The Insurance Crisis : A Rag Blogger discussion

Discussion Updated June 14, 2008

The following provocative article about our health insurance crisis was brought to our attention by Roger Baker. It has stimulated a spirited discussion among Rag Bloggers whose comments and personal experiences follow this article.

Please add yours using the "Comments" feature at the end of the post.

Thorne Dreyer

Ranks of underinsured U.S. adults increase 60 per cent
By Victoria Colliver / June 10, 2008

The number of adults nationwide who have health insurance but face financial risk due to high out-of-pocket expenses - known as the underinsured - increased 60 percent between 2003 and 2007 to more than 25 million, a study released today found.

Middle- and higher-income families, those with annual incomes of at least $40,000, experienced the sharpest increase among the uninsured, nearly tripling from 4 percent in 2003 to 11 percent in 2007, according to the study by the Commonwealth Fund, which was published online in the journal Health Affairs.

While an estimated 47 million Americans have no insurance at all, health experts say people who are required to pay high deductibles and co-payments for limited benefits often go without care due to costs.

"Lack of insurance is only one part of the problem as even the insured have serious gaps in coverage," said Karen Davis, president of the Commonwealth Fund, a private fund that supports independent health research. "Insurance coverage is the ticket into the health care system but, for too many, that ticket does not provide genuine access to care."

The study based its data on a survey of about 3,500 adults conducted from June to October 2007. About three quarters of the respondents were between the ages of 19 and 64 years old, meaning most were working adults who were not yet eligible for the federal Medicare program.

Those defined as underinsured had health insurance all year but had out-of-pocket medical expenses of at least 10 percent of their income, or 5 percent for those with low incomes.

The report's authors said people with individual or small-group coverage, typically those who worked for a small business or were self-employed, were more likely to have insurance that required substantial cost sharing than those with coverage through large employers.

Forty-five percent of the underinsured reported difficulties paying their medical bills, being contacted by collection agencies for unpaid bills or changing their way of life to cover their health expenses.

"Here in the United States, you can have health insurance all year long and still go into medical debt or face bankruptcy," said Cathy Schoen, senior vice president of the Commonwealth Fund and lead author of the report.

A 61-year-old San Mateo County woman, who declined to be identified out of fear that she could lose her policy, said she's incurred $35,000 in out-of-pocket medical expenses in the last six years despite never having a gap in health insurance.

"I've put stuff on credit cards up to my elbow," she said. She and her husband changed their lifestyle to afford their share of medical costs, but have not had to file for bankruptcy.

Some of her uncovered expenses include $5,000 for her share of three MRIs conducted in January 2007 for a back injury and a recent $1,750 bill for three injections that were not covered by her Anthem Blue Cross small-group business policy. The policy costs $1,000 a month for her and her husband along with a $5,000 annual deductible.

"The rates keep going up, but they keep cutting services," she said, noting that she still feels fortunate to have health insurance.

To read the report, go to commonwealthfund.org or healthaffairs.org.

Insured, but vulnerable

A study released today by the Commonwealth Fund found that people who had health insurance all year but were required to pay high out-of-pocket expenses experienced some of the same problems as those with no health insurance at all. According to the study:

*About 68 percent of the uninsured and 53 percent of the underinsured said they went without needed care because of cost, compared with 31 percent of those with adequate insurance.

*Nearly half - 45 percent - of the underinsured reported financial stress due to medical bills. About 51 percent of the uninsured and 21 percent of those with better coverage said they experienced similar financial difficulties.

Source: Commonwealth Fund

Source. / SF Gate


Comments from Rag Bloggers:

So, 47 million + 25 million = 72 million
divided by about 266 million who are under 65, and we get 27% of Americans under 65 are either uninsured or underinsured.

Scott Trimble

...and I'm one of them. I have asthma, it's considered life-threatening enough to get insurance denied on my behalf. The only "offer" I have had as an adult was from a company that was willing to insure me as long as asthma and other respiratory illnesses were not covered.

My former landlady had breast cancer, and she too has been denied insurance--unless she signs a form allowing them to exclude any related cancer (and what all would those be? Anything?) from her policy.

This is obviously all upside down. It would be like an auto insurance firm saying they would cover you, as long as you didn't have an accident. Why have we allowed the insurance companies in this country to operate in this way?

Alyssa Burgin

We have been among those underinsured. Here's the greatly shortened version of our personal story (with a built in cautionary tale):

My wife Annie and I have had health insurance on and off ever since we grew up (some time in our 30s). In 1990, I had cancer. I had insurance at the time and it wasn't an awful policy. Nevertheless, I had to fight them over most of the bills I was getting. They tried to deny benefits at every turn.

Fortunately, despite being sick and tired most of the time from chemo, surgery, etc., I was able to muster up the energy to do battle with the benefit deniers, sometimes having to escalate the battle to the company's supervisory level. I fought and, for the most part won. Being young and basically strong helped, but being a tenacious, pushy NY Jew didn't hurt either. I wondered at the time (and still wonder) what happens to people who are old or weak or just too sick to engage in arguments over every bill. I suspect that they just give up and get screwed out of the benefits that are their due.

After that, the insurance company started jacking up my rates every six months. There was nothing I could do because no other insurance company would take me having had cancer recently. So I paid the rates and paid and paid until my nose hurt. See, here in Texas they cannot raise one person's rates. They can only raise the rates of all members of a "class". So they raise the rates and those who can switch to a new policy or a new company to get a better rate do switch. They did that until the only members of my "class" left were those too sick or uninsurable to switch. Five years later, I was considered thoroughly in remission and I was able to get a policy with another company at better rates. I went with that company until their rates got too high and then I switched again, this time to Unicare (I call them un-care). Their rates were ok at first but then they started to soar at every renewal. To keep the rates manageable I kept raising the deductible until it got to $5,000 (the highest they went).

So, a couple of years ago I started shopping around again. I would find what seemed like a decent policy at a decent rate, send in my application with my $25 (or so) application fee, and later (often much later) find out that I had been denied. Seems that old cancer had become a problem for these companies even though I was now over 15 years in remission. I tried four different companies and was denied by all. Annie also had a few things in her medical history that made her less than the most desirable candidate for insurance.

Meanwhile, since Unicare didn't cover much (they covered no prevention) and we had that $5,000 deductible anyway and we were shooting our wad on the insurance itself (about $11,000 a year for the 2 of us), we held back on going to the doctor. Annie, partially out of fear of becoming even more uninsurable, put off her mammogram for 3 years. ACC, where Annie teaches, started allowing adjunct professors to pay their own way and get into their group insurance so last year we finally left Unicare and switched to he ACC group policy. It took a while because we had to wait for the right time of year to sign up and then weren't actually covered until some months later but we are now on that BC/BS plan.

Some time after we were covered, Annie got a mammogram and found out that she had stage 2 breast cancer. She is now in treatment and we feel like part idiot, part victim for having put off that exam. If done sooner, the lump would have no doubt been detected when it was a lot smaller and more easily treatable.

Again, what do the uninsured do? I guess they skip things like mammograms altogether. And the same might go for the underinsured like us. Anyway,the cautionary part of all this is, whatever the price, get it together and get those exams every year. Do it cursing the system all the way but do it. Then get out and raise your voices in support of a real, egalitarian, comprehensive single-payer system. It's the least a civilized society should provide its citizens.

Ric Sternberg

I think, if the federal government doesn't come through with universal single-payer care soon, we should form a nationwide healthcare co-op, a nonprofit group to insure everyone. According to Conyers' numbers (from his website on HR 676), it would cost us about 15% of our paychecks, but my current policy costs almost that much now, and I still have to cover co-pays and deductibles. Personally, I wouldn't even begin to know how to organize such a beast, but it must be possible, and we can't wait forever.

Scott Trimble

Single payer will go a long ways, but we ought to pay a bit of attention to our public health officials as well.

Drugs are not the answer to health. Or certainly not the only one.

Public health officials say that as long as we have the enormous subsidies for junk food, and no subsidies for real food, that it will be impossible to achieve adequate health care for our people.

Real food keeps getting more expensive, junk food is cheap.

Back in the seventies, grass fed beef was cheaper than corn fed!! But thanks to the enormous subsidies for feed corn and soy, pastures are getting converted to corn.

Please check out Public Health Action on the farm bill.

Janet Gilles

I don't think we're just talking about "drugs"--I don't take any drugs at all for asthma or for anything else. I'm talking about what Ric was talking about--putting off necessary care, exams, etc., to prevent catastrophic illness or at least catch it when it is in the nascent stages. I don't get mammograms because there's really no point to it. If they did find something, I would just have to die of it, because there's no way I could afford to treat it. I can't be the only person out there who is doing this, there are legions.

No amount of eating grass-fed beef is going to help me or anyone like me. In fact, I don't eat beef and haven't done so in 28 years. People need the ability to get routine medical care--not drugs, necessarily---routine medical care, in the hopes that they don't come down with catastrophic, fatal illnesses.

Alyssa Burgin

Yes, but okay,

What if ninety percent of catastrophic illness could be prevented by eating a healthy diet in the first place?

Prevention is preventing something, not diagnosing it early after you get it.

Does it make sense to subsidize an unhealthy diet?

That is what we do, the farm subsidies only go to junk food, none to real food.

The public health authorities say we can never solve the problem of health as long as we subsidize junk food, so that people on a budget are forced to buy unhealthy food because good food is too expensive.

Janet Gilles

No beef, regardless of what it was fed before being ruthlessly slaughtered, is food. It's not good food. It's not junk food. It is poison, full of the death that brought it to the plate.

And I would like to reiterate Alyssa's point: none of us were talking about drugs, although it is true that the modern medical industry has come to be heavily reliant upon them. But moving to a universal single-payer system should begin to counter that, as the drug companies will no longer have the ability to influence doctors that they now do.

However, Janet's point is also valid, even if the example is not. A large part of our declining health can be attributed to the SAD (Standard American Diet) which is composed far too much of animal proteins from meats and dairy, along with all the saturated fats that go along with them, as well as white flour, white sugar, high fructose corn syrup, and other processed foods. A vegan diet high in whole grains, fiber, vegetable proteins, and low in unsaturated fats, but with some care taken to assure a proper balance of omega-3 to omega-6 fatty acids...is key to good health.

Nevertheless, things like broken bones and other injuries have considerably less to do with diet, and do require medical care. And preventative and diagnostic measures are also quite important to long term health, but as Alyssa points out we need to be able to have confidence that we will be able to address a problem if it is discovered. Again, for many, if not most of us, that will require universal single-payer....

Scott Trimble

The problem is progressives are always demanding medical care, but ignoring the reason for our poor health.

Half the calories or more in the American diet are white bread, high fructose corn syrup, deep fat fried (corn and soy oil) and other completely empty calories, all government subsidized by the Farm Bill.

We would have been demanding medical care for all the sailors with scurvy, when what they needed was limes or cabbages.

The government pays huge sums of money to provide junk food, (commodities in government speak). Driving the farmers who actually grow real food off the land.

Doctors don’t study nutrition, public health officials do. And that is the problem, empty nutrients provided at government expense.

Janet Gilles

This is not an either/or situation. As the MDS founding principles state:

". . . we advocate: the restoration and preservation of the earth's robust ecological health; the extension of human rights to include universal healthcare, decent housing, lifelong education, fortifying nutrition, reproductive freedom, meaningful work and the right to organize, bargain, and petition collectively to impartial arbitrators; Universal healthcare and fortifying nutrition and the restoration of the earth’s robust ecological health."

That pretty much cuts out vast herds of cattle raised to be eaten after being fattened with corn. They are also the worst sources of methane gas which is damaging the ozone layer.

David Hamilton

For example, many problems are caused by lack of bone density, considered inevitable with the aging process, yet scientific studies consistently show that bone density will increase with aging, giving sufficient nutrients in the diet.

You cannot get this information from your doctor, as they do not study nutrition.

A system that simply pays for drugs and doctors and hospitals is doomed to failure.

Janet Gilles

Right! Several issues: Improve nutrition, protect the earth, provide health care! Where's the argument? And for those who would blame the patient for somehow doing something wrong nutritionally, causing or contributing to their illness, I say HUH?

When I got cancer I was a vegetarian and ate organic food as much as possible (even grew some myself). I exercised regularly and, except for working too hard lived a healthy lifestyle. I had large cell, non-Hodgkin's lymphoma (a 22cm tumor). That was the same type of cancer that was so prevalent among Iowa corn farmers (a 30% higher incidence than the general population at that time). Their cancer was very likely caused by a certain herbicide which happens to be a kissin' cousin of paraquat. I never came into contact with an Iowa corn field but I sure as hell came into intimate contact with a certain Mexican crop. In my earlier days I was poor and could not bring myself to throw out anything, particularly my favorite substance, tainted and off-smelling though it might have been. That's what I think caused my cancer - the US government and their misguided (lunatic) eradication program combined with my own youthful feeling of immortality which led me to take chances.

Bottom line though, was when I got sick I was willing to do anything to get well. Who cared what the cause was? The lousy, greedy, ill-informed, pill-pushing medical establishment was one place I turned. I also did nutritional, herbal, homeopathic, stinky Chinese teas, affirmations, etc. In the end, who knows what worked. But I would not have wanted to forgo the chemo. And that's where we began this discussion - we need good insurance so everyone can have all possible cures available to them.

Ric Sternberg

Yeah, I get a little sick of the blame-the-victim mentality that I often see when health care is discussed. That has no place in this discussion or any other, frankly, and when one starts talking about nutrition, or pollution, or any of these things, it starts to look like we're saying that if you get sick, you deserve it. Well, all I did to get asthma was CHOOSE THE WRONG PARENTS.

Of course we all want organic foods and a halt to deadly pesticides, healthy diets, and great nutrition. But that is not what I'm talking about right now. I'm talking about health care. Is it a right or is it not? Why do other industrialized nations have it and we don't? And why the hell do our pharmaceutical companies and our mega-monolithic-over-merged healthcare companies bulge at the seams of their profits, stuffing cash in their pants as they go--?

We need good insurance, as Ric says, so that we can all take preventative measures, we can all have prophylactic health care, and we can all live our lives as we intend them.

Alyssa Burgin

Paul Krugman spoke on the UT campus awhile back, and said that France has the best health care system in the industrialized world.

Coincidentally, they subsidize their small farmers and their local agriculture.
You can’t have one without…

…The other.

Janet Gilles

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