Monday, March 22, 2010

Monday Morning Musings

Jason woke me up before he left for work this morning and told me that I shouldn't read reader comments on any news sites today. I took that to mean the health insurance reform bill had passed.

I know the media calls it health care reform, but essentially where it will do the most good for the average working American is in the insurance reforms.

Here is a tale of two families. One is five years into the battle, one is just beginning. Both are intact, middle class, both parents college educated, working good jobs, neither living above their incomes. Each had a baby born with serious health problems.

The first family maxed out the cap on their baby's insurance fairly quickly (organ transplants on one year old babies will do that), they then, like responsible parents, added the baby to the other parent's insurance policy. But that insurance company had a six month waiting period. Okay, so the child's health problems were so significant that the baby qualified for Medicaid. Whew! That could cover the lapse. But Medicaid insisted that the private insurance company was the primary and the private insurance insisted that Medicaid was the primary. In the ensuing battle of the insurance companies, the child was denied essential services because the bills were going unpaid. The family had on several occasions to decide between paying the mortgage or buying the child's anti-rejection medications. After a certain time (3 months I believe) the bills became the sole responsibility of the parents, neither insurance was responsible for even a portion of the bills. This family now has over $500,000 in debt from the period where the two insurance companies played "you pay, no you pay". So the parents were reported to credit agencies, bill collectors began calling literally every hour from 8 a.m. until 8 p.m. Their credit is ruined. Only because this was the only "bad" thing to happen to them (i.e. no layoffs, no one else got sick, no car broke down) they are hanging on to their home.

This is what millions of working families have endured under the current for-profit insurance companies making decisions system.

We shall see how the tale of the second baby pans out. That family is also an intact, college educated, both parents working good jobs, not living above their means family. The baby is covered under one parent's policy. Under the reforms passed, either the policy will have no caps or, when they want to switch to the other policy, there will be no six month waiting period. There will be no reports to credit agencies, there will be no bill collectors calling, there will be no lapse in essential treatment for this child.

This what millions of working families will have on their side once the insurance companies are required to provide the services that their policy holders pay for.

Another situation that I have personal experience with.

A person is diagnosed with a chronic illness (diabetes, heart disease, kidney disease, hypertension, high cholesterol). Their doctor gives them a little information in their 10 minute appointment, hands them some pamphlets. The person is then left to navigate the vast amount of information that is out there and make the proper decisions and life style changes necessary. Easier for some than others.

There have been many studies on many different chronic illnesses and many different programs but they all have essentially the same result: for every dollar you spend on education on a disease, you save multiple dollars down the road in expenses for complications.

Under the reforms, prevention will have a place at the table. So, a person newly diagnosed with diabetes will have education classes paid for. They get accurate, up-to-date, personalized information about all aspects of their disease over many classes so they can absorb the information and understand how to care for themselves and how to implement the changes they need to make. Result: their diabetes is well controlled, they are healthier in all aspects, need fewer doctor visits, continue to work and pay taxes, pay their bills and keep their insurance. Without teaching, some do okay, some end up with repeated doctor visits, hospital stays, amputations, blindness, kidney failure, loss of ability to work, go on disability, can't take care of themselves, need home care or nursing home care.

It's just cheaper to pay for prevention. Remember that old saying "an ounce of prevention is worth a pound of cure"? Well, I've been saying for years that America (in the health care sense) has wasted its ounce of prevention and it is now time for the pound of cure.

It will cost more initially to get these things up and running. But it will save more in the long run. That is what we need to return to. The long run. We are living in such an instant society. We are so used to things happening overnight, or sooner. We elected Obama on the hope of change. Then two days after he was sworn in, we started grumbling. "Where is our change?"

To paraphrase Amy Grant, it's gonna take a long time to turn this boat around. America is so huge it is going to take a long time to turn around the economy, the health industry, the education system.

Thor sez: I'll bite those bill collectors like this!
(Lame, I know, but the picture makes me smile)


chucker said...

Thanks for an intelligent assessment.

Knee jerk reactions/party-flavored rant and the growing cult of "nothing is good" wears on me and my positive outlook.


Pixel Peeper said...

I admire you for your skill to summarize all this with such common sense!