Some (personal) Medical Insurance Facts

While the country is swirling with monumental discussion, facts, statistics, opinions, lies and myths about the medical care and medical insurance issues, I thought I would share some of my personal facts regarding my wife’s and my medical coverage; anecdotal though it may be.

Medical Insurance:

When we retired in 2006, our group (state public employee) medical insurance premium for our joint coverage began billing us $893.76 per month. Prior to retiring our employer paid for this coverage. Today our premium is $1,157.46 – a 29.5% increase in premium costs over 6 years. The current rate of inflation is 2%.

Last year our monthly health care premium actually went down from $1,159.52, to $1,157.45 this year – a $2.07 per-month decrease. However, the plan has changed whereby we now must pay $500 out-of-pocket before anything is covered. So essentially, our medical costs have actually increased 3.5% over last year.

This year, our insurance provider is requiring all customers to participate in a mandatory “Health Engagement Model (HEM) program”. A surcharge (penalty) of $17.50 per person will be added to our monthly premium if we do not comply with the HEM requirements, which consists of watching online training videos. Between my wife and me, we have spent six hours on this process. Emphasis for those of you who decry government interference regarding your health care, note that these are private company hoops we are having to jump through – not government.

Over these six years, our group coverage has forced us to change insurance companies four times. As a result, we have had to change from medical providers and facilities with whom we have established doctor-patient relationships over years. Emphasis again, for those of you who decry government making decisions about your health care, note that these are private companies, making choices for us who we will be allowed to see – not government.

Pharmaceuticals:

One prescription my wife takes cost $543.78 for a 3-month supply in 2007. This same prescription charges the insurance company $912.58 today. This is a 68% increase in the cost of this drug over five years. Our co-pay for this prescription was $15, it is now $75.

… researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion. [1]

Dental insurance:

We discontinued dental insurance as the premium amount plus the out-of-pocket costs for non-covered expenses was more than simply paying for services directly.

Final thoughts:

Our medical insurance premium, deductibles and co-pays consume one-third of our disposable income. I often wonder how many Conservative local business owners would much rather I spend that $19,800 a year in their local restaurants and businesses than send this money to out-of-town insurance companies? Multiply my $19,800 by the thousands of people like me – this amounts to millions of dollars denied the local economy.

Consider that for every car you buy, every bag of groceries, every movie ticket, every magazine, every gallon of gasoline… the cost of employee medical care premiums is factored into the price of what we pay for those goods and services. Why wouldn’t Conservatives rather want to either A) reduce the cost of their goods by that factor and increase sales, or B) pocket the additional profit from the reduced overhead, by having their employee insurance costs picked up by a single payer government plan? A single-payer plan seems like a win-win for every business in the county except medical insurance companies. Our business leaders must be the laughing stock of the remainder of the developed industrial world.

My final thought on the ACA (aka: ObamaCare)

It appears to focus of this law is directed entirely on insurance coverage but little on containing the rise in medical costs and the demise of medical outcomes. But hey… it’s a start.

References:

1. Big Pharma Spends More On Advertising Than ResearchAnd Development, Study Finds, ScienceDaily.com, January 5, 2008.

 

What exactly is "Obamacare"?

I ran across this fairly concise yet thorough overview of what exactly the provisions of the Affordable Care Act (affectionately known as ObamaCare) at the web site Reddit.com

Rather than completely republish the article, I will merely link to it below. It is presented in simple information points. I encourage you to browse the key points; whoever did prepared this did an excellent job.

What exactly is Obamacare and what did it change?

The underlying opposition to the Affordable Care Act come primarily from those who claim they don't want government making medical decisions about their health care. But just under half our population is already currently receiving government managed health through Medicare and Medicaid with few complaints and at administrative costs far under that of private sector insurance companies which have a profit incentive to reduce costs. Employees of government medical insurance providers do not earn multi-million dollar bonuses and salaries.

It is an established fact that the USA has the highest medical costs with the lowest outcomes of any developed country. The facts speak for themselves. If you don't like the Affordable Care act, what is your alternative in a system where these costs increase far greater then inflation every year? Opponents, I'm listening.

Health Care Regulatory Malpractice

Back in mid March I went through Aortic Valve replacement surgery. I’m one of the “lucky” ones who have group medical insurance through my former employer. It’s not free though. Here is how the stats for my procedure break down:

Days in the hospital: 23
Doctors and PAs involved in my treatment: 28
Gross charges billed to insurance: $265,136.49
Amount paid by insurance: $246,013.49
Out of cost paid by me: $915.00
Monthly insurance premium: $1,159.52

These are not the final costs; bills continue to “trickle” in. Of the 28 physicians I can recall actually seeing maybe ten.

When President Obama took office, he pushed through an initiative to revamp the medical insurance industry. To my thinking less than half the job has been addressed by this legislation; he focused on the insurance side of the overall health care issue, leaving the medical delivery system relatively untouched. This is like having the fire department trying to save your burning two-story home by trying to put out the fire on the ground level only – the whole upstairs is still a conflagration.

Each of the 28 doctors billed insurance separately, and multiple times for each time they looked at my chart. That means 28 separate financial transactions, not including the labs, hospital, et al. Heck, if a couple of these doctors just wanted to pick up some side revenue, they could have falsely claimed they provided treatment – the insurance company would have no way of knowing. Nor would I.

Pharmaceutical companies charge outrageous prices for their products. True many likely had high product development costs. But they also par with auto companies in the amount of time and money they spend on prime-time television advertising. I have seen as many as three pharmaceutical ads during one spate of commercial breaks. Who pays for that? I can guess.

The two largest medical providers in town share common real estate and parking lots. But they do not share patient medical data between them via their independent computer systems. Yesterday my cardiologist faxed a blood draw request to the lab in the next building. Yes, in the 21st century – FAXED!

I know people love to gripe about government, and Big government at that. But the city doesn’t have two water departments, there is only one DMV in town, people can apply for Food Stamps and Unemployment insurance compensation in one building. More importantly, NONE of these government agencies have CEO’s who draw million dollar annual bonuses.

It all kind-a makes me sick.

Bag your Tea, switch to Coffee

Well the Tea Baggers have won and Massachusetts voters have spoken and voted in a Republican to replace Ted Kennedy. So now the message is clear: “If you have your own employer paid health insurance, we don’t give a rat’s-ass if you die for lack of medical care, or go bankrupt over medical bills”. This country is increasing all about - “I got mine – go get your own”.

The Republicans can now block any health care reform proposed by the Democrats. This will be a slam-dunk as keeping Democrats on the same page is like trying to herd cats. Republicans, on the other hand, are like The Borg – They think in unison like the collective. Independent thinking is frowned on in the GOP.

Republican mouthpiece, Senator John Andrew Boehner is continually parroting “Americans don’t want Washington-Run health care.” I really want to ask him; ” …you mean like the Washington Run health care YOU enjoy, John?” Really, I think there is an opportunity here for the Republicans to make a clear statement about what the American people want really want – Republicans should all give up their government “Washington Run” health care and self-pay their own insurance. That way we Americans could be confident that the Republicans are not just mouthing support for the insurance industry and really believe their own rhetoric. I’m waiting!

The same thing for these dumb-ass Tea Baggers who don’t want “Obama Care” or “Socialized” medicine; let’s put all their names into a database so that when they turn age 65 they are denied Medicare. Well hey; we don’t want you guys compromising your ethics. Uh, just be aware that private insurance companies do want customers of Medicare age except under “supplemental” policies. So be sure to save your pennies to cover that that coronary bypass surgery because you sure as hell don’t want “Washington Run” Government to be involved in your health care.

I’m going to go out on a limb here and speculate, but I am guessing roughly around 100% of these Tea Baggers have completely subsidized medial insurance through an employer or other patron. We Americans never get charged up about an issue until it affects us personally. As much as I admire Candice Lightner, founder of Mothers Against Drunk Driving (MADD), she didn’t become an activist until her daughter was killed by one.

When my daughters were young, they asked me what the difference was between a Republican and a Democrat. I responded that a Republican wants America to be a place of opportunity for their family, their friends and other deserving people like them. A Democrat wants the same thing… but for everyone.