Don't Know How She Sorts It

I just watched this short documentary, about a cook at the Sigma Nu frat house at Ole Miss:

Ten Dollars an Hour from Ben Guest on Vimeo.

Here's the math of Leasse William's life, from the whiteboard talk in the documentary:
She makes $10/hour, and works 50 hours a week, nine months a year, and either works minimum wage or gets unemployment (the income is about equal) for the other three. Her taxes (yes, people at this income level pay taxes!) are $3600, and her health insurance, which she buys on the private market, costs $2400/year. This leaves her about $14,200 in take-home pay, which is near the Louisiana poverty line -- and that already includes the possibility of government-subsidized unemployment benefits.

Now, poverty is a systemic problem, and it's not clear whether it can be simply fixed by legislation, more consideration shown to employees by employers, an insistence on racial equality, or any other individual undertaking. But the absolutely back-breaking cost of medical insurance is something we can fix with legislation, and the legislation is in Congress right now, in the form of the public option amendments to the Baucus bill.

Leasse's problem isn't just that her insurance is expensive -- it's that she doesn't have any extra resources to fight her insurance provider to protect her coverage. If, let's say, she wakes up bleeding from the nipple one morning and her insurance company refuses to cover it as an emergency, she's not going to be able to do what any smart person would want to: lawyer up and spend a couple of days making angry, pointed phone calls. She's back to work, if she can work, ten hours the next day. Every dime that insurance providers and brokers like the GradMed people (who don't provide real health insurance and wouldn't insure anybody in this documentary, but who seem like good representatives of the industry to me) steal and waste -- every bit of that $2400 a year that goes into marketing, salaries, profit, obsessive rereading of "Dying for a Public Option" -- comes out of the money that Leasse is setting aside for her own care, and it's money that she frankly doesn't have in the first place. Those costs are passed along to her in the form of claim denials, copays, coinsurance, and rescission.

And this doesn't just cost Leasse. Medical bankruptcy would put her right on unemployment (which her job seems to expect her to collect already), eventually on welfare (if she's lucky). This couple in a recent PBS NOW episode, like many others with chronically ill children, limits their own income so that they can qualify for Oklahoma state child health benefits, because their asthmatic daughter may need an expensive operation to repair her damaged lungs at any time. From a purely practical perspective, we are wasting the country's resources, both human and financial, by dumping them into the insurance industry.

And it doesn't just cost money. Our system of health insurance is unjust. It punishes those who can least afford it, and enriches those who do not deserve it and haven't earned it. Instead of strong citizens united for the common good, it creates fear and division and resentment. We can do better. We're so close to making a change for the better.

Why's Wayne Worried?

Talked to a friend the other day whose father, who we'll call Wayne, is still a bit on the fence about significant national health care reform -- he doesn't want to lose his current insurance. I think he's probably representative of a good portion of the lukewarm opposition to a public option -- it'll be hard and expensive to make a big switch, learn a new system, and he's doing fine now.

One of the reasons that this kind of attitude can persist is that health insurance companies hide costs and show benefits -- your health insurance payments don't appear, itemized, on your paycheck, so you're often not exactly sure how much your employer's paying per year. Plus, a good portion of insurance company cost-saving measures (abandoning paying customers -- rescission -- and refusing to cover drugs and procedures because of the costs) are hidden, and blamed on the customers and the drugs, respectively. This means that the customer who develops an expensive, life-threatening condition is found, by some slight of hand, to be at fault, and expensive treatments are labeled as 'insufficiently tested' or 'unnecessary'. There is currently no way to measure or compare how, and how much, insurance companies use these methods. So we don't really know how much we're paying, and we don't really know what we're getting.

What we do see is that when we go to the doctor's, our insurance coverage knocks off a significant amount of the price -- my doctor's visit goes from $80 to $10. That feels like a great benefit. But if you're paying $2400 a year (and that'd be a pretty cheap policy), it's nothing -- you'd need to go to the doctor's 32 times in a year to break even, which is a little more than once every other week. What you're paying for is what happens if you get very sick. Brain scans and protracted physical therapy and hospital stays, etc. etc. Wayne's never gotten that sick: he doesn't know how quickly the insurance company turns from a no-hassle discount into a tight-fisted adversary.

That's why there's this immense flood of stories of people who have been heartlessly screwed by their insurance companies. We are promised that we will be covered, and then we're not -- and it's shocking (note the family in the last link that is dropped from their insurance provider of 35 years), and we are surprised, and we want to tell someone.

Because of the system, though, this will happen over and over again -- until Wayne hears enough stories to realize that this can and will happen to him unless he works hard to ensure a public option for himself and his family.

PS: I also have found one person who got screwed by our health care system and then fell in love with it later -- but I think he's more or less one-of-a-kind.

Rescission

Rescission! Hah! Good God! What is it good for?

Profit profit profit.

Rescission is the insurance company practice of denying coverage to insured policyholders, and it is overwhelmingly applied in situations where the policyholder has a right to significant payment.

Here's the step by step:

1) You or your employer pay thousands of dollars in dues to an insurance company.
2) You get sick.
3) Your insurance company decides that in retrospect, you weren't eligible for coverage from the start, sometimes because you didn't fill out forms correctly, sometimes because they identify a previous condition that you didn't know about, and call you ineligible because of it.
4) The insurance company keeps all those dues, and you are suddenly sick, uninsured, and broke (because those dues weren't cheap!)

Rescission is different from the argument that expensive treatments aren't covered, it is a complete denial of all insurance and it's much more profitable for insurance companies. This article is the best explanation I've seen about rescission's impact on insurance company profits -- all the companies have to do is get rid of about half of a percent of their sickest patients, and their financial outlook becomes much rosier. Remember, though -- one of the things you pay for when you or your employer sends a check to the insurance company is a promise that if you become part of that expensive 0.5%, you'll be taken care of.

And let's not forget -- we live in a country where even 'not for profit' health insurance CEOs make millions and for-profit CEOs take hundreds of millions of dollars in stock options, while the number one cause of bankruptcy is health care bills.

Insurance Companies Kill

It might seem like a dramatic title -- do insurance companies really kill people? -- but the video below is one of the reasons I started this blog in the first place:

Linda Peeno confesses to manslaughter

They are stealing from us. Our government doesn't allow any of the things we need to live to be monopolized by businesses. We subsidize food -- we share water -- we give the air away for free. Why do we have a system in which one company determines the extent of your health care?