Health Care in America - Choice?

by Roland Lindsey

"Choice" is a word we hear from talking heads and politicians nearly every time they talk about Health care in America.  President Obama recently declared on talk radio, "Choice, competition, reducing cost, those are the things I want to see accomplished in this health care bill."  Nancy Pelosi said, "I agree with the president when he said a public option was the best way to keep the insurance companies honest, that it would be the best way to increase competition so that we can lower costs, improve quality of care, retain choice and expand coverage."

On the other side of the debate, the Republicans have opposed Democrat plans for health care reform, often claiming it would take choice away from the American people.  Representative Paul Ryan claimed the federal bureaucracy would replace "choice and competition."  Representative Bob Latta claimed "I believe people should have the choice to keep their own insurance, or Health Savings Accounts, if they are satisfied with their coverage and not be subjected to government intrusion into their personal choices."

Republicans have introduced a plan called "The Patient's Choice Act of 2009" that would create state insurance exchanges.  The purpose of these exchanges is to make it easy to compare and select plans.  Apparently they have never heard of http://www.ehealthinsurance.com.  The plan would also... give people money to buy health insurance.  And if you are uninsurable through these plans?  They will do what Washington State did and create a "high risk" pool that would be more expensive, but would still provide coverage.

So much concern over preserving "choice" or granting more "choice."  After consulting my own experience, I pause to wonder, "Why do you keep saying that word?  I do not think it means what you think it means."  Like 56.5% of Americans, I have always received health insurance as part of my total compensation from my employer.  Odds are good that you receive your insurance this way, so I ask you:  When was the last time you made a choice in your health insurance?

At a recent town hall in Waukon, Iowa, Republican Chuck Grassley suggested that you can receive quality health insurance by working for John Deere, or the Federal Government.  The questioner asked, "Okay, so how come I can't have the same thing you have?"  Grassley responded, "You can. Just go work for the Federal government."  I'm reminded of Ronald Reagan's words on his 1961 record:  "...and pretty soon, your son won't decide when he's in school where he will go or what he will do for a living.  He will wait for the government to tell him where he will go to work and what he will do."

I decided to see what would happen if I were to exercise my choice in the American Health Care system.  I currently am subscribed to a large insurer through my employer.  They cover my wife and I, but I do not cover my two daughters through this plan.  This is because my wife works at a much larger company than I do, and is also covered by the same insurer on a better plan, and it is much cheaper to cover the children through her company than mine.

My current plan has a yearly deductible of $500, and $4,000 out of pocket maximum.  Let's see how the my current insurer for individuals does.... wait a minute.  I can't buy a plan from them because I live in Washington.  Ah, my company is incorporated in another state, that explains it.  Alright, let's pick the most popular companies in Washington instead.  After running my information through ehealthinsurance.com, I found.

Regence Blue Shield - $1000 Deductible, no max out of pocket... but a $5000 coinsurance max!  That's close enough, I guess.

Premera Blue Cross -$1000 Deductible, $2000 coinsurance max

Group Health - $500 Deductible, $12,500 out of pocket maximum.  Ouch.

I sent a message to Regence to ask them about pre-existing conditions and whether or not we would be able to be in one of their standard plans.  I received an e-mail from them the next day.    It read:

Thank you for your recent inquiry.

Unfortunately we are not able to provide you an answer until we've received the application and Health Questionnaire for each person to be on the plan.

When you apply as a family we look at each individual person separately. In some cases part of a family can be accepted and others declined.  To be eligible for health coverage each person would have to score 324 or less on the Health Questionnaire. The scoring system can be found on www.wship.org.
https://www.wship.org/Docs/SHQ%20Scores%20sort%20by%20number%20-%2001%2021%2008.pdf

is the link to the actual scoring tool so that you don't have to search for it on www.wship.org.

I urge you all to download this document.  I was able to discover rather quickly that neither my wife, nor one of my daughters would be eligible for private insurance from any of the insurance providers.  My wife is medicated for bi-polar disorder, which immediately gives her a 217 score.  Add to that a 144 point migraine headache, and she is disqualified from receiving treatment.  My daughter is treated for ADHD, that oh-so-commonly diagnosed condition these days.  That starts her off with 276 points.   Add 28 points for hay fever, 33 points for a yeast infection, and she joins the ranks of the uninsurable.  Sorry, Governor Palin, Down's Syndrome is a condition listed for "automatic denial."  It appears the "death panels" already exist.

Washington has a plan that provides insurance for the uninsurable.  Before you get too excited, you must realize that the plan is not exactly optimal coverage compared to what we currently have through our employers.  I will guarantee that if any of us needed a transplant, or contracted a degenerative disease, we would not avoid bankruptcy on this plan.  However, it is a plan I could "choose."  How much would it cost?  $2,080 a month.  If you consider a much lower level of coverage at a cost exceeding 10 times what we currently pay a "choice," then we have a choice.  Even considering what our employers pay on our behalf, this "choice" is much more expensive.

So if we individuals don't have a choice, who does?  The insurance companies clearly don't compete for our dollars.  For whom do they compete?  Our employers.

But not so fast.  Eight months ago, my employer moved from a plan with Met Life to a different one.  They did this because the cost of the Met Life plan was far and away beyond our budget for health care.  I recently discovered that we may have to switch again in January.  The reason?  The premium for our coverage has increased 35% from this same time last year.  Our small company cannot afford a 35% increase in our highest outflow besides payroll.  The corporate controller confided to me that our company doesn't really have a choice in plans; we are subject to the whims of the market, and whatever plan we can afford.  Another controller I know told me their premium went up 18% in the last year.  I hope I will be able to keep my doctor when our plan changes again.

CNN Money had an excellent piece in January outlining the problem.  It was entitled "Health care:  The hidden business killer"  I would suggest you read it.  Our employers are as enslaved as the rest of us, feeling they have no options, and no choice.

For those of you that believe we have the "best health care in the world," and you support this belief based on the "choices" you have, I challenge you to do the research.  Ask yourself the questions.  And pray you hold onto your job.  Do we want the system that we have?  An expansion of the system that we have?  Do we actually want more choice?  The only choice we have is a Hobson's choice:  The first horse, or no horse at all.