On health care the US is no longer a moral outlier

Last edited Sun Oct 13, 2013, 03:46 PM - Edit history (1)

I was asked to give a presentation as part of a panel discussion on the PPACA. Pretty much old hat for people at DU. What I find interesting is the extreme curiosity that people have about it. There were several stories that were similar to mine and a number of people in the audience were having verification problems, which I hope visiting the local signup locations will help. People who want to find a local physical location to sign up can go here:

https://localhelp.healthcare.gov/



Anyway here are my notes, again nothing really new for DUers who are the best informed people you will meet:



Before getting in the details of what I have found in applying for the Patient Protection and Affordable Care Act I would like to spend a moment on the larger issue of what happened on October1st, 2013. It is something I have been talking with people in different countries about for the last 34 years.

Exactly 34 years ago today I was on a remote border island in Indonesia and after work my colleagues and I were talking about American health insurance. I was Chief of Operations of refugee resettlement for ICEM the agency that would resettle more than a million people from South East Asia.

It was as close to MASH as you could imagine including a rather unconventional corp of bored and zany doctors. We worked 14 hours a day on Tanjung Penang Island trying to accelerate the out processing of 100,000 boat people. Then we would go over to the tables in the town square eat noodles, drink beer and amuse ourselves. With no radio or TV we were left to our own devices.

In the group there were doctors from Australia, Canada, Switzerland and the Nordic countries. One of the games we played was when there would be an American staffer or official visiting I would set up the evening by asking “How is Congress doing on reforming health care”. The ‘Mark’ would make some comment that would always end with “ well we have the best health care system in the world”.

The rest of the night would be spent watching these doctors refute every myth about socialized medicine and socialized health insurance and dissect the unwitting American before your eyes. Now these doctors were from all different political backgrounds and most of them quite conservative but they all liked their system. They were smart and would slowly and skillfully disembowel the hapless traveler.

The Coup de Grace would come when one of the doctors would say “Bob lets put all of the myths and misinformation aside and please answer this one question, ‘ Bob how can any wealthy developed country advance the proposition that only those with money should be able to access health care from a moral perspective. How do you justify it morally Bob?.” Que the Australian doctor “Right get your hand off it Bob, don’t be a bongo you are a few Kangaroos loose in the top paddock”.

The most important thing that happened on October 1st, 2013 is that the US crossed a moral line and joined all of the other developed countries saying that everyone in the US deserved affordable access to health care.

That is the headline and it is a big deal.

Up until 14 years ago I was able to use the best plans in the market. I made a transition and now was self employed and because of an obscure ear condition that had no treatment costs was still considered uninsurable, defying all logic.

When President Obama introduced the PPACA I was disappointed because I was hoping that I would be getting a single payer universal plan like the ones my colleagues talked about 34 years ago. The more I read, including things like a ceiling on the medical loss ratio and evolving away from ‘fee for services’ the more I liked it.

I was uplifted last year when nearly 13 million Americans received more than a billion dollars in refunds because their insurance companies were found to have exceeded the 20% Medical Loss Ratio. I was amused that Texas was the largest recipient of refunds and wondered if those Texas politicians who rail against Obamacare want their citizens to return those overpayments back to the insurance companies.

When Oct 1st came I felt that it was finally my turn and I got on the healthcare.gov website.

My wife and I simply wanted some basic coverage that would save us from a catastrophic event. I simply wanted to end the day thinking “if my wife or I get cancer or have a heart attack please give us a chance to fight and not live the rest of our life in staggering debt.”

In 1999 we faced one of those moments when my wife had stomach aches and we went into the doctor who said “you will need to stay the night and tomorrow you are going to have a hysterectomy. You have multiple large ovarian cysts and we are worried that if any of them become transient they will cause a cardiac event”.

We were glad that we had been paying for the most expensive medical plans in the market and we asked the doctor what would happen while we waited for the paperwork to be finished. A clerk came in and said that we were denied. My wife and I were now shocked and the Doctor said “I will handle it”.

He had the clerk return the call to the insurance adjuster. He started in a small voice “I am curious what medical school you went to. Oh? Because I went to Harvard and did post graduate work at John Hopkins and sit on the National Board for Board Certified Gynecologists and I found your reasoning completely devoid of any medical reasoning whatsoever. (now in a booming voice) “what city do you live in, because I am going to discharge this woman now and if a cyst breaks off and she has a heart attack I am going to fly to that city and make a deposition with the prosecuting attorney charging you with manslaughter. Oh its approved, thank you”.

He told me he had to threaten Manslaughter about 3 times a month to get something approved.

Now we just wanted to make sure that if we had one of those events we wouldn’t spend the rest of our lives in debt.

To make matters worse two years ago I picked up a new hobby: diabetes, not as much fun as advertised.

It took me two days to finally get my account opened. In the beginning the site was down a lot or not working properly. It took me 45 minutes to get somebody to answer my call or respond to the live chat function.

But late at night on the third day I got through. The pages are well constructed and don’t require much information. When I got through to the third page we had a problem with my wife’s verification. We know why, they have added an additional letter to her name on her green card so it didn’t surprise us.

We couldn’t call through to Experian as it was past office hours.

The next day we got in and the verification issue had been resolved.

They asked if we wanted to go directly to the Market Place or see if we qualified for a subsidy. I never have qualified for any government benefit and wasn’t going to waste my time but I decided ‘what the hell’ and pushed the button.

They had warned me that I may need to provide them with all kinds of W2s, 1099s and tax figures. When I pushed the button, none of that happened.

It instantly came back with a $ 3600 subsidy. Last year was a little unusual for me, I spent part of the year moving to Tucson so I had lower than average income and a lot of write offs.

But I was stunned. Even though I had read everything I could about the Act including the Senate bill I had no idea that we would qualify with an adjust gross income of about $ 40,000.

That took us to a page that showed us the range for the Bronze, Silver, Gold and Platinum plans. We had expected to just get the cheapest Bronze plan.

Instead we went for a Gold plan that has the following:

1) Free preventative
2) Low copays, Dr. visit $ 17.
3) Covers 80% of all costs
4) Maximum out of pocket $ 10,000
5) No deductible.

Hundreds of doctors are on the plan. The cost is $ 750 but after the subsidy we only pay $ 444.

For a couple approaching 60 with diabetes in the family this was stunning.

There have been a lot of distractions because of the mechanics and legitimate stories about the gliches. I also understand that others may not get the benefit I did or may need even more assistance. Here is what I see as being lost in the media:

1) The US is no longer the moral outlier among developed countries when it comes to our health insurance system. It is the policy of the government that everyone have access to affordable health care.

2) For the first time people can apply for a government benefit or subsidy and (when the system is working) get an instant statement of what that benefit is. You don’t wait for someone to process your application and get back to you in 3 months, an instant answer comes back in seconds.

3) The structure and nature of the subsidies are much larger than anything I have seen in the media.

I know that a lot of people are frustrated and concerned and I simply would like to encourage you to stick with it, use the call center and the live talk option and all the resources to get the maximum benefit.