Thursday, September 23, 2010


a less impressive truth

On September 23, 2010, the first provisions of the new health care legislation go into effect. Or do they???

The provisions are:
(1) Dependent children must be eligible for coverage under a parent's insurance until age 26.
(2) Coverage for an illness can no longer be denied if it is related to a "preexisting condition".
(3) Coverage cannot be denied by insurers if they find, after the fact, errors on an insurance application.
(4) Preventative care must be paid for without charge or deductible.
(5) Coverage decisions can be appealed either through the insurer or through and independent source.
(6) Insurance costs will be regulated.
(7) Insurers can no longer impose annual or lifetime limits on payments.

These are important and reasonable. They actually seem straight forward, but in no way revolutionary. They are adequately called reform, in that they are ethical and appropriate.

But they are very misleading and far from equitable in their application.

(1) The dependent children must not be eligible under any other coverage. The parent's coverage must be through an employer with at least fifty employees. The coverage cannot start until the next enrollment period, probably in three months.
(2) The preexisting condition coverage only applies to newly issued insurance. Insurance already in effect is exempt. This improvement only applies to children. For adults, all insurance can exclude preexisting conditions until 2018, eight years hence.
(3) Insurance currently in effect is exempted from the after-the-fact exclusion proviso
(4) Preventative care is mandated only for newly issued insurance: insurance already in effect is excluded
(5) For insurance already in effect, only the insurer is the arbiter of appeals
(6) There is no regulation for the cost of insurance already in effect.
(7) The lifetime and annual limit elimination only applies to NEW insurance. Insurance currently in effect is still allowed to limit the payments. Even for NEW insurance, the annual limits will continue to be restricted for the next four years, as the limits are raised, only to be eliminated in 2014. Furthermore, the limits will have limits on what procedures and diagnoses will be allowed… and those are not specified.

In effect, if you are already insured, you are screwed.

It is not very impressive if the truth is told.


I disagree that the provisions "are important and reasonable". In fact, they are important but completely untenable and ultimately unsustainable.

First, it undermines the possibility that any health insurer can remain in business and will drive everyone to the single payer (i.e. government) system.

Second, this works in opposition to Americans assuming more personal responsibility for their health care. The problems to be solved by these provisions, while important, should be prioritized for each individual by every individual.

Several questions come to mind:

1. Why are these provisions even necessary? The practices they intend to 'fix' are there for a practical reasons. To think that we can just will them away is wishful thinking. Has anyone considered why these practices exist and the consequences of eliminating them?

2. Why, after thousands of years of human existence, do we assume that we can be spared the responsibility of making life and death decisions for our families?

2a. A tragic case study: A family member is dying of a terminal disease, how much money can a) the family, b) the insurance company c) the medical community d) the state e) the US government spend to extend their life? a) $100 a day? b) $1000 a day ? c) $10000 a day?

In essence, rather than a patient/family needing to make the decision as to whether they can afford to pay for treatment, the rest of society is charged with making the decision.

3. It is often postulated that a person fighting for the life of a loved one should not be faced with bankruptcy. Who, then, should go bankrupt?

4. For years I've heard that a an elderly person on a fixed income should not have to choose between paying for medication or paying for food. Why? Who should choose? Why shouldn't supermarket just provide food rather than the drug companies providing the life-saving drugs? In fact, drug companies do have such programs. I am not aware that supermarkets are doing their part.

I believe if we look around the world, the countries that attempted to address these problems are going bankrupt.

These provisions will perpetuate the notion in Americans' minds that someone else is responsible for paying for their health care, and if someone else is paying for my health care, then I need it.

Medical advancements over the last 50-60 years have been mind boggling. It has raised Americans expectations for what is possible. But their expectations for the cost has not kept pace. Decades ago, American corporations pad the full cost of health insurance, laying the foundation for our current expectations.

50 years ago:
I have a heart attack, take an ambulance to the hospital, I am pronounced dead in the emergency room. Total cost: $300?

I have a heart attack, take an ambulance to the hospital, get resuscitated in the ambulance, get to the emergency room, get scheduled for triple bypass surgery, get put on perpetual heart medications, 10 year later, diagnosed with colon cancer, surgery, chemo,... you get the idea:
Total cost: $500,000?

I have no idea of the actual numbers, but I'm sure there is several orders of magnitude.

To think that legislators are smart enough to solve this problem without creating 100 other, perhaps worse problems, is a pipe dream. I wish for a politician with enough wisdom to know when they cannot fix a problem and do nothing. A pipe dream of my own.

I have no 'solutions' myself. Perhaps, some things about the human condition are just not fixable.
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