Pre-Exempt This!

Posted: November 29, 2008 by April Watkins in Current Events, Current Issues, Health Insurance, Issues, Politics
Tags: , , , ,

Health insurance…the bane of my existence! The concept of our health insurance /health care system is, at best, like a journey through Alice’s wonderland, where nothing is what is seems and the answers are found in riddles.

*image courtesy of ABCNews

*image courtesy of ABCNews

Whether you lean right or left, are Democrat, Republican or Independent, the disarray of our health insurance system effects us all.  Both sides of the political aisle have proffered solutions; some okay, some too liberal and costly, some too cost-conscious and skimpy.  But no one, no leader,  no…true Statesman has taken the initiative to look at this problem in its entirety – from a federal and state view, from the view of the businesses and hospitals, from the view of the employees, and from the view of the American people.  Instead, it has been addressed one view at a time; one symptom-by-symptom where nothing has emerged to cure the giant albatross.  It is apparent to me, as I am certain it is to you, that the politics of this issue have created a stalemate that hurts, not the politicians that continue to belabor their tired ideas, but the common American who is struggling to keep his/her family fed, clothed, housed and healthy.

With the economic turmoil and massive layoffs we are experiencing, employer-based health insurance is quickly becoming a dinosaur.  Most working Americans receive health care benefits and insurance through their respective employers.  The employer contribution percentage, affordability of coverage for dependents, and quality of health care service vary from employer to employer.  Therefore, it is truly impossible to know what you really get until you are actually hired, use the insurance, and find out that it doesn’t cover the things your family needs.  At that point, you are either stuck with it and pay for the non-covered aspects out-of-pocket, look for a separate individual family policy, or do without.

The problem with our health insurance system is multifaceted.  America does not have a cost-effective, workable alternative to employer-based health insurance.  The cost of private policies is beyond the reach of the poorer and middle classes.  Additionally, the pre-exemptions and out-of-pocket costs are added financial burdens that simply cannot be absorbed by the family budget.  If you have no job or have been without work for more than 120-180 days, the cost of most insurance policies is initially higher per individual.  The idea of an alternative health coverage system, similar to that of Congress, as an option for those of us who fall between the cracks of employer-based coverage and public assistance coverage seems to be a good idea at face value…if it is kept intact and not altered to be a massive HMO.

cycle-of-colorBecause the health and health insurance industries have not had an insightful and resourceful Federal overseer, the problem has become a vicious cycle.  Our hospitals are struggling to keep their doors open, cutting budgets to the very basics – which is not good for patients or employees who are overworked and overtired.  To help offset the soaring cost of operations for hospitals (big and small); hospitals are forced to charge more for services and drugs.   The drug companies seem to use the U.S. as their source of income production, while providing low-cost or free drugs to other countries around the world.  Congress should set a ceiling on drug prices to halt this practice.  However, having said that, drug companies are in business to make money, and they need to be compensated equitably in order to continue research and development on new drugs and therapies.   So, any cap on drug pricing needs to be a careful study of both sides of this issue.

My final comment on the health insurance/ health industry deals with the the personal experience of a dear friend.  After the terrifying diagnosis of breast cancer, trying to keep her household running smoothly, and pretending to be the same ole mom, stress was the worst thing that my friend needed.  Instead of an intelligent and comforting conversation with her physician, instead, she and her doctor find themselves arguing with the HMO as to what it deems “routine and necessary” vs. what it considered “non compulsory tests.”  [aka – they’re not going to pay.]  To me this is an OUTRAGE that any garden-variety clerk has the authority, moreover the audacity, to dictate to Ph.D. on treatment of a fatal disease.  How many of you have had or has known of someone who has had a similar situation happen?  Who in Congress would put up with this if it were their mother, wife, sister, or daughter?  In essence it boils down to this…ahem…an HMO clerk can mandate to me and my physician whether or not I can be treated for a fatal disease with the latest and most effective, cutting-edge technology; additionally, (who would never sell 25 boxes of allergy meds to one person), can be trusted without a Federal Law of limited purchase.  Instead, we must waste our time and gasoline to travel several times to the store to purchase ONE box of Zyrtec (that’s 15 pills – not enough for a full month) for my allergies. 

[Yes, yes…I understand and support the need for control of illegal drug manufacturing – so please, don’t send your diatribes on how drugs affected your family – it effects us all, but the silliness of the lengths to which some will go to prove a point…well, leaves me speechless.] 

Any way you look at this problem it is a doozy.  None of the people it touches will be pleased with a new plan or new mandate.   However, change in any industry is inevitable, and health insurance/health care, like the automotive industry, has reached the point of no return and must adapt to the needs of the American public – especially in this time of economic pandemonium.  And that is…Why It Matters.

May the Lord bless you and keep you
in this Thanksgiving season.

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