The
healthcare squeeze
We have all felt the squeeze at the pumps as gas prices
have escalated, but few of us have noticed the quiet squeeze of insurance
companies as premiums have continued upward and benefits have declined.
Recently, I opened my mail to read a notice concerning an umbrella policy that
I have always carried. This policy, although expensive, gave me peace of mind
through the years. But the notice informed me that a whole
litany of causes of action were no longer covered and in certain
conditions that they would no longer pay for attorney fees. In addition they
reserved the right to place the agreed amount of coverage with the court and
walk away — leaving me to defend myself! Boy! What an insurance plan? The same
is happening with other types of insurance, and it is time for us all to stand
up at the ballot box and tell these large companies that we will not take it
any longer.
Private health insurance companies are making the
argument, by their recent actions toward tiered drug co-pay, for a national
health insurance plan as well as stricter government regulation. If health
insurance does not cover you or your family during a serious illness — what use
is it?
Historically, private insurance is a social compact that
allows us to spread the risk of catastrophic loss for each individual out among
a large group of rate payers, and the larger the group the better this system
usually works. This is true of all types of insurance, be it public liability,
fire, or health insurance. But the social good of private insurance also
certainly has developed its down sides.
Without adequate insurance coverage, most professions and ordinary
people could not function because the individual or business could not cover
the potential loss from error or accident. But in the public health field the
confluence of the
deep pockets of insurance companies and their attempt to save costs and
increase profits has caused escalating personal
health costs for the seriously ill, and this, in turn, is starting to
destroy the social compact that allows us to spread the risk of catastrophic
loss — which is the main purpose for having insurance.
Until recently the
concern and the debate for national health insurance was for people and families lacking any
health insurance, but that concern and debate is shifting to those who have
health insurance and still may face catastrophic loss that will ruin them
financially. Gina Kolata, of the New York Times,
points out that virtually all insurance companies are shifting away from
traditional drug co-pay fixed amounts of $10, $20 and $30 to tiered pricing
that makes the sickest pay the most for medicine. Under this new system costs
can run as high $100,000
a year for medicine needed for serious illness. So if you thought
you and your family were home free with health insurance it is time to think
again. Tier 4 and Tier 5 plans can change your co-pay from $20 to $325,
especially for drugs with no generic equivalent. These drugs are used to treat
common diseases such as cancer, multiple sclerosis, arthritis, hepatitis C, and
hemophilia.
What has brought on this new system, in which the sickest
person pays the most, while the healthy person pays much less? This is an
erosion of the basic concept of insurance coverage and is an attempt by the
insurance companies to keep costs down and profits up. It is a quiet squeeze
because most of us do not look closely or understand the fine print in
insurance notices, and most insurance companies, under current lax regulations,
do not have to notify you of changes in coverage. Most folks get the first
notice of a Tier 4 or Tier 5 program at the drug store when they try to pick up
their drugs. Experts say most companies have changed to this system or will be
doing so. It may be time to call your health insurance
company and check, and while you are doing so you might mention how
angry you are about the changes or proposed changes.
The larger the pool of rate payers the better a
catastrophic health insurance program works, and the
largest group we could conceive of would be in a national health insurance
program. Private insurance companies have, by their actions, increased the need
for stricter state and federal regulation.
We are now the only modern nation that does not provide health insurance
for its citizens. It is time for America to join every other modern,
industrialized nation in the world and provide national health coverage for
each and every American.
Ken McCalip is an Orcutt native who holds bachelor and doctorate degrees in
history, cultural geography and law from various California universities. You
can send him email at foxmt.one@verizon.net