Courtesy of MAPLight.org, we now have a clear window into a show of solidarity for the public option in the Senate. And it’s fairly disturbing to see how easily our senators can be bought. Read it here.
Brave New Films is at it again.
This time they are showing you where your health insurance premiums actually go. If you’re a fan of health insurers, DON’T WATCH THIS. We don’t want you questioning your loyalties.
But did you know 987 of its members pay their entire yearly premiums to support Wellpoint lobbyists?
© 2009, Actively Fused LLC blogsurfer.us
This morning I browsed through the “Coming Soon” section of MSN Movies and was surprised to see that, although no movie had a critic’s rating yet (due to no pre-screenings on which to base one), each one had at least one—and sometimes dozens—of user ratings.
In fact, The Time Traveler’s Wife had a user review! What was it based on? Nothing but the book and a 2 minute long trailer. Hey, if you want to write a book review, go to Amazon.com. If you want to rate or review a movie, watch it. Simple concept, no?
But speaking of Amazon.com, I was relieved to note while browsing their New Releases that user ratings aren’t allowed until the book is actually released (or advanced release copies are distributed). That stops a lot of clueless editorializing, but unfortunately not all of it.
Joining in the online discussion on a recent Dick Francis novel I just finished, a reader rebuffed my critique. It wasn’t until days later that the reader posted an update that basically said, “Now that I’ve read the whole book, I agree with you.” What? Why are you discussing a whole book when you’ve only read a chapter or two? Just to create noise and feel a part of things?
Sadly, anyone who looks only at the average ratings or reviews on these sites has no idea many of the individual ratings that comprise it are baseless. So it is with the healthcare reform debate.
Where Is The Patient?
So what does all of this have to do with the current healthcare reform climate?
Many entities have strong lobbies and position stands—the AMA, AHA, AHIP, PhRMA, California Nurses’ Association, US Chamber of Commerce, labor unions…and the list goes on. What is missing here? A single entity representing informed patients. Isn’t healthcare, and especially healthcare reform, supposed to be all about The Patient?
Yes, there are multiple groups representing some patients—MoveOn.org, Campaign For America’s Future, and Health Care For America Now among others. But there is no single group representing The Informed Patient. And there are plenty of uninformed individuals masquerading as patients, fear mongering and opining and talking about everything but healthcare.
Opinionated Non-Patients
For instance, a 2008 Kaiser Family Foundation poll found that those who rarely or never use their health plans are TWICE AS LIKELY to rate their private plan as excellent.
That’s not satisfaction. It’s cluelessness.
Especially when the same poll indicates 32% of respondents or a household member had difficulty paying medical bills.
Presumably it’s also non-patients who were surveyed in a June 2009 New York Times/CBS News study often quoted by AHIP President Karen Ignagni. It found:
77% of Americans are satisfied with their existing health coverage But in the same study 72 vs 20% of Americans also favor the creation of a public plan
Bottom line? Non-patients don’t know what they want because they have no experience with the existing healthcare maze.
The Informed Patient Litmus Test
So how do you know whether you are an Informed Patient? How do you determine whether you are entitled to assign a 5 or 1 star rating and write user reviews?
Simple. Take this quiz:
The Informed Patient Quiz
1. Are you a patient (i.e., been under a healthcare provider’s care recently)?
2. Do you have health insurance?
2a. If No, have you read and understood a provider’s bill for services?
2b. If Yes, have you read and understood an Explanation of Benefits for provider services?
3a. Do you know your other health insurance plan alternatives (i.e., what you are eligible to sign up for)?
3b. Total Premium for your insurance (including employer portion, if applicable)?
3c. Annual Deductible?
3d. Co-Pays and/or Co-Insurance percentages?
3e. Annual Out of Pocket Maximum?
3f. Lifetime Maximum Benefit?
4. Do you know how to determine In-Network vs. Out-of-Network providers?
5. Do you know which services are covered under your health plan?
Grade The Quiz
If you answered “No” to #1 or #2a or #2b, you are not an Informed Patient. In fact, if you answered no to #1 and #2, please don’t complain about any requirements to become insured. Get smart before you become intimately acquainted with bankruptcy and wage garnishment.
If you answered “Yes” to two of the three questions #1, #2a, #2b, you are a Patient. If you answered “Yes” to all the remaining questions, congratulations, you passed! You are an Informed Patient.
For those that didn’t pass? Please shut your mouth.
Because if you’re not an Informed Patient, you have no opinion. Pure and simple. You may have bought the product, you may sell or service the product. But if you don’t use it, you have no valid opinion in the healthcare reform debate and no right to be counted—you are either originating or propagating stereotypes and propaganda.
And to those Informed Patients out there? Carry on and don’t let the powers that be water down your healthcare reform. You use it, you depend on it. Call your representatives today.
©2009, Actively Fused LLC
In Anatomy of a Public Plan, we covered the basics of a public plan (realizing that Congress hasn’t agreed upon or released any specifics yet). Now let’s take a look at current-state private plan structure.
Private Plan Basics
Private plans come in two flavors, group or individual.
Group Plans
Group plans (such as one through your employer) accept any member in the group. Many smaller group plans (i.e., for small businesses) may require a high percentage of employee participation for continued coverage.
These plans are the saving grace for those with pre-existing conditions, as they are often the only means to obtain coverage. However, they only cover your pre-existing conditions if you belonged to another group plan for a designated minimum duration within 63 days of signing up with your new plan. Huh?
An insurance representative wrote a nice rant on the benefits of group plans. Unfortunately access to group plans is shrinking dramatically with the economic downturn and rapidly escalating premium costs. This is because your employer typically pays a portion of your premium. And as anyone who has experienced the nasty shock of COBRA cost upon separation from their employer can tell you, the full premium is mind-boggling.
Individual Plans
Individual plans will only cover those without specified pre-existing conditions, or will create a “rider” (read: we don’t cover that) for any undesirable pre-existing conditions. This is determined during the insurer’s medical underwriting process, designed to minimize its financial risk.
Most insurers do not make their pre-existing condition exclusion lists public, but here is a nice compilation from the California Department of Insurance:
Automatic Applications Denial (partial list)
- Health problems for which you have not seen a doctor;
- Health problems that a doctor cannot explain;
- Health problems for which you have not completed treatment;
- AIDS;
- Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process;
- Cancer, under treatment;
- Sleep Apnea;
- Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities;
- Heart disease;
- Renal failure or Kidney Dialysis;
- Diabetes with complications;
- Cirrhosis;
- Multiple Sclerosis;
- Muscular Dystrophy;
- Systemic Lupus Erythematous;
- History of transplant;
- Lymphedema;
- Current infertility treatment;
- Hepatitis;
- Hemochromatosis.
Basically, your parents incurred a pre-existing condition bringing you into the world. Hopefully you chose them right and didn’t inherit any pre-existing conditions. But you incubate your own potential pre-existing conditions dealing with everyday stresses. Among them is that your individual plan may also be cancelled at any time, usually when your claims exceed your premiums paid. And your premiums may be unaffordable anyway.
As the insurance representative rant above failed to cover individual plans, I challenged the omission (see comments) and obtained a succinct reply revealing the real reason that writer supports a public/private option. Simply, the public plan will pick up all the undesirables that don’t make business sense for private insurers to cover. Nice.
Make Your Voice Heard
As you can see, the current private plan setup doesn’t provide you the consumer with real choice. You are either:
President Obama has told Congress he wants a healthcare bill prior to summer recess. This is your chance to tell your representatives that you want real health reform, real choice.
Contact them today and tell them only a real public plan option is acceptable.
© 2009, Actively Fused LLC