The Morality of Insurance

Oooo...that's a heavy title.

I think – and worry – about health care a lot because I use it. A lot. Matt, on the other hand, couldn’t tell you what type of insurance plan he has, co-pay and deductable amounts, or if he has a primary care physician. Insurance companies must love him: he is pure profit. This is just another way we balance one another out.

And that is the crux of insurance: to balance and spread the risk. Sometimes you take more than your share of the draw, and other times you give. But it is all for the collective well-being of society. I’ve been thinking a lot about the accompanying opinion piece: it discusses charging people with unhealthy habits more. Along the lines of, “You smoke, so why should I have to pay for your treatment when you get lung cancer?” and “Well, you’re obese, so you’re at a greater risk of heart disease and diabetes and I work hard to maintain my weight” and the list goes on and on. Although, on the surface, I agree (I am an unyielding snob when it comes to smokers), it’s a damn slippery slope. And like the piece says, we all have bad habits (Oreos, anyone?). I agree, only I should get my hand slapped because I can’t keep my fingers out of the cookie jar. I am an overweight woman and little will power. But it’s so much more than that. I go to the gym, I walk my dog, and I eat my share of vegetables.

The less you make, the more you weigh. Should we blame nutritional ignorance, our education system, or the corn subsidies that make our packaged food that much cheaper? (I’m with the latter.) When do genetics come into play? How can you really ascertain the origins of a condition?

I’m with the article’s author, Dr. Sandeep Jauhar. None of us enjoy paying the cost of illnesses that could have been avoided. But, as a modern society, is that the fix we want? To burden those already burdened?

Read more HERE.

Finally

I realized I haven't written about the health care bill being passed. I found out of its passing at 5:30 am on Monday, screamed upstairs to Matt by simply saying, "It passed!", and did an early-morning jig with the dog looking wearily on.

I'm still smiling.

27 going on 60

I am the only person I know, who, in their late 20’s, gets short of breath (in the bad way) when thinking of retirement savings. I can’t help it.

My co-worker Courtney called me neurotic as I sat fidgeting in her office chair waxing poetic about long-lost private-sector pensions. I recently found out about how lush teachers’ pensions and benefits can be, and have been nursing a mean jealous streak ever since (and the urge to ditch it all and become a teacher). I tell Matt things like, “We need a Vanguard account!” (Note: I know nothing about mutual funds or Vanguard accounts…I just like to say it). Matt tells me to, essentially, shut-up. “We have 40 more years to figure this out,” he says. The thought of working 40 more years is almost as depressing as our bleak financial future. Sometimes he says, “You might not even be around 40 years from now, so quit worrying.” (Lovely.) He follows that up with, “We’re young – who do you know who puts money into their 401(k) like we do?!” to which I reply, “EVERYONE!” and bury my face in my pillow. In a moment of panic this week I upped my 401(k) contribution from 10 to 15% and demanded Matt do the same. I also like to say we need a Roth IRA. I have NO IDEA what a Roth IRA is but I heard Suze Orman talking about them, and I want one.

Two weeks ago I announced, over omlettes, that we needed a budget. “We need to control our spending!” I huffed. Mid-chomp, Matt said, “What spending? I don’t buy anything,” to which I replied, “Well, I do.” We then logged on to view my credit card statement and, after subtracting things like food and gas, I was left with what I spent on a skirt and dress and some odds and ends I picked up at Target. I replied that they were obviously necessities and they didn’t count, but the crux of my argument was that, “You’re a guy; you wouldn’t understand”, which I don’t think he bought. So much for our budget.

I wouldn’t call us particularly thrifty, and we’re definitely not spend thrifts. We’re just…normal. I will forever be a champion of economy cars and the thought of having a Coach bag just ticks me off, but I love going out to eat and furnishing our home (relatively cheaply, of course). And damnit, if that frilly skirt is $100 bucks but I swear, swear, swear I’ll wear it all the time and I love it and I won’t buy another thing that month, then YES, I’m buying it. Look, it’s all about balance. And a good skirt.

I bring this up because I also worry about medical expenses. For example, like many of my surgical Crohn’s brethren, I have to bear a monthly B12 shot for the rest of my life. The negotiated rate with my insurance carrier (I am on a high-deductible plan, so I essentially pay in-full until I meet my deductible, but all “in-full” prices are the negotiated and preferred cost through the carrier) is $156. One hundred and fifty-six dollars for a shot of …a vitamin. Per month. Negotiated rate. The “negotiated” rate for Pentasa, my maintenance drug, hovers slightly under $500 a month. So, yes, I worry about money. And insurance. I think I should.

It is a bad thing to have Crohn’s and be a neurotic worrier. Stress makes my symptoms worse. And duh, stress also inhibits your ability to conceive. Last month my ob/gyn told me I need to reduce my stress. This statement elevated my stress. Couldn’t she see that was futile? That I’m having trouble with work, with trying to had a kid, and by golly, with the fact we have no retirement savings and no solid plan in place?! I thought that but all I said was, “Okay.” That’s pretty much how it always goes.

Matt will often sit me down and say, “What can I do to help you relax?” The first answer is always food. Tortilla chips or chocolate are often involved – but that really goes without saying. After that, it gets a bit grey. I’d like to believe I’m the least high-strung member of my family – it’s in the genes. But I ask for impossible things. Past answers have been, “New intestines and/or immune system”, “my own dog hotel business” (no laughing!), “you making 200k a year or winning the lottery”, and “a 30 minute back rub” (trust me, the last one is impossible). He’ll respond with, “Well, what about one of those puddings in the fridge?” “With whipped cream on top?” I’ll ask. “Yes.” “Deal.”

Now if you’ll excuse me. I have to go study for a test I have tonight that I’m worried about.

PS: You may have noticed (well, probably not, who am I kidding?!) that my posts have been less frequent. I’m enrolled in a class that will hopefully prepare me for a professional certification exam I’m taking in May. It would be a lie to say I have no time to post, but I love to watch t.v. on my time off. I adore t.v. I am nothing but an uneducated commoner, what can I say?! Posts until the end of May might be less frequent, but don’t worry, they’ll still be filled of my complaining (about health care, money, oh, you name it!) and of course food (that’s a given!).

Health care round-up!

Sometimes I forget how good Jon Stewart really is...until I see clips like these.

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Anchor Management
http://www.thedailyshow.com/
Daily Show Full Episodes Political Humor Health Care Reform

Last but not least, folks are committing fraud to get their hands on some decent health care. Ooo, ooo, pick me! I know what may help alleviate this problem!

Kisses to Keith

I never really understood celebrity crushes. Brad Pitt? Eh. George Clooney? God no - he comes off as a narcissistic womanizer. Johnny Depp? I can't like a guy who wears more eye-liner than I do.

What can I say; I go for substance over looks, and that's why I've harbored a crush over Keith Olbermann for the past few years (anyway, I think he's pretty darn fetching). Now, he does lose some points for getting his start in sports and continuing to do that part-time, but the man is an angry liberal. Well, I'm an angry liberal. And he gets my blood boiling - in a good way. Isn't that cause for swooning?

And although I loathe all these pseudo-political commentary shows, it's nice to know Olbermann and Rachel Maddow are out there. Fighting the good fight.

Here's my pretend boyfriend calling out some politicians who get big donations from insurance companies. Oh, Keithy....

PS: Okay, Edward Norton isn't so bad, either.

I <3 insurance execs

Will Ferrell can do no wrong. Well, with the exception of Land of the Lost earlier this year, and Semi-Pro last. Okay, so the boy's track record isn't so hot lately. Nevermind that, and watch this.

Click here for his very informative PSA.

Health Care Fit for Animals

This is a good one. Kristof speaks to Wendell Potter, who was previously an Exec at Cigna (shout out to my insurance company, woot woot!), and left his high-flying lifestyle after being witness - and entrenched in - the indignities the insurance industry. He details their profit-y ways, saying they often: 1) denied requests for pricey procedures, 2) engaged in "rescission", which means the insurer abruptly cancels the policy on a technicality (aka no legit reason) because the person with the policy, who has paid their premiums for years, suddenly (how dare they) gets sick, and 3) sky-rockets policy costs for small businesses because one employee gets sick, and thus many times the employer can no longer provide coverage.

Someone close to me complained a few weeks ago about the blog. She asked me why is it always about "boring health care". I responded there is nothing boring about this, her health (my god, livelihood) depended on it, and if this isn't keeping you up at night, then you just aren't listening.

Please read.

Op-Ed Columnist
Health Care Fit for Animals
By NICHOLAS D. KRISTOF
Published: August 27, 2009
Why a health insurance executive decided to speak out against an industry that he was once paid to defend.

Frontline's "Sick Around The World"

Matt and I love Frontline. Every Tuesday night it's this: Nova at 8, Frontline at 9. It's a total nerd-fest, and we wouldn't have it any other way.

If you haven't seen this, please watch (grab some popcorn and plop down in front on the laptop). In "Sick Around the World", Frontline dissects the health care of other democratic nations (who aren't "socialist" by golly!!!). and just how they do it. Maybe my readers aren' t one the 48 million Americans who don't have health care, but you never know...you very well might be soon enough.

PBS's Coverage of "Sick Around the World"

Paul Krugman on Health Care Reform

Op-Ed Columnist
All the President’s Zombies
By PAUL KRUGMAN - NYT
Published: August 24, 2009
Reaganomics has failed to deliver what it promised, yet people still believe that government intervention is bad, and leaving the private sector to its own devices is good.

XOXO to Barney Frank

Most of you have already seen this, but I couldn't resist this beautiful response from Barney Boy Frank.

Why We Need Health Care Reform, by President Barack Obama

August 16, 2009

Why We Need Health Care Reform

By BARACK OBAMA

OUR nation is now engaged in a great debate about the future of health care in America. And over the past few weeks, much of the media attention has been focused on the loudest voices. What we haven’t heard are the voices of the millions upon millions of Americans who quietly struggle every day with a system that often works better for the health-insurance companies than it does for them.

These are people like Lori Hitchcock, whom I met in New Hampshire last week. Lori is currently self-employed and trying to start a business, but because she has hepatitis C, she cannot find an insurance company that will cover her. Another woman testified that an insurance company would not cover illnesses related to her internal organs because of an accident she had when she was 5 years old. A man lost his health coverage in the middle of chemotherapy because the insurance company discovered that he had gallstones, which he hadn’t known about when he applied for his policy. Because his treatment was delayed, he died.

I hear more and more stories like these every single day, and it is why we are acting so urgently to pass health-insurance reform this year. I don’t have to explain to the nearly 46 million Americans who don’t have health insurance how important this is. But it’s just as important for Americans who do have health insurance.

There are four main ways the reform we’re proposing will provide more stability and security to every American.

First, if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family — coverage that will stay with you whether you move, change your job or lose your job.

Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.

Third, by making Medicare more efficient, we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies. This will not only help provide today’s seniors with the benefits they’ve been promised; it will also ensure the long-term health of Medicare for tomorrow’s seniors. And our reforms will also reduce the amount our seniors pay for their prescription drugs.

Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable. A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition. The companies either refused to cover the person, refused to cover a specific illness or condition or charged a higher premium.

We will put an end to these practices. Our reform will prohibit insurance companies from denying coverage because of your medical history. Nor will they be allowed to drop your coverage if you get sick. They will not be able to water down your coverage when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses. No one in America should go broke because they get sick.

Most important, we will require insurance companies to cover routine checkups, preventive care and screening tests like mammograms and colonoscopies. There’s no reason that we shouldn’t be catching diseases like breast cancer and prostate cancer on the front end. It makes sense, it saves lives and it can also save money.

This is what reform is about. If you don’t have health insurance, you will finally have quality, affordable options once we pass reform. If you have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care you need. If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan. You will not be waiting in any lines. This is not about putting the government in charge of your health insurance. I don’t believe anyone should be in charge of your health care decisions but you and your doctor — not government bureaucrats, not insurance companies.

The long and vigorous debate about health care that’s been taking place over the past few months is a good thing. It’s what America’s all about.

But let’s make sure that we talk with one another, and not over one another. We are bound to disagree, but let’s disagree over issues that are real, and not wild misrepresentations that bear no resemblance to anything that anyone has actually proposed. This is a complicated and critical issue, and it deserves a serious debate.

Despite what we’ve seen on television, I believe that serious debate is taking place at kitchen tables all across America. In the past few years, I’ve received countless letters and questions about health care. Some people are in favor of reform, and others have concerns. But almost everyone understands that something must be done. Almost everyone knows that we must start holding insurance companies accountable and give Americans a greater sense of stability and security when it comes to their health care.

I am confident that when all is said and done, we can forge the consensus we need to achieve this goal. We are already closer to achieving health-insurance reform than we have ever been. We have the American Nurses Association and the American Medical Association on board, because our nation’s nurses and doctors know firsthand how badly we need reform. We have broad agreement in Congress on about 80 percent of what we’re trying to do. And we have an agreement from the drug companies to make prescription drugs more affordable for seniors. The AARP supports this policy, and agrees with us that reform must happen this year.

In the coming weeks, the cynics and the naysayers will continue to exploit fear and concerns for political gain. But for all the scare tactics out there, what’s truly scary — truly risky — is the prospect of doing nothing. If we maintain the status quo, we will continue to see 14,000 Americans lose their health insurance every day. Premiums will continue to skyrocket. Our deficit will continue to grow. And insurance companies will continue to profit by discriminating against sick people.

That is not a future I want for my children, or for yours. And that is not a future I want for the United States of America.

In the end, this isn’t about politics. This is about people’s lives and livelihoods. This is about people’s businesses. This is about America’s future, and whether we will be able to look back years from now and say that this was the moment when we made the changes we needed, and gave our children a better life. I believe we can, and I believe we will.

Barack Obama is the president of the United States.

Something to ponder...

Here's a great blog entry on Salon.com regarding the hypocrisy of those shouting down any sort of reform in the town hall meetings taking place across the country. The author, Darren Hutchinson, provides us with this delightful stinger:

Ironically, many of the people whom the article portrays as fuming over "socialized medicine" probably have state-sponsored health plans. Accordingly, if the protesters actually applied their anti-government rhetoric to their own lives, many of them would lose health insurance coverage or would have to spend a fortune to obtain it.

For the whole entry, please click here. For the author's own blog, you can visit it here.

Top Five Health Care Reform Lies

Courtesy of Moveon.org.

Lie #1: President Obama wants to euthanize your grandma!!! The truth: These accusations—of "death panels" and forced euthanasia—are, of course, flatly untrue. As an article from the Associated Press puts it: "No 'death panel' in health care bill." What's the real deal? Reform legislation includes a provision, supported by the AARP, to offer senior citizens access to a professional medical counselor who will provide them with information on preparing a living will and other issues facing older Americans.

Lie #2: Democrats are going to outlaw private insurance and force you into a government plan!!! The truth: With reform, choices will increase, not decrease. Obama's reform plans will create a health insurance exchange, a one-stop shopping marketplace for affordable, high-quality insurance options. Included in the exchange is the public health insurance option—a nationwide plan with a broad network of providers—that will operate alongside private insurance companies, injecting competition into the market to drive quality up and costs down. If you're happy with your coverage and doctors, you can keep them. But the new public plan will expand choices to millions of businesses or individuals who choose to opt into it, including many who simply can't afford health care now.

Lie #3: President Obama wants to implement Soviet-style rationing!!! The truth: Health care reform will expand access to high-quality health insurance, and give individuals, families, and businesses more choices for coverage. Right now, big corporations decide whether to give you coverage, what doctors you get to see, and whether a particular procedure or medicine is covered—that is rationed care. And a big part of reform is to stop that.

Health care reform will do away with some of the most nefarious aspects of this rationing: discrimination for pre-existing conditions, insurers that cancel coverage when you get sick, gender discrimination, and lifetime and yearly limits on coverage. And outside of that, as noted above, reform will increase insurance options, not force anyone into a rationed situation.

Lie #4: Obama is secretly plotting to cut senior citizens' Medicare benefits!!! The truth: Health care reform plans will not reduce Medicare benefits. Reform includes savings from Medicare that are unrelated to patient care—in fact, the savings comes from cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse.

Lie #5: Obama's health care plan will bankrupt America!!! The truth: We need health care reform now in order to prevent bankruptcy—to control spiraling costs that affect individuals, families, small businesses, and the American economy. Right now, we spend more than $2 trillion dollars a year on health care.The average family premium is projected to rise to over $22,000 in the next decade—and each year, nearly a million people face bankruptcy because of medical expenses. Reform, with an affordable, high-quality public option that can spur competition, is necessary to bring down skyrocketing costs. Also, President Obama's reform plans would be fully paid for over 10 years and not add a penny to the deficit.We're closer to real health care reform than we've ever been—and the next few weeks will decide whether it happens. We need to make sure the truth about health care reform is spread far and wide to combat right wing lies.

Enough is enough

Update: I can't sleep and am reading about health care reform, of all things. Just read the following comment and had to chuckle (sadly) and reiterate: "An uninformed citizen is the right wing's best customer."


http://www.singlepayerusa.net/
http://egan.blogs.nytimes.com/2009/08/09/palins-poison/?em
http://www.npr.org/templates/story/story.php?storyId=106180134
http://www.healthreform.gov/


Don't get me started on Sarah Palin's ill-informed "death panel" comments regarding the Obama administration's health care reform policies. I love making fun of her (who doesn't?!) but her comments are dangerous fabrications and a blatant distortion on the truth, and it's terrifying her equally misinformed conservative followers believe these lies and have made health care town hall meetings screaming sessions, and are, in turn, halting any progressive health care reform.

(And, apparently, when I'm mad, I write in long, run-on sentences.)

"Sick in America"

From Frontline's "Sick in America" (click here to watch):

At its best, American health care can be very good. For Microsoft employee Mark Murray and his wife, Melinda, their employee health plan paid for eight years of fertility treatments and covered all the costs of a very complicated pregnancy. "If it wasn't for our health insurance," Murray says, "we wouldn't have a baby boy right now." The Murrays' medical bills totaled between $500,000 and $1 million, and their plan covered every penny.

But beyond large, high-wage employers like Microsoft, FRONTLINE learns that available, affordable, adequate insurance is becoming hard to find. Small businesses face a very bleak outlook for finding and keeping coverage. Coverage is becoming more expensive and less comprehensive, with high deductibles, co-pays and coverage limits. Georgetown University Research Professor Karen Pollitz explains that for many people, the current system is "like having an airbag in your car that's made out of tissue paper: I'm so glad that it's there, but if I ever get in a crash, it's not going to protect me."

Outside of employer-based health care plans, matters are even worse. Americans seeking insurance in the individual market must submit to "medical underwriting," and if they have a pre-existing condition, they will likely be denied. Kaiser Permanente Chairman and CEO George Halverson says frankly: "I could not get insurance. I've had heart surgery, and so I am completely uninsurable in the private market. So it's important that I keep my job."

Across the U.S., FRONTLINE finds people making life decisions based on health insurance, stuck in jobs because of so-called job lock. One such person is 23-year-old Twin Cities, Minn., resident Matt Johnson, who put his career dreams on hold to get a job at Menards home improvement store because its benefits package covers his ulcerative colitis. Americans even stay in bad marriages, says Professor Pollitz, "because they just can't afford to divorce their health insurance."

For those Americans who find health coverage in the private market, there's no guarantee it will protect them. In 2007, Palm Desert, Calif., realtor Jennifer Thompson received a letter from Blue Cross accepting her for coverage that read: "Congratulations! You have been approved for coverage with Blue Cross of California. ... The immediate value of your coverage is peace of mind." But then Thompson discovered she had a cancer that required surgery, and three days after leaving the hospital, she received a letter from Blue Cross saying that her insurance was "rescinded," leaving her uninsured and owing more than $160,000 in medical bills. Blue Cross cited Thompson's previous history of cancer and results from a recent doctor's visit as the reasons for the rescission. "Our system is not working," says Professor Pollitz. "It's designed to cut out on you right when you need it the most." When questioned about Thompson's case, Sam Nussbaum, chief medical officer of WellPoint, which owns Blue Cross of California, told FRONTLINE that because of legal considerations, "I can't speak to that circumstance ... but no one likes to see a situation like this. People are buying health security."

In the past, some states required insurance companies to cover everyone but found that many people waited to buy insurance until they fell ill, causing "adverse selection," or a higher ratio of unhealthy to healthy people in the insurance pool. As a result, insurance companies stopped doing business in those states. Today, only five states—New York, New Jersey, Massachusetts, Maine and Vermont—guarantee everyone insurance, a "privilege" reflected in premiums. "If we look at the average premium of those states," says WellPoint's Nussbaum, "that premium is three times higher on average—maybe $600 to $700 versus a [state] where the insurance market has allowed medical underwriting."

For some Americans, life becomes a quest to find and keep health insurance. In 1994, Nikki White, a Bristol, Tenn., native with dreams of becoming a doctor, was diagnosed with lupus, a serious but treatable autoimmune disorder. Too ill to work, she lost her health insurance for several years, but then received coverage from the state's Medicaid program. Soon, budget cuts made her ineligible for the state program. A few months later, White was rushed to the ER with severe lupus complications and racked up nearly $1 million in medical bills. She finally secured insurance under the government HIPPA law, but her condition was too advanced, and in 2006, at the age of 32, she died. White's primary care physician, Amylyn Crawford, tells FRONTLINE: "Nikki didn't die from lupus. Nikki died secondary to the complications of a failing health care system."

Around the world, other developed democracies offer universal health care, requiring insurance companies to cover everyone. People are mandated to buy it; insurance for the poor is subsidized; and governments control prices by setting the cost of everything from doctors' salaries and hospital rooms to drugs and MRIs. But efforts to implement similar policies in the U.S. have proven unsuccessful. In 2006, Massachusetts implemented reforms mandating everyone be covered by health insurance, but there are still problems of affordability. FRONTLINE profiles the Abramses, a Massachusetts family of four earning $63,000 annually, who found that although they were too prosperous to receive a health care subsidy, they could not afford to buy a health care insurance policy at around $12,000 a year. "What we're finding out in Massachusetts," says veteran insurance industry executive and consultant Robert Laszewski, "you can mandate that people have health insurance, but if it costs more than they can afford, it doesn't matter."

As President Obama launches his plan for reforming health care, Kaiser Family Foundation President Drew Altman tells FRONTLINE: "This is the first big opportunity for health reform since ... [the] early 1990s. And a question is again, pointedly, whether we will blow the opportunity again this time or [whether] we will actually get it all done or get something significant done." But consultant Laszewski wonders if Americans have the will to make it happen. "Every doctor I meet says he's underpaid. I've yet to meet a hospital executive who thinks he or she can operate on less. I have yet to meet a patient who is willing to sacrifice care. So we have this $2.2 trillion system, and I haven't met anybody in any of the stakeholders that's willing to take less. And until we're willing to have that conversation, we're just sort of nibbling around the edges."