Wednesday, June 17, 2009

Putting your money where your medicine is.




There is nothing I find more frightening than a group of people that include attorneys, “community organizers”, and career politicians trying to hammer out a healthcare plan, not even knowing basic anatomy and physiology - much less anything about the healthcare system.

Did you know that there are actually healthcare professionals in Congress? There are 20 members of Congress with medical degrees, and 3 nurses. I wonder if any of those individuals were tapped to help form this healthcare “plan” that no one seems to know anything about. Except Charlie Gibson…maybe.

After listening to all of the background noise being tossed around CNN, NPR, ABC, MSNBC, Fox News, and the like, I wondered what a REAL solution would be to the healthcare “crisis” in the United States. My first question to myself was, what’s the real crisis here? You can walk into any hospital in the United States and expect – and DEMAND – the highest quality of care. And usually the hospital workers will scramble to give it to you, lest they lose their livelihoods from a lawsuit.

Hmmm…maybe we have something here…maybe healthcare costs are going up because of hospitals and healthcare workers having to hemorrhage huge amounts of money in liability protection to prevent them from frivolous lawsuits?…but I digress…

Barack Obama loves to reference the thousands of Americans that have had to file for bankruptcy protection because of high medical bills. And to be fair, these people are out there and the problem is very real. But it’s important to note that if someone has accrued enough medical bills to have to file for bankruptcy, it would have to be thousands of dollars. Most healthcare facilities and organizations are more than willing to work out payment plans, because they know that costs are very high and the average Joe can’t front that kind of cash. More often if you are willing to make a small, regular payment, you’re okay. You get in trouble when it gets into the thousands of dollars. Also, there are thousands of programs available to help in crisis situations that offer financial assistance with healthcare expenses – this blog would be a mile long if I listed these things here…but here’s the teaser – you’ll hear more about that at the Independence Day Tea Party in Charlotte…(wink, wink, nudge, nudge…)

Everyday healthcare doesn’t cost that kind of money. Nowadays, you can walk in to most any pharmacy and get hundreds of generic drugs for less than $10 a month. Primary care copays, with standard health insurance, range between $5 and $50. Granted, if you pay out of pocket for a physician fee for a physical, that will cost in the neighborhood of $300-$400, but most medical practices give discounts for those who pay out of pocket. Where I work, we're always scoping out deals for patients on things like surgical bras, wigs, breast prosthesis, wheelchairs, walkers, the list goes on and on, by calling everywhere from medical equipment suppliers to logging on to Ebay. (Yes, I've looked on Ebay for things for my patients. I have no shame.)

So why are insurance premiums so high? I had the privilege of talking to a gentleman on Monday night who had a HUGE amount of experience in the health insurance industry and gave me a lot of insight. Thank you, Josh - you rock!

Let’s say you have a group health plan that covers 50 people. 49 of those people are normal, everyday people, get their yearly physicals, and take either no prescription medication or less than 5 prescription medications. 5 or 6 have a baby. 10 or so may have a surgery for gallstones, appendicitis, and the like.

Then one member gets cancer, or requires open-heart surgery. Immediately, the healthcare cost that insurance company has to cover will skyrocket, in many cases, to over $100,000 in a very short period of time.

Now, it would be great if insurance companies were charities. But they’re not, and that's just hard, cold reality. As with most American enterprises, they are private businesses with employees, expenses, and shareholders just like everything else. They have to find a way to cover these expenses, pay the overhead, and somehow manage to turn a profit. So they jack up the premiums.

Please understand that I am NO proponent of government involvement in healthcare – PERIOD. I don’t cringe as MUCH with state healthcare plans such as Medicaid (I still cringe), but I do not think the Federal government has ANY business getting involved in healthcare. Where in the Constitution does it say that is the Federal government’s responsibility? Since when did healthcare have anything to do with national defense and infrastructure? Sure, you could say “infrastructure”, but you’d be REEALLLY stretching it, even if you used the "living document" explanation.

However, it seems that Mr. Obama is absolutely hell-bent on the government getting involved, in a big way. And from the sounds of it, he’s not real open to any suggestions or ideas other than his own. So after talking with Josh, we came up with this idea that I thought...man, this could work!...and I went a different route.

I called Sue Myrick’s office and figured maybe they’d listen to the idea. And they did.

First, I have to give MAJOR props to Sue Myrick’s Healthcare Legislative Correspondent, Sarah Hale, who took the time out of her (VERY busy) schedule to take my call and listen to the idea. Sarah has an amazing knowledge base about the healthcare system and healthcare policy - I was calling to give them information, and I ended up learning a great deal from her! Thank you, Sarah!

OK...here's the idea. If the Federal government has to meddle, then they can meddle where it’s REALLY needed – in catastrophic situations. I played around with numbers, and gave them a hypothetical example of a catastrophic healthcare plan: A catastrophic healthcare plan that would cover medical expenses above $100,000, and the balance would “zero” out in increments (5 years, 10 years, etc.). There would have to be qualifications: this couldn’t include expenses for things like plastic surgery, lasik, or stuff like that. Come on, guys. Real catastrophes. Things like new diagnoses of catastrophic illnesses – cancers, autoimmune diseases, illnesses that have very expensive treatments that are necessary to cure the disease or keep the patient alive. Catastrophic injuries from accidents, things like that. Once the balance of medical expenses go over $100,000, the government could step in and negotiate with the healthcare provider for reimbursement.

What would qualify someone for this coverage?

My idea was an American citizen over 18 years of age that has filed Federal income taxes within the past 3 years and is registered to vote. (There are several existing government programs for 18 and younger, so I figured this could be a grownup plan…look, it's just an idea, I could be creative with it, darn it!) Why those qualifications? If you pay Federal income tax, you’ve paid into the program. If you’re registered to vote, you’re obviously not a convicted felon and (hopefully!) are a legal American citizen, hopefully solving the problem of the benefits being sucked dry by the population of “undocumented” individuals.

The question came up, what about if the person has an existing insurance plan? Well, that’s the idea. We WANT people to have private insurance – the insurance would help with the costs going up to $100,000. Here’s where I think some version of this might work:

Once the expenses of the catastrophic illnesses are covered (which would take a HUGE amount off of the $1 - $1.3 trillion -that's TRILLION, guys - more money than ANY of us will EVER see in a lifetime!- total that is being thrown around, when you’re not covering EVERY SINGLE LITTLE THING), private insurance companies would not need the exorbitant premiums to cover them. Thus, as Josh explained to me, costs for private insurance would plummet because they’d get a hand with the catastrophic illnesses.

And maybe, just maybe, the cost of private health insurance premiums would be – for the first time in decades – affordable.

It’s just an idea. Of course it has holes, just like everything else – that’s why task forces and committees (as bureaucratic and irritating as they are) are necessary. But here’s the part that made me smile from ear to ear – Sarah reassured me that there are versions of this idea being drafted by Republicans, and they are fighting like hell just to get SOME consideration of them. (Great minds think alike!!!) But I was able to take some comfort in the fact that although right now I feel completely helpless, and that my career and my patients’ future medical care are in the hands of a president that hasn’t a clue about healthcare, there are people out there fighting for some viable alternatives - and took the time to listen to an idea of a couple of tiny little North Carolina constituents.

1 comment:

  1. Kristie,
    I see this as an extremly viable beginning, of a great way to handle this aggravating, forced "National Healthcare Plan".
    So far there are only snippets of information on any of the 4 plans being bandied about. As fast as they come out of Committee, a squabble begins and they're withdrawn.
    I'll begin putting this idea into the "Ready Made" communications I write. I'm thoroughly in favor of it.
    I sent one out yesterday on healthcare. It will be the first of many on that subject. I hope you can find time to send it to your legislators - reworked to your specs, of course
    Sandi

    ReplyDelete

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Kristie Chapman is a Registered Nurse, Independent Legal Nurse Consultant and healthcare policy advocate from Charlotte, North Carolina. In March 2009, she was awarded a grant from ONS for the Nurse In Washington Internship, receiving training on healthcare policy advocacy and meeting with members of the House and Senate to discuss current healthcare issues. She is active in the Mecklenburg County Young Republicans, the NC Federation of Republican Women, the Hospice and Palliative Nurses Association, and "CAUTION", a grassroots group in Charlotte whose mission is to inspire, educate, and unite citizens to take an active role in their communities to preserve our Constitutional freedoms. Kristie has spoken at conservative events including the Charlotte Tax Day Tea Party, Patients First Bus Rally with Americans for Prosperity and the Healthcare Reform Town-Hall Meeting in Charlotte sponsored by the Charlotte City Council At-Large campaigns of Tariq Scott Bokhari and Matthew Ridenhour. Kristie is currently Vice-Chair of the Mecklenburg County Young Republicans and continues to teach healthcare policy advocacy seminars in the Charlotte-metro area.

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