Letter to the Editor: Health care costs

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Those who have health care insurance provided by an employer might be interested to know that those of us who are left to fend for ourselves have been notified by Anthem Blue Cross (the only insurer in the state willing to cover individuals) that it intends to apply to the Insurance Commissioner for an average premium increase of 22.9 percent for 2010. This comes on top of an average increase of 18 percent last year… and so on over many previous years.

To put this in perspective: if the rate increase is approved, two adults aged 40 – 44 with two children will pay $1,736.28 per month for coverage with a $2,250 Individual/$4,500 Family Deductible. Another example: A couple aged 55+ will pay $1,084.18 per month for coverage with a $5,000 Individual/$10,000 Family Deductible. To be clear: these deductibles apply each year so these sums have to be paid out first each year in the event of a continuing medical problem before insurance kicks in.

Anthem can get away with this because there is simply no alternative. It is true that Anthem’s costs are increasing because the costs of medical care are rising for a variety of good and bad reasons, and because healthier, younger people are giving up insurance leaving the elderly and sick to be covered by Anthem. It is a vicious circle. Of course, those who give up insurance will use the hospital emergency room – a very expensive way to be treated – and, in many cases, will be unable to pay their bills leaving the rest of us to pick up the tab.

Health insurance simply cannot go on like this. As a first step, the Insurance Commissioner should take Anthem to task for the egregious increase it is seeking and then should find ways to encourage other insurers to compete in this market place. At the premiums now being demanded, surely some company will see an opportunity?

Alvin Da Costa
Farmington

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15 Comments

  1. Perhaps you should lobby your legislators to allow you to buy insurance across state lines. If it is good enough for automobile insurance why not health insurance? While you are at it ask them to remove mandates such as maternity coverage or drug and alcohol counseling. Mandates and the limit on competition across state lines increase premiums beyond the average person’s means. It is not Anthem’s fault what they are required to cover or who they have to cover, but insurance is the spreading of risk and the more mandates placed on them the more they have to pass aound. I used to have Anthem and was told by a doctor that they were the cadillac of insurance plans. They should be they have the best benifits. People should look at health insurance the same way they look at auto insurance. You don’t expect your auto insurer to pay for an oil change or a flat tire do you?

  2. What the doctor probably meant by Cadillac Coverage was that it was good. This isn’t something that gets us from point A to point B — we all need good health care coverage. Health costs straight from the hospital are too large for someone to cover regularly with just a paycheck. I agree we should definitely be able to buy health insurance from anywhere and not be forced to buy from any specific provider. But blaming the victims is not the way to go on this issue. Point your ire at the companies — Anthem Blue Cross just made how multiple billions of dollars in profit and now they increase their premiums? Criminal.

    Thanks, Alvin, for the reality of the situation. Sadly though for some reason this gets the people fighting with each other so nothing can actually get done about the problem.

  3. There are a number of issues. One is that becasue you cannot be denied health insurance in Maine and this is an older, sick, tobacco using, very overweight state , insurers pay for alot of tests and care. As their products continue to be obscenely expensive ,less people buy them, thus the costs must be shared among fewer and fewer people ,thus costs go up
    Of course so do the profits becasue we allow unlimited for profit health insurance companies in this country.Congress has refused to touch this.
    There are a few things that can be done. One is for employers to pay for primary care if they do nothing else.The most useful part of care is primary care and it is relatively cheap. If employers paid for -simply flat out paid for -4 visits a year they would prevent many many ER visits and hospitalizations and keep people comfortbale and well and at work.Cheaply.
    Any doc worth their salt knows how to get at least some meds and tests dirt cheap -but you have to come in. Which you will not when you pay cash .
    Another solution is to engage your doc in a dollar a day program Most docs can take car e of you for $30 a month every month and then a small charge at visit time . The same charge every visit no matter what. This is legal and is being done
    However, the bottom line is that people in this country do want a plastic card to plunk down to cover things –fair enough -but do not want the government to administer that, do not want to have to pay for it, do not want to spend time with a doc who is wiliing to spend it, to avoid tests and work on complex issues,and continually sends people to congress who mean well but can get nothing done.due fo both corruption/lobbying influences and the mxed messages we constituents send them

    Health care will not change in this country until every player at the table changes Certainly insurers are for profit and they will never change until legislated out of their present type of existence But the fearmongers make the pubic resist that too We have seen the enemy an d he is us.

  4. You shouldn’t compare what car insurance covers to what health insurance covers. The costs involved are so drastically different. According to Alvin Da Costa’s figures, it would cost me $1736 a MONTH (with the proposed increase) to cover my family of four with health insurance. I don’t pay that much for my two cars in an entire YEAR. If I could purchase health insurance for the price of car insurance, sure I’d be willing to pay for some preventative “maintenance” directly. Unfortunately, health insurance costs are way beyond reasonable. This country needs a DRASTIC overall of its health care system!

  5. “People should look at health insurance the same way they look at auto insurance. You don’t expect your auto insurer to pay for an oil change or a flat tire do you?”

    are you then saying that it’s unreasonable to expect health insurers to cover preventative care?

    interesting analogy, if you assume that most americans have comprehensive auto insurance instead of just the bare minimum liability requirements. then there are those that simply choose not to drive, or to drive without insurance out of economic necessity. i wonder how many people die every year because their auto insurer drops them over some rust on their car or a knocking sound from the engine. i wonder how many people succumb to poor health later in life because they chose to spend their money on food, bills, and clothing for their children instead of having their car’s engine tuned up and their oil changed regularly.

    you’re comparing apples to oranges. auto insurance exists because choosing to drive a car is taking a tremendous risk, and if you injure somebody or damage something, you’re covered. so no, nobody expects their auto insurance to cover routine maintenance or preventative care. if your car breaks down, you fix it, you buy a new one, or if you can’t afford it, you walk. if you break down, you need to see a doctor. and if you can’t afford that, well you’re screwed.

    excuse me if i’m reading too much into those two sentences.

  6. Let’s go, Lance. Step up and show people how you feel. One cryptic sentence does us no good. Do you have any ideas about how to help this situation? You can call Charlie and Chandler to see how they feel first if you want to, but let’s hear YOUR ideas. YOU are an elected official.

  7. For clarification, the comparison to auto insurance comes up alot .Docs who are unhappy – many of us frankly- also use this comparison. Because while it is cultural that Americans DO put down a plastic card expecting it to pay for everything in health care , in an economic model, if indeed you had an auto insurance card that you put down for every oil change, gas fill up,windshield cleaning ,registration etc the the cost of that auto insurance would soon be driven sky high in trying to cover all those services – some of which would be varying daily like gas prices ,and the insurers would be saying oh we need a premium hike to be able to cover all this..Just like health care is some ways Not an exact comparison

    This forum does not have adequate space to cover more but here is an example that patients-who have enough trouble being patients for pete;s sake– lost in a bureaucracy, made to wait ,worried about money their job /time off/pain etc do not know . One example. Anthem tells a woman that getting an IUD put is in “covered” .That means the patient does not have to pay. Patient likes that -YAY However the IUD itself ,not to mention the skill to insert it , (,and forgive me if this is a delicate topic. it is merely a good example) the IUD itself costs 400.00. Anthem etc will”reimburse me” weeks and weeks later,after filling out complex forms that get rejected and sent back half the time $150.00 . Yes. that’s right Those of you who have jobs are paid within 2-4 weeks the same amount for every hr or however your salary is set up .It now behooves the public to drop the assumptions they hold and learn that docs are paid in bizarre uneven frustrating ways forcing us to think about this money garbage constantly.SO -If I want to offer an IUD to a woman I have to PAY 250.00 to do it . Yet the patient hears that this is “covered”. It is ILLEGAL to bill the patient for the difference. “Coverage “to a doc is nasty advertising game played by t he insurers

    To fix health care the recipe is simple–though not simple to execute. We need a basic set of primary care services covered for people. We need primary care re invigorated inthis country. In every other high fucntionaling industrialized coutnry in the world primary care is the heart of health care.In the US people outsource every organ to a differnt vastly higher paid specialist, thus driving up error rates and costs.Primary care docs need to be paid differenlty- globally ;not stuck nickel and diming pateitns by fee for service.Be a ware that docs who read XRays and fix catatracts are paid 3-5 times as much a s primary care docs who are often unable to stay in business without second jobs. ASK ME how many I know who have closed up shop all over the country becasue they cannot pay their bills Really.
    We need one payer even if it is different say regionally and NO IT DOESNOT HAVE to be the government but it darn well needs to be overseen tightly by someone
    We need to make care simple accessible efficient, and with patients having their care coordianted so they know who is i n charge, and can prevent errors and unnecessry testing and admissions.
    Congress does not get this
    MAny docs do.
    Talk to your doc and get them to work on “open access scheduling.”
    Support a single payor-drop your fears Get facts Every other industrialized coutnry IN THE WORLD does this.
    Ca rry your own med list and
    be involved in your care.
    Vote out legislators who will not make change ChAnge is very veryh ard and risky for them but we cannot wait any longer can we?

  8. Thanks, Alvin. It is my understanding that Anthem/Blue Shield is part of Wellpoint, which is about to raise rates in California by 39%. And no one is figuring out how to stop this cycle. Unless there is some competition, I don’t see it happening. What we have in Washington is a government of the corporations, by the corporations and for the corporations. And this is a problem that affects people in both parties. And as if it wasn’t enough to have this be the case in the legislature, now the Supreme Court has aligned itself with the power of the non-person, the corporation. Health insurance companies have very few limits now, nothing to control the monopoly, no anti-trust provisions, and until things shift around, this is only set to escalate. One only needs to check the campaign contributions that Snowe and Collins receive from this industry to get to the root of the problem.

  9. Thank you, Doctor Antonucci,
    Your description of the health care industry from the doctor’s perspective. Single payer is essential for real change. I support it and will vote for a candidate who does, too. Obama did not. He could have, but he did not. Will Ralph Nader run again? If he does I will vote for him because he supports single payer.

  10. Coming in on this late but Single payer is not the answer

    These ideas actually cut the cost to the individual, in the “now” not in the “future” like failed Democrats plan.

    * Provide a refundable tax credit – $2,300 for individuals and $5,700 for families – to purchase coverage in any State, and keep it with them if they move or change jobs.
    * Provide transparency in health care price and quality data, making this critical information readily available before someone needs health services.
    * Create state-based health care exchanges, so individuals and families have a one-stop marketplace to purchase affordable health insurance without being discriminated against based on pre-existing conditions.
    * Equip states with tools like auto-enrollment programs and high-risk pools, so affordable health coverage can be accessed by all.
    * Address health care’s growing strain on small businesses, by allowing them to pool together nationally to offer coverage to their employees.
    * Encourage the adoption of health information technology and assists states in establishing solutions to medical malpractice litigation.

  11. Although increased choice of insurance provider sounds attractive, it would most likely increase the cost of healthcare delivery. Even the smallest of healthcare providers need full-time employees working diligently to decipher the complicated billing requirements and collect payment from insurance companies. Every plan in Maine is already vastly different in terms of covered services, deductibles, copays, billing codes, referrals, levels of coverage, ect. It would require even more of our valuable resources to be dedicated simply to collecting payment, instead of to services provided. It could be enough to drive many providers and hospitals out of business.

    Also, why are we ok with allowing employers to choose our healthcare coverage? I know that many businesses would be most happy to be relieved of this duty and expense. A single payer system could allow more business resources to be dedicated to job growth.

  12. There is no alternative to Anthem because any potential alternative would have to sell the same product, by mandate from Augusta. The new insurance company would quickly realize that it would have to charge the same premiums as well, or lose money hand over fist. Those mandates chased away all the other companies in the early 90s and they ain’t coming back until the Augustacrats admit that they are 100% incompetent to manage any aspect of health car/insurance. Don’t hold your breath.

  13. Thanks Hutch. Very interesting reading.

    No doubt, this plan would decrease federal spending on healthcare. I’m not convinced that it would decrease the actual cost of healthcare delivery. Insurance companies will probably pay out less, not because healthcare costs will go down, but because the most affordable plans will offer the least coverage. The plan will increase administrative costs for healthcare providers and hospitals(most of whom are already struggling to stay open).

    I would like to see a plan that addresses both the cost to the consumer, as well as the fiscal and administrative challenges faced by providers. This is the only way that true savings will be realized while maintaining the highest quality of care and covering the most citizens.

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