I am constantly reading references to community clinics in a context that presents them as being free or very low cost. Community clinics in many places are a life saver, but they have a new role. They function as traps for the unwary in Massachusetts. Few people seem to realize that the clinics in Massachusetts, are no longer inexpensive. Instead, a visit to a clinic for an injury sustained at home or at work triggers a process that results in a poor person being signed up for insurance they often cannot afford, or a huge fine, whether they want it or not.
This results in regular monthly bills that MANY working people often cannot possibly pay, and because of deductibles, they often are thrown into a terrible situation when they do get seriously ill, because they must pay a deductible as well to access care. Chronically people are left with no choice other than move out of the state. Will chronically ill Americans be forced to move out of the United States to survive?
The default is that when attempting to get care of any kind, they are signed up for something they cannot afford, but need, and they end up with huge debts. Their only way around that is to apply for increasingly scarce funds that are each year, stretched thinner. For most people, those with modest, low incomes and manageable, chronic illnesses, its a stark choice, move out of the state or pay money they don't have.
People with illnesses cannot "not get care". That is not an option, although its obviously what politicians like those who hired Obama's chief economist last year wanted them to do. (As they are the un-insurables, the most expensive group)
The end result is a train wreck between politician assumptions and the chronically ill working poor's ugly, harsh reality.
The poor are not able to negotiate this.
The mandated "crapsurance", in their case, is the enemy of the acceptable because it costs too much, it still leaves huge gaps - not covering things that are medically necessary completely, with no extra cost.
Unlike all European health plans, it fails to cover all necessary CURATIVE CARE and all medically necessary drugs. What it does cover, it pays for 70% of the cost. The remaining 30% can represent a huge amount. Even if the government promised to pay that (which it doesn't) thats too much. Also, those over 40 must pay TWICE what younger people pay, making t impossible for many of those over 40 to afford health insurance.
They cannot comply, they cannot pay. Nobody is willing to fund the huge gap between the HUGE COSTS, and the subsidies which are shrinking. The number of people who need subsidies also grows as medical costs rise, often by double digit rates. Funds available to the poorest of the poor who still have addresses to register to vote at, and the large numbers of working poor who are considered too well off to get help, but who still cannot to ever pay off these growing debts are not enough. When the additional costs like co-pays, deductibles and uncovered costs are added in, its even worse. This situation applies to Obama's national plan, which shrugs off these concerns, but which doesn't fund the additional cost, which would be substantial, of addressing this issue. Indeed, adding a cap on out of pocket expenses, as they sometimes claim to have done, (!) would multiply the cost of the bill by many times. The subsidies also are being cut every year, relative to the costs, especially the uncovered costs, of healthcare. This is a situation on the edge of a crisis. It's on the verge of collapse. Without REAL change it wont last four more years.
In 2008, Americans voted for real change, not more of the same. This is a crucial issue, passing a national affordable quality health care bill that is designed to work, not designed to fail or punish the poor for something that is not under their control. (After all, experts say that within 20 years, most current low paying jobs will be automated.)
This is why hundreds of doctors in Massachusetts have been fighting for national single payer. They do not want to see the nation swindled into making the same bad choices as Massachusetts, which result in over half of the precious money of poor people being wasted on insurers and billing them, and broker profits. Ultimately, many of these growing debts will never be paid, They should be forgiven. We need a national amnesty on medical debt, and a reduction in the spending on the military, in order to fund healthcare reform adequately. The $262 a year per American for subsidies in the Senate bill will not address the gap between the $9000/year per capita expense of healthcare insurance premiums, uncovered costs, and what many families can afford to pay.
These are some stories from Massachusetts residents:
Feb. 18, 2009
Massachusetts' health reform has resulted in a significant number of individuals newly insured through state-subsidized health plans, MassHealth, or private insurance coverage. For some patients, this has improved their access to care.
Gabe: "I'm an actor and got lucky enough to get cast in the commercials for the Health Connector. I quickly signed up for a plan. Having paid $400 bucks a month before; I now only pay $220 a month. Currently, I'm receiving better benefits and have less out of pocket expenses."
Gabe's story reported by the Commonwealth Connector
However, for many other patients, the Massachusetts health care reform has not worked so well.
Despite the efforts of the state agency tasked with administering the reform to ensure affordable coverage, many Massachusetts residents are unable to afford the insurance options available to them.
John and Judy are in their sixties, but not yet eligible for Medicare. After their retirement, they became uninsured. They knew they needed good coverage because Judy was recovering from breast cancer and chemotherapy treatments. They thus purchased a Commonwealth Choice Gold family plan with premiums at $1,400 per month, which consumed nearly half of their $3,000 monthly income.
John and Judy's story reported by Andrew Cohen and Carol Pryor, "In Debt But Not Indifferent: Chapter 58 and The Access Project's Medical Debt Resolution Program."
Yvonne is a 48-year old woman who could not afford the $91 per month premium contribution for her employer-sponsored health insurance plan. Although her income was less than 300 percent of the poverty level, she was categorically ineligible for Commonwealth Care because her employer paid more than one third of the insurance premium. Yvonne successfully applied to the Connector Authority for an affordability waiver from the individual mandate, in order to avoid the tax penalty. Although she had partial Health Safety Net coverage, the $1000 annual deductible made it difficult to access care.
Yvonne's story reported by Andrew Cohen and Carol Pryor, "In Debt But Not Indifferent: Chapter 58 and The Access Project's Medical Debt Resolution Program."
Because of the cost sharing associated with the private insurance plans available under the reform, many patients cannot afford the care they need.
Nancy is a middle-aged woman who enrolled in the state's subsidized health plan and is now very glad to have health insurance without a monthly premium. However, she still finds it difficult to keep up with the co-payments for her frequent doctors' visits. Nancy borrows money from her children to cover those costs.
Nancy's story reported by Andrew Cohen and Carol Pryor, "In Debt But Not Indifferent: Chapter 58 and The Access Project's Medical Debt Resolution Program."
Ken has diabetes and hypertension. Last year he was unemployed and MassHealth covered the full cost of his medications. He is now employed, with private insurance through his employer. His medication deductible is now $700; after reaching the deductible, he will need to pay 20% of the cost of the medicine. He works in retail and supports his unemployed wife and five children. He cannot afford his insulin with his new insurance, so he has stopped it and his hemoglobin A1C (a measure of diabetes control and a predictor of complications) has been getting worse.
Ken's story told to Dr. Rachel Nardin by his physician
Kathryn is a young diabetic who needs twelve prescriptions a month to stay healthy. "Under Free Care I saw doctors at Mass General and Brigham and Women's hospital. I had no co-payments for medications, appointments, lab tests or hospitalization... Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That's $340 per month, provided I stay well." Upon becoming "insured," Kathryn's medical expenses consumed almost one-quarter of her take home pay.
Kathryn's story collected by MassCare
Many patients, like Kathryn, who were well cared for under Massachusetts' old system have found that the reform has reduced their access to needed care.
Anna, a middle-aged woman with two children, suffers from post-traumatic stress disorder. Under free care, all necessary treatments were covered. Now that she is insured by a Commonwealth Care plan, she has had to forego weekly visits to her therapist and has halved her medication dosage, trying to stretch her supply of pills out to avoid the unaffordable co-payments.
Anna's story told to MassCare by her physician.
A local clinic that cares for persons with human immunodeficiency virus (HIV) has reported three cases to the state of patients who were no longer able to obtain continuous HIV medications because they could not afford the co-payments of their frequent visits. Starting and stopping HIV medications is dangerous to the patient, and to the community, as discontinuities in therapy can cause the HIV virus to develop resistance. One of the patients has a highly treatable cancer, but declined chemotherapy because he could not afford co-payments for his visits. Under the state's previous free care program, these patients had received their medications and visits without co-payments.
Story told to Dr. Rachel Nardin by physicians and staff of the HIV clinic.
The implementation of the reform, with its complicated rules and regulations that overlap with existing programs has created confusion and coverage gaps for patients.
Jane, who applied for the state's subsidized health plan, received a letter telling her she had qualified for both Commonwealth Care and the Health Safety Net. The letter told her that if she received care under the Health Safety Net, she would have to pay a $1,900 deductible. Thinking this deductible applied to her health plan, she did not see a doctor because she thought she would have to pay the deductible first, which she could not afford.
Jane's story reported by Andrew Cohen and Carol Pryor, "In Debt But Not Indifferent: Chapter 58 and The Access Project's Medical Debt Resolution Program."
Jean was unemployed and uninsured after being laid off from her finance administration job. She delayed seeking care for an injured wrist until the pain became unbearable and she had to go to the Emergency Room of a local hospital. The staff at the front-desk handed her a blurry print-out of a form to apply for MassHealth and the Health Safety Net, but it was illegible. Jean went home and waited until she received a bill before contacting the hospital about financial assistance options. Since more than 10 days had passed since she had received treatment, Jean was no longer eligible for Health Safety Net retroactive coverage.
Jean's story reported by Andrew Cohen and Carol Pryor, "In Debt But Not Indifferent: Chapter 58 and The Access Project's Medical Debt Resolution Program."
The Massachusetts reform does not ensure that people can maintain continuous coverage.
Christin had a new job with a six-month waiting period before she could get coverage under her employer's health insurance plan. Less than one month before the waiting period would have ended, she experienced severe abdominal pain from kidney stones. The treatment left her with $6,500 in hospital bills.
Christin's story reported by Andrew Cohen and Carol Pryor, "In Debt But Not Indifferent: Chapter 58 and The Access Project's Medical Debt Resolution Program."
The reform leaves students especially vulnerable.
Andres was a student when doctors diagnosed him with cancer. He had university-sponsored insurance that left him with tens of thousands of dollars in hospital and doctors' bills. As an insured person, he was eligible for six months of retroactive coverage under the Health Safety Net, which paid $28,000 of his medical bills. Hospital-based physicians wrote off an additional $8,000 in bills. Andres also appealed his insurer's coverage denials, and his insurance ended up covering $9,800 in claims that it had previously denied. Unwilling to seek additional medical care under his current plan, Andres tried to purchase insurance, but found that as a student he was not eligible for a state subsidized health plan. However, as a student with no income, he could not afford to buy a non-subsidized plan and had to borrow money to pay for a Commonwealth Choice plan.
Andres' story reported by Andrew Cohen and Carol Pryor, "In Debt But Not Indifferent: Chapter 58 and The Access Project's Medical Debt Resolution Program."
A random survey of Massachusetts' residents affected by the reform found that half of those affected by the reform said that they had personally been hurt by it. The Massachusetts reform is not a model for the nation.
Monica had recently moved back to Massachusetts and was solicited by mail to enroll in Commonwealth Care, which she did to avoid the tax penalty for being uninsured. After leaving her full time job for part-time work so she could return to school, her income dropped by 60%. She informed the Connector of her change in income by phone but was unable to afford her insurance premiums. She received threatening notices from the Connector indicating that she would be disenrolled and thus subject to the tax penalty for uninsurance. She appealed this decision to MassHealth, which determines eligibility for Commonwealth Care.
"After a two hour hearing I was told that although MassHealth determines eligibility for Commonwealth Care, that's where the collaboration ends. I was also told that I should not have been eligible for Commonwealth Care as a full time student, which the Connector representative failed to mention to me when I told him of my income drop eight months earlier. The MassHealth workers had a difficult time explaining the Massachusetts model to me and when asked about the appeal process for the Connector, they looked at each other quizzically and admitted that they were not sure how to go about appealing a decision that fell under the Connector's jurisdiction. After so many months of dealing with inept bureaucracy, I have given serious thought to leaving Massachusetts. I am researching graduate schools in other parts of the country- places where I will willingly pay taxes, but will not be forced to pay my hard earned money to subsidize a $12 billion dollar a year insurance industry. The Massachusetts model is a punitive model that causes stress and worry to many residents. I would not recommend it to anyone, nor would I want to see it implemented throughout the country."
Monica's story told to Dr. Rachel Nardin and reprinted with her permission.
Should we cover Obama and Romney's medical experiment?
Is there any evidence that shows that this "treatment" is both safe and effective?
No, and there is a lot of evidence showing that it isn't.
Is there any better, cheaper treatment available.
Yes, its called single payer, and its been shown in study after study, in nation after nation, to be both safe and effective.
It also saves billions of dollars and improves our whole nations mental as well as physical health.
We really have no other choice.
What's with the delay?
How would a state single payer plan work?
To go single payer, you need to throw out the insurance companies. Otherwise its not single payer and it cannot save the big money.
Otherwise, the whole thing falls apart in terms of economy. They fall into a number of traps. (Including the GATS one mentioned in the comments and in my recent diary)
Option is the way they kill affordability. Option is the way they kill quality for working people Just like insurance plans, those in "options" find that choice is only available to those with lots of money. Those who can't pay huge amounts will find they can't afford the options they supposedly "can afford" and subsidies will be far too small. The state is also trapped even if it buys drugs for those in its own limited option plan, it will be forced to pay retail prices for drugs and the plans will also then have far sicker risk pools, because they have to compete with cherry picking private insurers who will always offer a better deal to the healthy.
Which brings me to the biggest lie of all. Its a bald faced lie to say that covering more sick people will lower premiums. We need to accept that if we decide to avoid real change and stick to the private insurance model as the default, we wont have either affordability or quality. That is the price they are volunteering we pay, because they can get away with it, they think, and its the biggest one you can imagine. Its a deal killer. Its going to cost each of our families hundreds of thousands of dollars in our lifetimes. Its the equivalent of buying a home or having a child. That what they are giving away in quality of your life. And of course, bad medical care often means a shorter, sicker life.
Why do you think an MRI costs $98 in Japan and $3000 in the USA? because the Japanese government REGULATES THE PRICE and we don't. Thats why. What difference does it make for somebody? An MRI often means an accurate diagnosis and a life saved. An X-Ray often is so blurry and confusing only a very experienced radiologist knows how to read one correctly, and even if they did, the HMO wont give them that much time. If they take that much time, they will lose their job.
What it all comes down to is a choice we must make. Life, or death. Honesty, or lies. Community or disunity and segregation.
Why did they lie and many, continue to lie, to promote a designed to fail public option as a viable choice? To prevent discussion and debate about single payer, which works.
Any insurer of last resort, as any public plan, of any kind would need to do, is going to have big costs, and the savings of single payer need to be big to offset that expense. Without thse savings, the whole thing becomes unworkable, as we are seeing in Massachusetts. If they hide that fact, then the naive idea that somehow, people can afford to waste 50% of our money on an ecosystem that preserves private insurers, who waste half of our money, may to some, remain plausible. (if you don't thik about it too much.)
What is a Risk Pool (naschip.org)
Just lok around. Every time it appears that people are waking up, the disinfo campaign cranks into high gear. Everywhere, people are trying to confuse the false hope "options" with single payer. Here's a simple way to tell the difference. Single payer means JUST ONE PAYER. Just one plan. doctors all get paid. Everybody is included. Nobody has to apply. You are in. You don't have to pay bills. If you don't pay your taxes, sure, the state goes after you, but, you dont get cut off from medical care. Your healthcare is not connected to your job. if you lose your job, you still can go to any doctor, and your healthcare remains the same. Rich and poor get the best care available.
No other insurance plans, exist, competing (in this case) to drive UP prices. It means the state plan buying drugs directly from manufacturers, at prices that reflect international norms. It means everybody in, nobody out. No "buy in" required. Everybody is in, nobody needs to be trapped into it by trying to get healthcare at a clinic, for example. Its not a trap. All providers, all doctors, ALL doctors are in network. No more medical segregation. No more Medicaid, or Medicare. Everybody gets the same GOOD care. That saves a LOT of money because its simple and uncomplicated. Its in everybody's interest to help it work.
So, of course, the disinformation campaign is working on hiding this. What they are describing - trying to confuse us, is NOT SINGLE PAYER. For example, most of us realize that the public option model is designed to fail, just like the state high risk pools, its a big money loser. But few have really thought about why. The need to waste so much is why.
The "options" are optional because most can't afford them. They are basically state high risk pools, except they are presumably open to others - but only those others who can pay the premiums, which will inevitably be quite high. They always are going to run into the same problems that the many previous attempts (Tenessee, massachusetts, California, etc) have run into - #1 is OBSCENELY HIGH, UNCONTROLLABLE PRICES. Look at the Massachusetts fiasco above.
Its interesting to see this aggressive campaign to confuse people about what single payer is and isn't. It shows hat the insurance-industry funded paid blogging army have been instructed to push these misconceptions. Those in the know - the ones who sign their paychecks, obviously see single payer as the only affordable, credible option we have- So they must spread lies about it, and delay the process by which people become more informed about healh insurance issues as long as they can by promting meaningless phrases like "public option" that can mean a great many things, "all things to all people", but promise nothing in the way of affordability or quality, for as long as they can, or lose.
If you want to see single payer in action, just look at Canada. Single payer could be done in a state, but that means that they pick a date, and after that date, everybody is covered by the plan, and private insurance is no longer. No "supplemental" plans. Healthcare is paid for by taxes, so everybody who resides there, all ages, all health status, all incomes, is "in".
Then doctors and hospitals can save quite a bit of money on staffing, and employers wont have to worry about their employees health care. The state contracts directly with drug companies to buy the drugs for the entire state's population, and drug stores can be given the task of distributing them, perhaps taking a small fee (small enough to not deter people who need them from getting drugs- no more than $5)
Taxes would rise, but everybody would come out way ahead.