This article was originally published in The Litchfield County Times on September 18, 2009.
I am a working American with employer-based health insurance, and I support the Democratic plans for health care reform.
Let me tell you a bit about my family. My husband is a cabinetmaker. I am a self-employed jack of all trades. We have a blended family of five children: one self supporting, two in college, one in eighth grade, one in first grade. As to income, we are - in the words of the country song - "above the below, and below the upper."
This year, our family will spend over $20,000 on health insurance and out-of-pocket medical expenses. It is by far our single largest expense, bigger than housing, gas, food, or education. This is how it breaks down:
1. Our monthly health insurance premium is $1,007 (that's $12,085 per year). My husband works for a small business and we pay 100 percent of the premium through a payroll deduction. This is what we pay for family coverage (two adults, three covered children). Our annual deductible for in-network coverage is $5,000. The deductible for out-of-network coverage is $8000. Since the two teenagers attend out of state colleges, we inevitably have some out-of-network expenses.
2. So far this year, we have paid $2,855 in physician bills, $2,753 to dentists, $889 to hospitals, $797 for optometrists and eyeglasses, and $662 for prescriptions. That adds up to $7,956 in out-of-pocket medical expenses, on top of our health insurance premiums. We have been able to run $5,950 of that through our health savings account, which gives us a tax benefit. We have two dental crowns ahead of us this fall, yet to be done or paid for (and no, we do not have dental insurance).
At this moment in our lives, given that we have health insurance in force, our biggest health care concern is cost. However, we have no ability to shop around. My husband and two of our covered children have asthma. I have an expensive OB/GYN history. We flunk medical underwriting. Absent a qualifying event, like my husband losing his job, our health insurance options are limited to the choice between our existing carrier's high deductible plan and the same company's HMO.
What it comes down to is this: we are price takers. Given our pre-existing conditions, our knowledge of how health catastrophes can strike, and how much we still have left to lose, we will pay what we have to pay to maintain coverage in force.
Our second concern is access to health insurance. We are acutely aware that there are any number of situations that could result in our losing access to health insurance at any price, and then what will we do? There is no happy answer to that question. Without insurance, our monthly bill for asthma prescriptions would be $648. That money - the cost of breathing - will not in itself break us. It will take some sort of crisis. We have had enough life experience to know that a crisis will come. Without health insurance, the question is not whether we will go bankrupt, but when we will go bankrupt.
Third, we are concerned about the inequity, inefficiency, and immorality of our existing health care system. These are issues that should concern us all.
Last week, I got an Explanation of Benefits for laboratory work done at Waterbury Hospital. The amount billed was $1,295. All of it was covered by insurance. The amount allowed (the insurance company's negotiated rate) was $188. Since we have met our deductible for the year, our responsibility was $0. Did this make me happy? It did not. Yes, I was very glad to be covered. I know that if we did not have insurance, we would be liable for $1,295, since we make too much money to qualify for any sort of hospital aid program. That is wrong, wrong, wrong. The amount of time and money that is spent administering a system where every customer is charged a different prices-and the poorest customers are charged the highest prices-does not in any way contribute to our country's health; it just adds to our country's costs. I challenge all you hospitals, and drug companies, and doctors - Why don't you take matters into your own hands and establish a self-pay rate, equal to the Medicare rate, for people who have no health insurance?
Our health care system is not just broken. It is radically broken and it needs big fixes, not tinkering at the edge. I favor the Democratic proposals because:
1. They end discrimination against people with pre-existing conditions, putting all health insurance companies on a level playing field. They forbid insurance companies from dropping people because they become sick; people across the political spectrum agree that practice is wrong.
2. They expand the marketplace of insurance options for small businesses and people without insurance. The public option-which I personally think of as a de facto expansion of Medicare-will provide a workable, competitive option in the many markets that currently have no effective competition. I will trust a federal option before a trust a newly-formed health care cooperative program.
3. They push health care providers to begin serious work on the many factors that add to the costs of health care without adding to its quality.
The Democratic proposals are not perfect-among other things, the different legislative proposals are just too long and too complicated-but they address the major issues. They are bold proposals to address a big problems that affects not just the uninsured, but also the working insured. The Republicans had eight years to address these problems; in their tenure, the number of uninsured and under-insured Americans just grew. I applaud President Obama and Congress for getting as far as they have as quickly as they have.