Why every private sector company should want single-payer, Medicare-for-all

Yesterday, I made a call to Verizon Wireless to cancel my MiFi card. At $59.99 per month for unlimited use, it was an expense I could live without. But I won’t be saving that money for long.

In March, I am expecting Anthem BCBS of Ohio to increase my health insurance premiums at least 20%. I still have to find about $100.00 in savings I am paying some other private-sector company to break even with where I am today. I may have to stop eating organic food.

I’m most definitely not buying an iPad Mini.

“Why are you canceling your MiFi service?” the woman on the other end asked me, expecting some service issue she could happily resolve with some equipment upgrade.

“Well, I am fixing to transfer some more wealth to the private insurance company, BCBS, that the good folks at the GOP are saying is my freedom of choice,” I explained. “You know, if we had single-payer, Medicare-for-all, we wouldn’t be having this conversation. Pretty soon, the medical industry will have all the money we might be paying you.”

With incomes being flat and no sign of them rising, us middle-aged, middle-class folk will have to get the money from somewhere to pay for our medical care. The private-sector medical industry doesn’t show any slowing for their appetite for increasing costs.

If you are a private sector company, why are you not supporting single-payer, Medicare-for-all? In ten years when you wonder why your customers have no money, won’t you at least wonder why the medical services industry is the only growth industry?

Something to think about.

Emergency rooms, magical thinking, and the poor

Emergency Room

To hear Mitt Romney (and many others) tell it, Emergency Rooms are the physical embodiment of Mother Theresa, treating indigents like Jesus treated the lepers. The great seas of health care are suddenly parted for the poor and ill, and outstanding bills just miraculously become absorbed into the ether of write-off’s and tax exemptions.

This type of magical health care thinking isn’t limited to multi-millionaire politicians. Many in the public also believe ER’s effectively fill the wide gap between sickness and insurance. It’s a fallacy that has become so engrained that its standard line — get sick, get treated by an ER, get the tab picked up by someone else — goes nearly undisputed by those on both the right and the left.

That’s simply not the way it works.

Setting aside the fact that ER’s are not mandated to treat what their doctors may consider a non-emergency — a subject which merits its own, separate discussion — many uninsured ER patients find themselves saddled with bills they can’t hope to pay. These bills are not just from the hospital, but from outside physicians, diagnostic services, and laboratories, none of whom are mandated to treat the indigent or uninsured for free.

Depending upon the state and the hospital, uninsured patients may meet with a hospital social worker who will have them fill out forms for state aid or other programs. There is no guarantee of approval, and even when someone does qualify, benefits may not extend to other services rendered in the course of care.

On a trip across the US, I spoke to several people in dire straights due to medical debt. One of them was a homeless man in his 30s. John M. was a single laborer who was working a temp job when he was hit with over $8,000 in medical bills for non-work related wound that had led to a staph infection. In the hospital, he met with a social worker who helped him apply for aid. Later, he received notice that he didn’t qualify due to his income and status as a single person. The bills started pouring in, not just from the hospital, but from doctors whose names he didn’t recognize and labs that had processed his tests.

When bills like John’s go unpaid, hospitals and other businesses may “write them off,” but contrary to what many people may believe, this does not mean that they disappear. Collection agencies buy such debts for pennies on the dollar and then may vigorously pursue the patient-debtor, through judgments, wage garnishments, and bank account liens. To add to the confusion, medical debts can be bought and sold many times over, involving an almost incomprehensible string of collection agencies.

Like many people with medical debt, John attempted to work with the collection agencies on a payment plan, but there were too many of them, each demanding that their bill take precedence. Desperate for relief, John went to an agency that specializes in helping debtors reach payment agreements and was told he didn’t make enough to carry the minimum monthly payment that would be required. At that point, John considered filing for bankruptcy, but he couldn’t afford the attorney’s fees.

Four years after his illness, with his credit ruined and with several court judgments against him, John’s low wages were garnished and he could no longer afford his rent. He applied for a second job as a cashier at a home goods store and was told that they’d run his credit report as a matter of practice. It was the same at other places he applied. While he was never told why he wasn’t hired, he suspected that his low score had something to do with the lack of call-backs, particularly since he’d never had such a problem finding a minimum wage job before.

John scrambled for a cheaper place to live, but none of them were cheap enough to make up for the loss of wages, and all of them required better credit than his. He was told he’d need a cosigner or a larger deposit, neither of which he had. Feeling he had no choice, John quit his job and found work with another temp agency, hoping to outrun his garnishment and at least catch up on his rent. Within two months, the collection agencies had found his new place of employment and set the wheels in motion to collect their pay. John was eventually evicted. Jobless, he lived out of his 14 year-old truck for a while, but then his truck died and he couldn’t afford repairs. He sold it for scrap so that he could eat. He showed up at the county day labor office every weekday, hoping to make enough money to rent a motel room. Sometimes there was work, sometimes there wasn’t. Sometimes he slept in shelters, but many times he slept in the streets. When winter got to be too much, he scraped together enough to take a bus to a warmer climate. When I met him, he was among many of Florida’s homeless and his prospects for crawling out of the hole were dimmer than ever.

Of course, not all stories are as extreme as John’s, but the fact that some are is a stark reminder of how easily a life can be unraveled, particularly when medical debt can bring a host of life-altering consequences.

Some people do end up qualifying for State programs, and there are some hospitals which have developed their own foundations to assist in care, but there’s no national uniformity to the system. While an uninsured person at one hospital may qualify to have their ER charges reduced or paid for by another entity, another person, at another hospital, may not.

In any case, medical debt is on the rise and collection agencies are becoming increasingly aggressive in pursuing debtors.

The Commonwealth Fund, a private foundation that sponsors health care research, estimates that 22 million Americans were contacted by collection agencies for unpaid medical bills in 2005. That increased to 30 million Americans in 2010. – March 2012, USA Today

As the article in USA Today points out, credit may be wrecked even when medical debt is paid. Slow and late payments can stay on records for seven years, and as much as ten if there is a judgment involved. There is also a valid and growing concern that collection agencies are misusing the court system to have debtors thrown in jail, adding the element of warrants and jail time to people’s background checks which, like poor credit, may diminish their future employment and housing opportunities. Poverty by itself is a vicious cycle that is difficult to escape. Adding collections, garnishments, judgments, bad credit, and arrests to the list of obstacles can make it nearly impossible. In the bigger picture, it would seem to do more harm to our economy and social structure to keep people locked in the cycle of medical debt for years on end, rather than to offer them a real solution.

Despite receiving tax exemptions to care for the uninsured and poor, some hospitals have gone so far as to sue these patients for what they are owed. Others, as noted, turn their debts over to collection agencies. In the mix are the outside services which are not given the same exemptions, and which aren’t subject to the same guidelines.

The result of all of this is that both patients and the medical care industry are suffering, while collection agencies are growing richer. By 2007, the number of collection agents had doubled from the early 1990s, while industry revenue tripled to $15 billion (on $40 billion in collected debt).

So, no, emergency rooms are not the answer for America’s sick and uninsured. The illness that’s treated today should not result in years of financial consequences, which not only affects individuals, but society as a whole. To what end is a culture that binds people to medical debt in ways that may cost them their homes, jobs, and futures? To what end is a medical system that only increases the need for shelters, welfare, and other social services — while burdening the healthcare industry with millions of dollars in extra costs? An America that grows poverty is not as valuable as an America that grows potential. Anyone who would argue against that is as short-sighted as they are unreasonable.

A calculation almost every American man over fifty has made in his head

There is one calculation that almost every American man over fifty* has made in his head that he will almost never admit to. The ones who have made it more than once and many times a year are the ones who have families and responsibilities who now find themselves at the scary end of a medical diagnosis and/or the threat or reality of unemployment.

That calculation is:

Am I worth more dead than alive?

….

The columns and totals never really see a piece of paper, but they are nonetheless very real.

In the assets column:
That term life insurance that has five more years before it expires and has no value: $250,000.00; Cash in the bank: $50,000.00; That 401(k) I started too late; $30,000.00; Stocks and bonds I randomly bought; $35,000.00; House equity, assuming it can actually be sold in this economy: $100,000.00… and on through the value of furniture, cars and power tools in the garage.

In the liabilities column:
I just got fired, so my unemployment is only $481.00 a week but bills with mortgage and food is $2,100 a month, losing $200.00 a month… I’ll soon lose my health insurance and COBRA is a $900.00 set back per month making that $1,100.00 a month just standing still… if I am unemployed for more than six months, that will be about $10,000.00 gone from the bank account, making the past couple years of savings a waste of time… chances are, I will be unemployed for the rest of my life in this economy, so that will just stretch on, losing my family $20,000.00 a year with me being alive. I will lose my health coverage in less than a year and a half… That is a lot of cash, and that life insurance policy just inched its way to being one year less valuable with no employment in sight…

I just got diagnosed with a pretty serious health condition that will make it difficult for me to work. I will soon be out of a job as my employer will get tired of me calling in sick all the time… I will lose my health care coverage.. if I go into the hospital, that will cost about $8,000.00 a day, depleting my cash in about a week… the mortgage is due in a week… the last tuition bill is due in a couple months… and on and on down to how much dog food is left and how much that will cost to replenish…

If I die today, my family will be ok. If I die in a year or two, my family will be bankrupt, penniless and possibly homeless.

Sure, the kids will say that I am worth more to them alive than dead, regardless of how much money I have. Yeah, “I love you even if you are broke,” “you bring joy to others around you” and “life is not always about money” are things I expect to hear from friends and family.

But I know they are not true. Not really.

Our culture rewards those who are healthy and able to work and shuns those who have fallen on hard times. It guts the sick, dying and unemployed quickly in order to salvage what it can before the corpse begins to rot. It knows the time value of money.

Men know it too. We have made those calculations in our head at every turn throughout our lives. When we buy a house, we calculate how long we’ll have to be employed at this job to pay the mortgage in full. When we have kids, we calculate what we’ll have to earn and sock away to pay for the birthday parties, soccer practice, bicycles, cars and college tuition even as we watch them laugh and dance as if they haven’t a care in the world; even as we laugh and dance with them. We worry our backs and minds will give out before we are able to deliver them into adulthood and breath a sigh of relief when we no longer have to be concerned they won’t have enough to eat.

When we get to about fifty, we eventually make the ultimate calculation. We arrive at a break-even, whether anyone wants us to or not; whether we admit it or not.

The only thing we fear more than getting it wrong is losing the ability to execute if we ever needed to.

*With the exception of highly-paid politicians or the super-rich who never have to worry about health care. For clarification, this isn’t me. I’m fine and gainfully employed at my own company despite my best efforts at getting my boss to fire me 🙂 This is a persona of a 50+ year old man who had a “good job” for most of his life.

Jumbo

There is an old joke that goes something like this:

I had a nightmare last night I ate a giant marshmallow. When I woke up, my pillow was gone.

Ok, settle down.

Your nightmare joke is now a reality. Meijers had pallets of these JUMBO marshmallows staged alongside the graham crackers and Hershey chocolate bars. Really, these things were grotesquely huge. I think it might be national S’mores week to coincide with Independence day. Nothing says freedom like… marshmallows?

Happy Fourth of July. How much more American can we get? Oh, about another 100 pounds per person, I would reckon.

Be a patriot and eat up.

You are a deadbeat piece of crap

help wanted cheap

When did the United States of America go from “shoot for the moon” to “circle the wagons?”

We appear to be on a race to become the sickest and dumbest of the developed nations where nothing is going to be possible. The enemy this time is not the Communists, Soviets or al-Qaeda. The enemy is your deadbeat neighbor who is sucking your hard-earned money out of the tax coffers to finance his lavish lifestyle. He is buying big-screen TVs with his unemployment checks and taking extravagant vacations with his Social Security checks. If he is a teacher, he is enriching his pension plan from your sweat and aching back. If he works for the government, he is an over-paid lazy bum who is the reason your health insurance plan at the plant stinks.

Do we really want armed police officers and firefighters hired by municipalities at bargain-basement prices? How stupid and ill-trained do you want the teacher to be teaching your children? Have we abandoned the notion altogether that good schools increase property values? We seem to accept the argument without question from the Right that the public employees need to lower their expectations of compensation and the value of work rather than the private sector workers increasing their expectations.

Smart people are being driven out of politics by zealots and bullies under the mis-guided notion that small government is good government. But a small government that enables corporations to rape the human resources unchecked for the sake of profit only is not a good small. Even small government must be balanced.

The secret to getting cheap labor appears to be convincing everyone that they are not worth the salary or benefits they are asking. From the Tea Party to the GOP to the media, the message appears to be consistent — human beings are just too darn expensive.

Break out the torches and pitch forks, folks. We are turning against each other and it isn’t a healthy debate.

Celebrate your win not your opponent’s loss

winningsoccer

Do you strive to win in an effort to push yourself to do the very best you can, with the expectation that your best will result in a win? Or do you focus your energy solely on defeating your opponent?

The difference is subtle, but changes purpose and meaning entirely.

I think the definition of good sportsmanship comes down to one statement: Celebrate your win, not your opponent’s loss. It works for sports, politics, business and life.

There is an old joke about two campers and a bear coming upon them in their campsite in the woods. One camper immediately starts putting on tennis shoes while the other starts running away, barefoot, yelling at the other camper to run fast or he’ll never outrun the bear. He shouts back, “Never mind the shoes. Run!” whereupon the other camper retorts, “I don’t need to outrun the bear; I just need to outrun you.” Many people choose to focus on outrunning their opponent. It is the easier of the two. You can see the goal as you only need to be slightly better than him.

There is a short-term upside to focusing merely on defeating your opponent. You will probably win a lot of races early on. But, you will never, ever, ever know how fast you can run. Or how far. In short, you will never be the very best you can be.

On the other hand, winners run past the first base as fast as they can. Winners follow the ball until it is either in the goal or out of play. Winners run past the finish line at top speed and winners keep selling even when they’ve made their monthly goal. Winning for these people is organic and happens regardless of what their opponents do. A win is always because the winner is able to outrun the bear, regardless of whether or not he has an opponent.

We’re seeing a lot of “defeat my opponent” strategy in politics today. Not a day goes by when I don’t get an email encouraging me to “defeat the health care bill.” Or some email encouraging me to “stop Obama” or make him a one-term president. Why not emails encouraging me to “embrace tort reform and tax code reform to enable cost-effective insurance plans?” “You lie!” is perhaps easier to shout as a mob. “Say NO!” takes less effort to write on a placard than reasons to support a point of view.

But when you live to win by defeating your opponent, there is no plan after that. After you win, what do you do now? You didn’t plan for anything after the win, only the win itself.

What bothers me most about the tea-baggers, right-wing media screamers like Limbaugh, Palin and Hannity and GOP today is not that they may be right in their opposition, but that they are spending more energy in screaming “NO!” for the sole purpose of defeating their opponent rather than in crafting a plan.

Their whole plan is to merely outrun the Democrats. As the bear dines on the Democrats, one by one, the bear will continue to be hungry and looking for food. And the GOP will have no one else to outrun but their own.

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If money were no object, here is what I would gift to you #letsblogoff

First, I would buy health care for everyone who was willing to take care of themselves. If you don’t have health, you have nothing. Then I would buy an education for everyone willing to learn. Educated people influence others around them to want to learn. Lastly, I would buy a home for anyone who is homeless and wanted one. Everyone should have some place to call home.

Then I would figure out how to save time in a bottle and give it to all the writers and artists who left works unfinished. The world is a poorer place without artists and the art they create. Most often, they just need more time.

And I would create bottles of compassion, wisdom and patience to give freely to those who need each. Because there is no such thing as a self-made man and those who think they are need to be reminded from time to time.

Happy Holidays from Rufus, Sallie, Charlie and our intern Zoey. We wish you and yours lots of cold noses and many long, pointless walks.

This blog post is part of a blog-off series with a group of bloggers from different professions and world views, each exploring a theme from his/her world view. This was about “if money were no object, what would you gift.” To explore how others handled the theme, check them out below. I will add links as they publish.

Anthem Blue Cross Blue Shield of Ohio is calling me a liar. Again.

I’ve had three small, routine claims this year so far and that triggered the letter I posted here. More accurately, my daughter went to the doctor for a routine physical because that is the responsible thing to do.

I know that from an insurance company’s point of view, determining if they can shove off costs to another insurance company is the fiscally responsible thing to do and I understand subrogation. I used to buy insurance for groups of employees in a past life as an HR VP and I also understand insurance laws as a result of me selling medical devices in a past life. I get all that. Goodie for you, Anthem BCBS of Ohio, you are saving your shareholders money.

As a customer of your plan where you increased my premiums 21.8% last year and 18.2% the year before and consistently for the past seven years, let me tell you how I read your letter.

Dear Double-dipping pile of crap customer,

We think you are lying to us about what insurance plans you have and think you’re trying to stick us with the latest medical bill you generated. Since we have your nuts in our hand anyway, we’re going to make you jump through all these stupid hoops just because we can and you can’t do a damn thing about it because this is legal. And while we’re sending out this stupid letter, we’re going to hold up payments to your doctor until we get your response back. But it’s not likely we’ll pay any part of the claim anyway; we just like to watch you dance you miserable piece of crap.

Thanks for your money. And since you really don’t have much a choice in Ohio anyway, we really don’t care if we piss you off. You’ll come crawling back.

Have a really crappy day.

Regards,
Faceless person blah, blah, blah.

Before anyone jumps in here and tells me that I should shop around and not buy from Anthem if that is the way they treat customers, buying individual health insurance in Ohio is like a torturer showing you the implements he is going to use on you and you picking out the one that will hurt the least and will kill you the fastest if used. Then hoping he’ll not ever use it. Anthem Blue Cross Blue Shield sucks, but the other choices suck worse.

And now insurance companies claim they have to raise premiums 20%+ to offset the costs of the Health Care Reforms passed earlier this year? What were the increases for last year?

And why again should we not be furious with health insurance companies? Is it the wholesale leeching or the blatant insults? Or is it a dread fear that our lawmakers who may be in power starting next year are entirely clueless about the state of health care insurance in HIS OWN STATE?? Please, somebody tell me as with my health insurance choices, I am literally dying to know.

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