Our Broken Government: The Need For Healthcare Reform

March 6th, 20101:00 pm @ Angela Odom


I have wanted to write something on health care reform for a while but there are so many variables. For me, the issue boils down to what individuals need, not partisan bickering, not selling your vote quid pro quo, and certainly not the high end, intellectual discussions over whether a woman should or should not receive money for an abortion. At some point, all of this pseudo intellectual masturbation should cease and thought should be given to the needs of those individuals who want and need a real health care bill.

Recently, I stumbled upon this video on CNN:

In this case, a man’s wife is slowly dying at home. When he was initially laid off from his job, he was given a severance package. The severance, possibly COBRA, allowed insurance with a $2,500 deductible. In order for this man — who is now working as a independent contractor and no insurance — to afford such a high deductible or purchase insurance outright, he will have to at some point miss a mortgage payment, not buy groceries for his family, miss payments on credit cards and/or will have to miss a payment or two on his car note. It is not feasible for him to lose his home under the circumstances.

What is really needed here is a way for this gentleman to, at the very least, get some form of insurance suitable to his income level. Can he or his wife receive some sort of emergency health care program until he is able to find work that will afford him health care? Can Congress work on some form of plan, quickly, that will allow this family to receive health care that will not bar him because of pre-existing conditions? This is what is needed.

In the United States, health care is expensive. If you spend any amount of time in a hospital, when you see that bill you won’t believe some of the expensive charges. You can go to your local drugstore and purchase a bottle of acetaminophen for a few dollars but, while in the hospital, two of these pills might run you a thousand plus dollars. Why so much?

Hospitals look for ways to recoup the costs they pay forward to those without insurance or those whose insurance is not adequate to cover the costs involved with their stay. Both individuals and insurance companies audit bills and will negotiate with hospitals to lower the bill. Again, returning to CNN, consider the following:

Adding to the expense is big pharm and our our broken government, both are moving at a snail’s pace in allowing for more generic drugs. Consider the New York Times article entitled Generics Face Longer Wait for Approval.

The delays, caused by a growing backlog of applications at the Food and Drug Administration, may be costing consumers and the federal government hundreds of millions of dollars a year as they continue in some cases to pay for name-brand drugs even after their patents expire, industry analysts said.

* * * *

With lawmakers preparing to meet at the White House next week to discuss ways to give more Americans access to health insurance, generic makers say that underfunding of the F.D.A.’s generics office is denying consumers access to more affordable drugs. The agency’s office of generic drugs has a budget of $51 million for fiscal year 2010, up from $41 million in fiscal 2009.

Drugs are becoming more expensive every year. I will never forget one drug I took — a drug I was on for a short period of time I might add — cost about $800 to $900 per month. Mycophenolate mofetil (CellCept) is typically taken for the life of organ transplant patients. Since there is presently no less expensive generic brand on the market, an organ transplant patient must have some form of insurance in order to afford such a costly drug. I will also add this is not the only drug they will take for the rest of their lives. My co-pay for CellCept was about $40.00 per month. Who paid the rest? My insurance company.

Insurance companies are in the business of making money. Let’s say you are paying out-of-pocket for health insurance at $1,000 per month. You purchased this plan in January and by December you have paid $12,000 into your insurance plan. In January of the following year you end up in the hospital with some sort of catastrophic health event. You have insurance right? You should be covered right? But, your hospital bill is $38,000. Who will pay that bill? You have only paid $12,000 into the plan, who pays the rest?

Now let’s say you were sent home with a handful of prescription drugs. Some of these are generic, many of them are not. You fill the prescription but you’re shock to find one of the drugs, a non-generic drug, will cost you $140 in co-pay. Your total prescription bill is $180. Let’s say your non-generic drug retails for $800 per one month supply. Who pays for that? Remember, you only paid $12,000 into your plan.

In the past, many of us got off cheap because the hospital ate some of the costs and your insurance company ate some of the costs for your care. Going forward, we may not be so lucky. If you and/or your employer did not pay enough into the plan, you can expect you will be billed for thousands of dollars which is why the high deductible plans and Medicare plans with donut holes have come into existence. The health care welfare plans we once enjoyed will soon come to an end as health care costs skyrocket.

As noted in the first video, the former GM worker who was laid off is now working as an independent contractor. Many companies, particularly start-ups, cannot afford expensive health plans. As a result, more and more employers are going the independent contractor (IC) route which offers no insurance. The IC is responsible for his/her taxes, health care, and FICA costs.

If you should lose your job, your job search may lead to working as an IC where you will have to purchase your own insurance. If you have a pre-existing condition you will also find yourself either unable to get insurance or you will pay a very high cost with an equally high deductible in order to get insurance. If you are not making enough money to afford these costs you will be uninsured.

With unemployment running around 10% and the use of ICs instead of employees, insurance companies are not doing too well right now. Young people — typically the insurance industry’s bread and butter because they typically need very little in the way of health care — are either unemployed or they are opting out of health care because the cost of living is so high. If you are making a lot of money today, you, yes you, are paying the brunt of the health care costs. Why? Because costs are being passed on to you.

For those without insurance, they are being carried in to the local hospital’s emergency room and they cannot be moved if they are not in stable condition. They will stay there until they are stable and at that point will be moved, perhaps and providing they do not die, to a county facility because they have no insurance. Who will pay for that? Yes, there is a reason for $1,000 Tylenol tablets.

Holding up a bill because you want to include the purchase of insurance across state lines is really not the bridge people should literally die on. Holding up a bill because you want or don’t want women to use the money for an abortion, again, not the bridge regular folk — like the aforementioned man and his wife — not thinking about an abortion should die on. These folks, Republican, Democrat, Libertarian and Independent should get it together and concentrate their attentions on getting help to those who need it now. Forget about all of this psuedo intellectual masturbation. People are dying, literally, for some kind of health care reform.

Again, insurance companies are in it for the money. If they insure a person with a pre-existing condition, the person being insured will never pay into the plan what will be needed to cover them over the long haul. The insurance company sees a person, say with diabetes, as a person who will at some point need care for Chronic Kidney Disease (CKD), amputation, wound care, hospitalization, etc. and that will cost more than the person could ever pay into the policy. Congress needs to focus on cutting costs.

Health care reform, for me, means starting at the top of the health care pyramid. Costs must be brought down which means there will, invariably, be some push back by all involved.

It’s reminds me of the old English fairy tale of The Old Woman and Her Pig. The woman bought a pig and oh my, does the story get good as she tries to get the little pig home. The pig wouldn’t jump over the stile so she gets a dog to bite the pig, gets the stick to beat the dog, and it goes on and on. People cannot afford insurance so they use the ER as their primary care physicians. Hospitals are used to seeing their emergency rooms being used for primary care so they pass the costs on to insurance companies who then pass the costs on to employers and employees and those at the bottom of the rung get screwed.

Medicare and Medicaid is getting screwed too because there are a few crooks in the mix as well. The crooks, feeling the government has deep pockets, will charge Medicare and Medicaid thousands of dollars a year for a wheelchair that costs about $500 if purchased outright. Who pays for that? The taxpayers. Again, considering the aforementioned New York Times article “the federal government hundreds of millions of dollars a year as they continue in some cases to pay for name-brand drugs even after their patents expire.” Who pays for that? The taxpayer.

Our little Mensa members — I like the fact that in Spanish Mensa means foolish or stupid — in Congress need to get a grip on what’s really going on in our society. I don’t know too many people receiving cost of living raises — like 34% — to cover the costs of how much everything is skyrocketing. If they are for the people they need to begin to act like they are. Palin talked about “death squads”. Well, they are already out there and people are slowly dying every day.

Sure, the bank bailout was a necessary evil because it perhaps saved your employer’s finances . . . and your job . . . and your insurance benefits. If the banks should fail one day your employer may fail, you may lose your job, and you too may find yourself dying for health care.

Tags:  Healthcare Reform, Pharmaceuticals