Health coverage boon for young adults

By Ray Long and Monique Garcia
Chicago Tribune
August 19, 2008
Young adults could stay on their parents’ health insurance until they turn 26 under a new law pushed by Gov. Rod Blagojevich and approved Tuesday by the Illinois Senate.
The estimated 300,000 twentysomethings who are eligible wouldn’t have to live at home — or even in Illinois. And if they’re in the military, they could remain covered by mom and dad until they turn 30. They must stay single, however.
http://www.chicagotribune.com/news/nationworld/chi-legis-insurance-20aug20,0,6922973.story

For those who contend that comprehensive reform is not politically feasible and that reform must occur in incremental steps, this is precisely the type of legislation that they support. Young adults frequently fall through the cracks in health insurance coverage, having one of the highest rates of uninsurance. This legislation provides them with another option for health insurance and, theoretically, should reduce the total numbers of uninsured.
Should we celebrate this success of the incrementalists? Maybe, but before we do we should attempt to understand some of the other policy implications.

• Young adults with conditions such as diabetes, hypertension or HIV infection need coverage and would more likely continue in their parents’ plans – a classic example of adverse selection. Whether individual or employer-sponsored plans, allowing more high-cost adults to opt into the insurance pools will inevitably cause an increase in premiums. At a time when affordability of coverage already has become a problem, higher premiums will cause more to drop coverage.
• In small groups, adding one individual with significant chronic disease can cause premiums to skyrocket, making the plan unaffordable for the entire group.
• Even if initially in good health, young adults can develop chronic conditions while covered by their parents’ plans, which might make them uninsurable when they are no longer eligible for those plans. They would be disqualified for the low-cost plans designed for the young invincibles.
• Keeping an adult child on the plan can cause the premium to be set at a family rate rather than at the much less expensive rates for individuals or couples. A policy that expands the window of eligibility is of little value if you can’t pay for it.
• This legislation requires that the adult child remain single. Basing eligibility for insurance coverage simply on marital status can have perverse policy implications, possibly impacting the very foundation of the family.
• The primary reason that so many young adults are uninsured is because they have difficulty spending a large amount of money on health coverage when they need the money for other purposes, and it is quite unlikely that they would need much health care anyway. They would rather take their chances. Of course, as free riders, if they should ever develop major problems, they would shift their costs of care to the rest of us.

The benefits of this legislation are greater than the deficiencies, but it is such a tiny baby step, and a flawed one at that, that it cannot begin to compensate for the persistent deterioration in coverage that continues to plague us.
No celebrations today – not until we have comprehensive reform that automatically and permanently provides equitably-funded comprehensive coverage for everyone.

Health coverage boon for young adults

By Ray Long and Monique Garcia
Chicago Tribune
August 19, 2008

Young adults could stay on their parents’ health insurance until they turn 26 under a new law pushed by Gov. Rod Blagojevich and approved Tuesday by the Illinois Senate.

The estimated 300,000 twentysomethings who are eligible wouldn’t have to live at home — or even in Illinois. And if they’re in the military, they could remain covered by mom and dad until they turn 30. They must stay single, however.

http://www.chicagotribune.com/news/nationworld/chi-legis-insurance-20aug20,0,6922973.story

Comment:

By Don McCanne, MD

For those who contend that comprehensive reform is not politically feasible and that reform must occur in incremental steps, this is precisely the type of legislation that they support. Young adults frequently fall through the cracks in health insurance coverage, having one of the highest rates of uninsurance. This legislation provides them with another option for health insurance and, theoretically, should reduce the total numbers of uninsured.

Should we celebrate this success of the incrementalists? Maybe, but before we do we should attempt to understand some of the other policy implications.

* Young adults with conditions such as diabetes, hypertension or HIV infection need coverage and would more likely continue in their parents’ plans – a classic example of adverse selection. Whether individual or employer-sponsored plans, allowing more high-cost adults to opt into the insurance pools will inevitably cause an increase in premiums. At a time when affordability of coverage already has become a problem, higher premiums will cause more to drop coverage.

* In small groups, adding one individual with significant chronic disease can cause premiums to skyrocket, making the plan unaffordable for the entire group.

* Even if initially in good health, young adults can develop chronic conditions while covered by their parents’ plans, which might make them uninsurable when they are no longer eligible for those plans. They would be disqualified for the low-cost plans designed for the young invincibles.

* Keeping an adult child on the plan can cause the premium to be set at a family rate rather than at the much less expensive rates for individuals or couples. A policy that expands the window of eligibility is of little value if you can’t pay for it.

* This legislation requires that the adult child remain single. Basing eligibility for insurance coverage simply on marital status can have perverse policy implications, possibly impacting the very foundation of the family.

* The primary reason that so many young adults are uninsured is because they have difficulty spending a large amount of money on health coverage when they need the money for other purposes, and it is quite unlikely that they would need much health care anyway. They would rather take their chances. Of course, as free riders, if they should ever develop major problems, they would shift their costs of care to the rest of us.

The benefits of this legislation are greater than the deficiencies, but it is such a tiny baby step, and a flawed one at that, that it cannot begin to compensate for the persistent deterioration in coverage that continues to plague us.

No celebrations today – not until we have comprehensive reform that automatically and permanently provides equitably-funded comprehensive coverage for everyone.

Health of the Nation — Coverage for All Americans

Charles D. Baker, Arthur Caplan, Ph.D., Karen Davis, Ph.D., Susan Dentzer, Arnold M. Epstein, M.D., Bill Frist, M.D., Robert S. Galvin, M.D., Ruben J. King-Shaw, Jr., Thomas H. Lee, M.D., Jonathan B. Oberlander, Ph.D., Sara Rosenbaum, J.D., Steven A. Schroeder, M.D., and Reed V. Tuckson, M.D., moderated by Arthur R. Miller, J.D.
The New England Journal of Medicine
August 21, 2008
Shattuck Lecture
Sara Rosenbaum: [Access to care is] the most basic ethical issue of all. But it is a national decision on our part. It’s not the federal decision; it’s not the state decision; it is a national social decision. And we’ve been very bad about this.
Steven Schroeder: I think that a country should be judged by how it treats its less fortunate. In that respect, I’m ashamed of our country.
Jonathan Oberlander: If there’s one lesson that we’ve learned about health reform in the last few decades, [it’s that] being right doesn’t count for very much. We can come up with lots of stories to evoke moral outrage. And it’s not just about the uninsured. There are many Americans with insurance who have inadequate protection and who file for bankruptcy every year because they’re underinsured. But if we’re going to fight this battle for health reform on moral grounds, we’re going to lose.
Jonathan Oberlander: The price tag for universal coverage really is not that much. If you talk about adding the uninsured to the existing system, you’re talking about roughly $100 billion a year. We already spend over $2 trillion, so it’s a mark-up but not much. When we cut taxes in 2001 and 2003, we found the money to do that. When we passed the Medicare Prescription Drug Benefit in 2003, we found the money to do that. When we went to war in Iraq, we found the money to do that. So this is a question of priorities. And the uninsured are not a political priority.
http://www.nejm.org/perspective/health%2Dof%2Dthe%2Dnation%2Dvideo/

It would be worth your time to either watch the video or read the transcript of this very unusual Shattuck Lecture. For one hour Arthur Miller prods this panel on a discussion of important challenges to the American health care system. Comments are invited at the link above.
You likely will be disappointed, but that is precisely why you should at least skim over the transcript. It is disconcerting to see how ineffective a select panel of noted experts can be in framing the problems, much less in approaching any real solutions. Some exceptions are represented by the individuals quoted above.
We can do it – easily. But will we? If the ethics won’t drive us, what will?
(Hint: money. Establishing a value-based single payer system that takes care of everyone would cost less than passively accepting a continuing intolerable increase in health care costs in a system that leaves so many out. We need to target those who pay the bills.)

Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families

By Sara R. Collins, Ph.D., Jennifer L. Kriss, Michelle M. Doty, Ph.D., and Sheila D. Rustgi
The Commonwealth Fund
August 20, 2008
Using data from four years of the Commonwealth Fund Biennial Health Insurance Survey, this report examines the status of health insurance for U.S. adults under age 65 and the implications for family finances and access to health care. Insurance coverage deteriorated over the past six years, with declines in coverage most severe for moderate-income families. As result, more families are experiencing medical bill problems or cost-related delays in getting needed care. In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses).
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=700872

And…

Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families

By Michelle M. Doty, Ph.D., Sara R. Collins, Ph.D., Sheila D. Rustgi, and Jennifer L. Kriss
The Commonwealth Fund
August 20, 2008
Analysis of the 2007 Commonwealth Fund Biennial Health Insurance Survey finds the proportion of working-age Americans who struggled to pay medical bills and accumulated medical debt climbed from 34 percent to 41 percent, or 72 million people, between 2005 and 2007. In addition, 7 million adults age 65 and older had these problems, bringing the total to 79 million adults with medical debt or bill problems. All income groups reported an increase. Families with low or moderate incomes were particularly hard hit, as were adults who had gaps in health coverage or those underinsured. Because of medical bills or accumulated medical debt, an estimated 28 million adults reported they used up all their savings, 21 million incurred large credit card debt, and another 21 million were unable to pay for basic necessities. Sixty-one percent of those with medical debt or bill problems were insured at the time care was provided.
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=700868

How well is our health care financing system working? Two-thirds of adults under 65 have problems with their health insurance and paying for health care. Forty-one percent have medical bill problems or are paying off medical debt, even though sixty-one percent of these individuals were insured at the time care was provided.
So what is the response of the politicians to this health care financing crisis? Sen. John McCain says that we should allow insurers to sell us more affordable plans (even though that means that the stripped-down plans would not provide adequate financial protection in the face of medical need). Sen. Barack Obama says that we should authorize only plans with adequate benefits, whether public or private plans (even though that means that even more of us would be unable to afford to purchase the plans). Sen. Max Baucus, Chair of the Senate Finance Committee which must clear all health care financing legislation, says that comprehensive reform is not feasible and that we must proceed with smaller incremental steps, beginning with expanding the children’s health insurance program, and tweaking Medicare.
Wouldn’t you think that the politicians would be interested in reform that would allow us to continue to fund the most expensive health care system of all, without the necessity of exposing individuals to financial hardship merely because they need health care?
I was interviewed by a Canadian journalist this week. He said that the Canadians could not understand how we could spend so much money on our health care system and yet leave so many without adequate protection against financial losses for health care. They think that there is something very fundamentally wrong with our health care financing system that can be fixed. If only we could get our politicians to acknowledge that there is a solution that would actually work: a single payer national health program.

Charles D. Baker, Arthur Caplan, Ph.D., Karen Davis, Ph.D., Susan Dentzer, Arnold M. Epstein, M.D., Bill Frist, M.D., Robert S. Galvin, M.D., Ruben J. King-Shaw, Jr., Thomas H. Lee, M.D., Jonathan B. Oberlander, Ph.D., Sara Rosenbaum, J.D., Steven A. Schroeder, M.D., and Reed V. Tuckson, M.D., moderated by Arthur R. Miller, J.D.
The New England Journal of Medicine
August 21, 2008
Shattuck Lecture

Sara Rosenbaum: [Access to care is] the most basic ethical issue of all. But it is a national decision on our part. It’s not the federal decision; it’s not the state decision; it is a national social decision. And we’ve been very bad about this.

Steven Schroeder: I think that a country should be judged by how it treats its less fortunate. In that respect, I’m ashamed of our country.

Jonathan Oberlander: If there’s one lesson that we’ve learned about health reform in the last few decades, [it’s that] being right doesn’t count for very much. We can come up with lots of stories to evoke moral outrage. And it’s not just about the uninsured. There are many Americans with insurance who have inadequate protection and who file for bankruptcy every year because they’re underinsured. But if we’re going to fight this battle for health reform on moral grounds, we’re going to lose.

Jonathan Oberlander: The price tag for universal coverage really is not that much. If you talk about adding the uninsured to the existing system, you’re talking about roughly $100 billion a year. We already spend over $2 trillion, so it’s a mark-up but not much. When we cut taxes in 2001 and 2003, we found the money to do that. When we passed the Medicare Prescription Drug Benefit in 2003, we found the money to do that. When we went to war in Iraq, we found the money to do that. So this is a question of priorities. And the uninsured are not a political priority.

http://www.nejm.org/perspective/health%2Dof%2Dthe%2Dnation%2Dvideo/

Comment:

By Don McCanne, MD

It would be worth your time to either watch the video or read the transcript of this very unusual Shattuck Lecture. For one hour Arthur Miller prods this panel on a discussion of important challenges to the American health care system. Comments are invited at the link above.

You likely will be disappointed, but that is precisely why you should at least skim over the transcript. It is disconcerting to see how ineffective a select panel of noted experts can be in framing the problems, much less in approaching any real solutions. Some exceptions are represented by the individuals quoted above.

We can do it – easily. But will we? If the ethics won’t drive us, what will?

(Hint: money. Establishing a value-based single payer system that takes care of everyone would cost less than passively accepting a continuing intolerable increase in health care costs in a system that leaves so many out. We need to target those who pay the bills.)

By Sara R. Collins, Ph.D., Jennifer L. Kriss, Michelle M. Doty, Ph.D., and Sheila D. Rustgi
The Commonwealth Fund
August 20, 2008

Using data from four years of the Commonwealth Fund Biennial Health Insurance Survey, this report examines the status of health insurance for U.S. adults under age 65 and the implications for family finances and access to health care. Insurance coverage deteriorated over the past six years, with declines in coverage most severe for moderate-income families. As result, more families are experiencing medical bill problems or cost-related delays in getting needed care. In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses).

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=700872

And…

Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families

By Michelle M. Doty, Ph.D., Sara R. Collins, Ph.D., Sheila D. Rustgi, and Jennifer L. Kriss
The Commonwealth Fund
August 20, 2008

Analysis of the 2007 Commonwealth Fund Biennial Health Insurance Survey finds the proportion of working-age Americans who struggled to pay medical bills and accumulated medical debt climbed from 34 percent to 41 percent, or 72 million people, between 2005 and 2007. In addition, 7 million adults age 65 and older had these problems, bringing the total to 79 million adults with medical debt or bill problems. All income groups reported an increase. Families with low or moderate incomes were particularly hard hit, as were adults who had gaps in health coverage or those underinsured. Because of medical bills or accumulated medical debt, an estimated 28 million adults reported they used up all their savings, 21 million incurred large credit card debt, and another 21 million were unable to pay for basic necessities. Sixty-one percent of those with medical debt or bill problems were insured at the time care was provided.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=700868

Comment:

By Don McCanne, MD

How well is our health care financing system working? Two-thirds of adults under 65 have problems with their health insurance and paying for health care. Forty-one percent have medical bill problems or are paying off medical debt, even though sixty-one percent of these individuals were insured at the time care was provided.

So what is the response of the politicians to this health care financing crisis? Sen. John McCain says that we should allow insurers to sell us more affordable plans (even though that means that the stripped-down plans would not provide adequate financial protection in the face of medical need). Sen. Barack Obama says that we should authorize only plans with adequate benefits, whether public or private plans (even though that means that even more of us would be unable to afford to purchase the plans). Sen. Max Baucus, Chair of the Senate Finance Committee which must clear all health care financing legislation, says that comprehensive reform is not feasible and that we must proceed with smaller incremental steps, beginning with expanding the children’s health insurance program, and tweaking Medicare.

Wouldn’t you think that the politicians would be interested in reform that would allow us to continue to fund the most expensive health care system of all, without the necessity of exposing individuals to financial hardship merely because they need health care?

I was interviewed by a Canadian journalist this week. He said that the Canadians could not understand how we could spend so much money on our health care system and yet leave so many without adequate protection against financial losses for health care. They think that there is something very fundamentally wrong with our health care financing system that can be fixed. If only we could get our politicians to acknowledge that there is a solution that would actually work: a single payer national health program.

www.harryandlouisereturn.com
August 20, 2008
Scene: In the kitchen, at the breakfast table
Harry: Health care costs are up again. Small companies are being forced to cut their plans.
Louise: Tell me about it. You know, Lisa’s husband just found out he has cancer.
Harry: But he’s covered. Right?
Louise: No. He just joined a start-up, and he can’t afford a plan.
Harry: Too many people are falling through the cracks.
Louise: Whoever the next president is, health care should be at the top of his agenda. Bring everyone to the table, and make it happen.
(This ad campaign is sponsored by the American Cancer Society Cancer Action Network (ACS CAN), the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).)
2008 Harry and Louise ad:
http://harryandlouisereturn.com/
1994 Harry and Louise ad:
http://www.youtube.com/watch?v=Dt31nhleeCg&NR=1

What a refreshing change. In fourteen years, Harry and Louise’s breakfast table conversation has changed from, “If we let the government choose, we lose,” to “Bring everyone to the table and make it happen.” But what does this mean?
At today’s press conference inaugurating this ad campaign, it was clear from the diverse groups involved that the message is that we must all join together to make reform happen. But before the press conference was even over, red flags were raised.
Most disconcerting was the fact that AHIP’s Karen Ignagni was invited to express the support of the private insurance industry in this effort, even though AHIP is not a sponsor of this campaign. During the Q&A, she indicated that AHIP was prepared to support its specific proposal for reform (a model that uses private plans to insure the low-cost healthy, while shifting those with higher-cost needs to taxpayer-funded programs).
When Teddy Davis of ABC News asked about the problem of guaranteed issue without a mandate, Ron Pollack (Families USA) responded, “I don’t think that we’re prepared to answer hypothetical questions.” But really, are crucial fundamental policy issues to be dismissed as mere hypotheticals?
Sadly, this is merely another chapter in the saga of the strange bedfellow coalitions. The policy opinions supported by the participants are mutually incompatible and can only lead to a result that Ron Pollack has described repeatedly: everyone walks away, supporting their second favorite choice – the status quo (even though no one actually supports the status quo). This process is yet another recipe for political inertia.
There are some very fundamental principles which should garner broad support if we are truly serious about reform.
Costs must be contained. Projections that health care will soon consume maybe half of our GDP are totally unrealistic. Essential spending in other sectors of our economy will create a barrier beyond which no further funds would be available for health care. Tragically, the uninsured and under-insured have already crashed into that solid wall, and that includes many middle-income Americans. Cost increases will only move that barrier in front of more and more of us.
There are two fundamental approaches to controlling costs. We can withhold essential health care from people who cannot afford it, an option for the heartless, or we can demand a reduction in wasteful spending such as our profound administrative excesses and our non-beneficial high-tech services. The market has been and always will be incapable of controlling these costs since markets function to sell us more, not fewer, products and services. A monopsony operating in the public interest will be required to bring us greater value and affordability in our health care purchasing, and that can be accomplished only by enacting enabling government policies.
We can no longer accept the suffering and death that occurs amongst us merely because many individuals don’t have the resources to pay for care. Everyone must be included under the umbrella of a comprehensive financing system.
Since average-income individuals can no longer afford their pro rata share of health care financing, a transfer must be enabled through progressive tax policies. Rejection of this fundamental principle would equate with the tacit acceptance for too many of us of financial hardship and bankruptcy as a consequence of ill health.
Louise is right. We need to bring everyone to the table. That includes everyone who needs health care or may need it at some time in the future. That is everyone. Everyone.
Libertarian ideologues and moneygrubbers stand aside. Make room for the people.

www.harryandlouisereturn.com
August 20, 2008

Scene: In the kitchen, at the breakfast table

Harry: Health care costs are up again. Small companies are being forced to cut their plans.

Louise: Tell me about it. You know, Lisa’s husband just found out he has cancer.

Harry: But he’s covered. Right?

Louise: No. He just joined a start-up, and he can’t afford a plan.

Harry: Too many people are falling through the cracks.

Louise: Whoever the next president is, health care should be at the top of his agenda. Bring everyone to the table, and make it happen.

(This ad campaign is sponsored by the American Cancer Society Cancer Action Network (ACS CAN), the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).)

2008 Harry and Louise ad:
http://harryandlouisereturn.com/

1994 Harry and Louise ad:
http://www.youtube.com/watch?v=Dt31nhleeCg&NR=1

Comment:

By Don McCanne, MD

What a refreshing change. In fourteen years, Harry and Louise’s breakfast table conversation has changed from, “If we let the government choose, we lose,” to “Bring everyone to the table and make it happen.” But what does this mean?

At today’s press conference inaugurating this ad campaign, it was clear from the diverse groups involved that the message is that we must all join together to make reform happen. But before the press conference was even over, red flags were raised.

Most disconcerting was the fact that AHIP’s Karen Ignagni was invited to express the support of the private insurance industry in this effort, even though AHIP is not a sponsor of this campaign. During the Q&A, she indicated that AHIP was prepared to support its specific proposal for reform (a model that uses private plans to insure the low-cost healthy, while shifting those with higher-cost needs to taxpayer-funded programs).

When Teddy Davis of ABC News asked about the problem of guaranteed issue without a mandate, Ron Pollack (Families USA) responded, “I don’t think that we’re prepared to answer hypothetical questions.” But really, are crucial fundamental policy issues to be dismissed as mere hypotheticals?

Sadly, this is merely another chapter in the saga of the strange bedfellow coalitions. The policy opinions supported by the participants are mutually incompatible and can only lead to a result that Ron Pollack has described repeatedly: everyone walks away, supporting their second favorite choice – the status quo (even though no one actually supports the status quo). This process is yet another recipe for political inertia.

There are some very fundamental principles which should garner broad support if we are truly serious about reform.

Costs must be contained. Projections that health care will soon consume maybe half of our GDP are totally unrealistic. Essential spending in other sectors of our economy will create a barrier beyond which no further funds would be available for health care. Tragically, the uninsured and under-insured have already crashed into that solid wall, and that includes many middle-income Americans. Cost increases will only move that barrier in front of more and more of us.

There are two fundamental approaches to controlling costs. We can withhold essential health care from people who cannot afford it, an option for the heartless, or we can demand a reduction in wasteful spending such as our profound administrative excesses and our non-beneficial high-tech services. The market has been and always will be incapable of controlling these costs since markets function to sell us more, not fewer, products and services. A monopsony operating in the public interest will be required to bring us greater value and affordability in our health care purchasing, and that can be accomplished only by enacting enabling government policies.

We can no longer accept the suffering and death that occurs amongst us merely because many individuals don’t have the resources to pay for care. Everyone must be included under the umbrella of a comprehensive financing system.

Since average-income individuals can no longer afford their pro rata share of health care financing, a transfer must be enabled through progressive tax policies. Rejection of this fundamental principle would equate with the tacit acceptance for too many of us of financial hardship and bankruptcy as a consequence of ill health.

Louise is right. We need to bring everyone to the table. That includes everyone who needs health care or may need it at some time in the future. That is everyone. Everyone.

Libertarian ideologues and moneygrubbers stand aside. Make room for the people.

Letter
From: Anthem Blue Cross, Oxnard, California
To: Don McCanne
Dear Don,
Enclosed you will find a Part D Coordination of Benefits Survey. By completing the survey, it will help assure that you receive the maximum coverage benefits from your drug plan. …
http://www.anthem.com/

What’s this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system.
The three page questionnaire enclosed with the letter asks for extensive detailed information on matters such as employer, number of fellow employees, insurance company, group number, member/plan ID, Rx PCN, Rx Bin, Person Code, etc. The same questions are asked about the spouse’s employer and coverage as well. There are detailed questions about other supplemental drug coverage, about Coal Miner’s Medical Benefits, and about coverage under no-fault or automobile insurance. There is a detailed question about present or pending Workers’ Compensation claims, including the name and address of your attorney. There is another question about any illness or injury for which another party could be held liable, also including a request for the name and address of your attorney.
A quote from the forty-two page booklet on our Blue Cross of California Part D coverage (now Anthem Blue Cross): “… the prescription drug coverage you get from us will be secondary to your employer or retiree group coverage.”
This is not a process that would afford Anthem Blue Cross the opportunity to increase payment for any prescription drugs that qualify. Assuring that you receive the “maximum coverage benefits” refers to the maximum that will be paid after excluding the legitimate claims that they would shift to other potential payers. Under these circumstances, the maximum benefit frequently would be no benefit payment at all.
There could not be a more clear distinction between the business model of private health plans in the United States, and the social insurance models of private health plans used in other countries. Private plans unified in a social insurance program assist patients in paying for the care they need. Our private insurers, such as Anthem Blue Cross, use every devious method they can to avoid paying for the care that patients need. And they add more wasteful administrative complexity to the health care financing process, made even worse by the fragmentation of the financing system.
If we were to adopt a financing system using private insurers that would provide adequate affordable coverage for everyone, then we would have to totally transform the private insurance industry into a social insurance model. For that transformation to be equitable and effective, those who do not want to give up the coverage they have would have to acknowledge that their plan would be transformed anyway to comply with requirements for universal risk pooling, guaranteed issue, prevention of adverse selection, adequate benefit package, elimination of under-insurance, and other measures that define social insurance programs.
That transformation would be both politically and administratively more difficult and more expensive than replacing private insurers with a more efficient and effective single payer national health program. Besides, why do we insist on continuing to protect an industry that thrives by cheating us out of our health care benefits?