Pay More, Get Less
Find a Conversation
| Wed, 10-28-2009 - 9:16am |
Throughout the health-care-reform debate, this has been President Obama's central message to the 80% of Americans who say they are satisfied with their health insurance. But as the millions of Americans who receive coverage through their employers — and who make up a large portion of that satisfied 80% — start signing up for their 2010 coverage in the so-called open-enrollment period over the next few weeks, they may well wonder if the status quo is such a good thing.
No part of the U.S. health-care apparatus has been more sacrosanct in the current debate than the job-based insurance system that provides coverage for some 160 million Americans, or about 60% of all insured Americans. Yet the numbers behind that system show that it may be just as unsustainable as — if not more than — the U.S. health-care system as a whole, in which costs nationwide are on pace to exceed 20% of our gross domestic product by 2018. Premiums for employer-sponsored insurance increased 131% from 1999 to 2009, according to the Kaiser Family Foundation; over the same period, employee contributions to those premiums went up 128%. From 2006 to 2009, the percentage of insured individual workers with annual deductibles of $1,000 or more rose from 10% to 22%. Of companies that offered health benefits in 2009, 86% offered only one plan. (Watch TIME's video "Uninsured Again.")
"It's clear that the trend with workers for a lot of plans is spend more, get less," says Democratic Senator Ron Wyden of Oregon, a member of the Senate Finance Committee who has pushed, so far unsuccessfully, for the reform bills in Congress to give employees and employers more choices by allowing them to shop for coverage in the insurance marketplaces that would be established under reform.
Changes to 2010 health benefits, which reflect the first chance employers have had to restructure their plans since the economy started tanking in September 2008, look to be even more daunting than usual. Surveys indicate that in 2010, 40% of employers will shift more premium costs onto employees and 39% will increase deductibles, co-payments, co-insurance or out-of-pocket maximums. More employers are steering workers toward catastrophic health policies with deductibles as high as $5,000 or $10,000. (See 10 players in health-care reform.)
"In the absence of significant reform, we will continue to see an erosion of the employer-based system. Smaller employers are dropping coverage altogether. The ones who are able to offer coverage are under greater and greater pressure. the large-employer market, I see continued cost-shifting," says Tom Billett, a senior consultant for Watson Wyatt, a firm that advises companies (including TIME's parent company, Time Warner) on health-plan design.
Congressional-reform proposals would do little to change the current system. While some form of "employer mandate" would require employers to provide coverage or pay penalties, most large employers already offer benefits and many small businesses that can't afford them would be exempted from the requirement. Of the reform proposals that could have some long-term effect on the employer-based system, the most significant may be one that would levy a 40% excise tax on policies that cost more than $8,000 for individuals and $21,000 for family coverage in 2013. (The average total cost of individual and family policies in 2009 was $5,791 and $14,375, respectively.) Policy experts say these expensive plans lead workers to overuse the medical system, driving up costs for everyone else, and all observers would expect such a tax to be passed on directly to policyholders in the form of higher premiums — or less generous benefits.
The excise tax is just one of many ways the government and employers are hoping to change employee behavior. The days of paying a $15 or $25 co-pay for a visit to a specialist are slowly being replaced by co-insurance, a throwback to old-fashioned indemnity plans in which patients pay 10%-20% of the actual cost of each doctor's visit, lab test, procedure or prescription. When it comes to employee health, companies are going to stress "personal responsibility," says Kent Lonsdale, an executive vice president with the consulting firm Gallagher Benefit Services Inc.
http://www.time.com/time/nation/article/0,8599,1932184,00.html?iid=tsmodule
"Companies are going to stress personal responsibility." Personal responsibility in this case means making a choice between paying money you may not have to see a doctor or not seeing a doctor at all.
When they say a "throwback to the old-fashioned indemnity plans," I'm "old-fashioned" enough to remember those days. That's the kind of insurance my parents had when I was little. That's why most kids in those days never saw a doctor unless they were dying. I had measles, mumps, and chicken pox and never saw a doctor for them. A tetanus shot? No kid ever got such a thing - and I grew up on a farm with dirt, animals and rusty barbed wire. When I was growing up going to the doctor evoked instant terror in children because it was an event that was so rare.
Parents couldn't afford it. They had insurance, yes, but there was no such thing as co-pays, HMO's, PPO's, etc. First, you ended up paying a percentage of the entire medical bill, second the paperwork you had to contend with was ungodly and, if nothing else, you avoided a trip to the doctor just to avoid the paperwork necessary to get reimbursed.
When I first started work (way back when) this is the kind of insurance I remember having. It was an expensive pain in the butt. Again, you didn't go to the doctor unless you absolutely had to. There was no such thing as preventive healthcare. No one was going to spend that kind of money on expensive tests and office visits if something wasn't wrong.
Returning to that form of medical insurance will undoubtedly cause disease statistics to rise. Women will begin avoiding mammograms and GYN checkups, people in general will avoid colonoscopies and all the other tests that have saved so many lives over the past several decades. Simply because of the cost. Imagine, if you will, paying 10, 20, 30% of a medical/hospital bill in the range of hundreds of thousands of dollars, which is the norm these days.
We'd all better hope and pray that some other form of healthcare insurance comes along because for 60 years now we've been prisoners of the current industry, and they have twisted and manipulated our health every time they feel their profits are down. Now they want to make us "personally responsible," as if, all this time, we've somehow been IRRESPONSIBLE by paying the premiums THEY have required.
Less for more. Welcome to the new America.


Blessings,
Gypsy
)O(
"What is life? It is the flash of a firefly in the night.
It is the breath of a buffalo in the wintertime.
It is the little shadow which runs across the grass
and loses itself in the sunset.
- Crowfoot, Blackfoot warrior and orator
Mika Dog
"All things share the same breath;
the beast, the tree, the man.
The Air shares its spirit with
all the life it supports."
--Chief Seattle
"If there are no dogs in Heaven,
then when I die I want to go where they went."
~Will Rogers
"The greatness of a nation and its moral progress
can be judged by the way its animals are treated."
~~Mahatma Gandhi
Blessings,
Gypsy
)O(
Yep, we had changes here, as well. Our insurance has been restructured so that we have to use a core group of physicians/facilities in order to not be penalized and charged more.
Blessings,
Gypsy
)O(
"What is life? It is the flash of a firefly in the night.
It is the breath of a buffalo in the wintertime.
It is the little shadow which runs across the grass
and loses itself in the sunset.
- Crowfoot, Blackfoot warrior and orator
Mika Dog
"All things share the same breath;
the beast, the tree, the man.
The Air shares its spirit with
all the life it supports."
--Chief Seattle
"If there are no dogs in Heaven,
then when I die I want to go where they went."
~Will Rogers
"The greatness of a nation and its moral progress
can be judged by the way its animals are treated."
~~Mahatma Gandhi
Blessings,
Gypsy
)O(