a few personal anecdotes against McCain’s health care proposal

This is not about universal health care. I, and my family, would probably be worse off under universal healthcare, because we have a lot of coverage from our employers, which gets us really good medical care. I went to Cedars Sinai for Ben’s birth, after all – I got immediate, quality attention and a private room. I might not have had the positive experience I did under universal healthcare, with a more crowded hospital.

This is about the “consumer based healthcare” that McCain proposes, which can be detailed at his website:

John McCain Will Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage.
While still having the option of employer-based coverage, every family will receive a direct refundable tax credit – effectively cash – of $2,500 for individuals and $5,000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.

What McCain proposes is taking away the tax credits that go to employers that provide health insurance options, and giving it to the people to choose their OWN heath insurance coverage. But NOWHERE does it say that he will hold the insurance companies accountable to fair practices if this happens. And, without the clout of an entire company’s worth of business, it may leave millions of Americans open to a serious vulnerability at the hands of the insurance companies.

From Obama’s proposal – which is very similar, but includes accountability:

National Health Insurance Exchange:
The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

THAT is what we need in America. We need a system that stops the health insurance industry from fucking everyone over. Not universal healthcare – just accountability for the existing system. Let me share with you a couple anecdotes that explain why I feel so strongly about this:

Personal Anecdote #1: Jillian vs. United Healthcare – The Attempt To Not Pay For My Son’s Birth

Let me remind you all of the hell I went through with United Healthcare, when I was thirty-six months pregnant. First, we changed insurance companies on May 1st, and my obstetrician was no longer covered. In fact, my OB/GYN’s office had STOPPED accepting United Healthcare in February because UHC had an appalling track record of not paying bills in a timely manner, costing a lot of time and money to the clinic. Many doctors in L.A. are going this route: refusing to accept any insurance at all because of the difficulty of getting the payments from the insurance companies.

But I digress. United Healthcare promised they would pay for my pregnancy, under something called “continuity of care”. Since the costs of my OB/GYN alone would be around $5500, this was great news. I just had to get the forms to UHC within 30 days. Which I did. Many times. Then they proceeded to LOSE the forms multiple times. Eventually, this resulted in a form letter stating I didn’t get them the forms in time, so they wouldn’t cover the costs of my obstetrician. Cue murderous rage on my point.

Again, I’m 37 weeks pregnant when all this is happening, and rage-o-hol cannot be good for my unborn child. I’m trying to wrap up work and go on leave. I’m exhausted and stressed out enough, and it’s taking a major toll. It affects my sleep, it affects my ability to focus, and I literally waste ten business hours of my last month at work on this. The entire timeline of the whole nightmare is detailed in this entry I wrote.

This was eventually resolved, and I received a letter stating that my OB/GYN would be covered through my post-partum appointment. But the ONLY reason it was resolved was because my employer called the UHC account representative, who handled my case directly. Without my employer’s contact at the insurance company, UHC could have easily just dicked me around and then claimed they never got the forms, and I would have had to just pay my doctor up front to avoid being delinquent on bills, and hire a lawyer to hold the insurance company accountable for a promise they made me.

So I have my healthcare, and my doctor’s office just keeps billing United. Then United just kept routinely denying the claims anyways. Every time my doctor’s office sent a claim, United denied it. I would call in, spend half an hour on the phone, and get the claim fixed. Most claims took a couple weeks to turn around, so my doctor’s office was getting paid before the bills were past due. But the biggest one, for $4,500, for the birth, they kept “in process” for six weeks. I called in and was assured that it would be approved. Then, just as I was getting a second set of bills that were over 30 days due, United denied it. I called in, explained the situation yet again, and they did pay it. And thankfully, it was all resolved before the threat of collections came up. I’ve heard of United agreeing to pay claims and then delaying until the patient had to pay the costs themselves to avoid collections.

Finally, where possible, United have cut corners on the costs. Sure, they paid for my son’s circumcision, because it was done by my obstetrician. But they wouldn’t pay the WHOLE cost. They thought $350 was too much, so they paid $280 of it, based on “average costs for similar procedures in the area”. For my pathology services, they paid $155 out of $488, leaving me to make up the $333. This happens SO MUCH that the state of New York is actually suing United for it

By the way, the difference between what United pays and doesn’t pay doesn’t count towards my deductible. So, with my $1,000 deductible, I expect that I will only pay $1,000 out of pocket over the course of the year. Nope. That $333 doesn’t count towards it. United could continue to go on like this and cost me more than the low, $1,000 deductible that I pay extra to have. I’ll review next May and see if that happened.

Personal Anecdote #2: My Friends Don’t Have Insurance

I have friends who are reasonable healthy, normal, early thirtysomethings or late twentysomethings. They get exercise, don’t smoke, and are rarely sick. They can’t get healthcare as individuals. One of my friends just suffered a layoff at his latest employer, and that was the end of his healthcare coverage. Now he can’t get any of the major insurance companies to take him, because he’s had minor pre-existing conditions that aren’t even an issue at this time. Another friend has insurance under a small business plan for a company she doesn’t work for, because her own company is too small to issue insurance. Another friend is self-employed, so she pays for insurance that leaves her with a high deductible. Basically, if you do not have your own company fighting to get you the coverage, it’s VERY difficult to get the kind of (theoretical) quality coverageI have. This might be why four out of five Americans are uninsured – I’d bet a lot of them just can’t get decent coverage at a reasonable price.

This isn’t unusual. Insurance companies will refuse to cover individuals for many reasons – like if they are pregnant when they apply. Here’s a list of Consumerist stories on the subject.


The Moral Of This Story: The Existing System Must Be Held Accountable
The existing insurance companies must be held accountable for following through with their promises. And two of those promises have to be:

a) to universally cover anyone who can pay for premiums at a reasonable rate
b) to pay the costs of medical care as per the basic terms of the policy, and not make subjective decisions to pay less than 100% or create and find loopholes in policies to deny claims completely.

THAT would be a fair, free market solution. I would accept consumer based health care with accountability, and if I knew that I wasn’t leaving myself without my company to cover my ass, making me vulnerable to accepting whatever United Healthcare dictated. I would accept individual choice in health insurance IF the insurance companies covered people fairly, and then paid the bills accordingly, and didn’t try to skimp on payments or weasel out of them, or retroactively decide something isn’t covered, or dick people around until they HAVE to pay out of their pockets to save their credit ratings. One medical bill going to collections could cost me thousands in the form of a higher interest rate on a home loan. I don’t think health care should be related to credit ratings, but whatever.

So there you go. I don’t believe in putting health care in the hands of the government – although Obama’s plan is more like creating what Canada calls a “crown corporation” to issue health insurance to the uninsured:

Obama’s Plan to Cover Uninsured Americans:
Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress.

And for those of you that don’t like the government issuing health care because it creates a system that doesn’t work, McCain just intends to dump the problem onto the states, and make them responsible for issuing their own health care solutions:

John McCain Will Work With States To Establish A Guaranteed Access Plan.
As President, John McCain will work with governors to develop a best practice model that states can follow – a Guaranteed Access Plan or GAP – that would reflect the best experience of the states to ensure these patients have access to health coverage. One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

Obama is not offering to provide health care as in Canada, or the UK, but to give people an option to BUY health care insurance from a source where no one can be turned away. And if the existing companies were willing to do THAT, instead of being amoral, then we wouldn’t need the government to step in and create the system. McCain thinks the states take on the responsibilities to act the way employers do today, and contract with the existing health insurance companies for a sort of bulk policy that would cover all of one or more state’s uninsured. So he would just add a heavier layer of bureaucracy at the state level, instead of the federal level, which could cause an increase in STATE taxes to pay for it. Nice way to dump the problem on the state, McCain! That also leaves it at the discretion of each individual state whether they even take McCain up on that idea, and California MIGHT. MIGHT. We’re in a crapload of debt as a state right now, so it’d be a push. And states that slash back on socialist programs (like, say, Alaska) would probably not pay for it, leaving their citizens, well, forced to move to Oregon or go without healthcare.

So when it comes down to “which president would my family and I be best off under,” health care policy is one of the reasons I’m backing Obama as hard as I am. Under McCain’s health care plan, I (and many of my friends), would just get completely screwed by the health insurance companies. I don’t ever EVER want to have to fight for my medical bills to be covered again, especially not to a company I pay $250 a month to for coverage (that is ONLY for me and Ben, and that is $3000 a year, for those of you counting). I expect to get what I’m promised for that $3K a year, and not get the health insurance equivalent of a laptop box where the product inside has been replaced with bathroom tiles. The free market system only works when the consumers get what they paid for. Otherwise, it needs government control – and if that means another layer of government bureaucracy, so be it.

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