Health insurance for some

March 13, 2017

This Times Union story is disheartening, but not surprising.  It’s about legislators hiring rich cronies for part time jobs that pay little but provide State-subsidized health insurance, which is top-of-the-line and costs the employee very little (full disclosure — as a full-time, non-political State employee, and now as a State retiree, I too enjoy this benefit).

What the story doesn’t address, and what should be of broader concern, is the pricing policy for employees and retirees, who are required to pay a share of the cost of their policies.  There are two prices — for individuals with no dependents, and a higher family price for those with any number of qualified dependents.  Thus, the employee with a spouse and no children pays the same premium as the employee with a spouse and 15 children.  I do not know whether the cost to the State is the same regardless of the number of the employees’ dependents, but I do know that State employees with small families are paying a lot more per person for their health insurance than State employees with large families.  While this policy is great for State employees who have large families, it’s not so good for those making up the difference.  Even worse, it’s not a transparent policy — those who are making up the difference are not aware of who they are or how much they are paying.

I’m not saying the policy is indefensible; for example, where government jobs sometimes pay less than the private sector, the family insurance plan may make it practicable for someone with a large family who is an attractive candidate to take a lower-paying State job, which could benefit the public. And it is a way to make health care more affordable to those with larger families and, presumably, less disposable income (though that may not be the case of the part timers in the TU story, one of whom claimed a net worth of over $8 million). What I am saying is that it also presents apparent fairness issues and, as the TU story indicates, an incentive for abuse.  Open discussion of the issue — one that most taxpayers probably are not aware of — might benefit everyone.



Health care conundrums

February 17, 2017

As I advance in age, I am exposed more and more to the health care industry, despite having enjoyed relatively good health until recently.  As a retired New York State employee, I am blessed with excellent health insurance that covers most doctor visits, medical tests and procedures, as well as prescription drugs, with only a relatively modest co-pay. Here are a few observations:

First, it appears that many of our health problems are what a friend of mine calls “diseases of affluence.”  More appropriately, they should be called “diseases of lifestyle,” since they affect people of all socioeconomic strata.  A lot of these are directly influenced by government policies.  For instance, our auto-centric physical infrastructure minimizes the opportunities for and pleasures of walking and cycling, and cannot help but contribute to obesity and other problems based on lack of physical activity.  Our government subsidies to cane sugar and corn (the main ingredient of high fructose corn syrup) help make junk food and sugared soft drinks attractively priced.  This is especially so for the poor, since the SNAP program (formerly known as Food Stamps) allows their purchase with SNAP benefits.  If we collectively spent more on complete streets that were friendly to pedestrians and cyclists, as well as cars, how much could we save on health care (not to mention on school transportation)?  How about if we stopped subsidizing sugar?  I think it would be worth a try.

For all the criticism leveled against it, the Affordable Care Act (“Obamacare”) has achieved something great — it has shifted the dialog from whether health care insurance should be extended to many of those who don’t have it to how the present system should be replaced or improved.  Neither Trump nor his minions are suggesting that those who obtained health insurance through Obamacare should lose it, meaning that they recognize that there is no going back on government’s commitment to growing numbers of its citizens.  Whether things actually get better or worse remains to be seen, but at least no one is talking a bout a pre-Obamacare “reset.”  To me, that is yuge.

Just tell me when you want me to show up

December 28, 2015

A few weeks ago, I made an appointment with a doctor’s office.  I was told it was for 9:15 on a given morning, and that’s what I entered in my calendar.  Today, the office called to confirm the appointment, and the secretary added:  “We want you to be there twenty minutes before.”  My response:  “then why didn’t you tell me that when I made the appointment?”  The response was that the 20 minutes would be for me to fill out paperwork, which they only ask of first-time patients.  Again, I asked, “why wasn’t I told that when I made the appointment?”  The light bulb finally went on in the receptionist’s head, and she admitted I had a point.

Not long ago, something similar happened to me when I had an appointment with another arm of the same octopus (Community Care Physicians). When I showed up at the appointed time, I was asked if I just had come from having a sonogram.  I replied that that was the first time I had heard about a sonogram, and that if I was supposed to have come early for that purpose, I should have been told.  I received an apology, and the ultrasound technician squeezed me in.

Both these scenarios indicate that what I thought were appointments for me were actually appointments for the doctors who were seeing me.  While they were given the correct information about when I would be available for them, I was not given the correct information about what else was expected of me.  I understand and respect the value of doctors’ time, but Community Care also should understand and respect the value of its patients’ time, and let them know when to show up for what will be required of them, not just when the doctor herself or himself will be seeing them.





Universal health care

September 20, 2013

I’ve been reading a bit to bring myself up to speed on the health care controversy. The best book I’ve read so far is T. R. Reid’s The Healing of America (thank you, Upper Hudson Library Federation, for free access to the e-book version). I should have taken notes, but here are the major take-aways:
1. To have universal health care, a nation needs to want it. The deep rift over “Obamacare” reveals we are not there yet as a nation, even though 22,000 people a year die, and 700,000 go bankrupt, solely because of lack of health insurance in our country. Many people falsely believe that anyone can receive free care for virtually any ailment in hospital emergency rooms; even if true (which it is not), that would be terribly wasteful and less effective than appropriate care venues.

2.  In order to insure everyone, everyone needs to be insured.  The healthy and young will pay in until they become unhealthy, when the system starts to pay out; by then, new healthy insureds should keep the system in balance.

3.  Covering everyone does not mean covering everything.  There will have to be some rationing — for example, hip surgery may not be authorized for someone 90 years old who has other health problems.  The body that makes these decisions must have credibility, impartiality and transparency, or people will lose confidence in the system.

4.  Non profit payers are required to reduce overhead and eliminate the bureaucracy established for the purpose of denying coverage and claims.

5.  A central power – either a single payer or a government body that sets uniform rates for all payers – is necessary to bargain effectively with providers.  What Reid does not state explicitly is that doctors and other providers should be prepared to work for less under such a system.

Citizens of the US harbor many misconceptions about universal health care, in addition to the belief that a minimal level of care already is available to everyone:

1.  Universal health care requires “socialization” of medicine, with the government owning the facilities and employing the providers. While government ownership is one model, other countries that provide superior care to all their citizens for less cost than we do use private doctors and facilities, and give citizens broad choice of provider and (non-profit) insurer.  

2.  Government cannot run health care as well as the for-profit private sector.  Medicare is one of the largest, most popular and most efficient government programs, and its administrative overhead is far lower than our private health care sector, though it serves a higher need population.  Our system of veterans hospitals is an example of pure socialized medicine, where the government employs the providers and owns the facilities, and where consumers are not billed for the services they receive.

There are many ways to skin the cat, if we have the collective will to extend health care to everyone and resist the special interests in favor of the status quo.  Obamacare may not be the ideal solution, but it’s a step in the right direction, and long over due.