healthcare almost WASN't

Well, I need to talk about a kitchen table issue that so many families face here in Congressional District 8. My daughter had surgery. It was an out patient surgery procedure, and everything is fine, so please don't worry. This was a minor blip on the health radar. 

However, I found myself contemplating putting off her procedure, because of the costs. I'm still grappling with the costs. We already pay through the nose every month for the insurance premium- why is it still so expensive?  Now, granted, we haven't met the deductible yet. But on top of the insurance premium we pay monthly- $1,000- that’s roughly equivalent to a mortgage payment on a $200,000 house- we have to meet a $1,250 per person per year deductible before the insurance kicks in at all. That’s nuts! 

Then after we pay the $1,250 deductible, we have to pay a $400 hospital copay. Then, and only then, the health insurance we could be buying a second home at the beach for what we pay monthly to have the privilege of participating in this racket, finally kicks in.

Now you’d think that after all of that, they’d pay for the rest of it, and in fact, it used to be more common that health insurance did pay for the rest of it after you hit the deductible. But then some genius came up with this idea to shift the standard to something called “coinsurance,” meaning, after all of that, the insurance still only covers 80% of what’s left, leaving us stuck with the last 20%. The 20% determined to be our coinsurance bill is $2,690.00 !!! 

And no, don’t get your hopes up: that $2,690 -which is slightly more than the deductible for the next 2 members of this family- it can’t be applied toward the deductible for the family as a whole. Nope. Each individual covered has an individual $1,250 deductible to meet before this insurance is worth anything. God help you if you get sick in December and need surgery in January, because you’ll be paying that deductible twice, because insurance always goes by the calendar year. Merry Christmas and Happy New Year, y’all. 

Our total out of pocket expense for this minor outpatient surgery that lasted a scant 30 minutes and produced zero complications = $4,340.00.  The total cost, when you add in what insurance paid out = $13,450.00. It is mind-boggling to me that a medical procedure that simple could cost as much as buying my daughter a pretty nice used car. 

My family is lucky. We have coverage. Because of Republicans’ flat out refusal to expand Medicaid, there's over 634,000 North Carolinian's who don't have coverage at all, and everyone in that boat doesn’t have the choice of whether to put off something that isn’t actively killing them.

Everyone pearl clutches about possible “healthcare rationing” in the event of a Medicare-For-All system, but there’s at least 634,000 people here in North Carolina who are doing exactly that right now- it’s death panels by default. It’s worse though, because there’s no waiting list or even a preliminary visit when you are uninsured. There’s just the emergency room and the doctor telling you it’s too late. And then a bill so big it means certain financial ruination for you and your family. Because guess who gets billed the most of all in this system for the same services? The uninsured who can afford it least. If Medicaid pays out X, insurance patients typically get billed 3X, and uninsured patients get billed 5X. I might be a little off with those ratios, but it’s pretty standard that the people getting gouged the worst are the uninsured. I think that’s wrong and sets people up for both financial ruination and higher mortality rates. 

How many people are out there who have just quietly made the decision to die untreated rather than create that financial ruination from medical debt for their families? You might even know one of them.

We need to fix this broken system by repairing the cracks and building a new infrastructure that works better than this one. You can’t shop for stroke and heart attack treatment like you can a car loan. 

Every layer of this system is full of excessive bureaucracy and profiteering. We need to simplify and streamline the system from top to bottom. 

One big solution I see is in the billing itself: all medical billing needs to be set to a standard price-controlled rate that is fair to the providers and fair to the patients. We already have this infrastructure for Medicare and Medicaid billing. I’m sure that we could probably stand to improve those payout rates, but to get a firm handle on the runaway costs in the system, standardizing the billing and making it easy for everyone to figure out how much something will cost because it’s the same everywhere, will go a long way toward getting the train back on the tracks. 

We also need to at least create a grown-ups’ version of the S-CHIP low cost health insurance program for kids. This is resurrecting the “public option” that the lobbyists managed to kill for Obamacare with false promises of “bipartisan support,” and it was probably the most important piece of that puzzle to keep insurance costs from continuing to spiral upwards, unfortunately. But if we really care about fixing this system, if we are really serious about reducing the bloated costs, we have to do the work to reduce them, and that means every layer of profiteering in the system has to take a hit and accept that their days of price gouging a captive market are over. 

I suggest that we offer a Medicare buy-in premium, or an S-CHIP expansion buy-in, to anyone under 65 who wants it, that is a flat 5% payroll tax that gets taken out with the rest of payroll taxes. No cap. Just a flat 5%, and if you are married, no kids, 7% jointly (3.5% per spouse on their individual check) but families with kids get everyone covered at the flat 5% of gross household income. Then from there, you pay modest but affordable copays, and there are no deductibles or coinsurance, to make sure you can easily use this coverage because the point here is to resolve public health crises, not rake in gigantic profits for shareholders and CEOs.

This isn’t the complete solution and I don’t have time here to get into every nook and cranny detail on what’s obviously a very arcane and convoluted subject, but it’s a good start toward making this system better, and I look forward to sharing more of these ideas with y’all as 2020 approaches. In the meantime, I have got bills to pay, so I better get back to work! 

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