Sunday, September 6

Why Health Reform Requires Pulling the Insurance Reform Trigger Now

Senators taking a beating from the folks back home are looking for a way to not appear to be kowtowing to insurance interests by proposing a "trigger" in the Senate's health care bill that would allow a public option to take place if the private market fails to provide more access, more affordability, and more competition in 3 to 5 years.

On CNN's "State of the Union" Nebraska's Sen. Ben Nelson said that President Obama needs to support the trigger, "he has to say if there's going to be a public option, it has to be subject to a trigger. In other words, if somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a government-run option, but only as a fail/safe backstop to the process. And when I say trigger, you know, out here in Nebraska, in the Midwest, I don't mean a hair trigger. I mean a true trigger, one that would only apply if there isn't the kind of competition in the business that we believe there would be."

So where are we? Companies like Aetna, American Association of Retired Persons,American Family Insurance, Blue Cross and Blue Shield Association, Cigna, Fortis, Humana Inc., etc. provide insurance for millions of Americans. 76.2% of Medicare health spending in 2002 was on chronic diseases like diabetes, heart disease, cancer, and Alzheimer's disease. According to a white paper "Health-Care Cost Projections for Diabetes and other Chronic Diseases:The Current Context and Potential Enhancements", 49.2% of the US population is projected to have at least one chronic disease (47% projected on 2010) and 25.9% to have two or more by 2030 (Projected to be 23.5% in 2010).

Out of curiosity, I went to's website and projected the cost of insuring my wife and myself based on me having one chronic disease (in this case, I chose diabetes). Between my wife and I, we earn slightly under $48,000. Selecting the least expensive plan (provided by United Health One which is "the brand name of the UnitedHealthcare family of companies that offer personal health insurance products, including Golden Rule Insurance Company and United HealthCare Insurance Company" aka "the largest single health carrier in the United States" with 70 million customers)which had a $10,000 per person deductible and a cost of $180.43 for a plan that covered no office visits, but had a 20% co-pay after the deductible had been met and a $6,000 out-of-pocket limit. The plan does not include any prescription drug coverage. If my wife and I had ne stay in the hospital or routine check-ups on my "diabetes", we would pay $28,168.76 out of our incomes and/or savings or 59% of our income for the insurance. There were other plans, of course, but each had a higher monthly payment which a person seeking insurance would have to consider no matter how good the overall coverage was. I had a total of four options to choose from, which is not to say there aren't other options, just no other one's with on-line quotes.

The prevention of chronic diseases is tied to two controllable variables, prevention and maintenance of chronic disease. Both require doctor visits and access to prescription drugs. Based on my small experiment, it is clear that persons who would have difficulty accessing health care on there own would likely have less access to the very things that help them not to overuse it; doctors and drugs. Regardless of the plan I would have chosen, there would not be one that would offer the basic elements that Medicare offers, again--doctors and drugs.

This is an example why a public-option is so needed. The private market fails to address the very needs that would keep more of us healthy or healthier. Regardless of income, all of us deserve at least this much coverage. Given the lack of competition, access, and affordability that many experience today, why should we wait another three to five years to hear that it's still a broken system?

Epilogue: For the record, I didn't look up the profits for UnitedHealthCare until just now. On July 21, UnitedHealth Group Inc. reported a soaring second-quarter profit. The Minnetonka-based company said its profit more than doubled compared with the same quarter last year, when hefty legal charges weighed down earnings. UnitedHealth also said revenue rose 7 percent, as it saw strong growth in its public and senior health insurance. How did they do this, getting out of "unprofitable markets, paying off a fine based on business practices, paying doctors less, and yes, increased premiums.

Revenue rose to $21.66 billion from $20.27 billion on increased premiums, which grew partly because of price increases. UnitedHealth is the largest commercial health insurer based on revenue.

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1 comment:

desmoinesdem said...

This is why we need to pass health care reform through the budget reconciliation process. If we only need 50 votes (plus Biden) we can tell the Ben Nelsons of the Senate to take a hike.