Even the Insured Feel Strain of Health Costs

[Hissyspit]

Source: New York Times

Even the Insured Feel the Strain of Health Costs

By REED ABELSON and MILT FREUDENHEIM
Published: May 4, 2008
The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments. With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline. "It just keeps eating into people’s income,” said James Corbin, a former union official who works for the local utility in Tucson.

Mr. Corbin said that under their employer’s health plan, he and his co-workers are now obliged to pay up to $4,000 of their families’ annual medical bills, on top of about $1,600 a year in premiums. Five years ago, they paid no premiums and were responsible for only about $2,000 of their families’ medical bills. “That’s a big jump,” Mr. Corbin said. “You’ve just lost a month’s pay.”

Already, many doctors say, the soft economy is making some insured people hesitant to get care they need, reluctant to spend a $50 co-payment for an office visit. Parents “are waiting longer to bring in their children,” said Dr. Richard Lander, a pediatrician in Livingston, N.J. “They say, ‘The kid isn’t that sick; her temperature is only 102.’ ” The problem of affording health care is most acute for people with no insurance, a group expected to soon exceed 48 million, but those with insurance say they too are feeling the pain.

MORE

Read more: http://www.nytimes.com/2008/05/04/business/04insure.html

[lligrd]

1. Not Just The Cost But The Time And Effort Involved

We rarely go to our HMO because it is so hard to get an appointment and even when you do, you wait hours.

[pattmarty]

9. This is the thing that pisses me off about .............

.....the ass holes that slam single payer care. They say you have to wait to see a doctor in Canada, Britain, etc, but you have to wait here too and always had to.

[KillCapitalism]

21. Yeah that is crazy when people say that.

I'd rather wait a while than go bankrupt.

[truedelphi]

29. That is this household's experience as well

And if a treatment is needed, then Kaiser talks you out of it. Unless it really is a life and death type of thing.

[roguevalley]

35. I'm insured and now that my benefit is reached, the bridge I might

not get is out of pocket. I have to chose a month when I can pay my retirement straight to the dentist and eat mush for a month.

[Bluzmann57]

2. Yep. Premiums are rising faster than wages

For instance, I work at a place which offers insurance, not bad insurance except for the dental plan, and I pay $30.28/wk and that's for the singles plan. The family guys are paying around $75.00/wk. There is also a deductible which needs to be paid before the coverage pays $250.00 for singles and $500.00 for family. And it's approximately an 80/20 split, depending on what our people have done. I can't recall the exact numbers right now, but I read the other day where the cost of health coverage has risen around four or five times greater than wages have in the past 7 or 8 years. Health care is an issue which seems to have fallen by the wayside somewhat because of the failed economy and the war, but it is an issue which needs a lot of attention from our candidates.

[postulater]

28. Around here we would call your plan the Cadillac plan

You are lucky to have such good coverage for only $30 per week.

[RayOfHope]

37. That is dirt cheap. My employer is $560/mo family plan $1000 deductible

and the plan is with a a catholic hospital that won't do tubal ligations or vasectomies.

[4waterfalls]

3. People NEED to learn the truth

http://www.bestsyndication.com/?q=120407_universal_health_care_insurance_single_payer_differences_what_are_comparison.htm

if Americans only would realize the absurdity of private insurance companies...and the audacity of forcing us to purchase their plans,when there is a better way.A less costly,more efficient way.A way many countries have proven works,but we as the supposed greatest nation on Earth fail to adopt.Why? Because of pure unadulterated corporate greed.

[boobooday]

4. And if you have a chronic illness

The copays can add up to hundreds of dollars per month.

[OhioChick]

27. I Fall Into the "Under-Insured" Category....

My kid has a chronic illness and this year alone....I paid out over 10K.....and that's "with" insurance. It's killing me financially.

[boobooday]

36. Oh my God

And if you listen to the GOP they will tell you that you just need to shop around, maybe get a second job, etc.

[OhioChick]

39. Sad thing is....

I'm "already" doing side work.

[pattmarty]

41. How about a 3rd job????

[colinmom71]

44. Have you looked into the possibility of a Medicaid waiver....

for your child's medical needs? Some states have different names for their waiver program - Katie Beckett Waiver, Deeming Waiver, Medically Needy waiver, etc. These are waiver programs that relax the financial thresholds to qualify for Medicaid if a child's medical needs are so involved that they would likely require in-patient care (hospitalization, nursing home, etc.) if the parent were not able to care for their needs on an out-patient basis. There are also some financial guidelines under SSDI (Supplemental Security Disability Insurance, which comes with automatic Medicaid enrollment) that may be relaxed if your child's medical expenses exceed a certain percentage of your household income.

I'd suggest contacting your regional Children's Medical Services office to inquire about the best way for you to apply for a medical Waiver program or, if necessary, SSDI.

My son is severely developmentally disabled and he was transferred to our state's Deeming Waiver program once a significant raise in our household income made him no longer eligible for SSDI. He has Medicaid coverage as secondary to our private family health insurance coverage through my DH's job. Medicaid basically covers all of my son's medical expenses that insurance does not, like co-pays, deductibles, and prescription co-pays.

[OhioChick]

46. Thanks....Will check into.

The last time I looked into something similar a few years ago, they said that I'd pretty much have to be living under a bridge to qualify for a dime.

[eilen]

5. We have personal experience with this

and my dh is a union electrician. This is nuts, I'm getting bills and insurance statements that require me to pay in excess of our copays, they cover less in regard to our prescription plan and medical tests are not being covered. For example, my dh had what our family doctor called asthma. However, the doctor was not managing it well at all so we went to a specialist--a pulmonolgist. The specialist did a number of tests and then told us he did not have "asthma" but had experienced asthmatic bronchitis. He is no longer ill but we still can't figure out why he has shortness of breath at certain times. We had to pay over $500 for the testing and extra pay for the doctor (even though they claimed to be "a preferred provider")-- the ins. co. just didn't cover some things. I/r/t his shortness of breath, we believe it is environmental related to his employment.

I guess we might be considered lower middle class now making under $50,000 a year. I am not in a paying job right now but may end up finding something--that will definitely affect the quality of our lives. I am not looking forward to the stress race.

[Lorien]

10. I was insured when I racked up over 30k in medical debt

I'm self employed, so I can't afford the best insurance and have a $5000 deductible. About eight years ago I required two trips to the ER and one minor-but probably life saving-surgery. My insurer-NASE (the National Association for the self employed. Google them along with PBS and NOW and you'll read some real horror stories) initially approved everything, but when the bills came they refused to pay a dime of it. This isn't unusual behavior for insurance companies anymore. Other than raking in vast amounts of cash for their stockholders, it's really hard to see what purpose any of them have anymore.

[Trillo]

19. Great last sentence.

"Other than raking in vast amounts of cash for their stockholders, it's really hard to see what purpose any of them have anymore."

[truedelphi]

30. Yes that last sentence says IT ALL! n/t

[Clear Blue Sky]

6. The latest for expensive drugs...

Rather than just a fixed amount of copay, some plans (most notably Medicare) will charge a percentage of the drug cost. So the $40 copay could end up being a 30% copay instead. And on a drug costing hundreds of dollars, that adds up big time.

[elocs]

7. I am a single and paying about $30 a week for medical/dental.

They just increased the premium 20% and doubled the deductable to $5000. So I would have to pay out $5000 out of my pocket before the insurance would cover 80%. That's a quarter of my take home pay for a year. The thing is that the only thing I have used my insurance for is an annual physical and 2 dental checkups a year.

Plus, the deductable now is $5000 per person which hits the families hard. They also have a new rule that if your spouse has insurance available to them at their place of work, then the company will no longer cover them on their family plan. I know one woman whose husband was on her plan with her 3 children and he was dropped because he has insurance available at his work. The rub is that he has to go through a waiting period until he is covered, so for now he is without insurance at all.

The company I work for claims they paid out a million last year but only took in $600.000. At this time they are all happy because they did a record $2 million in sales last month.

[Edith Ann]

8. Premiums

We pay for individual policies because my husband is self employed and I work 2 days a week so I can't get company insurance. I pay 615.00 a month and my husband pays 1027.00 a month. I have 5,000 deductible and he has 2500.00. Please let me pay 1600.00 a year in premiums. By the way I belong to a high risk pool, not because I'm ill but because I was turned down for preexisting conditions. A sinus infection 5 years ago was considered preexisting. I was turned down By BCBS because I had female organs and might have to have them out. I don't have any medical problems with my female organs. I wonder about men and prostate problems? 95% of men will have prostate problems but I don't think they get turned down because of that statistic. This high risk pool is subsidized by insurance companies. They limit coverage to 500.000. They control this pool because they don't want competition. I was asked to be on the board of the state high risk pool once. 1 patient advocate and 15 representatives of insurance companies. How fair do you think that is? This is John McCain's plan.(the high risk pool that is). Now my plan. We need to put everyone on Medicare and let the insurance companies sell supplements. They will have around 46,000,000 new customers to help with profits. If Congress will leave the money alone it will sustain itself. People 0-35years old don't get sick (just the odd one out). After that we just need tweaked for the most part from 35 to 65. Most of the Medicare dollar is spent in the last year of a dying or elderly persons life. Some of that is because people will put a 99 yr old on dialysis or do heart surgery on them. Some of them get it whether they want it or not because families force it. Insurance companies make record profits. Congress needs to stop this killing of Americans. We need to stop our tax dollars from going to pay for elected officials and their families to have health care coverage when they obviously don't feel taxpayers deserve a quality affordable level of care. We pay for their care and insurance companies fill their pockets. What a deal.

[pattmarty]

12. Me, I say Medicare for all and fuck the insurance companies.

They can do just fine continuing fucking the populace on home insurance, car insurance and life insurance. You shouldn't have to have a "supplement" for healthcare.

[Edith Ann]

18. Insurance companies.

You would put a whole lot of people out of work and create if not a really really bad depression at least destroy a lot of families. We are all interconnected. We need to be fair and not act like corporations and Republicans with their all for one attitude.

[pattmarty]

22. I don't think so. You're not doing away with the paperwork/administrative...

...work, you are transferring it to the government. You will lose some jobs just because of the added efficiencies, but what the hell we've lost plenty of jobs already. The jobs thing is a whole different problem with different solutions.

[Edith Ann]

25. You need to research this.

Agents will lose their jobs and their families will go without. The agents don't get the lion's share of the premiums anymore. My husband is an independent agent and he now has to pay $600.00 just in gas a month to get to his clients. Some of the policies he sells to for example underage (-65) disability, he doesn't get paid for at all. The companies have to offer the policies so they don't pay the agents for selling them and that's how they control how many they get stuck with. If your over 75 and buy a medicare supplement agents don't get paid much by some companies. In the old days your commission stayed on the books as long as the premiums were paid and you got the increases along with the increases in the policy. Not anymore. The commissions vary depending on the company, most commissions are gone in 5yrs or so even if the policy is still in force. The agent is the line worker. He gets screwed first. I guess it's like our soldiers no one cares who loses as long as it doesn't effect them or their family. They only holler if it's a problem for them. By the way, We have socialized medicine brought to you by corporations. They call it HMO and the government doesn't stop them from doing anything they want to you. If you have medicare and a supplement at least the government makes rules the cooperations have to live with. HMO's and advantage programs are privatized medicare. And yes you do have to wait. My uncle opted to join a medicare advantage plan and pay no premiums. He waited 3 years for his knee surgery. He couldn't walk much the last 1 1/2 years. I think that they think if they wait long enough to treat you you will die and they can keep all the money.

[Habibi]

34. I'm sorry for the people that will lose jobs once

this silly country finally gets a single-payer system in place, but that's no reason to forego implementing it. They'll have to adjust to the new economic reality, like everybody else.

[pattmarty]

38. You need to take off your blinders. I am 61 yo and have seen....

...enough in my years about the "patchwork" (actually a better word is fucked-up) healthcare system. We now have a 3 tier system and I am not counting the unfortunate people that have no insurance. It IS getting worse and I'm not just talking about the expense. If your husband is an independent agent he obviously ain't paying the bills selling healthcare insurance. My agent that handles my home and car handles very little health insurance. YOU NEED TO DO SOME RESEARCH and take your head out of the sand.

[Edith Ann]

47. insurance

My husband doesn't sell property causality. He only sells health and life. He sells medicare supplements and some individual policies(not much, it's too hard to get people through underwriting with preexisting conditions.) He works hard to get dialysis patients covered because the insurance companies don't want underage disability. It's easier if your medicare age. My husband is 63. We remember when insurance wasn't so expensive and medical care was easier for people to afford. SO YOU NEED TO ENGAGE YOUR BRAIN BEFORE YOU CRITICIZE OR THREATEN OTHER PEOPLES LIVELIHOOD. WE DON'T HAVE ENOUGH TIME LEFT TO START OVER. DO YOU? And can the sympathy for those who lose their jobs because you don't have any.

[pattmarty]

40. ONE LAST THING; actually read ALL the other posts here.

[Edith Ann]

48. Posts

Didn't anyone teach you to respect other peoples opinions and situations? I'm sorry if you are having problems but, I'm not your whipping boy.

[Lorien]

14. Indeed. Here we are spending trillions to "fight terrorism" (at least thats

the official story) because nearly 3,000 people were killed on 9/11/01. Since then, how many American citizens have died because they were uninsured or under-insured? It seems to me that greedy, irresponsible insurers are a much bigger threat to the average American than "insurgents" in Iraq or Afghanistan!

[truedelphi]

32. Boy Do I hear you. n/t

[Aragorn]

11. A Country Doctor

I read the original article and (at first) only wanted to reply to 2 points.

1) Page 2 - No, we are not giving our "pay raises" (if we got one) to the health care system. Increased costs are given back to the employer!

2) Page 2 - Health care costs are not "disposable income". If they are, then our health is "disposable".

But I have a few things to add beyond that...

Yes, we need universal not-for-profit health care in the USA. We lose jobs to countries which have it, or have no insurance coverage, because multinationals make more profits that way. That's why I traded my Ford pickup on a Honda last month - it is assembled in the USA, Ford Focus is assembled in Mexico!

I decided against moving to an English-speaking country with universal health care to stay in the USA (Texas) but I charge uninsured or effectively uninsured patients the effective Medicaid rate, since I take Medicaid anyway. Their options are:
1) ER - way too expensive and usually poor treatment anyway - the "small town ER" is usually staffed by someone too lazy to run a practice and therefore not concerned about anyone's expenses or welfare. They run lots of expensive tests to CYA or blow them off altogether thinking they can't pay.
2) Wait a long time to see a doctor in the nearest semi-large city, and then pay a lot of money (if they are still alive by then) to get prescribed medications they can't afford.
3) See a local doctor - if available - and if they can afford the profiteering since small town doctors are even busier than big-city doctors and can scalp prices. If they are uninsured/underinsured but have $100-150 they can get in, but still face potentially sloppy care and/or expensive testing to CYA!
4) (My preference) See a doctor who will get them in right away and diagnose in a cost-effective way (like a stethoscope and physical exam instead of lots of lab tests and MRIs) and then prescribe the right medication in older but still effective brands (usually generic).

My folks grew up on the farm in Arkansas so I have no problem with plan #4. I actually worked my way through one of the best medical schools in the country so I relate to working folks with no insurance. But even the local Walmart pharmacist bad-mouths me because I changed a lot of patients to medications he can't make as much profit on!

I have had a website for 15 years, loaded with health information and links to more of the same. Come on people, demand better care and lower costs! From employers, from government (which allows corporate insurance to fleece you and your bosses) and even from your doctors. Demand (politely but firmly) to know what cheaper alternatives are available - to medication, to lab tests, to radiologic tests, etc, etc) and educate yourselves about your health and any diagnosed medical conditions.

I learned a long time ago that listening to the patient (along with medical knowledge constantly sharpened) gives me the diagnosis, which testing only confirms. I have long joked with patients that their knowledge of their condition along with education (such as my website, etc) will make them well quicker and longer, save them money, and "I will take all the credit for being such a smart doctor".**

Be smart. And demand changes.

** OK, maybe smart-ass....

[Lorien]

16. Welcome to DU Aragorn!

:hi:

You sound a lot like my doctor. She's from Brazil and sees mostly Spanish speaking immigrants (I'm one of her few patients who doesn't fit that description). Since she comes from a country where health care costs are reasonable, she tries to make them as affordable as possible for her patients.She tries to come up with as many treatment options as possible and will list them along with cost and effectiveness. She also believes that a patient should learn as much as possible about their condition on their own, and often suggests websites to visit or books to read.

Funny thing is, her receptionist said that she has declined to have health insurance because after dealing with health insurers personally for so many years she thinks it's all a big scam, and would rather save her money!

[Aragorn]

17. What a wonderful name!

Not on subject, but let me say - I often thought about a personalized license plate with my name (in 6 ascii places per Tx law) but when I heard 2 nurses discuss a similar plate for a local doctor, in a bad-mouth kinda way, I decided to use J R R Tolkien instead - so my old but personally restored 1966 Mustang is "Narsil" - the Ford that was broken and forged again.

So, you agree that doctors can make a difference! I am happy to report that many physicians do business the way yours does, and the way I do. We can't afford to advertise it much or we would all be swamped. People need to demand more and talk it up. However, it should be obvious that many doctors are into maximum profit. Somehow the TX Medical Board ignores the prohibition on corporate medicine and allows hospitals to hire/employ physicians - which makes for maximal profit.

I actually faced (and won) a case from a private for-profit hospital where my care was claimed to be "against the financial interests" of said hospital. That is, my quick but effective discharges of improved patients hurt their profit. I won mostly (IMHO) because their own records showed that they sent Medicaid patients to me preferentially, but sent privately insured patients to doctors who would keep them in hospital longer. Medicaid had a cap on total charges, while for-profits had a per-diem.

Think about it.

DUers, never overlook the profit motive for doctors and hospitals!

p.s. I presume a reply from "Lorien" to Aragorn"'s post means that many many readers see DU even when they don't reply. If so DU reaches a heck of a lot of people.

[juno jones]

23. Welcome to DU

You mentioned your website. Could you post a link? I'm always looking for health-related sites. :hi:

[Lorien]

24. Congrats on winning the case!

it's unbelievable what the for profit medical industry is willing to do these days. I have a GP friend in Ohio who is part of a group practice. When I found a device called the "Alpha-stim SCS" that effectively relieves anxiety, depression and insomnia he looked into it and was impressed. He suggested to the other physicians that they prescribe it for their patients. His fellow physicians nixed the idea because no ongoing revenue would be generated by prescribing the device. :eyes:

My father is a psychologist, and he sold his practice when his malpractice insurance went through the roof and most of his patients ceased to be reimbursed by their insurance companies for mental health care. Things have changed so much in just the last decade.

Names; yeah, most people here haven't noticed the origins of my user name. I have a kitten in my lap right now named Peregrin ("Pippin" for short, of course). I got him after losing a little silver fellow last year named Mithril. My other cats are named Oberon and Puck-sort of part of the same theme (Brit fantasy lit). The last guy I dated was a dead ringer for Viggo Mortensen too (unfortunately he didn't share Viggo's politics). ;-)

Glad to have you here! :hi:

[w8liftinglady]

26. welcome to DU from a country nurse!

I agree with everything you said.My only caveat is that,at least in my neck of Texas,we still have a lot of people with no high school education and no internet access.I do my best to educate them,but they have been conditioned to accept at face value everything their doctor tells them,without question.

[truedelphi]

33. Thank you for your devotion to the lives and health of your patients. N/t

[Vinca]

13. Most people are unaware there is a cap on their policies.

Given the high cost of treatment, it's not uncommon to exceed that cap, which is usually 2 million dollars. A local woman awaiting a transplant is on $2,500 worth of medication a day that is uncovered by insurance. That's just crazy. I can't afford insurance myself and don't wish the worst on the insured, but until it hits you in the face and we all rebel, nothing is going to happen.

[pattmarty]

42. You are exactly right in the cap. When I retired I was lucky.....

....enough to get health insurance (although I had to pay 10K yr for my wife and me) through a Blue cross group plan. At the time I was 54 and the cap on my plan was 100K. Yeah, your read it right 100K. With that kind of a cap, one even not serious occurrence can wipe out your insurance.

[bemildred]

15. I'm uninsured and it costs me nothing. nt

[Trillo]

20. Doctors say?

"Already, many doctors say, the soft economy is making some insured people hesitant to get care they need, reluctant to spend a $50 co-payment for an office visit.

This has been true for years for poorer, insured working folks, nothing new or particularly notable.

[clixtox]

31. I am in Vietnam...

Three weeks ago I couldn't urinate (I am 61) so I went to the ER at the Franco/Vietnamese Hospital (FVH) in Ho Chi Minh City. After getting a catheter and returning home I fainted and cracked my head on my bathroom sink, so back to the ER for stitches and three days in a private room to observe and diagnose why I was feeling woozy... I wrote the following paragraph to my family and friends back in Amerikkka...

I am back home today (4/18/08) and I am very happy about that! I enjoyed the quality
of care I received and the price was amazingly reasonable. The whole hospitalization,
over 3 days and nights, cost just over $1000 TOTAL, including meds, stitches (3 over my
eye), a cot for JOY! (my girlfriend) to sleep on (she was so sweet and helpful, and made sure I was
comfortable, feeding me fresh fruit she brought, and fetching stuff from home, like a laptop,
toothbrush, tweezers, nail file,etc., when we knew that I would be staying there for awhile), and consultations
with two urologists, an Ear, Nose and Throat doctor(about my fainting three times),
and the doc who sewed me up in the emergency room and checked in on me during the hospitalization .

I am feeling much better now. I have Blue Cross of California health insurance and I have been with them since about 1984. The hospital contacted Blue Cross but it was obvious from their correspondence that hey were only interested in finding a way to avoid paying for my care. Since I took a taxi to the hospital both times and not an ambulance they probably won't pay.

My total bill from FVH would have been much less if I hadn't divulged that I have(supposedly?) health Insurance coverage. Vietnamese patients without insurance also pay much less than the very reasonable amount that I paid.

I realize now that I actually, realistically, probably don't have real health insurance, the way the health insurance system in the USA works. The insurance industries only goal is to increase their own profits while making policy holders fight for the coverage they believed they were paying (a lot) for. The insurance companies subvert the system by bribing politicians, both state and federal, to allow them to easily weasel out of their responsibilities to their policy holders. This bribery is what allows the corrupt system to continue and this corruption is why single-payer, universal health care is "off the table".

Sound familiar?

[Hissyspit]

43. I posted your comment separately today:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=3246471&mesg_id=3246471

Hope you don't mind.

[curious one]

45. Warning -- check all your bills with your insurance company and make sure

that you are not being billed twice or more from your doctors and hospitals. They did it to me.