Improving Health Care

Any day now, the U.S. Supreme will rule on whether the Obamacare insurance mandate is constitutional. Seems like a no-brainer to me. How can forcing me to engage in commerce be constitutional?

But there’s a deeper question: Why should government be involved in medicine at all?

Right before President Obama took office, the media got hysterical about health care. You heard the claims: America spends more than any country — $6,000 per person — yet we get less. Americans die younger than people in Japan and Western Europe. Millions of Americans lack health insurance and worry about paying for care.

I have the solution! said Obama. Bigger government will give us more choices and make health care cheaper and better. He proceeded to give us that. Bigger government, that is. The cheaper/better/more choices part — not so much.

Costs have risen. More choices? No, we have fewer choices. Many people lost coverage when companies left the market.

Because ObamaCare requires insurance companies to cover every child regardless of pre-existing conditions, WellPoint, Humana and Cigna got out of the child-only business. Principal Financial stopped offering health insurance altogether — 1 million customers no longer have the choice to keep their insurance.

This is to be expected when governments control health care. Since state funding makes medical services seem free, demand increases. Governments deal with that by rationing. Advocates of government health care hate the word “rationing” because it forces them to face an ugly truth: Once you accept the idea that taxpayers pay, individual choice dies. Someone else decides what treatment you get, and when.

At least in America, we still have some choice. We can pay to get what we want. Under government health care, bureaucrats will decide how long we wait for our knee operation or cataract surgery … or if we get lifesaving treatment at all.

When someone else pays for your health care, that someone else also decides when to pull the plug. The reason can be found in Econ 101. Medical care doesn’t grow on trees. It must be produced by human and physical capital, and those resources are limited. Politicians can’t repeal supply and demand.

Call them “death panels” or not, a government that needs to cut costs will limit what it spends on health care, especially on people nearing the end of life. Medical “ethicists” have long lamented that too much money is spent in the last several months of life. Given the premise that it’s government’s job to pay, it’s only natural that some bureaucrat will decide that 80-year-olds shouldn’t get hip replacements.

True, surveys show that most Brits and Canadians like their free health care. But Dr. David Gratzer notes that most people surveyed aren’t sick. Gratzer is a Canadian who also liked Canada’s government health care — until he started treating patients.

More than a million Canadians say they can’t find a family doctor. Some towns hold lotteries to determine who gets to see one. In Norwood, Ontario, my TV producer watched as the town clerk pulled four names out of a big box and then telephoned the lucky winners. “Congratulations! You get to see a doctor this month.”

Think the wait in an American emergency room is bad? In Canada, the average wait is 23 hours. Sometimes they can’t even get heart attack victims into the ICU.

That’s where we’re headed unless Obamacare is repealed. But that’s not nearly enough. Contrary to what some Republicans say, we didn’t have a free medical market before Obama came to power. We had a system that limited competition through occupational licensing, FDA rules and other government intrusions, while stimulating demand through tax-favored employer-based “insurance,” Medicare and Medicaid.

If we want affordable and cutting-edge health care, there’s only one approach that will work: open competition. That means eliminating both bureaucratic obstacles and corporate privileges. Only free markets can give us innovation at the lowest possible cost.

Of course, that also means consumers should spend their own money on health care, limiting insurance to catastrophic expenses. Americans don’t want to hear it. But that’s the truth.

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Chuck Briese, Oak Ridge Now

Chuck Briese, Oak Ridge Now Chuck Briese has been a resident of South Montgomery County since 1988. He and his lovely and patient wife, Leslie, have six sons, with only one left to finish high school. Chuck has been a Cub Scout leader, a Little League baseball coach, a church youth leader, and a general troublemaker over the course of the past 25 years. He is obsessed with his lawn, and likes restaurants that serve food that fills up the plate. He has a tendency to tilt at windmills, which may explain why he started Oak Ridge Now.

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Pregnant? Your Insurance May Not Cover That

When Amy Tiller became pregnant six years ago, she was a high school biology teacher in Waynesville, N.C., and the health insurance plan she had through her school system covered the tab for the birth of her twins.

A few years later, when she discovered she was pregnant again, she didn’t give insurance a thought, assuming she’d be covered once again. But by then she had left her teaching job to open a personal training studio with her husband, and they were covered under individual health insurance policies.

Tiller was shocked to discover that her new plan didn’t cover maternity care at all unless she purchased a special rider for the coverage, something she could not do after she became pregnant. “I was paying so much — $400 a month” for the insurance premium, she says. “I thought it must be a mistake.”

It wasn’t. Tiller’s experience is common. Individual health insurance policies generally don’t cover maternity care, as a recent investigation by the House Committee on Energy and Commerce reported. In an October memo outlining its findings based on responses from the four largest for-profit health insurers — Aetna, Humana, UnitedHealth Group and WellPoint — the committee reported that most individual policies at those companies didn’t cover most of the expenses for a normal delivery.

The findings are similar to those of a 2009 report by the National Women’s Law Center that examined 3,600 individual policies across the country and found that only 13 percent provided maternity coverage.

The problems don’t stop there. If a woman is pregnant and applies for coverage in the individual market, insurers generally consider her pregnancy a preexisting medical condition and deny coverage. The Energy and Commerce Committee investigation also found that insurers sometimes denied coverage to expectant fathers and those who were in the process of adoption. The reason? Most states require insurers to extend coverage to policyholders’ newborn or adopted children, according to Brigette Courtot, a senior policy analyst at the NWLC.

As for maternity riders such as the one offered in Tiller’s plan, they’re often pricey add-ons that provide only limited coverage, with waiting periods of a year or more before they take effect, according to the committee memo and a 2008 NWLC report.

In 2007, average expenses for maternity care, including nine months of prenatal care and three months of postpartum care for a delivery without complications, were $10,652, according to a study done for the March of Dimes.

Although coverage for maternity care is required under the Pregnancy Discrimination Act of 1978, the law doesn’t apply to companies with fewer than 15 employees or to individual policies. Some states have tighter requirements: In 2010, 12 states mandatedcoverage of maternity care in the individual insurance market and 17 required it in the small-group market, according to statehealthfacts.org, a project of the Kaiser Family Foundation. (Kaiser Health News is a program of the foundation.) But, in general, if parents-to-be don’t work for a large employer, they’re out of luck.

Under the health-care overhaul law enacted this year, this coverage gap will close in 2014. Policies sold through state-based insurance exchanges, as well as new individual and small-group plans sold outside the exchanges, will be required to cover maternity care as an “essential health benefit.” The new law will also prohibit health plans from turning away applicants because of preexisting conditions — and those will include pregnancy.

In exchange for agreeing to cover everyone regardless of condition, however, insurers and many health policy experts argued successfully that everyone must be required to have insurance. Otherwise, they said, people would wait to buy insurance until they needed it, placing a disproportionate number of sick people in the system with not enough healthy ones to offset the cost of treating them.

That imbalance is what insurers have been trying to protect themselves from with regard to maternity care, says Susan Pisano, a spokeswoman or America’s Health Insurance Plans, an industry trade group. “It’s a challenge to offer an affordable maternity benefit in the individual market,” she says. “People who buy maternity benefits are people who believe they’re going to use maternity benefits.” The four companies cited in the House memo did not respond to request for comment.

Since about half of all pregnancies are unplanned, timing the purchase of maternity coverage can be tricky. When the Ablondi family’s Cobra coverage ran out in 2006, the Fredericksburg couple took out a policy on the individual market for themselves and their daughter, Abigail, now 4 1/2. Their policy’s maternity rider had a six-month waiting period, but since it had taken them two years to conceive Abigail, they didn’t expect that to be an issue.

Needless to say, they were surprised when Heather became pregnant four months later. Because they were within the six-month waiting period, the Ablondis had to pay all of the medical costs related to Heather’s pregnancy, which was considered high-risk because Abigail had been born prematurely. The total tab for the doctors, frequent ultrasounds and the Caesarean delivery: $25,000.

“It was frustrating,” says Heather. “The insurer basically told me, ‘You’re not allowed to get pregnant in the next six months.’”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family FoundationKaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Michelle Andrews

Michelle Andrews writes about health topics for a variety of news sources, including the Washington Post, US News and Word Report, and the New York Times. Her work appears on Oak Ridge Now courtesy of Kaiser Health News.

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