The Healthcare Maze

by on June 8, 2009 · 3 comments

in Economy, Health

By OB Rag Staffer

Our US employer-based corporate healthcare insurance system is a nightmarish maze of rules and expenses and deadlines. It keeps many patients from receiving the medical care they need. It provides easy access to medical care to those who need it the least, and denies it to those who need it the most. It provides a lavish, luxurious lifestyle for the corporate executives who reap its financial benefits (and who fight to keep it that way). The US healthcare system operates somewhat like a private club, granting membership only to the healthy, the wealthy and the well employed.

Wealthy people can afford to pay their medical bills as they go. The poorest people can get basic medical care through government aid programs. Some working people can get health insurance through their employer, but those jobs are getting harder to find or to keep. Still others can pay for private health insurance, but their coverage is expensive and at the whim of the insurance company. People who have lost their jobs (and group insurance) can keep their insurance, but they must pay for it themselves and follow a strict set of rules. Still others don’t qualify for anything they can afford, so they just go without.

There are several programs available to help people keep their healthcare coverage after losing their jobs. Here are a few examples of the restrictive (or expensive) options:

COBRA (Consolidated Omnibus Budget Reconciliation Act):
Allows a person to keep his or her employer group health insurance for up to 18 months after losing their job. The person must pay the entire premium every month, including any portion the employer had paid.

President Obama has passed a federal program that reduces the cost of COBRA insurance for certain people who qualify.

Cal-COBRA (California-Consolidated Omnibus Budget Reconciliation Act):
Allows a person to keep his or her employer group health insurance for up to an additional 18 months after losing a job. The person must pay the entire premium every month, including any portion the employer had paid, plus an additional charge.
http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_cobra.aspx

Conversion Coverage:
Allows certain selected people to buy a private health insurance from their former insurance company. The person must have exhausted all COBRA and Cal-COBRA benefits and must have been offered the Conversion Coverage. The person must pay the entire premium every month, at a rate set by the state. That premium can be hundreds or thousands of dollars a month.
http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_hipaacp.aspx

HIPAA (Health Insurance Portability and Accountability Act):
Allows qualified people to buy private health insurance from any participating insurance company. The person must have exhausted all COBRA and Cal-COBRA benefits. The person must pay the entire premium every month, at a rate set by the state. That premium can be hundreds or thousands of dollars a month.
http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_hipaacp.aspx

MRMIP (Major Risk Medical Insurance Program):
Allows qualified people to buy major risk private health insurance from any participating insurer, after having been denied private insurance. The person must have exhausted all COBRA and Cal-COBRA benefits. The individual must pay the entire premium every month, at a rate set by the state. That premium can be hundreds or thousands of dollars a month. MRMIP is the medical equivalent to Assigned Risk auto insurance for high-risk drivers.
http://www.mrmib.ca.gov/MRMIB/MRMIP.shtml

Medi-CAL:
Provides qualified people with limited health care. Medi-CAL is similar to Medicare, but with different eligibility requirements, and it is only available in California.

CMS (County Medical Services):
“The program of last resort for eligible adults, which covers only necessary medical services.”* CMS provides basic, necessary health care to people who meet the strict qualification requirements. Those requirements include strict limits on income and assets. Only San Diego County residents are eligible.
*http://www.sdcounty.ca.gov/hhsa/programs/ssp/county_medical_services/

Live with it:
For too many Americans, the only choice is to live with a medical condition and let it run its course without treatment. These people cannot afford any health insurance, but they do not qualify for public assistance. They cannot make it through the gauntlet of regulations, qualifications and expenses that it takes to get affordable healthcare coverage. It is difficult to comprehend how this can even be allowed, here in the wealthiest nation in the world, with the finest medical technology.

The point is that our healthcare system has been cobbled together with lots of different plans and programs. Some are open about their requirements, some are not, and the requirements can change. For an unemployed person who is sick, it can be mind-boggling.

If you do not qualify for any health care plans, welcome to the club. Join the more than 40 Million Americans who do not have healthcare coverage. These people must pay as they go and hope to stay well. And if someone were to develop a serious illness, they would be locked out of the system.

How many people could be cured of illness with the money that one insurance executive might spend on a yacht or a vacation home?

A single payer healthcare system would eliminate the maze of regulations and qualifications and expenses that exclude so many Americans from basic health care. If done right, it would guarantee access to basic health care to every American. It would relieve businesses of the financial burden of paying for employees’ healthcare coverage. It would encourage businesses to keep jobs in the US. It would not, however, make anybody rich.

Our American healthcare system works to make a small number of people very rich, while shutting out millions of others from even the most basic medical care. A single payer healthcare system could cutoff the torrent of money to the richest insurance executives. Unfortunately, too many Americans have been brainwashed to believe that a few individuals’ right to become extremely wealthy is more important than everyone’s right to basic health care. With that mentality, it will be difficult to get meaningful changes. Wake up, people!

Finally, let’s not forget the doctors and other medical professionals who work long and hard to keep us well, despite the dysfunctional system they have to work with. They are answering a noble calling and deserve our respect.

{ 3 comments… read them below or add one }

avatar lane tobias June 8, 2009 at 3:51 pm

thanks wireless mike, for giving us a clear picture of how confusing the health care mess can be for unemployed or uninsured people, especially those who are sick.

i also commend your last comment, because most people have a misconception of doctors as arrogant, wealthy, and self-interested. while there are definitely some upper crust physicians out there who fit that bill, the majority are becoming more and more frustrated with the maze of HMOs and lag in response time that major health insurers use to delay billing. our health practitioners, notably family physicians and nurse practitioners at community clinics, are definitely answering a noble cause.

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avatar Mathew Mccarty June 8, 2009 at 5:06 pm

swell words

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avatar Molly June 8, 2009 at 4:18 pm

Amen, Lane. (I’m not religious but I know you know what ah mean.)

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