Posted on 08/08/2009 10:10:06 PM PDT by Libloather
Rationed health care is already here
By Clarence Page
Published online 8/7/2009 10:15 PM
"Rationing" is one of the scariest words in the current health care debate.
It conjures up apocalyptic nightmare images from "Soylent Green," the sci-fi thriller about a future in which the old and weak are quietly lured into early extinction for the sake of future generations.
What the scaremongers don't like to talk about is how much our private insurers ration now - mostly for the sake of their own profits.
They're clever enough to avoid using the R-word. They use other words, like "Read the fine print on your policy."
My friend Sarah Wildman learned the hard way. She's the new mom with what she calls a "$20,000 baby."
That's how much she and her husband had to pay out of their own pockets after her insurer decided her baby was a "pre-existing condition."
Self-employed, Sarah and her husband fall into the individual insurance market, which the American Medical Association estimates to be as high as 27 million people.
Falling between the fully covered and the uncovered, their numbers have grown faster as thousands of Americans lose their job-based insurance every day.
Some of them are women who discover the hard way, as Sarah did, that if you bought maternity coverage after the pregnancy began, the fetus is viewed as an uncovered "pre-existing condition."
The Pregnancy Discrimination Act of 1978 requires employers with more than 15 workers to include maternity benefits in their insurance packages. But only 14 states require maternity coverage in policies sold on the individual market, according to the Kaiser Family Foundation.
And a report last fall by the National Women's Law Center found only 12 percent of 3,500 individual insurance policies included comprehensive maternity coverage. Another 20 percent offered it with a rider that cost as much as $1,100 a month. Others required a two-year waiting period.
Fortunately Sarah's story had a happy ending. She's a freelance writer for magazines like The New Republic, The New York Times, The American Prospect and the online publication Slate.
When she told the company's press rep she was going to write about their "crappy" maternity policy, "I got kicked up the food chain."
In the end, she reports, she was able to get 90 percent of her hospital costs paid by the company, which also promised to adjust claims paid to some similarly situated women.
After she wrote about her horror story in Double XX, a woman-oriented Slate spinoff, she heard from numerous fellow sufferers, some with hospital bills bigger than hers. Last Thursday she testified before the House Joint Economic Committee, which released a report that found women more economically vulnerable than men to high medical costs and related bankruptcy.
She also has received the inevitable scolding in today's heated blogosphere from opponents of national health insurance reform. It's her own fault, some said; she should have read the fine print. Right. As if everybody reads the fine print on their insurance policies - and understands it.
And she hears the fears of those who suspect national reform will lead to government rationing of health care. I'm old enough to remember how similar fears were vented when Medicare was born in the 1960s. It is now so popular that President Obama and others have heard satisfied, if a little confused, constituents say, "Don't let the government mess with my Medicare."
Left unsaid by those who raise fears of rationing by any "government-run" or government-related health care is how much rationing the insurance industry does now.
For decades, experts writing in the New England Journal of Medicine and elsewhere have concluded that we do "ration" health care. We just do it through gross disparities in race, sex, age, regions, income and education.
And, although Sarah's insurer may deny it, we also ration it to those who are lucky enough to have access to the big soapbox that she happened to have.
Under pressure, the private insurance industry has come to the table. A spokesman for the insurance industry recently responded to congressional criticism by listing concessions that the industry has offered as alternatives to a publicly funded option.
The industry has proposed "guaranteed coverage for pre-existing conditions, discontinuing rating based on a person's health status or gender, and a personal coverage requirement to get everyone into the system," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.
Sounds great. But why wait? Insurers don't need the government's permission to reform themselves. Just do it.
Socialism will do that to a free people.
But when the government is the insurance company, to whom can one appeal? It’s not as though the government will be worried about losing customers when private insurance is gone.
“Socialism will do that to a free people.”
Clarence Page worships under the flag of Socialism.
Sigh. Of course it has to apply to all companies. Which only the government can do. If private companies set it up themselves, it's called collusion, and it's illegal, besides private companies having no way to enforce it.
If company A provides coverage to all comers, including those who decide to buy insurance only after discovering they're pregnant or have cancer, then it will have to charge significantly higher rates than company B, which continues to exclude such risks from its pool.
People just don't understand the basics of what insurance is. It's a way of spreading out costs among a great many people. Insurance companies don't pay for anything, the other policyholders do. The more people who are high risk allowed into the pool, the higher the rates that must be charged to the low-risk members of the pool.
I’m curious about the parenthetical portion of your headline. It doesn’t seem justified by the article’s language.
There is also this. If you have an accident with your car and then try to buy car insurance to cover the existing accident damage, you can't get it. Why should health insurance necessarily be different.
FWIW, health insurance company profits represent about 1% of the money spent on health care in this country. That isn’t going to finance much of an expansion in coverage. That can only come from policyholders or taxpayers coughing up a bunch of dough.
This couple had insurance, Her prenatal care and delivery would be billed to her at the cost that the insurance company would pay. IE: List price $20K actual cost 6-8K. They would receive the discounted insurance price.
Other holes in the story are as follows. Once the baby is born He/She is immediately covered by the insurance policy BY LAW! If they had had a private insurance that covered maternity and immediately were covered by a new policy,wherever it came from, They have NO PRE-EXISTING CONDITIONS because there was never a gap in coverage. If they didn't have coverage for pregnancy they could have made arrangements with their local hospital and gynecologist to pay a reasonable amount for the delivery. Cash is king, particularly in the medical field. They wait for up to nine months to get paid for their work from Medicaid and Medicare, they would definitely take in cash what a welfare birth pays from the government.
This couple could afford whatever medical coverage they wanted, they chose to pay less for a policy that didn't cover their child's’ birth. Why should I be the one to help pay for it?
Clarence Page should try suing medicare and see how far he gets...
http://law.freeadvice.com/malpractice_law/nursing_home_abuse/nursing-home-lawsuit-medicare.htm
I feel that my father was not given proper treatment because of Medicare’s limits on what the nursing home could provide. Can I sue Medicare or the government?
Probably not. Although you can sue an insurer or a health care provider for failing to provide for the treatment you need, you generally cannot sue the government when Medicare payments are arguably not high enough to allow for a certain level of treatment.
Although class action lawsuits have been initiated in the past over the terms of Medicare coverage, such as the cost of premiums, it is ultimately the responsibility of your father’s nursing home to provide necessary and proper treatment.
The individual market represents about 9% of insureds. It is tiny, and it works for most who have it. It provides young people with solid insurance for about $41 a month in CA and most other states.
Yet, nearly EVERYONE agrees it is a disaster for those with health conditions, and in need of real reform. The insurance industry is now leading the charge, having recognized the terrible PR it generates. It is relatively easy to fix, and may not even cost any money. We just need a set of rules that all must abide by, that fully recognize the unappreciated, boring, but still important principles of insurance and risk spreading. This has been done before; I have seen it, (in CA) and it will work for the nation.
Sadly, most Dems I talk to would rather see a few people suffer and use them as an excuse to push the radical adjenda of socialize medicine.
If one mijdlessly repeats “Everyone is a right to health care,” without asking “HOW MUCH AND WHAT KINDS of health care, you forget that the means to an end matter as much as the ends. Insurance for all is impossible. Once it is available for all it becomes a benefit.
At least insurance companies can not force you to buy their plan, or force your wealthy neighbor to buy your plan for you. I am sure I could come up with hundreds of differences between the 2 entities. This author is doing mental gymnastics to try and make a point.
...you really shouldn't sign ANY AGREEMENT that you don't understand or have read.
The author of this article is quite correct that America practices rationing of health care, just as other countries do. We just use, at present, different methods of rationing than are used in most other countries. These methods are highly offensive to liberals.
In actual fact, rationing is inevitable whenever there is an economic good with essentially unlimited potential demand. In the long run supply just cannot keep up, and some form of rationing must occur.
What is seldom talked about here is the fact that what constitutes the “best possible” health care continues to grow in cost much faster than the economy. (When the economy isn’t actually shrinking.)
This means that once Obamacare passes we will pretend that Joe Blow the homeless guy will get the same care as the president of the US or of Microsoft. He won’t, of course, and we’ll have occasional outraged exposes of the differences. What everyone refuses to recognize is that our society cannot possibly afford to provide state of art medical care to all its citizens, and as that state of art continues to advance our ability to do so will continue to diminish.
Right now we could provide 1980-level health care to all for a quite reasonable cost, and historically speaking that ain’t bad. But we will continue to pretend we can provide SOA to all, and it ain’t gonna happen.
Back in the early ‘60s, our family doctors was telling us why he opposed what later became Medicare. His major point was that the demand for medical care was unlimited, or limited only by the means available. Therefore costs would go up and up, making nonsense of the figures then being thrown around by liberal reformers like Teddy Kennedy.
Insurance companies are controlled 100% by government now Clarence. ERISA and State regulations mandate what they can and can not do..You Dumbass!
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