So I'm going to take a break from my regularly scheduled football blog to bring you this political announcement, what glitters isn't always gold. Okay, I stole the line from "All the Gold In California". However, both the Republican and Democrat candidate have each laid out their plans for healthcare that's suppose to make us, the voters salivate at the thought of what we could have should we elect one or the other. The problem is, they both fall seriously short of addressing the cause. Okay, neither one of them are universal healthcare or even corporate sponsored healthcare, so let's not go with that argument.
What are my credentials in being able to determine this? Well, one, I don't support either candidate, so I can write this a little objectively. Another, for the majority of my career, after leaving the Air Force, I've been working with health care insurance in one way of the other for most of my after service career.
When I left the service and after I had my daughter (hard to get a full-time job when you're pregnant), I ended up as a medical claims examiner for five different HMO's in California. Our office had the contract to administer the claims for health maintenance organizations, which was just emerging at the time. While we dealt with the physicians and paying them, we also dealt with the patients whose claims we denied. The HMO's themselves were the ones who dealt with the companies and corporations and the various plans offered. As claims examiners, we had to be aware of each plan and the coverage under each plan.
When I returned to PA, I eventually got a position as an assistant to the director for a state grant funded center. Although we were covered under the state employees health plan, each month I had to submit our monthly premium requisition to the person overseeing our finances and funding. Next to our monthly rent, the centers cost of the health care premiums were the highest portion of our monthly costs.
I went back to college and took every computer programming/it class available and did the same with business classes and human resource classes. Once I got out, I got a job with a, you got it, an HMO...a medicaid HMO specifically. Boy do I miss the profit sharing checks. When I moved south, I ended up on the other side, medical billing software, my expertise in claims examining and insurance payment programming was one of the reasons I was hired. So I'd say I have about 14 years dealing with medical insurance in some fashion or another. So there's my qualifications, take them for what you will.
Let's discuss the health care plans.
John McCain has several steps in his program. He wants you to have the ability to go across state lines and be able to purchase health insurance on your own. He'll give you a 5,000.00 tax break if you do this. Of course, if you don't do this and have the gold plated cadillac plan paid for by your employer, then you'll be taxed. Sounds logical on paper. Competitive pricing brings down costs of premiums. If you're getting more then the "normal" tax payer, then you should pay taxes on the unneeded or optional benefits. Government would not be involved in the administration of the policies or premiums.
Barrack Obama would allow you to keep your current employer paid health insurance if you wish, or you could purchase into the same health insurance pool that the federal employees and members of congress gets (my guess, Federal Blue Cross/Blue Shield). Employers (can't determine if it's rich employers or large companies like Hewlitt Packard) would be fined for not providing some sort of health insurance for their companies (I'm guessing large companies since they're premiums would be smaller then small, rich companies due to the payer pool). Of course, children would be required to be covered under some type of insurance. Sounds good on paper too. Those who don't have health insurance can buy into plans in a large insureds pool at a much lower cost, then if they were to attempt to get it on their own. Large companies for the most part, already offer some sort of insurance benefits and have access to the reduced premiums per person due to insurance pools, so they're not actually at a risk of being fined.
Yep, both on the face look like viable plans that begin to address the problems, however, they fall very short and really don't address the rising health care costs.
Niether plan really will lessen the effect of rising health care insurance. Niether plan addresses the working poor and middle class who don't actually have the extra money to buy into it. Under McCain's plan, you have to have the out of pocket money first to buy into the health insurance before you get the $5,000.00 tax deduction. Under Obama's plan, it will be mandatory to insure your children, what happens if you're making just enough to cover your monthly expenses? Where does the extra money come from. Niether guarantees an increase in salary for compensation of the shift or loss of benefits under your employer.
If you've ever been on COBRA, you kind of get the idea of exactly the cost of your health insurance premiums between what you put in and what your company puts in. COBRA is a program that affords employees the ability to continue their health insurance should they leave their employer. For one year, you're able to buy into your companies plan for full cost of the premium. My mother was on COBRA when she switched jobs, until her new employers benefits kicked in. Her monthly payment for just herself was $365.00 a month. The place she worked for had been part of a larger insureds pool. It could be more for someone working with a small company.
So what's wrong with John McCain's plan? Quite a bit actually. First off, the McCain campaign has already stated that the goal is to have all persons on private insurance so that businesses wouldn't have to carry it. However, in the field of health insurance, competitive pricing doesn't work the way he thinks it will. Look at the major insurance carriers, AETNA, CIGNA, US Healthcare, the Blues. Their national but their pricings are based on the area of service. In other words, a state that has a lower cost of living rate, is going to have lower premiums and lowered adjusted fee schedules for their physicians. So what's the logical thing for a company whose sole purpose is to make a profit (and make no mistake, that's the insurance companies sole objective), raise prices to match the highest cost of living. What about these smaller companies. Well, there are thousands of health insurance companies out there, aren't there? Well, about 1/4 of them are pre-pricers for larger insurance companies, like AETNA, CIGNA, etc. Others are just another plan under the same insurance companies.
So, what's to stop them from eliminating them to give you fewer options? So the idea of competitive pricing may just turn around and bite us in the butt.
Okay, so they don't raise prices and they don't eliminate their smaller branches. Now you have the question of state regulation. The insurance companies set up offices in individual states because there are state regulations that govern how they operate, what they have to include. Obama is at least correct when he talks about that. Okay, so they are willing to conform the plan to the different state insurance laws, alot of insurances require you to see an in network provider to get the full benefit of the plans with lower out of pocket fees and copayments. First off, physicans are not required to accept insurance. In fact, alot of physicians will accept the major insurance carriers but the smaller ones, they'll ask you to pay up front and then you file the claim to your insurance company for reimbursement. What's the chances of your physician agreeing to accept the in-network rates of an insurance in Arkansas, if you live in NYC? My husband and I ran into the issue of fee schedule differences when it came to workers compensation.
As far as taxes go, McCain says those that are only going to be taxed are the ones with the cadillac plans. The one that offers cosmetic surgery and transplants. There's a term that insurance companies use to get away with not paying claims "not a medical necessity". If there's a plan out there that offers cosmetic surgery as an elective surgery, congress must be the only one that has it, and I suggest that we re-evaluate exactly what benefits our elected officials are receiving. My insurance plan allows for breast reconstruction surgery, but I have to have had a masectomy done to get it. I can have breast augmentation surgery to reduce the size of my breasts, but I have to have medical proof that the size of my breasts are effecting my health or keeping me in constant pain. Same with plastic surgery, I can have it, if I've been burned or disfigured due to an automobile accident. I dare anyone to go to their insurance company and ask them if they'll pay for a nose job. However, because I have these options in my insurance, I'll be taxed on this, or even be left without it, since the idea is get everyone on private insurance.
As far as Obama's plan. Well for the most part, it actually is a better plan since it does allow for large insureds pool that will drop individual premiums. It doesn't require you or your employer to drop your insurance. It doesn't even require your employer to pay full cost of your insurance. It does however set up a need for the government to administer these pools, or at least contract out someone to administer it for the government. It also leads to questions as to whether premiums would be supplemented with taxes or would it be like the COBRA program where the insured pays the full cost of the premiums. Will this enlarge the office of health and human services or will this create another government office. This is the biggest drawback of his plan. With the larger pools, who would the insured contact as their benefits administrator for issues between them and the insurance companies.
Though both plans offer alternative options, neither would stop the rising cost of health insurance and health care prices. One plan may hurt the individual insured more while the other would put more of the burden on the taxpayer. Like I said, they both fall short.