seajane

Thoughts from a Yellow Dog Democrat living in Olympia, in the great BLUE state of Washington

I am a liberal because it is the political philosophy of freedom and equality. And I am a progressive because it is the political path to a better future. And I am a Democrat because it is the political party that believes in freedom, equality and progress. -- Digby

Sunday, September 27, 2009

Health Care Triggers and What is Health Insurance?


The "trigger" alternative to providing a good public option health care alternative right out of the gate like Rahm Emanuel and Olympia Snowe are pushing is just cheap political cover. The ball-less and spineless politicians just want plausible deny-ability. The "trigger" offer them the opportunity to allow for a public option only under certain conditions and they can write lame options into the legislation so that those conditions would never get met in the real world, thus doing the insurance companies' bidding.

I say if we have to swallow this sour pill and put up with them making us wait, we need a good strong definition as to what adequate insurance means. Too many companies offer what they call "insurance" but is really just a discount club or coverage in only selected and mostly unavailable providers. Wal-Mart, always the leader, has figured this scam out. Here's how the Miami Herald described their coverage:
So here's how it works: Wal-Mart offers insurance, but aggressively shifts the cost onto its employees. The low-wage workers then pass up the unaffordable coverage and turn to the states. If this isn't exactly company policy, it is at least company philosophy. CEO Lee Scott, at the company's recent ''summit'' for the media, even described it. He said some state health programs are 'so lucrative that, in fact, it's hard to be competitive with them and certainly extraordinarily expensive to be competitive with them.'

Wal-Mart provides health care options to their employees and families that have a deductible of $1,000 for individuals and $3,000 for families. Standard services – including office visit co-pays, emergency room visits and ambulance services, per-event deductibles, and pharmacy co-pays – are not applied toward the standard deductible.

I got a quote from Assurant Health of WA. Here's the highlights:
Plan Type: PPO
Office Visit for Primary Doctor: $35 Copay for the first 4 visits; deductible and coinsurance thereafter; this benefit includes Primary Doctor, Specialist, Periodic Health Exam, and Periodic OB-GYN Exam Office Visit for Specialist.
Coinsurance: 50% after deductible
Annual Deductible Individual: $10,000
Only 1 provider in my county is part of this plan.

Yes the price sounds good -- $190 per month -- but what would I get? 4 exams at $35 then a 50% discount after I spend $10 thousand. One lengthy illness or complication and I'm bankrupt.

This kind of 'insurance' shouldn't be even called insurance. Yet under Olympia Snowe's proposal it would be consdiered affordable insurance and would prevent the trigger from being pulled.

We need strong minimum standards for what qualifies as real insurance that protects people, prevents them from having to go bankrupt or worry about how they will pay for a simple procedure. Something that controls costs and really provides prevenative assistance.

Don't let them stick us with this lame "trigger" without a strong definition and standard.

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