, etc. There are many ways we could bring these costs down, but the best would be single-payer, universal health care, one insurance pool for everyone, because it reduces the complexity and costs of the system. Also, it's fair.

Yes, most of us DO lose our medical insurance when we get laid off. I know all about COBRA and the option of turning that into a personal policy when it runs out. The problem is that working-class people, trying to survive on unemployment while spending months looking for another job, cannot afford to pay the premiums, even under COBRA group rates.

A Dec. 4, 2001 report on the Families USA website said that "A recent study ... shows that only one out of five people eligible for COBRA health coverage actually receive it because they can't afford to pay for it."
 http://www.familiesusa.org/media/press/2001/cobra.htm

You are completely misinformed about the Canadian health care system. As a nation they spend half of what we do and they have better measurable health outcomes. This is true of all the other industrial democracies who have universal health care. We pay much more than they do and get much less.

As for "stealing from the rich to cure the poor," I have no problem with that. The rich and the middle class have been stealing from working-class people by forcing us to work for low wages to provide them with cheap goods and services. Now they're trashing the safety net and cutting back or eliminating our health care benefits. Time for some good old fashioned class warfare.

Back bacon and beer, eh? 12.Feb.2003 20:00

Captain Canada

"Canadians also have private healthcare. All Canadians who can afford it use private healthcare. The only people who use public healthcare are those who can't afford it. Because the quality of public healthcare in Canada is not very good."

Ah, Americans. (Some of you are) So ignorant about what lies beyond your borders.

First of all, Canadians DO NOT have private healthcare. If you want things done privately, you go the States. One the big fights going on right now is to put a stop to creeping privatization (ie MRI clinics). The federal gov't recently agreed to invest an additional $28-$35 billion (depending on which newspaper you read) to improve our system.

The only people who use public healthcare are... everyone. You must be thinking of the United States if you mean a country where everyone has private insurance.

The quality of public healthcare in Canada is excellent. I challenge you to prove otherwise.

Europeans and Canadians rightfully consider the American health care system a complete joke. Our system is far from perfect, but I'll take it over yours any day of the week. The richest country in the world, and 40 million people without insurance. Not to mention all the seniors flocking over the Canadian border, physically and via the Internet, to avoid insane American drug prices. I could go on, but we all get the point, don't we?

chris

collapse of medical insurance 12.Feb.2003 20:57

tom

I know much about medical insurance. I buy it for my employees and my family, and as a rural family doctor, I bill it and participate in that monstrosity in ways I would be ashamed to admit. I have been burned by the tort system, and regularly practice "defensive medicine", but I agree that the notion that present plans for "tort reform" would change much are ineffective, simple-minded, and mainly designed to allow corporations to further erode their accountability to the public.

The "system" cannot be reformed, because it is a criminal free-for-all in which the biggest fish eat the littler fish and care nothing for the destruction they cause in their quest for profits and market share.

The proximate problems are insurance company and hospital administrations. But like our Federal administration, they did not get that way without a lot of help, and to a certain degree, they themselves are victims of the system-- even if they wanted to do the right thing (and individually, many of them do) they are prevented by "market forces."

The only solution is radical change. Eliminate the insurance companies, and install a single-payer system. There are many flaws in such a scheme, but only in a single payer system can preventive health have any meaningful market value, and only when everyone is covered can the insane distortions of the present pricing of health care be addressed.

The cheapest thing would simply be for everyone to die when they got sick-- we are going there, and fast.

The next cheapest is to have a rational, single-payer system which insists on accountability from everyone-- the doctors, the patients, the hospitals, the drug companies.

As long as we are distracted by "code orange" alerts and illegal "wars" on essentially defenseless countries, and feed our insanely bloated "defense" industry there will be no way of achieving that change.

Somehow, we need to get the people in front of the lobbyists in the Legislature and in Congress. IndyMedia is one force for change

Requiring private health insurance kills us 13.Feb.2003 20:58

Jack Herbert

James' figures are inconsistent with our actual premiums. My health insurance, through the state govt, one of the largest employers in the state, is well over $400/month for everyone, not just people over 55. For most employers, the same insurance must be higher. If you have to buy your own, it will cost much more, so his estimate of $400 for good insurance for people over 55 is a couple of years out of date. Reality is a lot crueler than James' numbers and availability. Pull out your own coverage, if you have it, see what you or your employer/insurance provider is paying for premiums, what you pay in fees for services if you need them, what it covers and what it doesn't.

Any of us who have coverage can look at the rate of growth of costs for the same coverage or worsening coverage and see that Lynn is right. Do it yourself. If you don't, and just keep assuming that someone will take care of you somehow, you will get hurt in the next couple of years. Remember the City of Portland's employee demonstrations and strike. The City (as well as LOTS of other employers) insisted that it couldn't afford to pay the health care premiums BECAUSE THEY HAD GONE UP SO MUCH. HELLO. YOU'RE NEXT. WAKE UP. It's got to be a lot worse for small businesses. Another couple of years and 25-40% higher premiums will cut your benefits or make you pay, even if you've got a great employer. (Private individuals would have to pay stratospheric costs, if they could afford them.)

The World Health Organization ranked the US's health care system 37th in the world. 37th! That's not a misprint. ALL the civilized developed countries, as far as I know, have single-payer systems, not private insurance systems. What does that and the inflation that will make our health care much worse in the next few years tell you about how awful it would be to have a single-payer system, about how much better off we are with the disintegrating system we've got? OOH, socialized medicine!!! Unthinkable!! Only for those who would rather die and kill than think.

Whether the health care providers are private or public in which countries, I don't know. That's a different issue. And that's probably what you mean when you say socialized medicine.

Compare our infant and fetal mortality, health of children, elderly, and lots of other groups with those of Canada and other single-payer countries AND COMPARE WHAT WE PAY.

The last study I saw showed $5,000/American/year for the whole country. That averages over all the people who aren't getting health care or are paying only a few bucks because they haven't got any more. The real cost per person who gets health care as good as Canada's must have been MUCH MORE than $5,000 apiece when they made the study -- $7,000, $10,000?? -- a lot of coverage isn't that great, and it's been going up all the time.

The same study found $2,700 apiece on average in Canada. A former minister of health for British Columbia, now at OHSU, Dr B(igelow?), and a former editor of the New England J of Med (probably the leading journal), Marcia Angell, sriting in the New York Times, both, I believe, said that the only thing wrong with Canada's system is that they don't spend enough. Canada apparently has a general fund that pays for health care AND other things. So the politicians take money to pay for other things and don't tax enough to pay for the other things and as much as it would take to make health care quicker. What is needed is a reliable source of income and a fund dedicated only to health care coverage.

So, Canada could spend significantly more, cut the waits that we hear about, cover everyone well, and still spend much less than we do and much, MUCH less than we would pay if we covered everyone privately.

But, private enterprise WON'T COVER EVERYONE. Private means, only those who have leverage or money get what they leverage or pay for. The rest of us don't get what we can't pay for and no one will give us. Adequate health care is way too costly for your and my donations to some nonprofit to pay for.

That's what governments are for -- for all of us to share the costs and organize our action together. Being against govt services is being anti-community, voting for every man for himself and abuse and death to women, children, older, out of work, disabled, ...... If govt is bad, it's because you and I and our fellows aren't informed and active enough to change it as needed and get it on track. Yes, it takes a hell of a lot of work. The myth of living as a consumer leads to community disintegration -- abuse by the powerful and neglect by all of us. Didn't everyone study government in school??? You're going to have to work at being a citizen or democratic, representative government fails. Duh.

So, a necessary consequence of private health care coverage is poor health care, suffering, and much more frequent, earlier death for the poor.

Some countries have decided that this is unethical.

ALL OF YOU WHO WON'T ACCEPT A SINGLE PAYER SYSTEM for health care ARE MAKING THE POOR and the NON-COVERED, NOT-RICH-ENOUGH, (probably MOST OF US some of the time and eventually) do without adequate health care. YOU'RE KILLING LOTS OF US.

It really isn't so hard to figure this out IF you take the trouble. If you still think private health care coverage as a national system is acceptable, you're extremely unethical. Just follow the facts. The conclusion is inevitable. There actually is a good reason that every civilized country that isn't poor has a single payer system. Only Americans have been too duped or selfish and cruel to get it.

Both Dr B(igelow?) and Angell said that the problem here is MAKING HEALTH CARE A COMMODITY, available only to those who have coverage or can afford it, instead of a human right of everyone. Ethics require that we make it a right. If you're too inhumane for that, please reform yourself; we can't afford you.

Yes, health care coverage for everyone would cost a lot of money, but it would be much more cost-effective, by avoiding a lot of emergency-room treatment, it would be humane, AND we would all be secure. When you get older, that part will start to sink in.

Death to those who aren't the fittest (luckiest, most agressive, best cheaters, ...) in the entrepreneurial competition that those who advocate the new global order demand is part of that paradise on earth that they promise us. Hard work is NOT what gets you security. Ask the Third World. The Third World is where we're headed, since we're not being active citizens -- informing ourselves and twisting the arms of decent, wise people to get them to be our representatives. What created the first world was active, responsible citizenship. Our first world is following the second (dictatorial communism). We are sinking back into the world we had before because we will only work for money, not together for our democracy and human welfare. When something really matters, we have to throw our lots in together or we will all hang separately. Remember?

nothing that a revolution could not cure 13.Feb.2003 21:41

Red

It 's amazing how much you can pay into the health care system when you are young and healthy without getting much in return. Sure you have the coverage if you are sick, but most young people do not need it very often. But when you are older all those systems start breaking down. Years of exposure to toxic chemicals at the workplace, and through tainted food etc. starts to catch up with you.

Face it the health system is a mess. There is no standardization for health and insurance forms. And the Insurance Industry is nothing but a big leach, draining away health care dollars while stalling on making payments to the Doctors, counting beans and denying benefits.

The medical schools should be free. Let them flood the country with Doctors to bring down prices. Paying off the costs of medical school, payments to malpractice Insurance, are all part of the problem. And again the Insurance Companys, who have lost heavily gambling in the stock
market try to make up for their losses by jacking up rates, not only in medical but in home insurance to.

The corporations are killing us. A revolution has been needed for far too long. Bush is taking us along the same road as Hitler did 60 years ago. Time for the working class to rule

Red