Health Care and Candidates

Whatever your political beliefs, if you have diabetes, health care should be at the top of your concerns when evaluating the campaign promises of any candidate.

I've had a couple random discussions with people of every political stripe lately, and what I've found is that people who have jobs or have spouses who have jobs that provide family health insurance have no clue what the rest of us are up against when it comes to getting insurance. Even worse, many don't realize how the loss of the job might bring with it the permanent loss of the ability to get health coverage thanks to their having a chronic health condition.

One person I know who identifies themselves as a rock ribbed Republican told me they are firmly opposed to any government intervention in health care and that, indeed, they wish they could opt out of Social Security when they turn 65. This person has total health care coverage care of a generous plan their spouse gets from a Fortune 100 employer. What they don't understand is that thanks to both having been diagnosed with preexisting conditions, were their spouse to lose their job, the power of the insurance lobby in their home state ensures that neither of them would able to buy private insurance at all.

If you have diabetes or for that matter, just about any diagnosis at all in your medical records, you have a "preexisting condition". In many states in the U.S. insurers are able to deny coverage to anyone who applies for insurance who has a preexisting condition. To get individual health insurance coverage you will have to give access to all your health records and you may even have to submit to a blood test. Even worse, if you do file a claim for an expensive hospital stay after getting insured, your carrier may refuse to pay it by saying that the claim points to your having had an undisclosed preexisting condition. This isn't hearsay. It has happened to people I know personally.

What exactly constitutes a preexisting condition? For one friend who was 22 years old, it was a single visit to an ER with a mysterious symptom which was diagnosed at the ER as being from a migraine headache. That was enough to keep them from being able to buy into a private health insurance plan. For someone else, it was having a doctor write in their record that they needed to have a hysterectomy. As it turned out, they didn't. But even years after refusing the surgery--with no further medical problems--the existence of that doctor's recommendation kept them from being able to buy into an individual health plan. A diagnosis of mitral valve prolapse--which is extremely common, was grounds for yet another person's health insurance rejection. Pre-diabetes? Forget it. Cancer of any type, you are uninsurable. Taking an antidepressant? That implies a preexistant condition too.

If you have a really serious condition, this lack of access to health insurance may lead to an early death. A recent study found that people with cancer are much more likely to die if they don't have health insurance mostly because they can't afford doctors visits and get late diagnosis, though the costs of chemotherapy may put it out of reach too.

I have a friend who has MS. This friend and their spouse are both self-employed and the family earns a good income. Unfortunately, at the time they bought their current health insurance plan, since they were both healthy they did not include drug coverage in their plan. Now after the MS diagnosis, they are trapped in their current plan with no possibility of buying another. Drugs for MS cost many thousands of dollars a month so the "private sector" insurers stay profitable by excluding new customers with MS from their plans. Unable to get the expensive drugs that show promise of halting the progression of this terrible disease, my friend may end up in a wheelchair years earlier than someone with a corporate job, just because someone checked off the wrong box on their insurance application a few years ago.

Another thing people who have insurance through their jobs don't understand is that just when you reach the decade of your 50s, when employers are most likely to fire you no matter how good your job performance, even if you can buy yourself self-paid health insurance it becomes extremely expensive.

All states I know of allow private sector insurers to use "age banding." That means that someone 30 years old may pay $300 less each month for the identical coverage offered to someone 50 years old no matter what the actual health history of these two people may be.

Massachusetts recently passed a law that makes it possible, and in fact, mandatory for everyone in the state to buy insurance. This is good in that it means that people with preexisting conditions and no employer can buy insurance. But since Massachusetts doesn't outlaw age banding, the monthly premium charged someone 50 or older in the cheaper plans runs about $500 a month per person with quite a lot of deductibles and the cost is predicted to rise steeply next year.

Where a person who has lost their job and has to buy their own insurance is supposed to come up with hat kind of money is a mystery that seems to have eluded the politicians who tout this as an "affordable" plan. For someone earning $100K a year $6,000 might be affordable, but the median family income in towns in the western part of Massachusetts where I live ranges from $35,000 to $51,000. The $12,000 a year it would cost a median income couple in their 50s to buy insurance is a huge bite of that income. For a family faced with a need to buy insurance thanks to sudden unexpected job loss it is out of reach.

When candidates talk about "private sector" solutions for providing health insurance they are talking like plans like that of Massachusetts that allow for-profit insurers to supply age-banded insurance to the public at any cost they decide to charge and passing laws that force everyone to buy this insurance no matter what it costs. Only highly paid politicians who don't have to pay for their own insurance could consider this a good, affordable, solution.

To me it seems ridiculous to think that private insurers who are paying the multimillion dollar salaries of the insurer's executives and the profits of their shareholders before a single dollar gets spent on health claims can solve the problem of offering affordable health insurance.

A health care "solution" that is really welfare for the insurance companies and HMOs is NOT what this country needs. We need to put the brightest NON-lobbyist minds to work on the problem and come up with a way of offering health care that is fair to doctors, hospitals, and people with health care needs.

I'm not holding my breath. The health insurance lobby is funding all the campaigns, so don't expect to see anyone propose a solution that regulates or limits the huge profits of the health insurers anytime soon.