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The Problem for Health Care Consumers

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Congress Writes the Laws

* Inequities in Access to Health Care Related to Complicated Array of Insurance Products

* Increasing Cost Shifting Away from Employers and Insurers to Patients

* Shady Insurance Sales Practices that Deceive consumers

* Limits on Choice of Providers

* Constraints on Access to Preventative Care

* Increasing Political Pressure By Corporate Interests to Privatize the Financing of Health Care

* Diminished Quality of Health Overall as well as Longevity

Americans are being priced out of health care. A typical employment-based health insurance plan in 2003 was $8,800 split somehow between the employer and the employee according to economist Uwe Reinhart. According to Reinhart, these prices in recent years have been rising at a rate of 10% annually. If this inflationary trend continues at only a 10% rate according to Reinhart, small changes in productivity growth, product price levels, and health insurance premiums could easily drive the fraction of total compensation that is absorbed by health insurance to over 50%.

As a point of reference that is more current, the Towers Perrin's annual Health Care Cost Survey data revealed that "the average corporate health benefit expenditure in 2009 was $9,660 per employee-an increase of 6% over 2008 figures." The 6% growth rate made 2009 the fifth consecutive year of single-digit percentage increases. However, many companies and their employees continued to face record-high dollar costs in 2009, adding to concerns about affordability, particularly for lower-wage workers and pre-65 retirees.

Underscoring the growing affordability gap, the Towers Perrin survey database showed that total health care costs had increased by 33% between 2004 and 2009, while the employee share increased by 42% during the same period. In 2011, this trend continues unabated, despite the ballyhoo surrounding health care reform now under fire relative to issues of constitutional viability.
Towers Perrin Health Care Cost Survey Shows Average Annual Per-Employee Cost of $9,660 in 2009 -- And the Health Care Affordability Gap Widens

A St. Petersburg Times article ( 4/23/04 ), quotes Florida Governor Jeb Bush as a strong proponent of so-called "Bare Bones" health insurance policies with low premiums, minimal coverage and high deductibles. While state lawmakers lift coverage mandates for cost- effective preventative care such as mammograms and other screening tests on the recommendation of the Governor, citizens covered by these programs are the losers.

Solutions such as those initially proposed by Jeb Bush in 2004 represented the first giant leap toward health care rationing. These plans severely limit access to more sophisticated and costly health care services through onerous plan restrictions and deductibles.

As more and more people are forced by economic circumstance into these bare bones coverage plans, a broader cross section of society is shut out of modern health care services. Consequent to this phenomenon, modern health care becomes a luxury commodity provided mostly by those of relatively modest circumstance (Nursing staff), to those affluent enough to afford premium health care insurance coverage. This paradigm should not be allowed to persist!

Quoting the Tower Perrins Survey the statistical data demonstrates an impressive finding: "Analyzing the 2009 data by coverage level, the average reported cost of medical coverage for active employee-only coverage is $4,860 per year and, for family coverage, $14,244 per year. While these numbers are impressive in themselves, the impact of current health care costs and cost increases is starkly evident when compared with wage increases over the past eight to 10 years an analysis that reveals a growing affordability gap and significant erosion over time in compensation values and employee purchasing power.

Even though employees at high-performing companies (Fortune 1000) are doing better overall, they are still feeling the legacy impact of years of rising costs, despite the best efforts of their employers today to keep costs down." One very big reason why we as a nation should cease to wonder why we remain mired economically in what is an Economic Depression!

Analyzing this data from a macro-economic standpoint, such over concentration of both employer and employee dollars in one sector of the economy represents a considerable constraint on overall economic growth and employment, wages and company profitability. I encourage people to read the report of this survey via link above.

Burden of Cost Continues to Be Shifted To Employees

The cost of health care coverage continues to be shifted to the employee both current and retired leaving many with fewer and fewer options, often due to affordability going without. Again quoting the Towers Perrin Survey: "The big story here lies in the cost increases for pre-65 retirees who are not yet eligible for Medicare," said Guilmette, "While successful employers have achieved sustainable levels of cost increases for their active employees, and Medicare eligible retirees have access to a robust Medicare Advantage product marketplace, costs for employees who retire before age 65 are skyrocketing. As employers continue to get out of the game of subsidizing and sponsoring retiree health care, pre-65 retirees are left to shoulder the cost burden."

The total annual cost for pre-65 retirees is the highest in the Towers Perrin survey, at $13,308. Pre-65 retirees are expected to pick up $6,960, or 52%, of this amount, which is 66% more than they paid just 5 years ago. Putting these numbers in historical context, the total cost in 2004 was $10,752, with retirees paying $4,200, or 39%. Making the comparison to today's numbers, total costs for pre-65 retirees have increased 24% over the past five years, but these retirees are now picking up a bigger share. Looking ahead, Towers Perrin predicts that, within five years, pre-65 retirees could be paying as much as 80% of the cost of health care coverage. According to Towers Perrin many of these employees are being directed into so-called Medicare Advantage Plans which involve the employee signing away their Medicare coverage for a Privately Administered Health Plan.

Medicare "Advantage" Plans... A Poor Substitute for Your Medicare!

It is amazing how easily most Americans merely take for granted the limitations on care available to them accorded them by their insurance companies. These inequities in my opinion as a health care provider, should not exist. If you have been a good law abiding citizen you should not have limitations on your access to quality health care spanning the full spectrum. The most outrageous aspect of the entire issue of financing access to health care in America is the charade that so many Americans at every socio-economic level have perpetrated upon them by shady insurance sales people.

People often believe erroneously that they have "good coverage" until they become ill with a serious disease such as cancer. The most nefarious aspect of this entire charade is that when signing up to trade their Medicare for an Advantage plan, the customer is not even aware of the differences in coverage between Medicare and the replacement plan that may well come back to harm them later both physically and financially.

While the warnings to Medicare beneficiaries are outlined in their manual of benefits, many continue to be lured away from their secure Medicare health care plan to the privately sponsored for profit Medicare Advantage (REPLACEMENT) plans by slick advertising both in print and paid television programming. While the content of the advertising features healthy active seniors boasting about how much cash they are saving in monthly premiums and freebies, nary a mention is made about what seniors are giving up in return for the freebies.

Never does one hear about whether or not a given plan includes 100 days of skilled nursing facility in-patient rehabilitation coverage as does Basic Medicare. No mention of exhorbitant co-pays... or the need to use in-network doctors which may exclude the patient from important specialty care without additional costs and most importantly, delays in treatment related to the need acquire approval from the Insurer.

As a provider of health care, I have witnessed the shenanigans associated with Advantage coverage where in my mind as a provider of care, the ONLY "advantage" associated with Medicare Advantage plans... accrues to the Insurer. Additionally, the choice of physicians is often limited to these unwitting Advantage clients, due to the fact that many of the best providers do not accept certain plans due to low/delayed reimbursement and/or circuitous and complicated claims processes.

As I have navigated the approval process working with families and patients to secure vital diagnostic/treatment services through the system put in place by corporate insurers via policies facilitated by corporate-owned politicians, I have characterized this phenomenon as "The Lawyering of Health Care."

"The Lawyering of Health Care"

Delay, Delay, Delay... A classic legal rejoinder! When at every step of the process there is delay, patient outcomes become jeopardized. There are enough delays in the process ordinarily speaking, arranging appointments with appropriate physicians for example impose some delay.

One example: When a woman has to seek out a surgeon on her own because there is no surgeon in her network who will perform the necessary procedure... (Mastectomy)... because the payment is so meager from the insurer to the surgeon... in light of the malpractice risk inherent to the provider when rendering care... leaving the patient to her own devices-finally finding a surgeon who would perform her surgery gratis after months of searching. No one should be placed in such a position... in America!

What I know about such issues comes from my own professional experience working with other medical professionals, case managers, patients and their families in search of treatment for serious illness and disability. For now, the best option for Americans currently eligible for Medicare is to keep their Medicare and purchase a good supplemental plan covering co-pays and prescription drugs. While this is the more expensive option up front, it is the best means of ensuring access to the care that you may need.

The Effect on Business and the Economy

The rising cost to business for employer based health care coverage places smaller employers at a competitive disadvantage with larger organizations relative to cost and competition for employees. This is unfair and is a significant drag on economic growth and employment. High costs for providing health insurance coverage diminish profits as well as employee earnings resulting in the major deficiency in our current economy... Decreased Aggregate Demand!

Meanwhile as premiums rise, health care services are restricted, and barriers to access are erected as a means of reducing costs to the Insurer... Result being, profits grow for the insurer at the expense of the insured and small business. Again, the prevailing direction is one favoring the shifting of risk and cost away from the insurer to the employer and the insured, as well as those unable to afford insurance, and the providers of health care who often provide basic care free of charge to those without.

Veterans Care
Veterans are increasingly bearing the brunt of budget cuts at the federal level. The closing of Veterans Administration health facilities displaces cost and risk from government to the consumer (Veterans). One veteran told me a story of brother who had to travel to Gainesville, Florida because the facility in Georgia had been closed as a result of budget cuts. The teller of this story, who was himself badly scarred both physically and emotionally from his Vietnam and Korean experience became emotional as he told me this. We have a whole new group of disabled veterans from depleted uranium Gulf War (1991 to present), blast injured amputees, traumatic brain injured and the psychologically (PTSD) scarred.

Our debt to our veterans must be repaid with the care necessary to put their lives back together while we the citizens encourage those in charge of deploying our military do so judiciously in defense of our nation and not on behalf of furthering the onus of corporate goals. I will support our Veterans access to appropriate and necessary health care services unwaveringly.


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