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Can one have too much health care coverage?

Much of the debate for expanded health care coverage and for a single payer financing and delivery system arises out of concern for people without access to the traditional portals into the health care system: employment, old age, or poverty.

Abundance

But some people can have a whole lot of a good thing and still their medical bills fall through the cracks.

Take Dinah for example.

Consider the ways she had access to health care.

She was employed and had access to employer sponsored health insurance.

She was married and had access to health insurance as a dependent on her husband’s plan.

Her husband died and she became eligible for coverage as a survivor through her husband’s plan.

Her husband also had a retirement from a previous employer and she had access to coverage as a survivor on that plan.

She retired and had access to retiree health insurance from her employer.

She remarried and access to her second husband’s health insurance as a dependent.

She also had Medicare.

And still she could not get her bills paid.

There were mix ups in signing her up for some of those programs and the ones she was enrolled in could not decide which paid first, which was her primary insurance.  She came to us in tears, wanting to discard the insurance she had been paying for because it was “no good,” convinced her only option was to go on Medicaid.

Confusion reigns.

And even when people and systems have it right, confusion reigns.  Each year we get calls from people during Medicare Part D open enrollment?  They are confused and some of the vendors seem to offer extremely misleading and inaccurate information.  Why does it need to be so complicated.

Take Frank for example.

Frank was taking care of his older sister’s affairs.  She was in a nursing home and had access to Medicaid, Medicare Parts A and B and D and her retiree insurance with our plan.  Yet she could not get her prescriptions paid for.  Why?  It seems that the private pharmacy used by the nursing home did not know how to submit claims to any other payer than Medicaid.  That was straightened out.

But Frank made an astute observation.  He said each time he called one of these “pieces of the pie” as he called them, he would get a little bit more information.  He complained that each of the pieces barely understood their own role and no one understood how all of these pieces fit together.  “If they can’t see the whole picture, how do they expect an ordinary person like me to figure this out?”

Or the members who battle workers’ compensation in part to pay the medical bills for their work related injury and also to have income to pay the insurance premiums that pays for the medical bills for their non-work related medical bills.

Single payer is needed not just to provide for the have-nots, but also to bring order into a chaotic system for the haves.

Photo credit:    Stijn

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In a recent report on National Public Radio (NPR) about a gang  rape in Rcihmond, CA, one person asked the question. “Where has all the humanity gone?”

The same question  can be asked in the current debate on national health care reform.

Is this our big tent? Photo by JL McGee

Where has all the humanity gone?

We are talking about Americans here

The politicians are wiling to deny undocumented immigrants access to the proposed Health Insurance Exchange.  But that is not enough for some.  They are afraid that hospitals will use federal funds to treat undocumented immigrants in the emergency rooms.

Aren’t some of these very same conservatives, also Christians?  Aren’t they familiar with the story of the Good Samaritan?  In case they forget, the moral of that story is doing good to your enemies.  Oh that’s right, Christian values don’t apply to government, because government funds are involved.  Unless, of course, its abortion.  Then then “Christian” values apply because government funds are involved.

By the way, since most countries in the world have some form of national health insurance, what about sending the bill for undocumented immigrants back to the country of origin?

It is easy to pick on immigrants, because most of us don’t know immigrants,  But there are lots of people that will be affected by health reform that we do know.

Americans are missing in this discussion

The public is losing its focus as Congress drones on about abstract details: public option or no public option,  this tax or that tax, this subsidy or that subsidy, this amendment or that amendment.  Will it cost 1.0 trillion over ten years or 1.01 trillion over ten years and how much is a trillion anyway?  Didn’t we spend that much in the sixty days before Bush left office?

We need to refocus the debate on the humanity.

We need to refocus the debate on people, real Americans, Americans who in most cases want to be in the workforce.

Jonathon Cohn wrote a wonderful book in 2007, Sick, the Untold Story of America’s Health Care Crisis.  What made the book so compelling is that he weaved an explanation of how the system works and doesn’t work with the personal narratives of  ordinary Americans who fell into the rabbit holes of America’s health care system.

Personal narratives

Now is when personal narratives need to be pushed to the front.

Jonathan Cohn isn’t doing it any more.  Now he’s inside the beltway and caught up in political navel gazing  for The New Republic.

Keith Olbermann of MSNBC made the strongest pitch yet for considering the humanity of the issue.

But his free clinics have not received much play in mainstream media and certainly don’t seem to have punctured the beltway barrier.  Rich Stockwell, MSNBC Countdown Senior Producer, wrote a moving description of the free clinic he visited in New Orleans on November 16^th.

New Orleans, La. — – It happened as I watched a 50-something woman walk out, after spending several hours being attended to by volunteer doctors. “She’s decided against treatment. A reasonable decision under the circumstances,” the doctor tells us as she heads for the next patient. The president of the board of the National Association of Free Health Clinics tells me why: “It’s stage four breast cancer, her body is filled with tumors.” I don’t know when that woman last saw a doctor. But I do know that if she had health insurance, the odds she would have seen a doctor long ago are much higher, and her chances for an earlier diagnosis and treatment would have been far greater…

Health reform is not about Democrats or Republicans or who can score political points for the next election, it’s about people. It’s about fairness and justice in a system that knows none. I’d defy even the most hardened capitalist-loving-conservative to do what I did on Saturday and continue to pretend that the system in place right now is working.

Countdown chose to highlight and raise money for the Association of Free Clinics because we knew the work they do is so vitally important and we wanted to show in real terms how great the need is. We invited several politicians to attend so they could see first hand how critical the situation is. All declined. Some explained that they talk with constituents all the time and know very well of the need for reform.

Mr. Stockwell reported on the clinic visitors:

• 83% are employed
• 90% had two or more diagnoses
• 82% had life threatening conditions

Bill Clinton is one of those who chose to ignore the event.

How is the reaction of Bill Clinton or any of the other Senators different form one commenter on a blog who wrote

Old people die all over the world every day. With or without health care

Ronald Reagan was called the great communicator in part, because he translated his political agenda into personal narratives.

The narratives that I hear every day include:

I can’t go to work because I’m sick and I can’t go to the doctor because I can’t afford my health insurance premiums.

I have no money, and I may lose my house, how am I going to pay this health insurance premium?

I am supposed to go on Medicare but my doctor won’t accept Medicare.  I’m scheduled for surgery.  I don’t want to change doctors.  What am I to do?

I just learned that my daughter, who is living with her mother, has no health insurance.  She has a tumor.  Can I add her to my health insurance plan?

The waitress I met who was approaching eligibility for Medicare.  In her entire working career she only had health insurance for five years.

Health care should not be so complicated.  Those making policy need to hear hear from humanity.