Practically Uncovered

If you have a strong union healthcare plan or if you live in the rarified air of generous corporate benefits, you will undoubtedly want to keep what you’ve got. Might be there too if you are already on Medicare (even as benefits will slowly erode if the current administration has anything to say about that), especially with supplemental coverage, or if you are just plain rich. And unless you are enrolled in one of those “not available for individual buyers” plans for glasses, hearing aids and dental work, what coverage you can buy for those ailments on the open market is hardly worth the cost.

Prudent consumers, carefully weighing privately available medical insurance hoping to find a reasonable alternative… well, sorry, such plans simply do not exist. And a free market not only has failed to produce falling prices, but instead we have rapidly rising premiums, contracted coverage, soaring co-pays and massively expanded deductibles. A few plans look cheaper but on closer examination fly in the face of the requirements of the Affordable Care Act by listing what they cover (effectively eliminating expensive treatments and diseases most like to be pre-existing conditions). 

Medical bankruptcies, especially among those who have insurance, are beginning to explode again.

As hospitals market to attract these prudent shoppers, they often list the cost for basic procedures… but fail to mention the little extras like anesthesiologists, operating theater and hospital room costs, nursing staff, additional medications that are routinely required, which can push the total cost to a vast multiple of the cited procedure. In short, such wildly inaccurate marketing information seems to border on fraud… but few do anything short of working out a payment plan with the hospital.

Where consumers have to pay for healthcare directly, unless you are rich and simply do not care, here’s the bottom line: affordable quality healthcare is a myth. It just does not exist. “High-deductible health plans, which are fast becoming the dominant form of coverage for U.S. workers, were supposed to empower patients. Backers said the plans would create engaged shoppers who would check prices and compare providers, forcing hospitals, doctors and drugmakers to control costs.

“Deductibles have more than tripled over the last decade for people who get insurance through their jobs, but the promised consumer revolution never materialized… Instead, Americans have been left shopping in the dark and increasingly struggling with medical bills they can’t afford, a Times examination of job-based health insurance shows.

“‘This idea that we were going to give patients ‘skin in the game’ and a few shopping tools and this was going to address the broad problems in our healthcare system was poorly conceived,’ said Lynn Quincy, former healthcare advocate at Consumer Reports now at Altarum, a nonprofit research and consulting firm.

“‘It’s clear now that the idea definitely hasn’t borne fruit,’ she said. ‘It hasn’t made people feel more confident seeking care. It hasn’t led to better value. And it’s had terrible consequences on patients’ ability to afford care.’

“Although Americans are willing to seek out lower-priced generic medications, few are comfortable shopping for medical care, studies and surveys show. Patients like Grimm who do try are often frustrated by incomplete or inaccurate information from insurers, hospitals and other medical providers.

“Just 1 in 6 covered workers tried to shop for the best price for a medical service in the previous year, according to a nationwide poll conducted for this project by The Times and the nonprofit Kaiser Family Foundation. Two-thirds of workers with job-based coverage said finding the cost of a medical treatment or procedure was somewhat or very difficult.

“Meanwhile, prices for medical care and prescription drugs haven’t moderated, as advocates of high-deductible insurance predicted. Instead, they have soared… The average price of a knee replacement, for example, shot up nearly 80% between 2003 and 2017, increasing at more than double the rate of overall inflation, a Kaiser Family Foundation analysis of commercial insurance data found.” Los Angeles Times, October 21^st. 

Even where consumers can search out more efficient and cost-effective hospitals and clinics, they often do not know how to price shop or are simply wary of leaving their vital health needs to the lowest bidder, often a service provider they know nothing about. “In one study of nearly 150,000 people covered by two large national employers, only about 1 in 10 who could shop for price information did, even if they had a high-deductible plan. And use of the tool was not associated with lower healthcare spending.

“In the Times-Kaiser Family Foundation survey, only about a quarter of workers with job-based coverage reported using an online cost tool… Americans show little inclination to find the best deal even for a basic medical service like an MRI scan, which can be as much as five times more expensive in one facility than in another, another recent study found.

“Researchers analyzing commercial insurance data from tens of millions of Americans reported only 14% of patients went to the lowest-cost MRI within a 30-minute drive of their house. Patients on average passed six lower-priced MRI facilities on their way from home to the place where they had the imaging, the study found.

“Many Americans don’t want to have to shop for healthcare, preferring to let their physicians guide their care… ‘We pretty much go where we’re comfortable. We’re not looking for the cheapest doctor,’ said Jim Morrissey, 39, a food service manager who lives near Harrisburg, Pa. ‘I’m loyal to the doctors I trust.’ … Americans’ lack of enthusiasm for medical shopping also reflects how little information is available about prices.” LA Times.

Developed nations wonder how the United States can deny universal healthcare as unaffordable… and then cut trillions of dollars from the tax bills of the mega-rich corporations and spend 41% of the global military budget while still losing all those “wars.” German healthcare, for example, is a uniform policy administered through private insurance companies with government support. Dental, eyecare and hearing are covered. The premium is a percentage of income, there are no co-pays, annual deductibles are capped at about $500, and prescriptions cannot exceed EU10/month. And trust me, having experienced the system, it is at least the equal of what rich insurance policies provide here in the US.

There is no developed Republican alternative. Twenty red state attorneys general, supported by the US Department of Justice, are suing the federal government to kill the entire Affordable Care Act. They are arguing that the only healthcare that works is a free and open marketplace, even as every independent research survey conclusively determines that this is beyond a false promise. 

Whether we phase a plan in over an acceptable number of years, fix what we have or find another path to universal coverage, the “one true thing” is obvious: the United States has finally reached the stage of a major healthcare crisis that is getting so much worse so much faster than anyone could have imagined. We have the most expensive healthcare costs on earth… and the most exclusionary system in the developed world. And it is finally and dramatically breaking down.

              I’m Peter Dekom, and it is time to get concrete and get a plan on the table that works for the American people!!!