OP-ED | Sign Me Up For New Insurance Option
by Sarah Darer Littman | Sep 23, 2011 1:43pm
(23) Comments | Commenting has expired
Posted to: Opinion
When I moved back to the United States from England in 1999, I was spoiled on the healthcare front. Republicans love to scare you with all the horror stories about the NHS and “socialized medicine.” I’ll admit it’s not perfect and there are problems with wait lists for non-urgent procedures. But let me tell you a true story. When I had my kids, I paid nothing. Zero. Zilch. But wait, there’s more. A midwife came to my house to check up on each of my babies and me for eight days after the birth – and I lived in the “suburbs” of a rural English village. And get this - my general physicians practice made house calls in the middle of the night. If that’s the evils of socialized medicine, sign me up.
But here’s the thing. I was also able to get private insurance at a very reasonable cost, in case I wanted to go see a London physician or go to a different hospital. I had a choice, and it was affordable.
When we moved back here, we were confronted with the ugly reality of the U.S. healthcare system. No insurer would cover us because of pre-existing conditions, even though we’d had private insurance abroad for years. It was terrifying.
As a self-employed person I’m able to get insurance these days as a small business, but it’s extremely costly, and each year my insurer charges more and covers less. So I was very excited to read about HealthyCT, a nonprofit entity launched by the Connecticut State Medical Society and the Connecticut State Medical Society-IPA. The group has filed a letter of intent with the U.S. Department of Health and Human Services to become a Consumer Operated and Oriented Plan (CO-OP) under the Patient Protection and Affordable Care Act. HealthyCT will offer consumers and employers primarily in the individual and small-business market an additional choice for health insurance through the state’s newly created health insurance exchange.
“As physicians – and as employers and consumers ourselves – we know that it’s time Connecticut had more options in the health insurance marketplace from an insurer that puts patients before profits,” said David S. Katz, immediate past president of the CSMS. “We at CSMS know from our own involvement fighting rate hikes on behalf of our patients that they don’t have access to insurance options that focus on quality of medical care and emphasize the patient-physician relationship.”
This is music to my ears. While I know that there are those who persist in believing that the free market solves every problem, as someone who has confronted the ugly reality of the for-profit health model vs. the alternative, I firmly believe that the free market, where lives are at stake, is not the best option. Sarah Palin might yack on about “death panels” under “Obamacare,” but believe me, if you’ve ever been through the appeals process with your health insurance company, you know full well that they already exist.
HealthyCT will be designed with quality and the physician-patient relationship at its core, not profits, according to Matthew C. Katz, executive vice president of the Connecticut State Medical Society. “Today, there is no not-for-profit option in the commercial market space. Unlike traditional health insurers that focus on claims and claims denials — which is to say, denying care or simply setting up administrative barriers — our focus will be on developing quality-based programs and processes that encourage the appropriate use of health care services and incentives for early detection and prevention of illness and access to medical care,” Katz said.
Of course the for-profit insurers aren’t as happy about this new development as I am. The national trade association for the health insurance industry, America’s Health Insurance Plans, wrote a letter to the DHSS on Sept. 16, detailing their objections to the CO-OP proposals. In this epistle, AHIP Executive Vice-President for Policy and Regulatory Affairs, Daniel T Durham, repeats the phrase: “level playing field” like a mantra.
I find this ironic and having been on the receiving end of the insurance company appeal process. It actually makes me furious. Consumers, the ones whose lives are actually at stake here, don’t have anything like a level playing field when it comes to purchasing healthcare, yet insurers insist on one for selling it.
As the CSMS’s Matthew Katz observed: “The health insurers don’t want real competition. They have been enormously successful in limiting competition in Connecticut in recent years through mergers and acquisitions. We have a highly concentrated market in Connecticut, and it is hard for a new insurer to come in and offer competitive rates. The benefit of the CO-OP is that it is not-for-profit and receives some federal funding to start, which helps level the playing field: It infuses competition into a market that desperately needs it. In this case the investor is the federal government and the ones who will benefit are the consumers, the plan members, who will own the plan.”
I, for one, can’t wait.
Sarah Darer Littman is a columnist for Hearst Newspapers and an award-winning novelist of books for teens. Long before the financial meltdown, she worked as a securities analyst and earned her MBA in Finance from the Stern School at NYU.
Tags: affordable health care, connecticut, csms, healthyct
(23) Comments
posted by: Terry D. Cowgill | September 24, 2011 7:11am
Sarah, I understand your frustration with the for-profit healthcare system in the U.S. But don’t delude yourself into thinking that birthing your kids in England cost “nothing.”
If you lived and worked in the U.K., you paid much higher rates of taxation, either in the form of income taxes or the VAT.
The money for that big, generous NHS has to come from somewhere. Whether it’s preferable to what we have is another matter entirely (I happen to agree that it probably is).
posted by: saramerica | September 24, 2011 11:47pm
Obviously I paid for it with my National Insurance Tax, as did every other working member of the UK populace. But I wasn’t paying $1950 a month in premiums, THEN having a huge deductible, paying massive copays, and being more covered services every year.
posted by: CitizenCT | September 25, 2011 8:11am
Sarah, you compare healthcare costs now in the US to healthcare costs in the UK 12+ years ago. Not really a fair comparison to ignore inflation and changes to healthcare practices. The UK, with its socialized medicine has a national debt approaching 80% of its GDP. They’re in worse financial shape than the US, though we’re catching up rapidly. Austerity measures are under way. It’s fair to be frustrated with US healthcare, for sure. But you need to benchmark comparisons on an apples to apples basis. The grass isn’t always greener on the otherside.
posted by: GoatBoyPHD | September 25, 2011 5:26pm
A full discussion has to include malpractice and the inefficient delivery system itself.
One of the reasons the VA gets accolades for lower costs is the use of a medical records system that gives them complete visibility into the back end for gathering metrics on plant, equipment and personnel utilization. They measure outcomes by the full supply chain to drive purchasing and other decisions making. Rhe VA hires experts from Big Box reailers like Walmart to improve their decision support systems.
Expansion decisions, such as a new ambulatory care center in lieu of a full hospital in a rural area are made based on sound fiscal analysis.
In general, the VA is free from malpractice claims but can be sued under the Federal Tort Claims Act.
http://tinyurl.com/gvffu
Romneycare and Obamacare have a few positives—guaranteed insuance, needs testing, and in Mass a very easy purchasing process (which CT will completely butcher from the looks of things).
The doctors and hospitals are happy. More, patients, more coverage, and guaranteed payment from either govenrment or an insurer. No more uninsured walk ins. Walk ins will be ‘enrolled’ during their stay.
Even better! None of the euro-style or vets-style of cost containment is being implemented. Runaway spiraling costs and malpractice can continue as usual!
Remember the outcry over mammograms in the US from last year?
Who is screened for breast cancer in the UK?
>>
The NHS breast screening programme uses breast X-rays (mammograms) to screen all women in the UK aged 50 and over who are registered with a GP. Women aged 50 to 70 are sent an invitation to go for screening every 3 years. <<
Every 3 years? There’d be a riot in the US as women’s groups will take advantage of the ignorant and enflame their passions
.
http://tinyurl.com/3qqaqmm
Superstition and inflaming the passions of the ignorant by non-profits like Susan G. Komen for the Cure won the day. Mob rule wins again!
Science takes a backseat to deep pocketed special interest groups!
posted by: GoatBoyPHD | September 25, 2011 11:36pm
More on the breast cancer screening debate from the UK
http://tinyurl.com/3ecuafj
And more from the US including suggestions for other improved screening programs like genetic markers which could be financed by the reduction of mammographies if science ruled the decision making rather than political groups demanding marginally effective screening.
These same industry groups and nonprofits who helped build the mammogram industry are often heavily financed by medical equipment manufacturers and not driven by science per se.
http://tinyurl.com/3q98m9q
posted by: saramerica | September 26, 2011 6:31am
CitizenCT - I could just as easily tell you about the cost of my insurance for a family of 4 on the CT State “Losers Pool” Insurance, which was all we could get when we moved back to the States 12 years ago. I could tell how that insurance didn’t have a prescription plan, so we had to lay out for all of our prescriptions and then apply for reimbursement, and how at one point United Healthcare owed us close to $10K and it wasn’t until I wrote to the Chairman of UHC copied to both Senators and my Congressman that I suddenly started getting reimbursement checks.
posted by: one-mans-voice | September 26, 2011 10:39am
If you are paying $1,950 a month for insurance perhaps you should do a better job of shopping.
posted by: saramerica | September 26, 2011 11:45am
Thanks for the snotty comment One Man, but when you’re a small business, your options are very limited. Face it, if an organization with over 5,000 people in it was turned down for cover, do you honestly think I have such a big opportunity to “shop around” as a one person business when I have one kid with Type 1 diabetes and another with Aspergers? Wake up and smell the coffee. Under this wonderful free market system we have in the US of A, I’m lucky I can even GET insurance,let alone be “privileged” to pay through the nose for it.
posted by: NOW What? | September 26, 2011 3:10pm
Oy vey! Virtually *every* self-employed person, small business owner or small LLC partnership member in CT knows *exactly* how dysfunctional, inefficient and over-priced our current insurance “system” is. And all of us who’ve been around long enough to know, know that the beginning of its deterioration began when Blue Cross and Blue Shield were allowed to convert from non-profits to for-profits and then later merge into (for-profit) Anthem.
The only way to try to improve the situation is to find a way to re-introduce non-profit medical insurance, be it via formal non-profit insurers or some other so-called “public option” vehicle. Heck, even the old for-profit MDHealth Plan, which was created and owned by CT-based physicians associated with the Conn. Medical Society (before it was sold to HeathNet) was better than anything that currently exists. The current ideas of the Connecticut Medical Society sound EXCELLENT. If the current for-profits don’t like the idea, TOO BAD.
posted by: Mitchell Young | September 26, 2011 4:16pm
For several decades CT had several non-profit health insurance plans - ndeed all the Blue Cross Plans were Non-profits - many still are.
They typically insure the lion’s share of people in the state in CT it was about 60% in VT over 70%.
In VT many folks still want to overturn it and put the state government in charge. Perhaps the agenda is not about profit after all.
By the way it was government that allowed, often pushed for the conversions to profit by the health plans. Why?
The large non-profits were overstaffed, expensive, often nearly bankrupt, unable to keep rates down.
Now you want to blame the profit motive, doesn’t the nurse and doctor and mid-wife, and health tech all seek a profit.
It’s not just the tea party that is enamored of simplistic answers.
posted by: GoatBoyPHD | September 27, 2011 3:25pm
Objective government figures on health care costs from 1960-2009.
Medicare? A 9.9% average increase per capita over 40 years. Private insurance? 11% per capita over the same period?
Sector growth of health care? From 5% to 18% of the GDP.
Let’s not pretend there’s a Democrat in CT who’s interested in driving down the real inputs to the spiraling health care crisis in CT.
Insurers are merely a convenient whipping boy to take the eye of the ball to protect SEBACcare for politicians and union members.
Pass a 90% medical loss ratio bill, end the denial of issuance for pre-existing conditions or risk, and level the premium costs between demographic groups then it’s done. A one-time cost savings from the insurers.
Mean testing and a state purchasing portal. Great! All for it. Neither lowers the cost of delivering health care.
Reform malrpractice pain and injury and suffering awards? Another one-time necessary fix.
The delivery costs are a mess. As the figures show from 1998 to 2009 the dollers paid to physicians more than doubled. clinical costs almost doubled.
http://tinyurl.com/mp32zx
posted by: GoatBoyPHD | September 27, 2011 5:05pm
There are also claims of cost-shifting between high median income states like CT and less affluent states. As it is, CT is one of the 5 highest states for premium growth of 145% since 1999 according to Kaiser with an increase of 110% in out-of-pocket expenses.
There’s there’s state employees with their plan which runs 15% higher than private insurance premiums.
Have any politicians been able to lower that premium through self-insurance and squeezing out Anthem and others?
I thought not. Cleverly, that is now prohibited by union contract.
Here’s a link to the state premiums from 2008
http://tinyurl.com/3zjr2cm
Not a bad example of government cost savings in insurance 
Anthem State Preferred POS family plan $21,474.18
Anthem State BlueCare POS family plan $16,430.96
The CTmirror has some good coverage today.
http://tinyurl.com/3v5zf4r
Insurers are a small part of the problem as Mass is finding out. Most of their plans are with insurers with 95% medical loss ratios or higher.
Theri recnt studies into cost drivers concentrates more on the delivery system and lack of industry metrics and visibility. Insurance companies aren’t the villian and areeasily regulated. One sidebenfit of legilsating low medical loss rations is it forces insurers to become better purchasers to drive industry reform. Not brute force cost cuttin but various forms of value care that assess risk groups for treatment and diagnosis.
Gone would be the yearly mammograms because the Women foundation wants it that way.
posted by: Joe Eversole | September 27, 2011 7:02pm
Sarah,
While I sympathize with your plight regarding affordable insurance, the fact of the matter is that there isn’t a free market system in healthcare. What you have here is the worst of both worlds. Government intervention, with for profit models. Don’t delude yourself that the free market can’t solve this problem. If they were given free reign, the competition for business would drive overall costs down. In addition, ending the malpractice issues would also drastically reduce the overall cost.
posted by: NOW What? | September 28, 2011 2:11pm
GoatBoyPhD - You said “Have any politicians been able to lower that premium through self-insurance and squeezing out Anthem and others?
I thought not. Cleverly, that is now prohibited by union contract.”
I might be misunderstanding what you’re trying to say, but the State IS self-insured, paying Anthem and United only for their customer claims processing services. Also, I believe the Anthem “Preferred” plan has been closed to new (state employee) enrollment for 2 or 3c years now… and most are in a POE or “Gatekeeper” plan (they’re much cheaper).
posted by: one-mans-voice | September 28, 2011 3:30pm
Sarah, if you are self-employed then you can deduct up to 100% of your premiums from your Federal return. So I guess you are not really paying $1,950 are you?
posted by: Christine Stuart | September 28, 2011 3:34pm
one-mans-voice,
I hope you’re not an accountant because that certainly isn’t the case. I also am self-employed and I can tell you even using an HSA you may be able to deduct a portion, but certainly not all of it and certainly not the amount you pay in premiums. You can only deduct the amount spent on medication and other medical devices which you have to spend out of the HSA. So you have to have the money up front and the reimbursement from the federal government hardly covers all of it.
Christine Stuart
posted by: one-mans-voice | September 28, 2011 3:35pm
Direct from the IRS Website:
http://tinyurl.com/4y9xqjc
Health Insurance Costs for Self-Employed Persons
If you were self-employed and had a net profit for the year, you may be able to deduct, as an adjustment to income, amounts paid for medical and qualified long-term care insurance on behalf of yourself, your spouse, your dependents, and effective March 30, 2010, your children who were under age 27 at the end of 2010. For this purpose, you were self-employed if you were a general partner (or a limited partner receiving guaranteed payments) or you received wages from an S corporation in which you were more than a 2% shareholder. The insurance plan must be established under your trade or business and the deduction cannot be more than your earned income from that trade or business.
You cannot deduct payments for medical insurance for any month in which you were eligible to participate in a health plan subsidized by your employer, your spouse’s employer or, effective March 30, 2010, an employer of your dependent or your child under age 27 at the end of 2010. You cannot deduct payments for a qualified long-term care insurance contract for any month in which you were eligible to participate in a long-term care insurance plan subsidized by your employer or your spouse’s employer.
If you qualify to take the deduction, use the Self-Employed Health Insurance Deduction Worksheet in the Form 1040 instructions to figure the amount you can deduct. But if any of the following applies, do not use that worksheet.
You had more than one source of income subject to self-employment tax.
You file Form 2555, Foreign Earned Income, or Form 2555-EZ, Foreign Earned Income Exclusion.
You are using amounts paid for qualified long-term care insurance to figure the deduction.
If you cannot use the worksheet in the Form 1040 instructions, use the worksheet in Publication 535, Business Expenses, to figure your deduction.
Note.
When figuring the amount you can deduct for insurance premiums, do not include any advance payments shown in box 1 of Form 1099-H. Also, if you are claiming the health coverage tax credit, subtract the amount shown on Form 8885, line 4 from the total insurance premiums you paid.
Also, do not include amounts paid for health insurance coverage with retirement plan distributions that were tax-free because you are a retired public safety officer.
Where to report. You take this deduction on Form 1040, line 29. For 2010, you can deduct your self-employed health insurance deduction in determining your net earnings from self-employment only for purposes of figuring your self-employment tax. If you itemize your deductions and do not claim 100% of your self-employed health insurance on line 29, include any remaining premiums with all other medical care expenses on Schedule A (Form 1040), subject to the 7.5% limit.
posted by: one-mans-voice | September 28, 2011 3:54pm
Christine,
I am not an accountant that’s why I cited the IRS website that says you can. Why didn’t you approve that comment?
posted by: saramerica | September 28, 2011 4:19pm
One Man - If I weren’t too busy actually trying to write a book proposal so I can actually earn an living I would produce a lovely little pie chart for you that would show you the huge percentage of my annual expenses that health care costs represent. I’m not just talking premium. I’m talking out of pocket.It’s by far the greatest expense in my budget.
posted by: GoatBoyPHD | September 28, 2011 7:03pm
Sarah,
Out of pocket is really a hidden tax when comparing the mandate on the working poor when compared to Medicaid recipients. Yes employers have to pay 2/3.
For someone in their 50s earning $30,000 a year they will pay around 6% plus deductibles and out-of-pocket when using it. a broken leg and that 6% begins to look more like 20% plus assuming there isn’t a work interruption.
I don’t like the work disincentive and the out of pocket disincentive to use the policy. Medicaid has it so much better!
posted by: Careful | September 28, 2011 8:05pm
Sarah Darer Littman: Although I basicallly agreed with your blog, minus your hereditary political shot against the GOP: You wrote, “When I moved back to the United States from England on the healthcare front: REPUBLICAN LOVE TO SCARE YOU WITH ALL THE HORROR STORIES ABOUT NHS AND SOCIALIZED MEDICENE!
Everyone should know that you are profoundly anti-GOP, but would you please try to limit your political emotions when you write, as I agree with most of what you write, but have told you in the past—that your continual political hate—ruins your usually good, intended message. Thanks you, Sarah.
posted by: NOW What? | October 1, 2011 12:23am
I just want to make one last comment on this subject. It “appears” to me, shall we say, that the Malloy administration is actually engaging in the on-going development and evolution of a pretty sophisticated plan to address these issues. It’ll take some time to further evolve and more fully implement, but they seem to be moving as quickly as they can without unduly upsetting the apple cart all at once, step by step.