I hope I never have to use my health insurance. That is a futile wish given the reality of the human body.
My family has used medical insurance only a handful of times over the years, but recently we required more care than usual. Getting help was disturbingly exasperating. Here are some of the things I learned during the experience.
Compared to national health care programs common in other developed countries, Americans pay significantly more. According to the OECD, in 2015 the U.S. spent almost $10,000 per person for health care, while costs for Canadians, Germans, French, and the British were about half that amount. Each of these other countries also provides health care to all of their people while our country leaves millions uninsured. Employers, who contribute to about two-thirds of non-elderly Americans medical insurance, have absorbed steadily rising costs, and those of us funding our own health insurance have felt the direct personal impact of the increases.
Our additional costs do not result in better medical outcomes. Life expectancy in America is lower than most other industrialized countries and our infant mortality rate is higher. Multiple chronic health problems like diabetes or arthritis plague one in four Americans, more than people in European countries.
Further exacerbating the problem is the complexity of the healthcare system. For example, in 2013 North Carolina’s Duke University hospital had 400 more billing clerks (1,300) than hospital beds (900).
To top it off, private insurers put up a fight when called on to pay their contracted share of the bills. I can share a recent personal example.
Bills for medical care provided over a three month period to a member of my family required more than 50 phone calls and took longer than seven months to resolve. Services preapproved by the insurance company were later denied when submitted for payment. After a laborious appeals process pursued by the medical providers and me, the insurance company reversed some of the denials and paid their share. I submitted several of the claims to the California Department of Managed Health Care, and was pleasantly surprised at their responsiveness and effectiveness. Their phone number is 1-888-466-2219. I highly recommend them to any patient struggling with their insurance company.
It became obvious to me that private insurance companies are in business to make a profit. Every time they pay on a claim, they make less money. There is no incentive for them to provide processes and customer service that are truly helpful. Complicated, time consuming and frustratingly discouraging billing practices cause many patients to give up, alleviating the insurance company from meeting their financial obligation.
The Medicare for All Act, introduced in Congress last month by a group of 17 Senators, proposes a universal healthcare system funded by the government that retains private health care providers and patient choice. Some of the highlights of bill are:
It is phased in over four years. Americans over 55 qualify. The qualifying age drops to 45 the second year and to 35 in year three. By the fourth year, everyone in the U.S. qualifies.
Out-of-pocket expenses including insurance premiums, co-pays, and deductibles are eliminated.
The current health care delivery system of doctors, therapists, nurses, hospitals – including Kaiser – remains in place.
Patients choose their own doctors, hospitals and other healthcare providers.
Prescription drug costs are trimmed by increased negotiating power from a larger group of patients.
Includes inpatient, outpatient, emergency care, preventive services, prescription drugs, mental health, substance abuse services, comprehensive maternity care, pediatric care, dental, audiology, and vision.
Eliminates the need for private health insurance companies and employer sponsored coverage.
Medicare, available in our country for over 50 years as a public alternative to private insurance, provides medical care to 55 million elderly or disabled Americans with a cost of about $3.2 trillion a year. Administrative costs are 2 percent, compared to 8 percent for private insurance and similar to the 2.5 percent in other countries like Britain. The cost to expand Medicare to everyone is estimated at $1.3 trillion, a 40 percent increase to Medicare costs today. It will be important for taxpayers to understand tax increases required to fund the Medicare For All Act so it can be compared to what we pay for insurance and medical costs today.
For example, my family’s private insurance premiums, co-pays, deductibles, dentist bills and eye doctor bills are $6,000-$12,000 a year depending on what medical events occur. Personally, I would be happy to pay more taxes – within limits – and eliminate the need for 50 phone calls and seven months to get fair billing established.
Please let your representatives and senators know how you feel.
Randi Swisley was born and raised in Auburn. She graduated from California State University at Chico with a degree in computer science. At Hewlett Packard, Randi worked for 20 years in engineering and management of research and development. She served for four years as president of the League of Women Voters of Placer County, as chairman of the WAC Municipal Advisory Council, on the executive committee of the Juvenile Justice Commission, the Auburn Technology Commission, the Auburn Oversight Committee, and is a happy member of the Sugar Plump Fairies promoting art and music in the area. In educating voters on public policy and ballot propositions, Swisley has appeared on state and local TV, on radio and in person.