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.
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.
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