Posted by: Genny Colby | November 5, 2012

National Health Care

How many of you have actually looked at the “statement of benefits” that your insurance company sends you after they receive a claim for services.  Do you see how much your doctor/clinic/lab/hospital/etc charges your insurance company?  Do you notice how your insurance carrier, due to “agreed upon fee rates” pays usually one-third to one-half of that amount?

Have you ever looked at what your prescription costs BEFORE your insurance kicks in and you are left with a mostly reasonable co-pay?

I hope after looking at these two things you realize that the medical field, insurance, and the pharmaceutical industries are FOR PROFIT.  Have no doubt…they want to make money.  Lots of money.  And if there is a way for them NOT to pay something, they will find it, or try to find it at least.

We are a family that has to have health coverage due to a pre-existing condition that requires daily medication and frequent doctor visits in order to keep good control of the condition. We have to be sure our employer offers some sort of health care plan, as we would not be able to get insurance as an individual; we would be denied.  The hubby has actually turned down job offers because the insurance package was either not there at all, or was so minimal that it was like having nothing at all.  Right now, everyone’s health is pretty good, no serious issues, no serious worries.  But there is a very real possibility that down the road our family may require more medical intervention, may have more costs that we would hope insurance would cover, at least a large chunk of for us.  So we pay close attention to insurance laws.

Some form of national health care has been in discussion/debate/etc since at least the Clinton years, if not earlier (I will admit that this is the time of my life that I began to pay more attention to politics).  I understand that this is a complicated undertaking.  And I understand that insurance and pharmaceutical companies have strong, well-funded, and powerful lobbies that have a lot to say on this issue.

Now, I am not here to say that the current legislation Patient Protection and Affordable Health Care Act 2010 is the answer to all our prayers.  Nor am I saying that it is the perfect piece of legislation.  I know there are issues with it, I know there are things that need tweaking, re-writing, adding/subtracting, or just plan figuring out logistically.  But it is the first REAL step into providing coverage of some sort for everyone.

We do not live in a third world country.  We have some of the best medical specialists in the world.  There is no reason that anyone/everyone should not have access to basic medical care, should be denied needed medical coverage because of a pre-existing condition,  have to worry every night if your child is sick enough that you should risk a trip to the ER and the subsequent bill, or how you are going to cover a doctor’s/hospital/pharmacy bill in order to get the medical care you need.

Now, there are some that will argue that anyone in need of medical treatment can simply go to the ER and they will not be turned away.  Okay, let’s talk about that idea.

By the time someone gets to the ER, his condition is so severe that advanced medicine, surgery, or other longer term treatment is required.  Would it not have been better to have been able to seek treatment at the first signs of a problem, before it got serious? Wouldn’t that save everyone time, energy, and money? Nice idea huh? But if you don’t have health insurance, you don’t generally have a primary doctor, you don’t generally go to the doctor (or take your kids) for preventative care. You wait until you have no other choice but to seek treatment of some kind.

The ER will treat the most serious and life threatening of issues.  They will set a bone, stitch up a wound, run diagnostic testing, even operate as needed.  But follow-up care, or continuing care is not provided at the ER.  So where do these people go?  They may be able to go to a free clinic, but that creates a whole new set of issues.

Now we have someone who has gone to the ER…how are they going to pay for that bill?  In most cases, they don’t.  Those fees are written off by the hospital or clinic, after many months of trying to collect on the bill.  But who really pays then?  We all do, as now hospitals, doctors, and clinics will raise their rates overall, costing those with insurance coverage to pay more.  And if your insurance company has to pay more, they are going to pass those costs on to the consumer with higher premiums, or larger co-pays, or larger deductibles.  Is this really a good system?  Would it not be better if everyone had access to some sort of insurance program that would provide coverage of some sort?  Wouldn’t that help keep these crazy fees under control and maybe see more of these bills actually getting paid?

And what about those who do need follow-up care?  There is a good chance that these individuals will have to choose between going to work (for a job they need, but does not provide health care benefits, or ones that are affordable) or taking a day off without pay to try to be seen.  The question still remains on how they will pay for treatment, medicine, therapies, etc if they have a chronic issue.  And how much of a risk are they putting their job at in order to go to such appointments?

If we are such a wonderful nation, full of opportunities… shouldn’t we not work together to ensure that everyone has a chance?  Why is there such a cry against ensuring that everyone has access to medical care?  If we had more accessible preventative care, we would see less ER and other emergency treatments needed.  We should see a healthier population, which in turn would be a more productive population.

Shall we talk about the enormous benefits that regular medical care can do for children? And no…this is not a debate on vaccinations, just simple well child check ups, or access to care if a child is sick.  Sick children can’t focus in school, but if a parent is worried about his job and how to pay for a doctor’s visit, then sick children come to school/day care.  And sick children can expose other kids to illness.  Strep throat, the flu, pink eye, croup, all these things can be easily dealt with a simple office visit.  But a parent who does not have health coverage probably does not have a primary doctor they can call, and if they do, they have to weigh the cost.  (I will save my rant on the state of our educational system for another day)

We are a nation of so much excess, we should first look to those at home that need assistance, make sure that the playing field is level so that we all can succeed.  A team is only as strong as its weakest player.  Let’s build a strong team.

Is the current legislation the be all end all, best option, don’t change a thing?  Of course not.  This is our first go round.  Does it have important pieces that will help our nation grow and be stronger?  I think it does…I think it is a good starting point, one we should grow and expand on, instead of just throw to the curb and say “figure it out on  your own”.


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