And please, if you feel strongly about health insurance, write or
call your legislators and let them know this is important to you.
There are 40 million people in this country who don't have health
insurance, and the number is growing with the economy in the
doldrums.
Thank you, Susan! This country spends more, per capita, than any
other on healthcare, and yet we have 40 million people with no health
care coverage, and many, many more, particularly the self-employed,
who are under-in sured and who will face ruin if they have a
catastrophic illness. Those i mbeciles in Washington, DC who loudly
proclaim that we have the best heal thcare system in the world should
talk to some of the 40 million with no coverage-- damn near anything
is better than no coverage at all! Access to basic health care
should be recognised as a human right, just as import ant as access
to food, water and shelter.
Those who are self-employed in this country face a particularly ugly
situation with healthcare, unless they are able to access a true
group policy 2E Individual health insurance is a confidence
game.Under invidual policies,you are effectively a risk pool of 1,
so if you are diagnosed with a ny ailments of even minor severity,
your premiums will increase as much a s 100% at renewal time, which
may well force you to drop your coverage. I t is also common for such
individual policies to be “underwritten on the back end.” This means
that you will be issued a policy fairly routinely, and your premiums
accepted, until you seek treatment for a serious medical condition.
At that time, your file will be pended, effectively stopping payment
to your healthcare providers, while your application for coverage is
reviewed, and your medical history (often going back five years
prior to your application) is investigated minutely for any
discrepancy which would allow the insurer to apply any of the “three
Rs”: retroactive rescission of coverage, retroactive rate increase
or a rider excluding coverage of the medical condition.Failing that,
the insurer will seek to establish that your current illness is
connected with, complicated by, or arose out of a pre-existing
condition. Even if the insurer uncovers no discre pancy, they
effectively block payment to your healthcare providers with these
tactics while the investigation is in progress, and I have personall
y observed several such underwriting investigations which took more
than a year to resolve. The insured in these cases is often forced
to both pay the premiums for their policy and pay their healthcare
providers out of pocket, and many cannot bear the financial burden.
(I’m not making this stuff up, and I didn’t just read it somewhere-
I am ashamed to say that I once worked for a Third Party
Administrator who em ployed all of these dirty tricks.)
Our system of healthcare financing does not just need to be
overhauled-- it needs to be discarded, and replaced by something
better and altogether different. I have been involved in healthcare
reimbursement for roughly 20 years, and in my experience the
Medicare and Medicaid models, where the coverage is spelled out
under governmental regulation, and where carrie rs administer payment
under governmental supervision, with government fun ds, result in the
vast majority of cases in prompt payment for medically necessary
care, with maximum protection of the rights of the patient, and with
the minimum administrative cost. From where I sit, single payor,
governmentally funded healthcare looks pretty good.
Perhaps those Orchid members in other industrialized nations could
give us feedback on their healthcare systems and how they work?
Lee Einer