An Open Letter to My Peers…And Congress

I am:

  • a business owner
  • a centrist Democrat
  • a woman (we are still the gender majority and statistically the greatest users of healthcare)
  • a Boomer (we too are a large number & statistically the ones who have the most to win/lose w/any reform)
  • a member of the middle class (ditto above)
  • self-insured (e.g. not through my business)

As you see, I represent a broad cross-section of those most impacted by any healthcare reform, and as a Centrist Democrat, I believe in fiscal responsibility while helping my fellow Americans who fall ill and/or die every day because they have no insurance.  Useful reform requires thinking and/both, not either/or.

I wish to speak directly to each constituency, member to member.

To my fellow business owners:

When we want to address a problem that only our company/industry is in a position to resolve, we would not ignore it – we would most likely take out a loan (or shall I say would like to if banks were lending…), and get to work on expanding what we must to take advantage of a window of opportunity.  We would carefully calculate the risk and determine that if we do it right, we will not only be able to pay back that loan, but make a profit. 

The “problem” that needs to be resolved here is that clearly the competition created between private insurers alone has not only not reduced customers’ costs, but continues to increase them, so that model has not worked in our market place.  Therefore a new model is called for.   Applying this business model to reform, the Feds would become an insurer so that we “customers” can then reap the benefits that such good ol’ American competition would generate with private insurers (because they are the only “industry” in a position to do so).  There will be an upfront cost – of course.  But using that as a reason for not doing it at all doesn’t make sense.  Doing it in a way that will ultimately pay back the “loan” and then remain solvent, does.

We say that compelling private companies to compete with the Federal Government is not fair competition, thus insurers will be placed at a huge and unAmerican disadvantage.  After all, without significant government subsidies, no insurer has attempted to provide coverages that compete with Medicare.  That said, however, this model has worked in other industries.  The best examples: public and private colleges/universities; what has compelled the US Post Office to work more effectively (or at least try…) has been the private company competition to it.  There is simply no well-thought reason this model cannot also work with health insurance. 

As for co-ops, those few in existence work so well because they are non-profits – like the government, they are not in it to make money, but simply put their earnings-above-expenses back into improving their services.  Therefore, isn’t that unfair competition to for-profits that must pay huge salaries and give shareholders returns on investment?  Either way, private industry will be competing with a not-for-profit entity of one sort or another, so in essence, co-ops would be equally “dangerous” as competitors.  Then, there is the icing on the co-op concept-as-misguided cake: the fact that the plan being considered right now would be in very few States/areas, and most likely would not be available to the majority of Americans in our lifetime.   There is another glaring flaw to the co-op concept, and that I’ve covered in “to my fellow self-insureds” below.

To my fellow Centrist Democrats (&  you, too, Republicans): 

Given the above formula, you disappoint me greatly by not seeing the fiscally responsible window of opportunity here to both improve competition/significantly lower insurance costs for us with a public option, and do so in a way that will pay for itself so any upfront costs are “repaid” and on-going costs offset.  That is both social and fiscal responsibility… which is what you purport to be all about.

To my fellow(?) women:

As the greatest users of healthcare, from child-bearing to the ever increasing incidence of breast cancer, we have the most to lose with reform that does not create real and significant competition – it is only such competition that will lower costs…that is capitalism…that is the American way and it works.  As I mentioned above, relying on insurance companies, even if you can purchase “across state lines”, to lower your costs as a result would be continuing to trust an industry that clearly does not have our ability to afford them at heart.  For example, they can simply congregate in states that have far less stringent laws for coverage, and then offer a lower premium…for less coverage – this is not a savings.  They will continue to do what they do now:  the two largest health insurers held half or more of all enrollments in 40 of the 42 states studied just last year by the American Medical Association.

Without an outside force keeping their prices in check, they have proven to us over almost a century that they will simply find ways around any lesser legislation, and we will continue to pay for it.

To my fellow Boomers:

All of the above in the “women” section, plus as we age we will be the major users of healthcare, and many of us have miles to go before we qualify for Medicare (the other “public option” of which we will happily avail ourselves).  That means years of exorbitant premiums, even if insurers can no longer drop us when we get sick or refuse to cover us with a pre-existing condition.  Great – we qualify – but we still can’t afford it….

To my fellow Middle-Class:

The poor will be covered – the rich can afford designer care so they don’t care – we’re the ones who will be left to live with the final results of this legislation.  So, what will reduce our costs without sacrificing the levels of coverage we need to stay healthy…or survive a devastating illness?  We’ve said we don’t trust the government to do a plan right…do we really trust insurance companies more…?  With reforms to Medicare to bring its spending under control, it becomes an excellent model to replicate. Apparently even without those controls everyone on Medicare loves Medicare and the rest of us can’t wait to get on it… If Medicare is that effective, useful, needed, it is worthy of replicating for younger Americans as an alternative to private insurance for those who qualify (which, like Medicare, would hardly be “everyone” but in fact quite limited – enough to make a real difference without creating an unfair advantage).

There is only one way we will realize not just immediate but on-going cost reasonableness while not sacrificing our coverages.  We can have both – this is America – when we want the best approach badly enough, we make it happen.

To my fellow self-insureds:

You, like me, have most likely at some point had insurance through an employer prior to buying your own for whatever reason.  Back in 2000 when I worked for someone else, I was given a choice of diminished coverages for the same employee share cost, or increased costs for keeping the same coverages.  This trend has continued and worsened for those with employer provided coverage.  To quickly emphasize this with a real example: Dawn Smith is an aspiring writer living in Atlanta; four years ago, she was diagnosed with a rare, but treatable brain tumor; her doctors are ready to remove it, but they can’t because CIGNA refuses to pay for the surgery.  This is a battle happening right now.

We know that this is then magnified 100% when we pay the entire bill ourselves, and with no more guarantee than has Dawn that we will be covered when we need it the most.

I have seen my insurance bill rise by 33% over the past 1.5 years.  This is simply unacceptable.  Yet I have the lowest-cost insurance available to me here in Florida, and the bare minimum of coverage (“catastrophic” only).  Of the “cost-reducing” options being forwarded in lieu of a public option by some members of Congress, one is the ability for us to go across state lines – in reality, that would reduce my premium very little (I’ve checked) and “co-ops” would take years to develop to the point of efficacy – that’s only after the years it will take to get them up and running…the existing co-ops being used as models have taken as long as 20 years to get to the point where they are now the models to be emulated.  You truly want to wait 20 years? 

And as for cost, co-ops may have premium increases that are less than their competition’s, but that doesn’t make those increases necessarily affordable. Washington State’s Group Health Cooperative of Puget Sound had annual increases for averaging 12.3 percent since 2000; they were 24.2 percent in 2003.

My fellow Centrist Dem’s/Biz Owners/Boomer Women/Self-Insureds, I ask you to consider my words to you peer-to-peer; they are long in coming and carefully thought out, I promise.  I have done my homework – do my own fact-finding rather than relying on pundits with a clearly self-serving motivation (ratings) on both sides of the issue.  I, like you, have the most to gain or lose if this is done…or not done…right.  I ask you to not only refuse to dismiss a public option, but insist on it. In fact, it is our only chance for reform that will be both meaningful and lasting.

What Are You Willing to Sacrifice?

‘Tis the season for health care reform overreacting, from Democrat Pelosi’s very silly & counterproductive “unAmerican” remark, to the unbeknownst-to-anyone-including-those-creating-the-bill “death panels” – aka having access to good & factual information from your doctor on handling end-of-life preparations – charged by Republicans and on which Republicans are now backpedaling as, yes, another overreaction.  This made more interesting by the fact that it was a Republican, Senator Johnny Isakson of GA, who introduced the bill’s end of life counseling option for Medicare… Oh, and by the way, my fellow Boomers, according to Medical News Today, one of the top 10 most common medical challenges for us as we age: Death & Dying, e.g. deciding how we want to live out the end of our lives and how we want to die….

What is not being discussed, and must be if we hope to reform anything, whether it’s our evermore dysfunctional health care system or a shaky marriage, is the “give” part of “give and take”…

And I’m not referring to Congress; I’m talking about…us.

It is an accepted fact that at times we must sacrifice for the greater good.  We Boomers’ parents did that big time to ensure a world free of fascist domination; foster parents make many sacrifices so they can care for others’ abused/neglected children; and, of course, our military men and women make huge sacrifices, as do their families, to keep us safe.  Americans often are willing to sacrifice a little – and sometimes a lot – to help others.

So I asked myself, “what am I willing to sacrifice when it comes to health care reform, so that others (many) who are suffering because their insurance dropped them for having a disease that is too costly, or are uninsured and as a result are not getting the healthcare some of them desperately need, will no longer have to live that way?”  Because that, to me, is what underpins much of the debate, fuels much of the fear, and ultimately decides the outcome: “you’re asking me to give up something for this, and I don’t wanna…”

It’s natural to think only of ourselves, what we have, and that we don’t want to chance losing something of our own so that others we don’t know can gain.  But, in retrospect:

  • it’s a good thing the Continental Congress ultimately fought that desire (for 2 years the vast majority of representatives wouldn’t even discuss the option of independence, in part because they knew it would be considered treason, but in greater part because they were afraid of losing their property and standing);
  • I’m very glad those who stormed the beach at Normandy didn’t feel that way, and;
  • I’m deeply grateful that those who ultimately lost their lives to gain basic civil rights for all, didn’t place their own self-interests above that of millions of fellow Americans subjugated to egregious forms of discrmination.

Now that I know that 10’s of millions of my fellow Americans, a number that keeps growing, have, over many years, experienced serious health ramifications because they have no coverage to get then well, this is a big enough problem to warrant serious consideration of my part in fixing it. 

I am thrilled that my 89 year old mother, and all of America’s elderly (and not so elderly…) have Medicare so at least here in America we don’t let our elderly go without all the care they need to have a quality life.  But that has only been since the 1960’s, prior to that, we did treat our elderly as we do our younger citizens now, and that’s nothing in which to take pride.

So, am I willing to pay a little more so that others can be healthy?  Am I willing to get a little less so someone with cancer will be covered after all?  Doctors, are you willing to make $3K instead of $4K a year* and perhaps drive a smaller BMW?  And, of course, we already know that the insurance companies are not willing to sacrifice anything but those who cost them too much, unless forced to do so…

A major objection from the most vocal of opponents, is based in this concern: “I like my insurance (whether private of Medicare) and don’t want it impacted at all!”  Is that reasonable or completely selfish?  Is it unreasonable to ask those who feel they are not impacted by the health care issue, to make some potential sacrifice so others may have even some of what they have (the operative word being potential, as for many it may never happen)?

My answer is, I am willing to pay a little more for the same coverage if that will help others – I am not willing to continue to pay more for less to benefit the insurance companies as \is happening right now.   I say that not completely selflessly (of course…): I know full well that I do already pay for the uninsured through the 33% hike I’ve seen in my premiums over just the last year.  If you think that’s not happening to you as an insured, just call your insurer and ask why premiums keep rising – they will readily admit that it is in part because they must try to recoup the rising costs of hospital medical care, for instance, associated with the mandate to care for the uninsured regardless of their ability to pay. 

Even those with good coverage know that at any time they can be denied care for a needed procedure, canceled, or as has happened regularly over the last many years even w/employer underwritten group health plans, pay ever more for less coverage.  This while insurance executives fly to their next stockholder meeting in their private planes with gold-rimmed dinnerware and hand & foot service (I’m not fabricating this – an ex-insurance exec told all recently to the St. Pete Times, and this was part of his story).

So, now I ask you: What are you willing to sacrifice for the greater good on this issue?  A little something can really go a long way.

*According to a 2008 survey of MD’s by Modern Physician, Physician’s salaries range from a low of $175K/yr (Internist), to a high of $600K (Radiologist): averaging $387K/yr.