Art by donna K mcgee
How many health plans have you belonged to?
If you are old enough to read this, you are the exception if you can count them.
Because you weren’t paying attention before adulthood, we will ignore the number of times you changed health plans as a child.
Maybe you are one of those very few employees who has stayed in the same job your entire working career. Even then, your employer has most likely changed health plans several times during your career.
And then you will retire.
Our plan just completed its annual open enrollment. Members are permitted to change medical or dental plans; to add or remove dependents, and change life insurance options.
Open enrollments highlights certain flaws in our current system.
The logic of an open enrollment is compelling. The object of any insurance is to spread the cost of any risk over time and over as many people as possible. Open enrollment helps to spread the risk over time.
The risk of health care is different than other risks that we insure against.
We buy life insurance to insure against death; auto insurance to protect against an automobile accident; homeowners insurance to shield against damage to our home.
Those hazards (the technical term) generally occur without warning. No one is likely to approach their insurance agent to buy auto insurance because they anticipate an auto accident in the near future.
Illness, on the other hand, can offer some warning. Someone may experience symptoms and has not seen a doctor. The doctor may have recommended expensive surgery. Or maybe it’s just a young couple planning to start a family.
Open enrollment is the only opportunity that insurers have to spread risk over time. By insisting that people enroll only during a specific time period, the insurer reduces the risk that someone is only enrolling because they know they have an approaching medical expense.
It may seem unfair to the person with an immediate and pressing need. But to the others in the group who ultimately foot the bill, it makes perfect sense. It is one reason why a mandate – an employer mandate or an individual mandate – makes sense.
Medicare has its open enrollment rules. Their annual open enrollment for Medicare Part B is from January through March each year and is not effective until July 1 of that year. Continue reading ‘Open Enrollment and Health Care Reform’
On Friday, I received an e-mail from someone who had just visited with several Capitol Hill staffers on health care reform. He was discouraged with the general response that health care reform was done – there was no room for new ideas.
He was promoting EMBRACE, the plan offered by the Healthcare Professionals for Healthcare Reform
Even more discouraging was the perception that Congress had a busy agenda and they were just eager to get this issue behind them. In addition, he was disheartened by the lack of provider unity on this topic.
He made the comment in his e-mail, “This isn’t health care reform, it’s insurance reform.”
I beg to differ. It is not insurance reform; it is an insurance industry bailout. It is a status quo bailout. Continue reading ‘The Baucus Plan: Reform or Bailout?’
I have often made the point that a major flaw in the health care status quo – I balk at using the word “system” – is that no single entity accepts full responsibility. With very few exceptions, everyone is trying to find someone else to pay the bill or the rest of the bill.
And too often the consumer is the rope in this tug of war.
I received a call from a member. He wanted to drop his employment based insurance. Why? His wife had insurance. Not an uncommon request in today’s market. But some questioning revealed that it was a bit more complicated than that.
It seems the member had been admitted for emergency cardiac by-pass surgery. After the surgery, he was referred to a rehab facility for cardiac rehabilitation. But the rehab facility refused to admit him until they got clarification on which insurance was primary.
I have determined which insurance is primary. I think I also understand a possible reason for the confusion.
I can not determine why a provider would deny care – or even suggest that care might be denied – when it was clear that one of the insurance companies would cover the services.
But that’s the way it is when everyone is looking for a way out.
In my last post, I wrote that health care reform proposals need to focus on the patient side of the health care delivery system by designing systems that eliminate the cumbersome, even tortuous routes that patients must travel to enter that increasingly privileged space – a person with health insurance.
An illustrative example is the Qualified Medical Child Support Order (QMCSO). QMCSOs apply to those children who live with one parent but the court orders the other parent to provide the health insurance. The parent who has custody of the child is called, logically, the custodial parent. The other parent is called, can you guess, the non-custodial parent. Continue reading ‘QMCSO – Say what?’
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