Wow, August just flew by but there’s been a lot going on in the news cycle these days. I’ve tried for the longest time not to weigh in on the political battle currently being waged in Washington centered around health care but it hits home too closely for me to be silent anymore. There’s so much misinformation out there and flat out ignorance that I feel the need to set the record straight on a few points of contention. The first is, the figure of 46 million uninsured Americans currently in the United States. Let’s just take it on face value that this number is somewhat accurate (it’s not because it includes many young and wealthy Americans who choose not to have health insurance as well as illegal immigrants).
However, for the sake of this discussion, let’s say it’s true. The debate is expressed two-fold in terms of the need to get those who are uninsured access and the affordability of health care for all. Let’s just talk about the accessibility aspect of this debate first. Access to health insurance for these uninsured people is available right now to anyone. In fact, insurance companies are standing by waiting to sign them up with their own individual health policy that’s completely portable to take with them from employer to employer. In fact, they can call directly to the insurance carrier or shop on-line to access this health insurance without even getting an agent involved.
The second issue, affordability, is a little bit more complicated because it’s a relative term. The real question is, how much can they afford. On this note, the variety of options are absolutely endless. I know for a fact that an individual can get a limited-medical benefit plan for less than 100 dollars in monthly premium or an individual comprehensive major medical plan in upwards of 200 dollars in premium per month. So affordability isn’t completely the issue either. So what is it really?
Ahhh, I think I know what the real issue is – pre-existing conditions. That’s the real sticking point in the whole health care debate. It’s the real reason why employer-sponsored group plans continue to see average increases of 20 plus percent each year. You see with employer plan the insurance carrier typically can’t exclude pre-existing conditions, so, they therefore have to accept everyone in the plan at the same rate – healthy or not. Now, you’re probably saying, “so, what’s wrong with that”? The answer is, nothing, if you’re the employee. To the employer and the health insurance carrier, it means everything.
Let’s take the employer first. The basis on which the insurance carrier uses to adjust employer plan rates is what type of claim exposure they’ve had. If employees are becoming a heavy burden on the health care system then they have to increase the premium every year at renewal time.
To the insurance carrier, it doesn’t give them the ability to properly assess rates on an individual basis. Now, before you start shouting to me, “that’s not fair”. I want you to first consider another type of insurance that we’re all familiar with – Auto Insurance. Just imagine if I came to you and said that your auto insurance premium was going way up because there’s been a rash of auto accidents and DUI’s in your area. You would be extremely upset at me and rightfully so. Why should you be punished for someone else’s reckless behavior. You don’t and that’s the point. Somehow we’ve taken the health insurance concept into an entirely different realm where no one wants to pay more because they may have a certain disposition to sickness for one reason or another.
Now, I now our present system is in need of some changes – not an overhaul. There are some things we can do to address pre-existing conditions and get a handle on the overall cost. However, we must not exclude equally weighty matters such as personal choices about our individual lifestyles and wellness and be a bit more open to the reality that if you’re a heavy user on the health care system you may need to pay more than others who aren’t. I don’t know how the finale of this current debate will end up legislatively but I can say this.
As a benefit specialist, I’ll personally commit to signing up as many of those 46 million uninsured who find themselves left out of an employer group as possible to get them into their own individual option.