Healthcare Matters

A week ago, I was going through my files to find a form I needed in order to fax a prescription over to an online pharmacy when I stumbled upon a stack of monthly health insurance bills starting in May 2001 when I first obtained an Individual HMO plan with Empire Blue Cross Blue Shield.  I became self-employed at about that time. 

Before I go further, it is important for me to state that I am a healthy individual.  I don’t smoke and I don’t drink, except for maybe a glass of wine about once a week.  I live a healthy lifestyle, I am physically active and I don’t consume sweetened beverages and I avoid foods that are loaded with sugar.  Apart from the seasonal allergies I get in Spring, I am hardly ever sick (my health records will attest to that) and the only times I have ever been hospitalized was once when I broke an arm back when I was a young 7 year old and a second time when I had my appendix taken out when I was still in my teens.  I probably see my Primary Care physician once a year when I have an annual physical check-up to be sure I’m doing OK and nothing is out of the ordinary.

That first month back in May 2001, my premium was $337.65 which worked out to be $4,051.80 per year.  I flipped over the stack of bills to August 2006 – the last month for which I remained on that plan - and the premium for that same coverage had gone up to $616.82 or an annualized $7,401.84, a whopping 183% of what I was paying back in May 2001.

Out of curiosity, I went online to get a quote for the same plan today and the premium has shot up to $1,549.30 a month or $18,591.60 annualized.  That works out to 251% of what I paid back in 2006 (less than 4 years ago) or 459% of what I paid back in 2001.

If the premiums keep increasing at that pace, the monthly premium for an Individual HMO plan would cost about $7,800 in another 10 years time when I will qualify Medicare.  I know I can’t afford that in-between period – I don’t think any self-employed or unemployed individual can.

As unemployment soared and as the duration of people staying unemployed increased with the latest recession, it has become abundantly clear that an employment-linked health insurance is not the solution.  COBRA has its limitations and is more costly for the individual as the former employer no longer picks up any part of the premium.

Even if one is fortunate enough to remain employed or is able to get a new job thanks to the job stimulus bill that was recently passed, rising health insurance premiums would force employers to shift more of the burden of healthcare plans over to their employees. 

The claim that “we have the best healthcare system in the world” is misleading – it confuses availability with affordability.

We need healthcare reform AND MORE. We need a “medical tort reform”, defining what is the standard of care that should be expected so that doctors are not over-prescribing tests and treatments that serve only to enrich the pharmaceutical companies and medical equipment companies.  We need a “prescription drug reform”, making medications more affordable – there should be no reason why Americans pay more for the same drugs than in other countries.  We need reforms that encourage healthy lifestyles and more physical activity for both the young and the old.

We need to continue the debate about what healthcare should or should not be but not let it hold us back from enacting what should be the first of all the necessary reforms.  As we gain experience from the present reforms, we need to refine those provisions that prove to be less than satisfactory.  Nothing will be perfect from the get-go and we need to be mature enough to keep working at it and make it better.

Reforming Government

It does not surprise me that so much of the negative sentiments over health care reform stems from a general sense of distrust in “Government”. The corruption we see reported in almost every State where elected officials abuse the position of trust and power GIVEN to them by their constituents feeds into that distrust and, over time, it has eroded our confidence that anything labeled as “Government” can be of any value or do any good. As the title of a Tyler Perry movie goes, “I can do bad all by myself” – we certainly don’t need to elect or pay anyone to abuse us.

Things have been so bad in New York that a New York Times editorial (Oct 18. 2009) titled “Fed Up with Albany” recommended voting out every incumbent member of the state’s legislature if nothing is done within one year to clean up the mess (click here to view the NYT editorial). Readers from outside of New York chimed in with their comments and left stinging remarks about the disgraceful and shameful behavior by their own state’s elected officials, voicing their agreement with the idea of voting out every incumbent simply because they are an incumbent.

Unfortunately, we often have an innate tendency to generalize issues and things and, in doing so, we destroy the good that is overshadowed by the bad. Identifying the real issues and dealing with them may be more time consuming but clearly more civilized and less damaging. In the Biblical story of Sodom and Gomorrah, even an angry God was prepared to spare the lives of the Lot and his family before he rained fire and brimstone upon those cities. We have a duty to separate the good from the bad; the wheat from the chaff.

In fairness to the New York Times, their editorial included a promise to outline the ways that the existing inbred system allows for abuse and what Albany could do to change its ways. I will watch for their recommendations with great interest – New York is the only home I’ve known since coming to the United States.

The purpose of my posting here is to go one step further because “Government” is not simply made up of elected officials sitting in the halls of power inside the Capitol buildings. It includes Public Services that are run by the Government, funded by tax-payers’ dollars. The people employed by these Public Services are often the only faces most of us will see in our dealings with the Government.

Whenever I have had to avail myself of the services they provide, I make it a point to smile and be friendly, hopeful that in doing so, I will make their day a little brighter and in exchange, what I need done will be achieved with some dignity and expediency. Happily, my tactic works better than 50% of the time so it isn’t a wasted effort.

Unfortunately I can also say from experience that often times the faces I see are dour and the attitudes appalling – almost as if by my being there with a need which only they could service, I have become an unwelcomed intruder in their plans for the day. I’ve had employees of public services disappear on me while I was standing at the service counter because it was their lunch time or a personal call came in on their cell-phone and they didn’t want me to listen in on their private conversation. I’ve watched in amazement as they would stop working on my case because colleagues nearby had started a conversation about something outside of work and they felt a need to be part of that conversation. I’ve had to fill in a tri-fold, 4-color pre-printed form simply because it was standard procedure – despite the fact that all information I had to provide is already in their computer system and unchanged – only to see the form tossed into a trash bin moments later. I could go on…

Public Service is where we clearly need reform as well if we want to improve on the image of Government. Standards of efficiency and quality of service must be set and independently audited to ensure compliance and there must be accountability where the standards are not met. Pay increases must be matched by better performance and increased efficiencies so that they are self-funded and no new taxes are required. Public Service employees must be treated as private sector employees are treated – lifetime employment should not be guaranteed and they should be subject to the same possibility of termination for poor performance and for cause. Outside expertise should be brought in to improve work-flow, eliminate unnecessary processes and costs while enabling greater automation and efficiency. Performance of Public Services employees can and should be bench-marked against performance of employees in the private sector and made public so that there is transparency and necessary actions be taken to weed out the inefficiencies.

There is no reason why public services cannot be just as efficient as the private sector. If virtual monopoly exists, find ways to break up that stranglehold. Private schools co-exist and compete with public schools and private parcel delivery companies co-exist and compete with the US Postal Service. Similarly, private transportation services compete with public transportation services.

If politicians, elected officials and public service employees are keen to keep their jobs, they need to do a better one. The nation is suffering from the cumulative and simultaneous effects of the bursting of the housing bubble, the near meltdown of financial services, and technologies and policies that have enabled the relocation of many of the so-called ‘middle-class’ jobs to lower cost countries. Policies of the past no longer serve the needs of the present or the future and changes must be made from the very top to the very bottom of “Government”. Failing that, we should start looking at outsourcing or off-shoring Government jobs.