Friday, May 01, 2009

A great many private health insurance plans don't protect your finances

A major reason for getting health insurance is so that you can have access to health care regardless of your employment status. That's important because is the case of severe illness, you may not be able to work so insurance is essential. The second reason is to protect your personal wealth from the unexpected and, in the case of many severe illnesses, extremely high costs of health care. So when you get laid off, one of the first things you need to do is get individual health care in the individual insurance market.

Consumer reports has recently investigate the health insurance offered in the private health insurance market for people who do not have employer-connected insurance. What they have found is that the private health insurance market offers policies which are either unaffordably expensive or which are so riddled with co-pays and limitations that they leave the insured on the hook for a great deal of the cost of health care which would have been covered by good employer or government insurance policies.

Here is the beginning of the report from Consumer Reports:

Hazardous health plans
Coverage gaps can leave you in big trouble

Many people who believe they have adequate health insurance actually have coverage so riddled with loopholes, limits, exclusions, and gotchas that it won’t come close to covering their expenses if they fall seriously ill, a Consumer Reports investigation has found.

At issue are so-called individual plans that consumers get on their own when, say, they’ve been laid off from a job but are too young for Medicare or too "affluent" for Medicaid. An estimated 14,000 Americans a day lose their job-based coverage, and many might be considering individual insurance for the first time in their lives.

But increasingly, individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with "affordable" premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.
The rest is quite worth reading so click through.

You may remember that the private insurance market was John McCain's and the Republican party's solution to the rising costs of health care. As this CR study shows, that may get you into the door of a hospital in the case of a major emergency, but it won't cover the costs. If it does, you are broke from paying the premiums before you got sick and you'll very likely be bankrupt when you get out in either case.

The rational solution to this is mandated universal health care financed by the federal government. It needs to be federal because both people and illnesses easily move anywhere in the nation. The problem is national so the solution needs to be national. Also, as medicare and medicaid have proven, they can pay out benefits with an administrative cost less than 10%, while the very best private insurers have an administrative cost of 25% or more. Much of that cost is caused by the fact that the private insurer has to make sure that they do not insure unhealthy individuals and also do not pay for care for individuals who are not paying for their insurance to the insurance company who pays for he services.

Mandated universal health care will lower some of the costs for the federal government because a lot of the administrative expense is involved in just making sure that uninsured and ineligible individuals are covered for health care. That would also lower costs for private insurers, as they could always determine how the individual was covered before they accepted them. The federal government, by dint of its size, also can negotiate the lowest costs for medications and health services. In Germany the similar solution is federally financed and state administered.

This program at minimum would cover catastrophic medical costs, the costs of chronic health problems like diabetes, high blood pressure, and perhaps the wide-spread causes of illness like obesity. I'd like to see it pay for universal dental care, also, since untreated dental problems cause a lot of other health problems like heart trouble and such. Services above and beyond those items like chiropractic care as well as vitamin therapy and alternative medicines which are not well researched could then be covered by private health insurance or by fee for service.

If the government offered this alongside private insurance plans through employers and private insurance, then the difference in cost between the private insurance and the government would have the majority of people move to the government plan because they got equal health care at significantly lower costs and with a lot less hassle and surprise bills or denials of service.

Health care providers (operating as private contractors) would all understand the rules of the major health care financer and be able to focus on providing medical care instead of having to hire three or four medical insurance clerks to deal with differing insurance regulations and with fighting with insurance companies to get various services covered for their patients. Appeals for denials of services would be public record and available to the press, unlike similar "appeals" to private insurers, so the public could be made aware of unfair financing practices. Note the several private health insurers in California were sued for waiting until someone got expensively sick, then going back and determining ways to cancel their policies and merely refund their premiums instead of paying benefits. This unfair process (which is probably widespread) only comes out against a private insurer after expensive and lengthy law suits, and then only if the currently declining media covers it. A government appeals process can be made separate from the issue of making a profit, unlike for private insurers.

Most average workers simply want access to needed health care for themselves and their families. Middle class workers want medical care access and protection of their family wealth, such as their home and retirement funding. Only a universal health care mandate properly designed will provide that. It clearly is not here for a great many people right now, and what is happening to the auto workers demonstrates how uncertain even employer-provided health care is.

Addendum 10:39 CDT

Here is a link to a story of how the employer insurance is abused by employers. Fired Zales worker recovers. My thanks to the commenter "anonymous" who left this link as a comment to my April 10th post on Social Security and Medicare Notes.

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