Florida continues to try to opt out of PPACA. This ill advised position is the darling of the Tea Party set and is supported by many Floridian conservatives. Some of my friends and family have taken great joy in gigging me about it.
One of those people changed their mind and called me today. This same person who went on and on about how "illegal" PPACA is, is now demanding to know why PPACA isn't extensive enough to provide some protection to her son. Her son, a Tea Party sympathizer, is also a middle aged, uninsured man with hypertension and "undiagnosed" type II diabetes who has a stay at home wife and 3 kids.
I'm not gloating. I feel sick. I'm sick at heart that this woman's son might suffer irreversible damage and could die because he has inadequate access to health care in the "richest nation in the world".
I'm sick over how conservatives are their own worst enemy when it comes to getting everyone adequate access to health care in the United States.
This afternoon's tirade included demands of why PPACA isn't in effect already (it is, but nothing in effect will help this 45 yo man). Why the exchanges aren't happening now. What's going on with Florida's participation in the high risk pools. Why is health insurance for this 45 yo man over $500 per month? Why is insurance for his entire family over $1,200 per month? Why isn't his employer required to offer him insurance when it's offered to every one else at his job? To say his mom was upset is an understatement.
There's precious little I can do to help. This man can get care, that isn't a problem. The problem is that if he gets the medical care he needs, he won't be able to pay his mortgage. We had a lengthy chat about what he could do and what is available to him in Florida. I do know a few physicians that have many uninsured patients and tomorrow I'll see what I can set up.
We hung up, then I got to thinking. Why? ...How does the Republican message win through? Because, when it comes to substance, the actual follow through on their political positions; we end up with Big Banks that take us down when they fail, Big Oil Spills that no one can plug for weeks and a Big Recession that takes a long time to turn around.
The same can be said about health care. Why isn't Bill McCollum's fax machine melting down with blow back on his law suit?
How is it people thought that HCR would bring about death panels
and failed to see HMO's already have death panels that kill their loved ones?
How is it people thought HCR would bring about health care rationing
and failed to see that our health care is already rationed according to their ability to pay for it?
How is it people say they are afraid of government run health care,
then, turn around and say "Don't touch my Medicare!!!"
How is it people say they are afraid of government run health care,
but aren't terrified of profiteer run health care?
How is it people claim HCR is too expensive,
but fail to see that it was already too expensive?
I asked my caller those questions and the answers were one meme after another. She thought HCR was too expensive, only irresponsible people needed help with health care expenses, respectable people have insurance.... and the BS flowed on ....and on. I didn't dare ask her if her son was irresponsible or worthy of disrespect, tempting as it was.
Her son is a hard working man who never calls in sick. He's overweight. He is trying to quit smoking. He drinks too much, but he's drinking less and less as he gets older (like many people). He doesn't exercise much outside of work, but his job requires a lot of walking, lifting, bending and twisting. He generally comes home pretty tired from all the activity. He doesn't pack his lunch, he does fast food. All in all, he's quite typical of many construction workers and car mechanics. He could make better choices, but doesn't.
There's also a lot of back story in his case that is really, very typical of the health care stories that happen to people every day in America.
The reason her son doesn't have employer group insurance is because his employer implied he'd be let go if he opted to take the insurance. He has a daughter who was born with a birth defect and her care 7 years later, is very expensive. Illegal? Maybe, but he'd have to hire a lawyer and go to court to find out and suing your employer is a bad way to get ahead. Plus, if he had the money to sue, he'd have health insurance instead.
The reason her son doesn't have an individual policy for his family is that if he has the policy, he can't pay his inflated mortgage for his "upside down" house.
The reason her son doesn't have an individual policy for himself is because he thinks it's "wrong" to cover himself and deny the rest of his family. (Never mind the boneheadness that he'll be dead if he doesn't get treated for the diabetes.) Plus, the hypertension is a pre-existing condition, which may put him in an even more expensive, high risk plan until 2014.
The reasons her son's insurance rates are so high are really to numerous to count but I'll list the high points here:
- Poorly regulated insurance companies.
- Poor negotiations with pharmaceutical companies and medical device companies.
- No demand for pay for performance from doctors and hospitals.
- No disincentive for over utilization.
- No way to challenge unrealistic expectations.
- No rewards for inexpensive, but efficacious care.
- No rewards for encouraging more patient self-care.
- Despite PPACA eliminating his daughter's pre-existing condition, that doesn't mean he can afford to pay the increased premiums that condition actuarily costs.
- His pre-existing conditions hypertension and elevated blood sugar are sure to trigger elevated insurance premiums if he's accepted at all.
- No challenges to cost shifting from Medicaid & unpaid care to private insurers
(and private pay people when they can get it, but that's another diary)..
What is too simplistic to say is the idea that insurance premiums are too high because our Congressional Members didn't get 'er done even if you might possibly think that idea to be true.
The reason her son has "undiagnosed" Type II diabetes is because his diagnosis code on his medical records is listed as "elevated blood sugar".... for the 4 or 5 times his glucose has been high. Sometimes it was 500 (3.5 times a high reading). This may be a case where the doctor is trying to "help" the patient remain insurable. The son doesn't want the diagnosis and argues against taking Type II drugs that will lower his blood sugar out of sheer bone headedness. He already spends about $1,500 per year on controlling his blood pressure, he's afraid of the added costs of managing diabetes.
(As a health care administrator, may I just say, ARGGGGGHHHH!)