Here is Marek the day he was born. Obviously Marek was not the healthiest of children on his birth day. Marek was born at 32 weeks gestation, eight weeks before expected. He was born at one hospital, transferred by ambulance to another hospital, and then lived there for the first six weeks of his life while he learned to breathe and eat outside the womb under medical supervision.
The total cost to us aside from our monthly insurance payment was $300.
This was in 2002, the year after we started our business and our group health care plan. We chose a plan, offered 100% paid coverage to our first employee at our expense, and we paid about $550 a month for our family.
Here is Oscar. Oscar was born in 2005 at 37 weeks gestation. He was playing at the park with us on his third day of life. We had downgraded our health care plan slightly so we were still paying about $550 per month for our family, and had a flat co-pay cost for hospitalization of $1000.
I'll include Matilda in here so she doesn't feel left out. In 2007 we had again downgraded our health care plan so we were still paying about $550 per month for our family. We were gambling that Matilda would not have complications at birth with a plan where we paid 20% of our hospitalization. With financial relief, though not physical relief, she was born at 39 weeks with no complications. According to my records, her birth cost us $1350.
With each child's birth, we are provided a snapshot of health care coverage versus expense at that time. And the difference is totally astounding to me: $300 for a preterm birth versus $1350 for a full term birth within five years. Same insurance company. About the same monthly cost.
As a self-employed person, I've always felt happy to be able to choose my own coverage options. But I have watched the cost of insurance go up ten percent EVERY YEAR. And this is not because of the medical complication of Marek. Interesting enough, once preterm birth is resolved, it's over and we are still placed in the most healthy insurance category. This increase is JUST BECAUSE.
Over the years our employee's appreciation of our health care plan has varied. Most didn't ever use it. There was the guy who went to the emergency room for stitches one night and didn't even understand how the coverage worked - he went to the wrong facility and had to pay for the whole thing out of pocket. There was the older guy who didn't think he could afford the $30 co-pay to get anything checked out (never mind that well visits are free with the plan). There was the guy that worked for us for five years and never used his coverage until he was leaving, so then he went and got a quick physical. It seemed that only those with families cared about the 100% paid health coverage that was given them.
Last year we finally cut our group coverage from the budget of our business.
So I have been intrigued by what our federal government is trying to do for us with the health care initiative. As a small business owner it is SO obvious that something needs to change with our current system. And I will admit that, for a change, I don't believe I have all the answers. But I am VERY worried. Is this going to be like the Credit Card Act which was supposed to help us, but instead caused the interest rates on all our cards to go up?
I watched Michael Moore's Sicko a long time ago. I watch anything by Michael Moore as informative entertainment with incredible bias. But I was struck by the number of health care experts that he managed to dig up. And I am hoping that our government did the same. Surely there is a panel of experts studying all the health care systems in the world? And surely these experts have recommended to our government a path of change based on what has worked in terms of efficiency, cost, coverage, and effectiveness? Aren't they? Can someone reassure me of this?
Just in case, here are the recommendations I would make to the government:
• Separate health care from the employer and give it to the individual. As many have pointed out, we all change employers so often, employer led health care no longer makes sense. This also allows us to see the actual cost versus benefit and make individual choices. Marek's birth cost us $300, but we were provided information of the actual cost which, if my memory is correct was well over $100,000. What a way to build brand loyalty!
• More openness into the drug industry. Why are we prescribed one brand versus a different brand? Maybe there is a better way than a drug to get the same affect like prescribing roller skating for depression?
• More taxation of lifestyle choices that directly affect our health: cigarettes, alcohol, fast food, etc. OR even better, tax incentives for healthy living: running shoes, ski passes, health club membership, sunscreen, etc.
• Government led health education plans. The big providers already do this. For example, information on when well health visits and screening are needed. And information about when something is truly worth a visit to the doctor. I have a book from my health care provider that I consult continuously before I make an appointment.
• Provide options rather than mandates. I don't believe people should be required to have health insurance. But I do believe everyone should have affordable choices. Why not offer catastrophic plans that are very affordable? This is really when health insurance is needed anyway.
• Create a merger of the big and effective health care providers already in place like Kaiser and Mayo. Or let them bid on a government contract for the entire country. They are already doing it. I have to believe they know more about running a health care system than our government.
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4 comments:
Isn't this opposed to the fiscally conservative label?
Other than that, I agree wholeheartedly on many points. But I just can't see how this meets the definition of fiscally conservative; I agree with it, but the label I don't understand.
Is this opposed to the fiscally conservative label? I didn't say Republican. I just want affordable, good insurance. Are you even buying your own insurance yet, Kyle?
Here's my thoughts on the fiscally conservative. You know I am all for keeping the government out of everything. However, there are rare instances when the government must step in, like a monopoly. I view health insurance as a necessity. We have to buy it. But the industry is working together and they are already regulated creating abnormal market affects. For example, had we kept our group insurance, it would have increased 20% plus the usual 10% this year because of a law that was passed which took away the good health discount. Also, Kaiser refunded ever member several hundred dollars last year because they had too much money at the end of the year, and as a nonprofit, it had to go somewhere. What I heard was that they can't lower their prices, because they would be undercutting the other carriers. However someone also told me recently that another insurance company is now cheaper, so who knows what is reality. How do we have the power as consumers to create change in this instance? We can shop around, and we can not abuse the system through extra use. That is all I can come up with, and it doesn't seem to be working.
Pondering more - how much consumer power is available when health insurance is usually obtained through the employer? If someone offered me even partially paid insurance, I would, of course, grab it with few questions asked. So how many of us are actually shopping around for this? I once sat down with our employees to show them the plan choices and see what they thought, and they did not offer much imput. So I just choose what I wanted as usual.
Also way back when I was in my twenties, I bought my own insurance since my employer didn't offer it. Every year I would call up my agent and complain about the price increase. Finally one year the agent actually yelled and cussed at me and that was the end of our relationship. In many insurance situations, there is this strange agent middle man making recommendations and a profit also.
And how does the medical and pharmaceutical industry play into this all? Really they are all so intertwined that they are one, they just aren't run as one unless you have a policy like Kaiser. What a mess!
I know this isn't labelled Republican. I don't see the Republicans as being fiscally conservative. The libertarians are closer to what I understand as fiscal conservatism.
Isn't giving the health care over to a single provider such as Kaiser Permanente or Mayo creating a monopoly that you say the government should intrude on?
Additionally I was under the impression that fiscal conservatism stands for lower taxes, economic freedom, and minimal influence from the government. The suggestions listed here, (though I agree with them) seem to raise taxes and appoint a health care provider to a monopoly.
I think there are too many middle men between consumers and health care. There is the employer that you mention, the insurance companies, the hospital affiliate, the hospital itself, and then finally the doctor. On the other side of the doctor you have the drug companies as well.
I believe in minimizing these, and the solutions you list focus on the employer minimization. I do think that having non-profit companies as insurers is a solution. Radical transparency in insurance companies should be encouraged, either through employer/consumer purchasing power and/or through government regulation/subsidy/taxation. The hospitals we can't do much about because they provide the doctors with tools and resources they can't otherwise have access to. The drug companies I believe need work, however. The primary issue I see is decreasing patent lengths on drugs. This does discourage innovation however, so at the same time, increasing subsidies on research should balance that out, while decreasing the number of years before generics can be released.
Where is the 10% increase each year going? Marketing for the insurers? Drug research for pharma? Doctor wages? Newer fancier fMRI machines? Insurers coffers? This info should be published by each insurer each year. This move towards radical transparency is something that our federal government has moved towards with Data.gov and other areas, and I think it could do a lot of good in the insurance industry.
I agree with your points, but the label is what I misunderstood.
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