Rationing of Care - Now or the Future

Hi everyone -

Just a short note to open up another facet of the Health Care Reform debate.

Are we headed for Health Care Rationing or is it already here???

As the week proceeded, I listened to more news talk shows and some of the debates happening on The Hill.
I caught some of the "interrogation" of the Health Insurance Industry in the Capitol. I found their conviction in their insurance rate hikes quite pitiful. The CEO of Wellpoint disclosed her salary - $1.1 Billion in salary, plus $80,000.00 in bonuses plus $8.5 Billion in Stock Options. She had the nerve to say the company's profit margin was ONLY 4% - well and that totaled $2.9 Billion. She said they needed to raise their premiums 39% to just break even next year - well how about taking some of those overhead costs down a bit - like the CEO's salaries or per diem rates?

So my question at the end of the week was "Aren't we already having our health care rationed?" It sure seems this way to me.

Let's talk about it a little bit.

I've heard the horror stories of the other "socialized" medicine nations - people who die while waiting on surgeries or treatments; procedures being denied, etc....

Well I think we're already doing that in our Nation - the difference is we're not calling it rationing of care. It's being hushed up - not talked about. It's known by another name. It's called "denied service" or "not medically necessary" or worse yet, give me lots of money and we'll do whatever you want.

Once again, lucky for me and my family, right now, I don't have to worry about these scenarios because I've got a great job with great medical benefits. If I want a surgery - whether it's emergent or not, all I have to do is make an appointment and have my doctors say it's OK to do because of my condition. No questions asked, not much paid out of pocket. My doctor and clinic appointment co-payments are next to nothing - $5.00 a visit. My prescriptions, the same $5.00 a piece. And I don't have to pay anything for lab work or x-rays or most procedures. I consider myself one of the lucky few. Maybe you all know someone with this kind of plan - and maybe you're lucky enough to have the same. But I don't think there are a lot of us out there today. And because of my insurance coverage, I don't dare decide that I don't like working where I do - I sure can not afford to go somewhere else.

A few years ago, 60% of families could afford their insurance premiums. Few would consider not having health insurance. Today's figures are more like 30% can afford their insurance premiums and many more are on the brink of trying to decide whether to keep their coverage or not.

Now let's take a look at just one case and tell me it isn't some sort of rationing of care. Say you've suffered from arthritis for a few years, all those years of high impact aerobics or football games in the park from our youthful years. In the morning, as each year passes, it gets harder and harder to get out of bed and more and more anti-inflammatories to get rid of the pain. Now, let's say you're only 30 years old or you're a little bit over weight.

Finally you decide to make an appointment with your doctor to see if you need some sort of joint replacement. After your initial consultation, x-rays are ordered and it's decided that you could use one but it's not an emergency. It's an elective surgery per your insurance company's guidelines. First you're only 30 and you're a little over weight. The insurance company decides they just aren't going to approve the procedure as your x-rays don't lie - your joints just aren't that bad YET. But, don't tell your pain that.

Supposedly, hip surgeries cost between $35,000.00 and $50,000.00 in the U.S. depending where you get them done.

Because you've been denied coverage for this procedure, if you want to have it done, you'll have to pay the entire amount out of your pocket. Now who can afford that? Not anyone I know. So you just won't be able to get it done now, sorry, maybe in 20 years when you're older and your x-rays confirm the pain that you've been having for years. Then your surgery will be paid for.

Isn't this rationing of care? You can't have it done unless you can afford to pay out of pocket for it - or go to another country where it's cheaper. Oh, and in Canada, it would be done - although you may have to wait a year.

Now, let's say, you already pay $1,115.00 a month for your insurance premiums - that's the average cost of an health plan for two - so let's divide it in half. So you already pay $6,690.00 a year for your coverage - which isn't even going to count because they aren't going to cover your surgery.

Let's change the scenario a little bit. Your insurance company now says they'll approve your surgery. But ......you still have co-payments and deductibles to pay. It's still an elective surgery, not emergent. So you're already paying almost $7000.00 a year in premiums. You have had your pre-op appointments and now are getting ready to set your surgery date. The hospital now tells you, you haven't met any of your deductibles for the year and you'll have a co-payment as well.

Your plan has a $3,000.00 per person deductible and a 30% co-payment. These are the types of plans you can get for $1,115.00 per month. Wow! What a plan. That's what we call affordable insurance in this Country. So let's do a little bit of math.

The hospital won't do your surgery unless you can pay the up front fees - because it's not emergent. It can wait. So you have to come up with:

Let's say your surgery is going to cost $42,000.00. That's in the middle of the guesstimate for this type of surgery.

You owe $3,000.00 up front for your deductible. You'll owe $12,600.00 for your co-payment. Again do you know anyone who can just come up with $15,600.00 out of pocket for your surgery. I sure don't.

And that's not even the whole story. You're also going to be off work for at least, at the very least 8 weeks or longer. You'll miss work. If you have vacation or sick time, you're lucky. But if not, you're out of your income as well. If you're lucky, you have short term disability coverage. Let's say you make $30,000.00 a year which is the current median income for individuals per the census figures. That's $5,000.00 you'll lose over 2 months time if you don't have paid vacation or sick time. Now, if you have short-term disability, you can recoup some of that - usually 2/3s. So you'll only lose $1,670.00 out of pocket. But wait, don't forget you'll have to pay income tax on that at the end of the year so you'll have to take $830.00 back out.

So let's do a quick tally.

So even if you have insurance and you have this type of common plan, you'll owe out of pocket....

$15,600.00 in deductibles and co-payments.
$5,000.00 in lost wages if you don't have vacation or sick time.

That's a total of $20,600.00 out of pocket when you have insurance that you're paying $7,000.00 a year for.


If you have short term disability, you'll pay......

$15,600.00 in deductibles and co-payments.
$2,500.00 in lost wages and taxes.

That's a total of $18,100.00 out of pocket when you have insurance that you're paying $7,000.00 a year for.

Now figure on top of that all of the credit card debt that you will be using too if you decide to just bite the bullet and start paying for some of this as you are really having a lot of pain. Think of the new interest rates of 20% if you're carrying balances.

And what if there are complications???

Now take the choice away - what if you have to have emergent surgery and you have these kind of deductibles and co-payments. What if you make $20,000.00 a year instead and you don't have a good job. What if you live paycheck to paycheck? I sure can see how one illness can bankrupt a family. Cant' you?

And if you're going to tell me that the hospitals will work with you on a payment plan - yes they will IF it's an emergency surgery. But they WILL NOT if it's an elective surgery. They demand their money up front or they won't even consider doing the surgery.

Now you tell me this isn't BS. Why do we even have insurance? I find this quite appalling and a bit of a mystery? What kind of Nation are we anyway? What happened to "We the People"? I guess we know the bottom line, the profitability of the insurance companies and even the hospitals and providers are much more important then the health and well being of our citizens.

It's all quite clear to me. There already is rationing. And people are suffering and dying already while waiting to get the care they need and deserve.

Bottom Line - it's here already. And even if you haven't experienced it, it doesn't mean it's not happening to some one else that you already know or may know in the future. We can only hope it never touches us and our loved ones.