Saturday, January 17, 2015

Health Care Coverage Shouldn't Be Political


Sooner or later, we all need health insurance. OK, maybe the 1% doesn't... but everyone else. When I was a divisional president of TimeWarner, I got the most platinum-plated health insurance money could buy. They took good care of their top executives. When my lawyer told me what they were giving me insurance-wise-- without even having to negotiate-- I was stunned. Even after I retired, they took incredibly good care of my insurance needs. And then I became eligible for Medicare and I was on my own. Well, not really on my own. I was on Medicare. And, I mean this literally: Medicare is better than the platinum-plated presidential insurance from TimeWarner. Better-- not "as good" or almost as good... better. Except Medicare Part-D-- Republican Party health care, which is not patient-centric, but Big Business-centric-- which is worse.

Last week, I went to my local pharmacy to refill some prescriptions. The last time I had refilled one was December 8 and the cost was $3.89. Tuesday the exact same generic and the exact same quantity was $77.80. It was one of half a dozen prescriptions I had to refill and their prices had all shot through the roof. When I called Humana to ask what the mistake was, they told me that's how Medicare Part D works. Medicare Part D, the Bush plan that shows exactly what Republican health care is all about. I don't like paying them but I can afford those prices. What do people do who can't?

Really-- what do they do?. Thursday, in a NY Times column by Margot Sanger-Katz, there are apparently some signs of a decline in financial distress connected to medical bills, mostly attributable to the Affordable Care Act. (Sanger-Katz is going by statistics but what I'm hearing anecdotally isn't always the same. This week I spoke with a long-time state legislator who signed up for Obamacare and has to drive 60 miles for the closest doctor who will accept it-- something I hear from plenty of people.)
After rising for a decade, the number of Americans experiencing financial distress from their medical bills has started to decline, a new survey has found.

The result provides new evidence that the Affordable Care Act, by providing uninsured people with health insurance, is also improving their financial security, a major goal of the law.

The large telephone survey, from the New York-based health research group the Commonwealth Fund, has been asking people about their medical bills every few years for a decade. In each survey through 2012, a higher percentage of Americans said they struggled to pay their medical bills, were paying off medical debt or had been contacted by a collection agency. The most recent installment of the survey, the first since the health law’s major provisions kicked in, shows a reversal in that trend.

The survey also found that fewer people were avoiding doctors’ visits because of concerns about cost.

“Health insurance really provides people with a financial means to get care,” said Sara Collins, a vice president at Commonwealth, who worked on the study. “We don’t know yet that the law is improving people’s health, but this is a first indication that people are affording care that they weren’t able to get in the past.”

The cost of medical care remains a financial hardship for many Americans. According to the survey, the percentage of Americans who experienced trouble with a medical bill or medical debt in the last year declined from a high of 41 percent in 2012 to 35 percent in 2014.

But that still means more than a third of all Americans struggle to afford the cost of their medical care. The high rate of problems with medical debt was the subject of a recent study from the federal Consumer Financial Protection Bureau, which estimated that more than a fifth of Americans have medical debt on their credit reports. Medical debt has been found to be a leading cause of personal bankruptcies.

Financial distress was a clear target of the health law, which sought to make health care more accessible and more affordable.

The survey also found that about 43 percent of Americans had avoided some sort of medical care in 2012 because of concerns about the cost. That rate fell in 2014 to 36 percent.

The reductions in problems with medical bills and debt mostly reflect the increases in the number of Americans with insurance, Ms. Collins said. The addition of health insurance means that people who in the past had no help paying medical bills now have new financing for doctors’ visits, prescription drugs and hospital stays. (Paradoxically, people who lack insurance often face the highest prices for such services, meaning they have less financial assistance and pay more than insured customers.)

But Commonwealth also found that, over all, even people who had insurance before 2014 were having fewer problems with medical bills than they were before. That change may reflect rules in the health law that require individual insurance plans to cover a minimum set of benefits for every customer.

There is another trend cutting against those improving financial protections for individuals. Employers are increasingly asking their workers to pay deductibles and other fees when they seek health care, and several recent surveys have shown that the average size of those deductibles and fees is rising. A recent national poll from the New York Times and CBS News found that 33 percent of people said that their out-of-pocket costs had “gone up a lot.”

The Commonwealth survey suggests that, in the last two years, the benefits for some people have outweighed the difficulties for others.
I'll never forget the first time I met Howard Dean. I didn't know much about health insurance at the time and I hadn't thought about why it was so important in the context of American politics. Dean was just getting started with a presidential run and he came over for breakfast. He was happily surprised to get a healthy breakfast of fruits and berries and ground up flax seeds rather than bacon and eggs and pancakes which, he told me, was standard fare on the campaign trail. That's what I knew about health care-- that and my TimeWarner platinum-plated policy. But Dean patiently explained to me about why profit and health insurance shouldn't be connected. I never forgot it and have always done whatever I could to back him. We're still a very far way from that-- and I'm afraid we're unlikely to get there in my lifetime.

This morning, in light of Obama's new push for paid leave, the Washington Post talked about the disparities in paid leave policies: the rich get to heal; the poor get fired. "Time off," they remind us, "is often feasible for the relatively well-off-- but low-wage earners, who need each paycheck to stay financially afloat, just don’t have that option. About 43 million American workers have no paid sick leave."
Access depends on occupation, the Post’s Chris Ingraham noted: 88-percent of private sector managers and financial workers enjoy the benefit, more than double the rate among service workers (40-percent) and construction workers (38-percent).

So, they keep working, through pregnancies and family deaths and the flu, afraid of losing their jobs-- or simply eight hours of pay, said Ellen Bravo, executive director of the advocacy group Family Values at Work. Parental leave, she said, is regarded an out-of-reach luxury.

“Those who most need it-- but can least afford it-- are in the most difficult position to take it,” Bravo said. “For them, what should be a joyous occasion of having a baby-- or a process of recovering for a few days-- becomes this period of falling into poverty, debt, bankruptcy…”

Obama's proposal seeks to change that, starting with the public sector: Federal workers can now take an advance of up to six weeks of sick leave to care for a new child or ailing relative, the president announced Thursday. They can also annually earn up to seven paid sick days.

...Today, only three states provide paid family leave: California, New Jersey and Rhode Island all offer four to six weeks of the benefits, financed through Temporary Disability Insurance programs. A handful are pushing mandatory compensation for sick days.

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