MEDICAL INSURANCE- NOT ALL EQUAL

October 28, 2010 at 3:45 pm 15 comments


There are many many people in the cyber world who are fighting for their lives and some like Hillary are fighting for their life and also medical coverage to be equal.

All I wanted was equal quality and accessible health care for all, but even when Americans had to make no change if they didn’t want to and were offered the congressional health plan, people still screamed about rationing and the possibility of even larger soaring health care costs.

What did we get?

Well, with the little reform that made it through, inflation has all ready eased. Insurance still cost 14% more than last year and americans still have no recourse but to pay the rising costs, but that’s better than the 28% last year.

And we are starting to ration.

This young woman is amazing and I would suggest you follow her thoughts as she continues to fight.

Chris Carr from Chris Alt Delete blog said in his most recent post

My situation (or anyone who will have to fight cancer for the rest of their lives after losing their job) is difficult in that I would like to go back to work if I could find a job but who is going to hire someone who has chronic cancer (especially in this economy)? Not to mention, what insurance company is going to carry me? The laws against discriminating against pre-existing conditions don’t kick in until 2014. So, for me to go back to work, I’d be taking a huge gamble that quite frankly I can’t afford to take.


Although MY Chris, my son, fought the same battles had the same treatment his coverage from insurance was amazing.

You see when he married Angela- he married into the Cleveland Clinic ‘s medical insurance- now coverage there for their Dr. employees is a lot different from what I am covered for and possibly yours.

Apart from the “professional courtesy charges” – they don’t pay the same when professional courtesy is applied…. EVERYTHING AND I MEAN EVERYTHING 100% was covered in Chris’ case.

Both stem cell transplants, the chemo, the hospital stays even the tests on the trial- apart from the initial deductible ( which we paid) not one penny for any medical tests , procedures were billed, all prescriptions once the deductible was met ( which we also paid for gladly)- the only thing it cost Angela and Chris was the parking fees at the hospital. There was NO CAP of their insurance………..

The fundraiser , for which I am still trying to find the words to write about- was NOT for medical expenses but for plane tickets and travel expenses to Texas- those unfortunately are not covered by anyones insurances- how Hillary and Chris Carr and others fighting this “curable cancer“( Hodgkin’s Lymphoma) manage is beyond my ken.

I wish everyone had the coverage that Chris was able to receive- for his wife to walk away from the loss of Chris with no debt is a very rare thing in the non Dr. world. In that respect she was lucky, certainly luckier than most in the same circumstances

It is bad enough that people are fighting for their lives but then to be faced with huge medical bills it too is an obscenity .

I don’t know what the ‘Health Insurance ” answer is in this country but for Hillary, Chris, Beckha , Mike and millions in this country that face this every day – I want equality!

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And the winner is for Lorain County Beautiful Awards The “other side”- A ghost of a chance

15 Comments Add your own

  • […] Read the original: MEDICAL INSURANCE- NOT ALL EQUAL « That Woman's Weblog […]

  • 2. thatwoman  |  October 29, 2010 at 11:16 am

    Hi Mary I re copied your commen t under this post it went to the LCBA post and will answer there too:)

    Loraine, didn’t you and your husband cover most of those extraneous out of pocket expenses yourselves? I’ve had family members who’ve endured traumatic illnesses. Some survived, one didn’t so I can well understand the costs associated with such illnesses. I’ve got to say that I’ve always thought it was tremendously good of you to carry the costs for Chris and Angela so that they didn’t accumulate a horrific debt. I’d think she’d be eternally grateful to you and Ernie in that your actions and selflessness and desire to help Chris made it possible for her to actually be able to go on with her life after Chris’s passing. It also must have been a great comfort to Chris and given him peace of mind to know that he didn’t have to worry about paying the bills afterwards since you and his father had taken care of that! They’re fortunate that they had you there! Since you took care of Chris so often, they also didn’t have to engage a private nurse and this would have also allowed Angela to continue her studies/residency. Yes, they certainly were lucky you were there and able and so willing to step up and take this burden onto yourself. Many other parents wouldn’t have been as willing or able…..hers weren’t

  • 3. Loraine Ritchey  |  October 29, 2010 at 11:39 am

    When Chris was first diagnosed Feb ( they were to be married in June) he was under his works insurance. It had a 3,000 dedutible and 80/20 – the initial tests and surgery etc we paid the co pays and also the deductible- he soon reached that with the Pet scans/ Ct Scans and surgery and drs and the initial chemo. .

    When they married due to “the life changing window” he was able to go under Angela’s insurance – it was decided that it was better and boy it was.

    I so admired Angela initially when Chris was first diagnosed- to go through with the wedding – she supported him – I tried to imagine how she must feel being a young bride- therefore we did what ever we could try to ease the way for them both- I just don’t know what happened with her – I believe she tired of the journey and knew probably better than we did what the outcome would be.. and wanted to move on … I don’t know but I guess I really didn’t know her…….. .

    But to get back to your question……..the Clinics insurance was fabulous covered everything- except again the initial deductible treatment and prescriptions- His uncle gave them a check to cover that deductible – so they paid it …..but were reimbursed.
    He also made up the lost wages Chris incurred each month. So Angela and hris weren’t out of pocket.

    When he went on the trial in Texas is was “out of network” so they were going to have to pay 30 percent for tests and treatment not covered under the drug companies trial for SGN35- I told Angela we would pick up that expense ……… however because the Lymphoma specialist at the clinic sent them out of network the Clinics’ insurance covered that as well….

    I thought about this yesterday when Mama Sue was saying to someone in the waiting room
    “Oh his one cough medicine is 300 dollars”-
    well I don’t know about the actual amount being 300 dollars but I thought at the time- she isn’t paying for it it is covered – why give the impression that they were picking up that cost –

    BUT none of it worked……but at least I know that contrary to the impression that has been given – There were no medical bills outstanding because of my son’s illness that Angela or her family had to pay- but that was down to the fabulous medical insurance of Angela’s employer……I just wish everyone could have that type of coverage.

  • 4. CCryder  |  October 29, 2010 at 1:43 pm

    I was told Angela was struggling to pay your son’s medical bills. Her mother is certainly giving that impression. You are saying that is incorrect?

  • 5. Loraine Ritchey  |  October 29, 2010 at 1:54 pm

    ABSOLUTELY!!!! THAT IS WHAT I AM SAYING –

    I had been informed that was the “disinformation” being put about probably for sympathy or justification of their actions- I don’t know- but I can tell you if that is being said it is untrue.

    Also my son went into that marriage debt free- he had no student loans or debt – actually had trouble getting credit for the 4 wheeler as he had no “debt history” –

    The only expenses Angela had that had anything to do with medical would be HER student loans…..

    Whilst I am grateful for the medical coverage and treatment Chris received HE CAUSED THEM NO DEBT
    and she was left financially better off than I will be after my husbands death………….

    I just can’t get my mind around these people- with so many peopel suffering from the horrendous debt caused by medical expenses to allude to the fact you are one of them when it isn’t the case just makes me shudder at their thinking and selfishness.

  • 6. Daniel Jack Williamson  |  October 29, 2010 at 10:32 pm

    For those already on government health care, such as Medicaid, they may already have personal experience with rationing under government health care, especially when treating mental health conditions. Not only has mental health not been on the same footing with other health conditions in the private sector, but there is no mental health parity under Medicare or Medicaid, either. If one has to resort to public mental health care providers, one can wait up to two months just to get an appointment for intake. That’s not the case with private-sector mental health care. Psychiatrists are to meet with mental health patients at least once every three months, but with public mental health care, a patient might not get an another appointment with the psychiatrist for 5 months. That’s not the case in private-sector mental health. Thus, industry standards are not being met for those relying on the government for care. Plus, the government health care is not 100% free, either. In Ohio, one who meets all other criteria for Medicaid must first pay a spend-down each month before getting a single dime covered under Medicaid. For those on Social Security, particularly Social Security Disability Income, the spend-down can eat up the majority of what income they receive each month, leaving precious little money to cover housing, utility, transportation, and grocery costs (though help with grocery costs through the Food Stamp program is often readily available, but still, even with groceries covered, there are still big monthly bills coming from a fixed income where more than half goes toward the spend-down). Medicare costs, too, are much higher for mental health care than for other medical conditions. Co-pays for mental health are much greater, even with Medicare Part B coverage, than for other doctor visits. Availability of practitioners is also curtailed under government health care, as fewer doctors are willing to accept Medicare patients due to the relatively poor Medicare reimbursement rates to providers. If this is the reality of government health care now, why would everyone want to have it?

    Back during my state rep candidacies of 2002 and 2004, I drew up my own remedy for the health care coverage industry. I reprinted it, nearly in it’s original form, at my blog:

    http://buckeyerino.com/2008/04/30/djw-has-a-health-care-plan/

    Some of the highlights of the plan I proposed are as follows:

    Private-sector health currently (and hasn’t been for decades) does not exist in a free marketplace. It is offered in a captive marketplace. Insurance industry political donations to officeholders in both political parties have ensured a steady pipeline of legislation designed to benefit the insurance industry to the detriment of consumers. This must be reversed. Marketplace reforms that strip away the legal advantages afforded to the health care insurers can level the playing field and allow true competition that doesn’t exist today.

    Health care insurers keep trying to migrate to deeper and deeper pocket$ to pay for health insurance. The health insurers like the employment-based model for health care, because a corporations pockets are deeper than an end-consumer’s pockets. With Obamacare, the health care industry has designs on the federal government’s pocketbook. Just follow the money and this becomes evident as U.S. Senators and U.S. Reps who voted FOR Obamacare have received significant campaign donations from health care coverage industry PACs. This must be reversed. When the insurers must get paid out of the much shallower pockets of end-consumers, they’d be forced to lower their prices or else not have enough customers to stay in business.

    Instead of having a mandated one-size fits all plan, there should be a smorgasbord of plans so that consumers can pick and choose which ones are most useful in light of their budget constraints. Insurers would have to offer a variety of products in order to win more customers than their competitors.

    Under the employment-based model of health care coverage, the employer chooses your options for you. You don’t get to pick which company, out of all the companies out there, you’ll do business with. You are either with one company your employer selected or with an abbreviated menu that your employer selected. When consumers don’t make their own choices, that is a captive marketplace. Consumers must choose in order for the market to be free.

    If you get an abbreviated menu of coverage providers from your employer, you have a brief enrollment window that usually opens just once a year. For the rest of the time, you are locked into that coverage. Insurer denied your appeal, making you hopping mad? Too bad, you can’t switch insurers. In the auto insurance industry, though, you can cancel your policy whenever you want and pick some other insurer of your choosing. Consumers must be able to enroll at will and switch coverage providers at will. Anything less, and there is insufficient competition to free up the captive marketplace.

    To retain customers in a truly free and competitive marketplace, health insurers will have to vastly improve their customer service. They’d have to bend over backwards for you knowing that you could switch to the competition at any time if they cause you to be angry and frustrated. Routinely denying claims would surely be a path toward going out-of-business, and I don’t think insurers would want to go out of business. Routinely denying coverage for pre-existing conditions may even cost them customers.

    The current trend, though, with the passage of Obamacare, is toward more consumers being trapped. There used to be medical savings accounts, where you could set aside some of your pay tax-free that you could use as a rainy-day fund for the times when you really really need it. Obamacare will phase out these accounts, taking one more tool out of the consumer’s arsenal.

    When I worked in South Korea as an English teacher, the number of Canadian teachers dwarfed that of the American teachers, even though Canada has one-tenth the population of the United States. Why so many more young Canadians working abroad than Americans? They come out of college with lots of government student loads to pay back, and with the nationalized health care, they just don’t see how they can make much headway toward their financial goals on entry-level salaries when the taxes are so high. In essence, they go abroad to escape high taxes, and high taxes are necessary in Canada to provide that health care and those student loans. I’m not ready for the price tag we’ll see in America once Obamacare is fully phased in.

  • 7. Loraine Ritchey  |  October 30, 2010 at 9:59 am

    Whoa DJ that is some comment deserves a post of its own …… and I would ask you to look at Hilarys post of October 29th on her blog V-O-T-E amd also her profile –

    http://baldiesblog.blogspot.com/2010/10/v-o-t-e.html

    for her it is simple

    Please remember the laws created by Obama-Pelosi’s Health Reform will save MY life, as well as the lives of others.

  • 8. Daniel Jack Williamson  |  November 2, 2010 at 12:50 am

    By the time Obamacare is fully phased in, which would be 2014, I respectfully submit to Ms. St. Pierre that it will not be the silver bullet she expected it to be.

    Rationed health care, with too few providers, too long of a wait period for service, and too many additional bureaucracies gumming up the works won’t save everyone’s life. It could even endanger a few.

    As someone who has already experienced the rationing of government funded mental health care, I know full well the awakening that others will be jarred with.

    I suffer from both ADD and bipolar disorder, both of which are inherited from my ancestors. My best psychiatric care was rendered when I visited a provider who worked on a cash-only basis. He didn’t have to hire a staff of medical transcriptionists to process all the claim forms. He had one receptionist who answered the phone, wrote out receipts for payments from patients, and greeted those who walked in the office door. That was his whole office staff, and that was the simplicity of her job duties. After switching to public health care, I regretted it. I couldn’t get an intake appointment for two months. Follow-ups were irregularly scheduled because of the multitude of patients and so few providers who actually wanted to work in a public mental health agency because of all the headaches associated with it. I had an appointment scheduled for three months out, but the day of my appointment, an emergency had arisen, and the psychiatrist had to cancel all the appointments of the day, and it was two months later before I got in. I soon discovered that my co-pays for this substandard care were equal to my out-of-pocket costs for seeing the cash-only psychiatrist. And with an office staff that numbered in the dozens to handle the paperwork, they still managed to screw up my account, overbilling me and not properly recording my payments. I had to meet with the office staff three times, bringing receipts and invoices with me, in order to get it all straightened out. Just what a bi-polar sufferer needs–more stress and another target for one’s anger. My blood did boil. But the reason why I switched to a public provider from my private provider was influenced by prescription costs. Just to treat bi-polar disorder, alone, my medications cost about $730 per month, which had to be paid for out-of-pocket while seeing a private practice psychiatrist who worked on a cash-only basis. My total gross income was $1170 per month, so, with the out of pocket office visits for, not just the psychiatrist, but also for the appointments with counselors, there was very little left for actual living expenses like rent, utilities, transportation, and consumable goods (cleaning supplies, toilet paper, groceries, etc.) With Medicaid, I could more easily afford the prescriptions. However, the amount of assistance from Medicaid is income-based. I had to meet a “spend-down” amount every month before Medicaid would kick in. My spend-down was $575 per month. I had to pay the first $575 of my medical bills out of pocket and then take the invoices and receipts into an Ohio Department of Jobs and Family Services office to present to a caseworker in order for the remainder of the monthly medical expenses to get paid.

    Bipolar disorder is degenerative, so as one ages, the condition becomes more severe, which is why it went undiagnosed until 2003 (age 38), but then became too obvious to ignore after that. By 2007, the symptoms were so disabling, making me so unfit for employment, that I was enrolled in SSDI, or Social Security Disability Income. I’d paid in enough money into Social Security over the years that I was an SSDI recipient rather than an SSI recipient. For those who hadn’t paid into the Social Security fund long enough, nor paid in money enough to qualify for SSDI who still had a disability covered by Social Security, they receive SSI. Those who work and pay into the system, as I did, are penalized for doing so compared to the SSI recipients. After taking my monthly SSDI and my Medicaid paydown into account, I had less money to live on than an SSI recipient. One of my brothers suffered a traumatic brain injury as a child that has left him permanently disabled, so he is an SSI recipient. With SSI, there is no Medicaid spend-down whatsoever. They have coverage from the first dollar, including eliminating all deductibles and co-pays for care, plus, they are eligible for the maximum food stamp benefit. At $1170 per month, I was too wealthy to qualify for food stamp assistance, for eligibility was determined by gross income, not income adjusted by the amount of the Medicaid spend-down. Therefore, my brother had more monthly income at his disposal than I did.

    After 2 years of Medicaid, I was enrolled in Medicare. My options even became more limited. Health care providers will regularly accept Medicaid patients because the bills get paid in full, with me paying a portion and the state kicking in the rest. I was looking to transition out of the public mental health providers because of the substandard care, Fewer providers accept Medicare patients because bills are not paid in full. The government pays a portion and requires the provider to absorb a loss on the cost of services rendered, so the poor reimbursement rate is shrinking the pool of providers, which is de facto rationing. If the government option had been introduced as part of Obamacare, it would have chased even more doctors out of the field, as they would feel unable to absorb losses from treating many more patients at the poor reimbursement rates of Medicare.

    Mental health conditions covered under Medicare are not on par with purely physical health conditions. If I make an office visit to see a family physician for an illness now, I’m covered. For mental health, though, I have big co-pays, especially for counselors.

    And now, here’s the next shoe to fall: I originally left the cash-only practitioner in order to get help with my prescription costs. Now I have Medicare Part D. I was diagnosed with ADD in 2007. So now I also wanted to add treatment for ADD to the regimen. Counseling has more limited benefit for dealing with ADD than it does for Bipolar Disorder. Medicine is the bedrock of therapy for ADD. The trick to prescribing medicine for ADD is that I also have bipolar disorder. I don’t have ADD in isolation. With the wrong medicine for ADD, I could have potentially dangerous flare-ups of bipolar disorder. So I received an ADD prescription that took bipolar disorder into account. I had a rude awakening when I went to the pharmacy. Medicare Part D wouldn’t allow me to have the prescribed medicine. We appealed. Twice. The medicine was not in their formulary. They said that before they would be receptive to an appeal, I first had to try two medicines from the 6 ADD drugs in their formulary. If those did not work, then they would take another look at an appeal. Those boneheads making that decision were only taking ADD, in isolation, into account when rejecting the appeal. Though the appeal said that there were complications presented by bipolar disorder, they didn’t care. So, not knowing what else to do, we were obliged to try two of the medicines from the list. There are 5 different categories of pharmaceuticals designed to treat ADD. All 6 of the medicines on the list were from just one of those categories, meaning that if the first was unlikely to work, all the other 5 were also unlikely to work, but, apparently, under Medicare Part D, they don’t care about such details. As it happens, all the listed medicines were amphetamine-based, which is clearly not something one would want a bipolar patient to be taking. With those two medicines, my condition was escalated to full-blown mania. This is an absolutely dangerous mental state to be in. They are lucky that I have no substance-abuse issues, as I totally abstain from all alcohol, tobacco, and recreational drug use. Many ADD sufferers have addictions. The vast majority of bipolar patients have substance abuse problems. Had I been numbered among them, my mental state was so dangerous that, fueled by drugs or alcohol, I may have gone on a rampage and killed many innocent people and myself, just as the Virginia Tech shooter did. If it were possible to sue Medicare for malpractice for forcing me to take a drug that endangered many people, I would do so. It wasn’t the provider that engaged in malpractice. It was the Medicare Part D bureaucracy that engaged in malpractice. But it’s government rationing. That’s what will happen as more are enrolled in Obama care, not just fewer physicians, not just more inefficiency due to bureaucracy-mandated paperwork, and not just longer waits for treatment, but denial of access to effective medicine. It’s ironic that I first sought public assistance in order to get the medicines I needed, and now I find the door is barred shut. Those who think that it is an over-exaggeration to say that rationing under government health care can amount to a death squad, well, let me tell you, because of their pharmaceutical rationing, a person in my condition at that point could have easily become a one-person death squad. Under my prior employers’ insurance policies, I would have had access to the drug I needed.

    I’m still waiting for an appeal. The matter is not yet resolved.

    I hope that eventually, with therapeutic counseling an the correct regimen of medicine, I can re-enter the labor force.

    Pharmaceutical companies in other nations offer their products at lower prices than in the USA. The market dictates that they do so. The can’t sell them for as much money because not enough people could afford them at U.S. prices, so pharmaceutical companies would not have enough customers in those countries without slashed prices. I remember how my out-of-pocket expenses for the cash-only psychiatrist were no more expensive than Medicare with my current co-pays. If we had a free marketplace, we could all get quality care at good prices and physicians wouldn’t be shortchanged for the care they provided. He had one person, only one, doing the office work. That saved him tons of money compared to the doctors that have to hire a whole crew of medical transcriptionists to jump through all the bureaucratic hoops. The cost savings for the cash-only psychiatrist were passed on to me, the patient. It could happen with pharmaceuticals, too. Instead of allowing health insurers to migrate to deeper and deeper pockets (from employer to the federal government) to pay more and more money to them, we should reverse it, (from employer to the consumer) so that we force insurance to be more competitive as they move to shallower pockets. This would put a damper on runaway increases in the costs of health care. With employer and government care, there is no incentive whatsoever to keep a lid on prices. Just like pharmaceutical companies can only charge so much for their products in other countries before their consumer base evaporates, we could create those same conditions here with a free marketplace. Prices would come down. Insurers wouldn’t be flush with cash to lavish upon legislators because they’d have to slash that expense to maintain profits in a competitive marketplace.

    Somebody foots the bill for my SSDI and Medicare. Sure, I paid into both of those funds over the years, but other taxpayers are involved, too. There can be no health care utopia as Ms. St. Pierre or others might wish when sustainability requires that someone foot the bill. If our government paid for every citizen to be screened for cancer and every other disease and then pay 100% of the treatment costs of whatever they find, with no marketplace to keep a lid on costs, what would the tax burden have to be? What mechanism would be used to keep tax increases in check while providing that level of coverage?

    Though Europe has a bevy of welfare states among the nations there, the result is that tax levels can become oppressive. This government confiscation of everyone’s financial resources diminishes what resources each individual has at their disposal for their own discretionary spending. It hampers their liberty. Is Europe really enlightened compared to the USA for the social safety net they provide? We have less economic equality than Europe does, but, we also have more room for upward mobility. That’s one reason why Arnold Schwarzenegger moved from Austria to the USA. There’s no such thing as “The Austrian Dream,” or even “The European Dream.” There is only “The American Dream.” Remaking our society according to the European blueprint would do great harm to the American Dream. Obamacare moves us in the European direction. A free marketplace for health insurance would help us return to our American roots and what has made this nation the envy of all others.

    On the face of it, at an emotional level, it’s quite appealing to be able to say, “We can all have health care whenever we need it, whatever condition we need it for. Obama’s health care bill is an important historical step along that path.” But 56 new bureaucracies were created in the Obamacare bill, and the bill, itself, is way way way more than 1,000 pages long. With something that convoluted, can we be absolutely sure it will save many more lives? At an intellectual level, the Obamacare bill requires much more examination and scrutiny before one make that assertion with such confidence, certainly more examination and scrutiny than Congress, itself, had given to it before the bill’s hasty passage, when many legislators admitted that they hadn’t even read the bill’s contents. I am wary that such oversimplified statements such as “Obama-Pelosi’s Health Reform will save MY life, as well as the lives of others,” may be more propaganda than actual truth. It’s what the bill’s sponsors want us to believe, but I am by no means convinced that it is so.

  • 9. Loraine Ritchey  |  November 2, 2010 at 12:24 pm

    Daniel again I want the sort of worry free medical care that was received by my son for everyone….. Now I am sure the Obama care has its issues as well- it has been watered down – and I also think there should be a choice…….. My cousin in England has a a choice he can through his company go private or he can go NHS – because he is in London and the amount of wait time for attention is longer as dictated by the amount of patients funneling into the number of NHS hospitals available in a certain catchment ( cosumer dictated ) he chooses to go private )

    However my other cousin in another part of England where the population isn’t clustered chooses the NHS there is no wait time in fact my Uncle who is 99 just had his cataracts taken care of .so I guess what I am saying is that there should be choices and if the “cap” by private insurance is reached then there should be something that kicks in for those that are suffering from life debilitating diseases…………….

    I have lived under three health systems , the British, the Canadian ( before and after their current health system) and here ….. all had their problems and issues, but that Clinic insurance was the best!

  • 10. Daniel Jack Williamson  |  November 2, 2010 at 6:49 pm

    As you can tell, I’m very passionate about this topic.

    I understand some of the points you make about the inadequacy of health care coverage. When I presented my own health care plan, I took many of these concerns into account. There is a solution to the cap, and it is called reinsurance. Lloyds of London is one such enterprise famously known for offering reinsurance. Some insurers, especially smaller ones, could go broke if they paid out huge claims for something both catastrophic and chronic. Reinsurance is a way to ensure that a company can remain solvent when they have to pay out astronomical claims. The insurer takes out a reinsurance policy just in case a claim for a patient goes way beyond their ability to pay. The reinsurance will only pay out a claim to the insurer if and when the costs for a patient exceed a certain threshold, a threshold spelled out by the reinsurance policy that both parties agree to. What’s in it for reinsurance companies? Only a fraction of the patients covered by the insurer will require payouts above the threshold, therefore they can still make money by issuing a reinsurance policy. The insurer contains their risk with the reinsurance and the reinsurer doesn’t have to pay out all that frequently.

    A free marketplace would also eliminate some of the limitations of current coverage. The government often mandates minimum requirements for what must be included in a policy. Insurance companies aren’t likely to go the extra mile beyond what is mandated. So, in a sense, the government is the one that’s creating the glitches in the first place via their market intervention. When health insurance customers get to pick and choose their coverage in a free marketplace, that would create a smorgasbord of menu options for the consumer.

    With car insurance the customer needs to have some kind of liability insurance, but, if consumers fully own their own car (no auto loan restricting the title to the car), whether they add collision insurance or roadside assistance or some other option is totally up to the consumer. The auto insurance consumer also chooses their own deductible. Health insurance could become the same way. Some health policies would only cover catastrophic illness or injury. Others would include prevention care. Just as auto insurance offers discounts that provide incentives for not getting any traffic tickets or getting married or having good grades, having an advanced university degree, or being a teetotaler–things shown to reduce risk–health insurers could offer discount incentives for those who show they have a membership at a gym and use it regularly, or such other incentives for reducing risk. Prescription coverage would be another option. They could also offer policies to consumers that cover pre-existing conditions, for, though someone might have a history of something chronic, like asthma, the insurance company can still profit if the consumer maintains their health in other aspects of their lives. Through all this, the consumer would choose their own deductible and copays, whereas, under the current system, your employer and the insurer decide the deductible and copays, and the consumer has no choice in the matter. Along that vein, Obamacare should not be phasing out medical savings accounts, which provide a consumer a way to, in a limited way, insure themselves for a portion of their medical expenses.

    The consumer also would also shop around for policies that would cover everyone that a consumer chooses to cover. This especially helps when you have an excellent salary but others who are important in your life who have much smaller wages can better afford to pay their fair share of the premium on your policy compared to the price of getting their own individual policy. Even a group entirely consisting of low-income earners may find a cost advantage to having a group policy over a bunch of separate individual policies. You want to have your kids, their spouses, and your grandchildren on the same policy? No problem. An insurer would probably jump at that chance, for the younger generations on that policy would balance out the risk posed by the oldest generation on that policy. Want to cover a same-sex domestic partner? There are insurers who could structure a policy that way, too. Do you room with a sibling while you’re still single? You can shop around for policies tailored to fit the both of you. Want to cover your live-in butler, housekeeper, gardener, nanny all on your policy? Not a problem. Want to partner with the next door neighbors to get a policy together? Why not? Just as you can pick up the tab for anyone you go to a restaurant with, and then divvy up each person’s share of the price of dinner afterward, insurance could work the same way in a free marketplace. At a restaurant, no one cares if the others at your table are related to you or not. Any configuration of people, whether a solitary individual, or not, could negotiate a policy for them. Just so long as the premiums are paid, and the people who are covered are specified, why would the insurance company walk away from a chance to make money by quibbling over who you want to cover on one policy?

    Want to dump your insurance company because they didn’t meet expectations? You could do so at any time. No more enrollment windows for changing coverage that only occur once a year. You and your next door neighbor don’t see eye to eye on each one’s share of the cost for the one policy that covers you both? Fine. Cancel your policy and you can each shop for separate ones.

    The chief government mandates needed in this free marketplace would be that insurers uphold their contractual obligations, and don’t drop or cancel coverage just because they have to pay out claims (that would be fraud to take premiums for coverage and then, when needed most by the consumer, the insurer bails out).

    In accordance with my wish to do away with employer-based health insurance, I don’t think the government should be including health insurance benefits in the compensation packages offered to government employees–not even for U.S. Representatives or Senators. In the current economy, on average, public sector employees are paid more than private sector employees, so public sector employees ought to be shopping for their own coverage out of their own pay, just like private sector employees. This would help trim the bloated federal budget, for sure. Their would be a few exceptions, though, such as the military, military veterans, and the diplomatic corps, since diplomats are dispatched all over the world, including places of high risk to life and limb.

    If the pre-existing condition is a catastrophic illness, such as cancer, where the insurers don’t dare touch it because they know from the get-go they cannot possibly make money from it, the government would be the insurer of last resort. Such consumers would have a nominal copay for their doctor visits and the government, itself, would have a reinsurance policy to minimize the impact upon taxpayers.

    As for living in London and using a private insurer due to the rationing of public health care amongst such a huge population, and opting for government care in the hinterlands where there’s no waiting, in the USA, how far would one have to live in the hinterlands for government health care coverage to be worthwhile? The places where I resorted to using public mental health care were in Sandusky and Tiffin. Those are small towns. The rationing I experienced were in dinky places like that–nowhere near the size of London. In the USA, their is a dearth of doctors in rural areas. Foreigners who earned medical degrees here in the USA who want to become permanent residents here are nearly comprising the majority of physicians in rural areas, and yet, even with that influx, the rural areas still need more doctors. If the only method we use for containing the rise in health care costs is the government mandating Medicare reimbursement levels throughout the country, more doctors will disappear. With a free marketplace, competition among insurers will both prevent costs from rising astronomically and prevent the exit of doctors from the health care industry. We can’t shrink the number of health care providers and still escape the effects of health care rationing.

    This is an approach that hasn’t been tried in the UK, or Canada, or the USA, but we can break the mold and try something else when what’s already been tried does not suffice. We can break new ground instead of settle for business as usual.

  • 11. Loraine Ritchey  |  November 2, 2010 at 7:28 pm

    In agree totally …..

    something needs to happen to make it equal and fair and also not dependent upon income OR the haves of the medical profession however I have to admit to being very grateful as should Chris wife as to that coverage………

    car insurance ever been hit by an uninsured driver on assistance Nothing you can do to get reimbursed and even when you take out the best coverage you think there are always loopholes like when a drunk uninsured driver hit my husbands truck parked outside our house pushing it back into my car…… well we had insurance best we thought only to find out that we would only be covered IF he had been sitting in the car!!!! but as it was parked whole other scenario………

    and if a neighbors tree falls on your house or you tree falls see what is covered then and who removes it………

    Also just found out recently that coverage was changed by our bank home equity loan they stopped covering when we followed their advice to get a lower interest rate although we were told when THEY contacted us “the only thing that will change will be the date of completion of the loan and the interest rate you are such a good customer blah blah blah so we signed ” and buyer beware trust not even your friendly home town bank when it comes to insurance because we just wasted 7,000 dollars………

    I just want everyone to have coverage that is equitable no matter the age or income – how we go about that well you have a better idea than I do I just want the cracks in the system filled in and I don’t want to be an attorney to read the gobbdle gook

  • 12. Daniel Jack Williamson  |  November 2, 2010 at 10:33 pm

    I hear you loud and clear on the way companies will misdirect their customers. The loopholes that those insurers enjoy were provided by legislators that the insurers paid off through campaign donations. Though I used auto insurance as a more consumer-driven marketplace than health care insurance, I do realize that there really isn’t a truly free marketplace for any insurance or financial industry. They have all bought and paid for unfair advantages over consumers.

    But, as I said about the health care insurers, if they bail out on you when you have a claim they need to pay out on, that’s fraud, and the government should begin criminal proceedings against those frauds just as surely as individuals who engage in fraud are dealt with in that manner. The misleading sales pitch that enticed you to make changes in your home equity line of credit that brought about some unintended changes that shortchanged you? Fraud. An insurance company says their policy is to cover something that you want coverage for but the fine print of the policy has so many exceptions that virtually nothing you want covered is truly covered? Fraud.

    And legislators are the co-conspirators that allow these companies to draw up meaningless contracts and then give you a misleading sales pitch as an enticement to sign on the dotted line. But, while individuals who perpetrate Ponzi scheme frauds are criminally charged and thrown into prison, these corporations are allowed by law to take a matter to arbitration when a complaint is lodged (sometimes arbitration is the only possible avenue of redress offered to a consumer, and that’s just wrong). If the consumer is permitted to pursue a complaint beyond arbitration, it takes place in a civil trial, not in a criminal trial. That’s a double standard for letting companies off the hook when individuals aren’t. Fraud is a crime (or ought to be).

    Definitely, the government ought to be doing a better job of policing while, otherwise, getting out of the business of intervening in the marketplace to carve out advantages for the politically well-connected.

    In a truly free marketplace, you would negotiate an agreement that would include what you want and exclude what you don’t want. Customized contracts, not one-size-fits all that excludes what you want and includes very little of what you really want. (One-size-fits-all is another aspect of legislation bought and paid for by corporate interests, as the biggest corporations with the greatest ability to fork over campaign donations push for the same standards to be applied nationwide, decrying a patchwork of regulations from jurisdiction to jurisdiction. Such standardizing of laws from locale to locale is just a ploy of the biggest corporations to stamp out any competition from smaller businesses who are much more willing to customize but aren’t in a position to fork over campaign donations.)

    The crisis on Wall Street prompted some to say that capitalism has failed and therefore that calls for a free marketplace should go unheeded. I don’t think it’s capitalism that failed. I think it’s cronyism that failed. Others, such as the big corporations, hypocritically say that there should be some marketplace reforms with less of a regulatory regime burdening business. I agree up to a point. I agree that there are a lot of unnecessary bureaucratic regulations that do hinder free enterprise (though sometimes the regulations that are in place were lobbied for by the big corporations to make it too hard for the little guys to comply with every requirement). The regulations that these businesses want to have relaxed, though, are the ones that hold them accountable. There’s too little accountability already. The regulations that should be relaxed are those that stifle competition, but accountability should never be waived. The big boys want just the opposite.

  • 13. Peter Potamus  |  November 3, 2010 at 11:09 pm

    Well said, Daniel Jack Williamson… the “corporate campaign contributions” to lawmakers are the equivalent of “bribes” when the manifestation of these laws/regulations are considered.

  • 14. She has a dream- Hillary St.Pierre « That Woman’s Weblog  |  January 16, 2011 at 4:30 pm

    […] 100% through everything he underwent- she was not left with horrendous bills ( far from it) – https://thatwoman.wordpress.com/2010/10/28/medical-insurance-not-all-equal/ no bills what so ever….. except reasonable deductibles( which we paid) . BUT then there are […]

  • […] Hillary found all this out at the age of 23 and spent the next 6 years fighting the disease of the “curable???” Hodgkin’s Lymphoma-( refractory) which ultimately claimed her young life , just as it claimed my son’s . Although due to my son’s wife’s insurance – she being a Dr. with the Cleveland Clinic -we had no such insurance worries. MEDICAL INSURANCE NOT ALL EQUAL https://thatwoman.wordpress.com/2010/10/28/medical-insurance-not-all-equal/ […]

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