Prisoner of Employer Health Insurance  Fri May 02, 2008

Well, it's happened to me. Something has come along that will forever limit what I can do with the rest of my life. My horizons have been narrowed. I see my future and that future is no longer as free and open with possibilities as it once was. What I now see is myself as a wage slave the rest of my days. I no longer have the option of going out on my own, of following the entrepreneurial path of being my own boss.

Why? What has happened to so constrict the options for my future? It's very simple, really. I became sick.

More after the fold.  

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• PlaneCrazy's diary :: ::

Just over a month ago, a swollen tonsil turned into a tonsillectomy, which exposed a rare form of throat cancer, especially in one so young with no risk factors, squamous cell carcinoma. This is the nasty cancer that heavy smokers get whose treatment can cause the disfigurement, the voice boxes, and all kinds of wonderful side effects.

I've never smoked a single cigarette, of any kind, in my life. I've never been a heavy drinker. I'm 10-20 years too young even if I was. But this has happened anyway. It may be viral related. Regardless, I have it.

Fortunately for me, it was caught early. I had a second surgery in which they discovered two lymph nodes with cancer, out of the 27 they removed. The good news is that the cancer was still encapsulated, and they believe they got any residual cancer from the tonsil bed, so the big, nasty tumors seem to be gone. I was definitely one of the lucky ones.

In two weeks I will begin radiation treatment to kill off any remaining cancer cells in the area. Believe me, I'm not looking forward to being on the receiving end of a linear accelerator for five-days-a-week, for six weeks. At the same time, I'm so very thankful that it is available to me. And that's because I live by one of the best cancer centers in the country, Duke University, and I have premium, employer-provided health insurance.

Great, you might say. That's all, relatively, good. The problem is, that now, I have a pre-existing condition. And not just any, but one of the big ones. What this means is that I will have to get follow up exams regularly for a few years. I will have to see the dentist more regularly for the rest of my life. It also means that I have a higher risk of additional cancers down the line.

But for my future, it also means that it will be practically impossible for me to afford, even if anyone would be willing to sell me, my own individual, private health insurance.

Forever now, I will be limited in what kinds of jobs I can look for. I will have to work for larger corporations with a big enough risk pool that I will be able to get their health insurance. If I ever decide to work for a smaller company that may have limited, or no insurance, or to start my own business, I may be completely exposed to the risk of falling sick again without insurance to help pay for it.

I grant you, my problem, right now, is nothing in comparison to those poor souls who develop conditions like mine without insurance. That's the real tragedy. That's the real suffering because one fears for one's life without any guarantee that someone will help pay for it. The uncertainty and stress is magnified ten fold.

But it's not such a large step from my privileged position of well-insured, to that scarier one of complete vulnerability. I've been there myself. For years during and after leaving graduate school my wife and I didn't have insurance. Fortunately we were young and healthy.  

But I cannot take that risk anymore of flying free without insurance. We have a young son. I will hopefully someday be a cancer survivor. My wife's never been quite the same since the full, classical C-section that delivered my son 11 weeks premature. Yes, we've used our share of the health care system these last 3 years.

Every event in our lives adds to the risk of needing more health care. Every tick upwards on the scale of risk makes it that much more important that I, and all others like me, limit the possibilities of our work to those companies who can afford to provide insurance regardless of pre-existing conditions. This is yet another hidden economic cost of our very broken health care system.

It is also a very short leap from being in a secure position of good health and low risk, to completely vulnerable because un-insurable. Those already in this position understand. Those of you who are lucky enough to be healthy and well-insured, be aware of what can happen in a very, very short time.

My example is only one of many, many reasons why our system is broken. It is not one of the most serious ones, but it is one that can happen to anyone, even those of us who do all the right things to stay healthy and are lucky enough to have good insurance. It doesn't take much to go from a winner in the current system, to a loser. We need to change the system.

The reformation cannot be in half-measures that only sound good from a short-term political perspective, like the stupid gas tax holiday idea. Instead, we need change that actually address the issues of the un-insured, the under-insured and those of us with pre-existing conditions. This will not be easy, and will not be quick, but it must be done.

And as Barack Obama said in a great video from an event in Indianapolis, "We can't put it off anymore. The time is now."

So very true.

Fri May 02, 2008

You've been wondering, I'm sure, exactly how unfair our healthcare system has become.  Very, very unfair is the answer.

This reality takes on a new urgency as John McCain goes around the country promoting a bogus "healthcare plan" for the American people, one that would exclude him with his pre-existing conditions, if he were not a U.S. Senator, and a recipient of heavily taxpayer subsidized government healthcare.

And since the media refuses to ask the maverick about his own healthcare benefits, which he wants to deny to you and me, I decided to do some research--to get a handle on exactly what people like John and Cindy McCain receive.

Locating information about their Cadillac Healthcare isn't easy.  It's buried deep in vaults inside the office of OPM which essentially acts as the HR department for the federal government.

But I've been able to piece together the disgusting reality.

After OPM, you go is the web site of the Federal Employee Health Benefits Plan (FEHBP).

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• nyceve's diary :: ::

As many of you know, the FEHBP is the benefit program for the federal workforce which includes members of Congress and our illustrious Senators.  Federal employees are entitled to their benefits. This diary is not about federal employees, it's about elected officials and high ranking political apointees.

Here's the information they'd rather us not know about.

As our premiums skyrocket, their premiums are stable!

As our benefits are whittled to the point where most of us have bare bones junk insurance (insurance in name only), as our co-pays increase year-after-year, their benefits are expanded.  I kid you not.

Here's the statement of NANCY H. KICHAK ASSOCIATE DIRECTOR FOR STRATEGIC HUMAN RESOURCES POLICY AND CHIEF ACTUARY OFFICE OF PERSONNEL MANAGEMENT before the SUBCOMMITTEE ON OVERSIGHT OF GOVERNMENT MANAGEMENT, THE FEDERAL WORKFORCE, AND THE  DISTRICT OF COLUMBIA COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS UNITED STATES SENATE

Growth Trends in Health Care Premiums for Active and Retired Federal Employees

OPM administers the FEHB Program, which covers approximately 8 million Federal employees, retirees, and their dependents. The FEHB offers competitive health benefits products for Federal workers, much like other large employer purchasers, by contracting with private sector health plans.

For five consecutive years, rate increases in the FEHB Program have declined. In fact, for 2007, rates increased only 1.8 percent. The result - approximately 63 percent of FEHB enrollees incurred no premium increase, while another 15 percent saw increases of less than 5 percent. For the past five years, the rate increases were lower than industry averages with the last three years being remarkably lower.

http://www.opm.gov/...

Here's more from an OPM press release. Please note that OPM is always seeking to expand FEHBP benefits. This is in stark contrast to almost non-existent benefits the American people must contend with, and our sharply escalating premiums and co-pays.

They take really, really good care of themselves

OPM Holds Average FEHB Premium Increase to about Two Percent for Second Year

Washington, D.C. -- The U.S. Office of Personnel Management (OPM) today announced health insurance premiums in the 2008 Federal Benefits Open Season that reflect an average two percent increase for the second year; premium increases for enrollees vary by plan, within a range of -47 percent to 132 percent. OPM also announced the renaming of the Federal Employees Health Benefits Open Season to the Federal Benefits Open Season to reflect the broadened scope of benefits available, including the Federal Employees Dental and Vision Insurance Program (FEDVIP) and Federal Flexible Spending Account Program (FSAFEDS). The FEHBP features 283 plan choices in 2008, one less than in 2007.

. . ."OPM works aggressively with health insurance plans to hold down premium costs for Federal employees, retirees and dependents, while at the same time negotiating expanded coverages," said Linda M. Springer, Director of OPM. "For example, at the prompting of OPM in its Call Letter to health plans, some plans are adding hearing benefits for children up to age 22. And, in response to OPM's emphasis on preventive-care services, many plans are providing benefits in accordance with the U.S. Preventive Services Task Force guidelines, while others have enhanced their preventive-care benefits for 2008."

http://fehb.opm.gov/...

So while Congress is assured of expanded healthcare coverage at a nominal cost,   the American people are dropping their coverage at an alarming rate due to unaffordable premiums and continually shrinking benefits.

What follows are the alarming statistics about us. Compare our reality to the reality of Members of Congress. Lowered costs and expanded benefits for them. Dramatically higher costs and dramatically shrinking benefits for us.

In 2007, employer health insurance premiums increased by 6.1 percent - two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400.

1. Premiums for employer-based health insurance rose by 6.1 percent in 2007. Small employers saw their premiums, on average, increase 5.5 percent. Firms with less than 24 workers, experienced an increase of 6.8 percent.

1. The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,100 in 2007. Workers contributed nearly $3,300, or 10 percent more than they did in 2006.

1. The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).

1. Workers are now paying $1,400 more in premiums annually for family coverage than they did in 2000.2

1. Since 2000, employment-based health insurance premiums have increased 100 percent, compared to cumulative inflation of 24 percent and cumulative wage growth of 21 percent during the same period.

1. Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits by 2008.

1. According to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 2000.2

1. The average employee contribution to company-provided health insurance has increased more than 143 percent since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115 percent during the same period.

1. The percentage of Americans under age 65 whose family-level, out-of-pocket spending for health care, including health insurance, that exceeds $2,000 a year, rose from 37.3 percent in 1996 to 43.1 percent in 2003 - a 16 percent increase.

http://www.nchc.org/...

Just to make you really appalled, let's end with this. Here's how Don Sloan, M.D., described Congressional health benefits.

There is an employee/insurance deal in the U.S. that includes unlimited doctor office visits of your choosing; covers all accidents, routine exams, physical therapy, labs and X-rays; and the like; unlimited hospital visits and stays; certain chronic care and rehab; full prescription coverage; and unlimited specialty consultations. For the employee and the entire family. There are no deductibles, no co-pays, and only a $35 monthly fee taken from an annual salary of $158 thou. Thirty-five dollars!

The group awarded this insurance looks forward to a full pension and continued coverage until their deaths. Quite a few, most in fact, were millionaires before they took on their jobs that got them such a perk. Who gets this coverage? It would be nice if it were the underprivileged or the chronically ill and debilitated or our veterans.

But no. For starters, the 535 members of the U.S. Congress, and add to that the few hundred in the upper executive and judicial branches of government. They are also members of a demographic group where seven were arrested for shoplifting, nineteen for writing bad checks, and eighty-four for drunk driving. This bunch also has an overrepresentation of felony indictments, and a few ended up serving time.

http://www.alternet.org/...

If all this makes you ill, you can call your member of Congress or Senator and let them know. Here's a link to the Congressional switchboard.

Mad as hell? Rally against AHIP - June 19 - San Francisco

And as Barack Obama said in a great video from an event in Indianapolis, "We can't put it off anymore. The time is now."

My question is, why did Sen Obama put it off to begin with?

 http://www.californiaprogressreport.com/2008/05/a_community_pha.html

Excerpt

A Community Pharmacist Speaks Out: What Med-Cal Cuts Passed Earlier This Year Means to My Patients—And the State of California

The 10% across the board Medi-Cal provider cuts that were passed almost unanimously by both Houses of the State Legislature and signed by the Governor spell doom for both patients and providers. Once again a group of politicians made no effort to get input from either the beneficiary or provider groups. They just took an axe and cut away 10% of the budget deficit. Paying no attention to what these cuts will do in the short term as well as the long term.

In the short term, all expensive life saving drugs will be effectively removed from Medi-Cal other than getting them via hospitalization. This is a rather costly way to provide prescription drugs to patients.

One example of a drug in this category is Thalomid. It is used for multiple myeloma and we use a lot of it. In a quantity of 84, which represents the patient taking 3 capsules a day for 28 days, the reimbursement goes from a current gross profit of $303.38 to a gross loss of $477.02. This is based on a drug that costs our pharmacy $7,856.97. In study after study any drug that has an Average Wholesale Cost of $95.00 or more, the pharmacy begins losing money. It is true that chain drug stores get a slightly better price in purchasing these drugs, but this 10% cut will eliminate their ability to fill these prescription drugs at a profit as well.

Most of my patients have Diabetes, Coronary Artery Disease, Kidney Failure or Cancer to name a few. To treat any of these conditions takes medications that are very costly. What will happen to these patients? As I said earlier they could be hospitalized and hopefully receive these life sustaining medications. This would overload our already overloaded hospital system. More than likely, they would just stop getting these medications resulting in death or at the very least severe complications. This would require additional treatment, another added expense for the already strapped Medi-Cal system (which currently ranks in the bottom three of all states in expenditure per patient).

One of the things that we do is deliver to these patients who are mostly shut-ins. What will happen to them when we can no longer service them?

These cuts were made with no thinking and will cost the state a lot more money than it is currently spending for a system that serves the patients who can least afford it.