All of us here have hopes for the health care reform process Many of us started the process with hope for the kind of transformative change that would create a just and workable system. It's now clear that won't happen this year. We are left to hope, at best for the kind of incremental change that will leave at least some of our fellow citizens better off than before. We hope for something our president and our party can point to with pride. Most of all, we hope that more of our fellow Americans will be able to get the care they need. But will they really? Will we really?
Most all of us have read enough by now, or seen enough, or heard enough to know the basic truth that coverage is not care. We all know of the many people who thought they were insured, but - when the chips were down - found that their insurance did not provide them the care they needed. A recent LA Times article makes it clear that last hope may very well not be realized in the current crop of health care "reform" bills.
Here's the headline of that article:
Healthcare bills lack protections against treatment denials, experts say
And that pretty well tells the story in itself. After all this fight and all these many months we may indeed succeed in getting more people's names on an insurance policy - likely at great cost. But will those people truly have access to the care they need? Quite possibly not.
Here's the subhead:
Measures pending in Congress push insurers to keep down costs and cover all regardless of health. That leaves the firms with a big cost-containment tool: refusing requests to cover treatments.
Once again, my mantra for this debate: Coverage is not care. Never forget that.
"Right now, the deck is stacked against patients," said Bryan Liang, director of the Institute of Health Law Studies at California Western Law School in San Diego. "Healthcare reform is not going to change the ball game."
Yet a patient's ability to fight insurers' coverage decisions could be more important than ever because Congress, in promoting cost containment and price competition, may actually add to the pressure on insurers to deny requests for treatment.
By requiring insurers to cover everyone, regardless of pre-existing conditions, healthcare reform will make it more difficult for insurers to control their costs, or "bend the cost curve," by avoiding sick people.
That leaves insurers with the other big cost-containment tool: turning down requests to cover treatments.
The article goes on to discuss the possible role of the public option in keeping the insurers honest on this front, but it's worth remembering that most of the bill versions currently pending limit access to the public option to various degrees. So it's a certainty that, no matter which version passes, most of us will still be "covered" by private insurance. And in the hard light of reality, that means most of us will still be subject to denials of care when we need it the most. Interestingly the article does describe at some length the difference in the experiences of two very similar patients who needed a liver transplant - one covered under private insurance, the other under Medicare.
UCLA doctors told Ephram Nehme, a San Fernando Valley produce market owner, that he could die waiting for a liver in California and encouraged him to go to Indiana, where waits were much shorter. But Nehme's insurer, Anthem Blue Cross of California, refused to pay for an out-of-state operation.
Fearing for his life, Nehme paid $205,000 out of his own pocket for the 2007 operation at Clarian Transplant Center in Indianapolis.
But if Nehme, now 61, had been on Medicare, the public insurance plan for people 65 and older, his Indiana transplant would have been covered.
That's what happened last year to Glen Ossiander, a retired Pacific Palisades artist. Like Nehme, Ossiander was being treated for hepatitis at UCLA. Like Nehme, he needed a transplant. And, like Nehme, he faced a long wait. And, like Nehme, he moved temporarily to Indianapolis where he underwent the transplant operation within two weeks at Clarian.
That's where the similarities end. Ossiander's operation was covered, without a hitch -- mostly by Medicare but also by his Medicare supplemental insurance provider, Anthem Blue Cross.
Ossiander, 68, who knew his hepatitis might eventually require a transplant, said he was relieved when he turned 65 because he knew it would be covered.
"As soon as I got onto Medicare, the hospital and everybody said, 'You really don't have anything to worry about now,' " he said. "You are on Medicare."
Now, I'll plead guilty to being one of those totally impractical single payer advocates who predicted as early as last year that taking single payer "off the table" guaranteed that the final compromise plan would be inadequate - so what do I know? But here are a few thoughts to keep in mind:
Since single payer won't happen this year, the most important task for many of us who still believe it's the right answer is to fight for the Kucinich Amendment to HR 3200, which at least preserves the option for states to do single payer in the future. And, if a "public option" (that is only an option for some) is the best we can hope for, why does that have to be a new program at all? Why can't it be, as others have suggested, simply allowing citizens to buy into the medicare program as their insurance. It makes sense as policy and it makes sense as politics - it's a known and trusted program that's hard for the Right to lie about. What I fear most right now is that the Democratic leadership is on a path to a version of "reform" that will leave too many Americans still subject to the insurance company death panels. And that makes no sense as either policy or politics