January 7, 2008

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.


Anonymous said...

All of this about insurance is absolutely true. My moniker on the MSNBC Health blogs is "uninsurable" -- for all the reasons you state. I lost my job in 2004 and thought I could do OK as a freelancer, as I had done in the mid-1990s. What I hadn't reckoned on was not being able to buy health insurance, at any cost. I could not even get coverage for my 16-year old son -- again, the dreaded "pre-diabetes" diagnosis. In my own file, I call it the Scarlet Letter "D". But even without the D, I was out on basis of: age, not having had a hysterectomy (just like your anecdote), obesity (OK, that would be half of America), history of migraine, history of depression, etc etc etc. And, even if you are healthy enough to buy insurance, wait til you see what happens to the rates when you pass 55.

The Old Man and His Dog said...

I used to work in the payroll department for a major insurer. Here's what I saw......I saw an insurance company crying poverty while paying out millions of dollars in annual bonuses each year whether they had a good or bad year...it didn't matter. Large parties for employees each year, subsidized lunches and company store, dry cleaning service, free specially catered meals at every meeting(which truly averaged at least one per day, sometimes up to 3 or 4 all with food), free limo service to get to and from work when needed(and this was for me, the lowly payroll admin), and free fully paid health benefits upon retirement at age 55 with 10 years of service, a company paid pension plan in addition to a 100% match of the 401k for the first 5% of contributions(vested immediately). Company cars for many, unlimited expense accounts....it goes on and on.

Insurance is a scam making many insurance employees rich while those that really need the insurance go untreated thanks to the insurance lobby and scumball politicians.

ooooooh did I just sound angry?

Scott S said...

You also raise some interesting points which are seldom discussed regarding healthcare, namely the fact that we do not currently have the right to dispute any information which may be in our healthcare records, such as your friend who had one doctor recommend that she needed a hysterectomy, which other doctor's determined was not a medical necessity in her case. Regardless, today she is not entitled under HIPAA or any other law to have that entry removed from her permanent healthcare record, and laws pending in Congress for electronic health care records fall far short of what is needed.

As a matter of fact, in February 2007, the U.S. GAO (http://www.gao.gov/new.items/d07238.pdf) released its report which showed that overall, the Department of HHS was only in preliminary stages of protecting patient privacy, and has not yet defined an overall approach for integrating its various privacy-related initiatives and addressing key privacy principles, nor has it defined milestones for integrating the results of these activities. The GAO identified a number of key challenges associated with protecting electronic personal health information.

Specifically, they defined the key challenges as understanding and resolving legal and policy issues, such as those related to variations in states' privacy laws; ensuring that only the minimum amount of information necessary is disclosed to only those entities authorized to receive the information; ensuring individuals' rights to request access and amendments to their own health information; and implementing adequate security measures for protecting health information. As of today, few (if any) of these issues has been addressed by Congress.

Even more troubling was that I have learned that the so-called advisory panel of "experts" on patient privacy no longer exists -- all of the members apparently resigned due to the lack of progress being made by HHS. We currently can dispute errors in our financial records through the Fair Credit Reporting Act, but we lack the same rights to our medical records ... there is far more to the healthcare mess than simple access issues, we need to seriously investigate how to resolve disputes, and also develop resolution procedures for these things, none of which is guaranteed by HIPAA.

E Melander said...

A truly great post! I too am among the uninsured being denied for taking a certain medication for infertility - a medication I paid for out of pocket anyway. It is really disgusting to see these insurance companies play games with peoples health.

Karyn said...

Hi, Jenny

I love your blog and have learned so much since becoming diabetic 2 years ago. Whereas there are thousands of web pages with excellent information available to us, your site provides it in a way that's easy to understand. In a sea of confusion, yours is an oasis for the newcomer or the veteran. Thank you!

In regard to your friend with MS, I wonder if either of these two sites might help her get the medications she needs... As you may know, Montel Williams was diagnosed with MS himself and has become a huge advocate for research and getting people the assistance and access they need to drugs which might be out of reach otherwise.

Here is his main page:

The Montel Williams MS Foundation

And a direct link to a partnership page:

Partnership for Prescription Assistance

These links may be something your friend is already aware of, but if not, I hope it's something that can help.

Keep up the good work, and thanks again.


Anonymous said...

We're going through the insurance search for my husband. Our COBRA coverage is going to stop at the end of this month (January). Bob has been calling around - looking for health insurance. We had no idea that he could be uninsurable.

Many agents said their company would not insure. Looks like we may be able to get coverage from AARP and United Health Care. We know that we need to put in all applications at once. Otherwise, we have to check off "Denied" after any one insurance company denies the application.

I've chosen to be uninsured and not go to any doctor since 1992 - after being a nursing student at Vanderbilt. Even when I've been covered, I haven't gone. Patient has no control of what gets put in the record. Once the info is there, it could make you uninsurable. Now I'm on Medicare.
I did have one problem once, and got it taken care of by an Italian doctor on a Costa Cruise. Care was excellent. Was given a prescription for Buscopan - cost $8 for 30 pills. Buscopan is prescription or OTC depending upon the country. Buscopan is not available for humans in the US - only recently available for horses by injection. Check ebay :-)

If a diabetic cannot get any insurance, it would be essential to buy and take the meds, manage diet, get lab tests, and get checked by doctor every 3-6 months depending on the results of your labwork (A1C & lipid profile). PAD assessment would be important.

You can get professional nutrition information from Dr. Bernsteins website for $89 for three months.
My husband is starting the program now.

Labwork cost is reasonable. For example, I purchased a labwork for $105 which included glucose, A1C, CMP, lipid profile. I chose which individual offerings to have based on results of internet searches. TSH may be another test you'd like to add.

Total Out-of-pocket costs would be doctor visits (2-4 per year), meds, labwork. Get a blood pressure home monitor. Take your blood pressure. Exercise. Eat right. Getting the A1C down is really important to avoiding complications.

Best advice of all is to read Dr. Bernstein's book: "Diabetes Solution" and visit Jenny's site often. I also find Dr. Bernstein's live webcasts very helpful - sign up at diabetesincontrol.com (scroll to the bottom).

Lucky for us, our real estate broker is going to offer group health insurance. This comes Just-In-Time.

Anne said...

This is a great blog and I have recommended it to all my diabetic friends. I do not have diabetes but I do have insulin resistance. I work for a large university and have "good" health insurance, but I have watched my benefits shrink and my coinsurance and copays rise every year. I have found lifestyle changes have made a huge impact on my health and I see the doctor much less often

Another site to check out if one has MS is http://www.direct-ms.org/

Verlin said...

I think that part of the problem is that Americans are easily fooled by the "communist" or "socialist" boogeyman rhetoric that comes up whenever a single-payer or similar system is suggested. Too many of us live under the myth that we have the world's greatest healthcare system, when in fact all we have is the world's most expensive healthcare system. We have to be smarter when it comes to healthcare spending.


Anonymous said...

I am 58 years old. I was diagnosed 16 years ago with Type 1 (1.5?) diabetes. Right now I have coverage through my spouse's employer plan. I am absolutely terrified something will happen to him or his job. We know several people that wanted to retire and could not, due to need for medical insurance. At least some of this problem is due to medical insurance as a profit based industry. The amount of money paid to the CEO of United Healthcare is obscene! First, at minimum goverment needs to regulate the profits of medical insurances. Insurances are doing now what they accused medical providers of doing when managed care came to be. The second thing goverment needs to do is outlaw the entire concept of pre-existing condition. I wonder what the insurance industry would do if they had to run their business the way they make the health care provider run theirs. We somehow need to get universal coverage and it would be good if we could do it without using a single payer system in order to maintain some competitions. Healthcare will be one of my primary areas of choosing a candidate. But I don't believe any of them has a clue about how bad things are.