Thursday, August 9, 2012

What You Need to KNow About Heath Insurance Today

Let me tell you a ( true ) story…

I am the Human Resource Director for a medium sized healthcare company. We operate in four different states and employ nearly 1,000 people. We provide services to people with disabilities. In this role, I have a front row seat to what is happening in the healthcare field, as I administer our benefits, in addition to seeing how our services operate. It is no exaggeration when I tell you that our biggest concern is for the cost of healthcare and health insurance in particular.  

The cost of health insurance is a direct threat to our existence and to the jobs for 1,000 people. There are 5 health insurance companies in Connecticut and we are at their mercy in regard to pricing. Due to the costs we have lost many good people. I have seen, in my experience, many people dropping their insurance or going without. I have also seen many providers, mostly specialists ( for now ), stop taking any insurance; to save money and aggravation. The insurance companies have told us, in no uncertain terms, that the fact so many people do not have health insurance raises the cost for the rest of us. 

Since we are in healthcare, we send a lot of people to the emergency room. Why? Because, like everyone else out there, we fear the cost of a law suit. When in doubt send them out is the mantra. Whatever happens in the healthcare system, tort reform has to be a part of it.  

Our employees who do not have health insurance do not go for their preventative care. When they get sick, they go the emergency room too ( as private Doctors can demand cash ), even though its not an emergency, because they can they stiff the hospital for the bill. They cant pay it. I am not saying everyones does this, but some do. I see the wage garnishments and get the collection calls. I am sure that they are sicker when they seek help as a result of not having preventative care. 

A Doctors office visit in Connecticut costs between $150 and $200, even before any tests or anything else is done. A ride in the ambulance is between $400 and $500. My friend, an ambulance dispatcher, gets upset because so many people view the ambulance as a “taxi” rather than something to be used in an emergency. The cost for an ER visit, again before anything is even done to you, in Connecticut is $1,200. Therefore, uninsured people and others who rely on the ER are absorbing the most expensive healthcare around, something the insurance companies have been clear affects the rates of the rest of us.  

Let me put that another way, the least able to pay are using the most expensive services. When something someone else does affects me or someone else, you have socialism, no matter how you define it. I now have a vested interest in what others do, because it costs me money. Its not something the President created, it was already here! 

Our employees are not illegal immigrants. As the HR guy, I have to make sure of that. Most of them are not lazy. In fact, most of them work two jobs to make ends meet. So much so that this has become a problem for us as an employer. I too work two jobs, even though I am one of the best paid in the company. Therefore, the argument that people who want healthcare reform are all lazy, illegal immigrants is not correct. Though I don’t discount insurance abusers are. 

The health insurance cost for a family is nearly $2,000/month (25,000/year ). My employer pays half. The cost to me is my second largest expense, right after my mortgage ($12,000/year for my portion of the premium ). In fact, the cost to me for health insurance is nearly equal to my mortgage per month. The cost has doubled in the past 10 years. In 10 years, if the trend continues, and it is expected to ( so I am told by the insurance people ), the annual cost for health insurance will be almost $50,000 ( my portion, $25,000/year ).  

My employer cannot afford that and neither can I. I have a $3,000 deductible to meet. Last year, we never hit that mark; therefore, the premiums I paid are all profit for the insurance company. I have only had a 1% pay increase since 2007, while my insurance has gone up 12 – 25% per year in recent years. 

In the meantime, healthcare insurance companies make money hand over fist. United Healthcare, the largest healthcare insurance company in America, made a profit of 1.4 billion dollars in a 90 day period this year. That’s PROFIT. This same company paid their CEO $102 million in 2009. That’s the person’s compensation for 1 year. To put that in perspective, that’s the lifetime income for nearly 50 average Americans!  

The other insurance companies are making sizeable profits and paying their execs equally large sums. A friend of mine who works in maintenance for an insurance company said that they will buy furniture and then discard it after 6 months, even though there is nothing wrong with it. When they put on a conference, they give out all kinds of free things and do it up big. These are my premiums they are spending! I see it as wasteful. 

Clearly, some are making money out there. In my small town alone there must be a dozen pharmacies. You can’t watch TV or even drive down the road without seeing an ad for this medication, this medical clinic, that type of medical care. Almost every time I go to the Doctors there is a pharmacy rep. there in their suit waiting to talk to the Doctor. They say that the average American, regardless of age, takes at least 1 prescription medication a day. I can only surmise that medical care is such big business because it is lucrative for some. 

As an employer we are not alone. Many people work for us just for the insurance because their spouses have none or the cost is even greater than ours. I used to hear people say, how come employer X has such better health insurance? I don’t hear that now. Today, the only people with good health insurance (except for the rare hold out employer ) are those who work in state or federal governments. Who pays for that? We do. Oh and unions too, they also still have good health insurance. 

On the other hand, people on Medicaid have good coverage. Yes, they have to wait in lines and put up with a lot of hassle, but whatever they need is taken care of. Its like a golden ticket. Unless they want dental care, then forget about it. A friend of mine who was disabled and could not work was on Medicaid ( she has passed away ). She absorbed hundreds of thousands of dollars in health insurance costs annually. Her medications alone were more than $10,000 per month! She had electric wheel chairs and other things paid for by Medicaid, that she never even ended up using. Was she a lazy illegal immigrant? No. Did she deserve to die simply because she was disabled? No. She had been a productive working American at one time. 

So there it is. No politics. No conservative vs. liberal views. These are the facts from a person who sees it firsthand, everyday. The system is broken. This is why I get so angry when people think the status quo is fine. Its not. Those who say everything is fine don’t know what they are talking about, period, end of conversation. If a person has insurance or if they have good insurance, they must consider themselves lucky and the minority. To say, leave the status quo as is, is like Marie Antoinette allegedly saying “let them east cake” and we know what happened to her.  

Whats Obama going to do? Whats Romney going to do? What are you and I going to do? Because something must be done. I have some ideas, perhaps I will write about them in the future. I don’t want something for free. I don’t want undeserving people to get something they shouldn’t. I want a system that is fair, where people get what they need in an efficient and effective manner, regardless of income. If that makes me a “liberal” then so be it. I think it makes me a realist. 

Thanks for reading. Feel free to share this, especially to those “conservative” people who don’t want any change.……..