Dear Congress, Please Don’t Regift My Health Insurance.

Normally I keep my letters to my congressional representatives short and to the point. But Health Care is extremely important to me. More important to me than any other issue, and I am very passionate about every issue, so that says a lot. I can’t believe I even had to write a letter like this, in this day and age, to the people who supposedly “represent” me. But, it was necessary, so I did, and I faxed this letter to both my Senators last week, to every one of their offices to be sure they’d receive it.  Many will not agree with me, including my representatives. And many will point out some inaccuracy  here or there in what I’ve written. But they would be missing the point of my letter – my intent is to express what I am feeling, my perspective, my own experiences.  My story the way I perceive it. Not a white paper or scientific study. Just my feelings, and my heartfelt request for their open-mindedness at the very least.

>> Skip this commentary & go right to the letter.

I’m posting my letter below for anyone to see because I want people to know the stories of people like me. I accept that there are differing opinions on this health care debate, and I can even say that in some respect I understand the view of most who don’t share in my opinion on the issue.  However, it infuriates me when a portion of those who do support a government-run health care system immediately attack me the moment I even hint that I’m opposed to the President’s policy on this. The standard attack lines come at me:

You people are so selfish! If you’ve ever had a medical crisis in your life, you’d understand and have a little more empathy…”

“The number of uninsured Americans is growing, premiums are skyrocketing, and more people are being denied coverage every day – how can you possibly not care about that?…”

“Oh, so you think we should just let people die because they don’t have insurance? 22,000 people die every year because they are uninsured…”.      and so on and so on.

Well, the truth is, I have had a medical crisis, in fact many in my life.  And I have found myself without insurance.  And I have been denied coverage because I do have pre-existing conditions.   And I have had over $150,000 in unpaid medical bills.

You see, unlike the very individuals who attack me so viciously as soon as I speak my opinion on this, I have personally experienced every one of the things that they assume I’m too sheltered to know anything about.  The truth is that I live with unrelenting life-long medical issues – a devastating disease, Lupus, that causes kidney failure for me at times, as well as permanent damage caused by a spinal injury and related surgeries.  Because of this, I sporadically become unable to work as I am in and out of remission – and of course as my job goes, so does my health insurance.  I haven’t even mentioned that my siblings and I all also grew up suffering the same scenario: we lived in a one-bedroom apartment – located between a seedy bar and a used car lot, raised by a single-mother only 18 yrs older than me, living on welfare, while mom worked three jobs to try and put food on the table.  I can remember trying to pay the doctor with Food Stamps.  For real. He was kind and gracious enough to accept IOUs and even homemade baked goods as payment instead.

That said, I’ve lived both sides of the coin.  I’ve been lucky enough to have great health insurance when I am employed, AND I’ve had the added, albeit unlucky, experiences of being insured through COBRA, through Medicaid, and through state-provided insurance programs (see Individual Health Coverage Program for NJ).  Oh, I’ve even had the experience of being treated by (caring, wonderful, heroic) doctors BECAUSE I was uninsured. Given this perspective, the reality is that the only occasions on which I have ever felt at risk of dying due to health insurance have been those when I was covered by government health insurance.

Do I have my issues with my private health insurance? Yes. Is it expensive? Sometimes yes, sometimes not at all. Do they need to be held more accountable? Yes, sometimes.  But at least I can hold them accountable – there are regulations and oversight procedures that as a consumer I can leverage to reach a resolution, which I’ve in fact done, successfully. Sure, we can implement some reform in private insurance.  But let’s make government insurance accountable first.  When I need an x-ray or MRI, I know my private insurance will let me have one.  But when I had government insurance, particularly Medicaid, they said “NO” to a simple x-ray, repeatedly.  Meanwhile, my very life was in danger, until months later one of my doctors heard of my insurance problem and called me into his office to do an x-ray himself – for FREE.  Thank God, because that x-ray changed my life forever and probably saved it (read about it in my letter below). When I need to see a kidney doctor, my private insurance gives me access to the best specialists for a $25 co-pay and covers my preventative maintenance tests and meds. Medicaid denies me any visit to a specialist at all, denies the doppler ultrasound, and denies my medication – instead they send me to a health care worker “training clinic” miles away…and then send me a bill for $75! We all pay a lot into Medicare and Medicaid, but no one seems to know where that money is spent – it doesn’t appear to be spent on covering any care, let alone any tests or anything preventative while a person works to get private insurance.  Instead it’s wasted on fraud, inefficiency and redundant operational costs.

The end point is this:  our country already has health insurance for the uninsured.  It’s just that it’s bad, it’s rationed and poorly run. There’s Medicare, Medicaid, and each state also has its own program for individual policy purchase (each state goes by a different name). Plus, there are even non-profit organizations that provide some assistance (i.e. I had help from Partnership for Prescription Assistance and The Lupus Foundation).  The government does not advertise this information well, it does not centralize any of it, and it does not have helpful, knowledgeable or courteous individuals assisting those who call or write inquiring about it. Further, it offers little or no resolution for anyone with billing or coverage issues through Medicaid or Medicare.  NO ONE in this country HAS to go without insurance. The issue is that the government-run insurance that does exist is poorly structured, poorly managed, and terribly rationed already.  I cried repeatedly while I was on it, which is probably the point. Government insurance is meant as a last resort.  Its very existence alone drives up the cost of private insurance in part because the government only pays 60% of what providers bill them, even when the charges are reasonable and the services/tests are medically warranted. Government insurance is what is in need of the major reform.  Fix that, and costs will start to decrease in the private industry. Incentivize that with tax credits or vouchers, and private insurance quickly becomes more affordable.

So let’s be honest here and call this what it really is.

This is a national effort to REGIFT health insurance. To take whatever “better” insurance anyone has been lucky enough to have, and to re-package it, re-brand it, dress it up with a fancy new federal logo (no doubt commissioned from Obama’s marketing firm using stimulus funds), and to deliver that gift to someone else.  Not to help needy Americans, but to payback political favors and to disrupt the health care/pharma industry in order to create new union jobs for heavy hitter political cronies like SEIU, NUHW, AFSCME, and others .  If this were truly about helping needy Americans, we’d be reforming Medicaid right this minute so the uninsured can actually use the government insurance that already exists.  We’d be enforcing the regulations that are already in place to keep private insurers in check, and we’d practically be going door to door and handing every uninsured person a tax voucher to go buy good health insurance tomorrow. Most importantly, every member of Congress and the White House would immediately cease accepting ANY political donation money from health care industry businesses, lobbyists, or unions.

I just cannot be polite over this issue anymore.  I personally have suffered terribly under government insurance, and I have every right to voice my concerns about the prospect of becoming a permanent policy-holder of a government-run plan.  The way that Congress is handling this “debate” is just not right.  If it were truly that important, we would not be rushing this through Congress without any input from constituents – real life Americans.  I cannot even begin to describe to anyone how unbelievingly frustrating it has been for me to fight something that I KNOW will be bad for me, because I’ve been there. All the while enduring unnecessary attacks from single-payer system and socialized medicine supporters who feel that bullying works better than listening.  And tolerating elitists who do not know me or anything about me hurling insults at me simply because I oppose the current proposal for Health Care reform.  I scream and yell at my television constantly, begging for my own President to please stop politicizing this and dismissing opposition altogether as “old thinking” or “standing in the way of America’s progress”.  My God!  This is my life I am defending, and I have been reduced to begging my Congresspeople to please take my calls, or read my letters or emails.  And when they don’t engage in discussion, I contact the media or I post on websites trying to plead my case – all of it perfectly respectful and polite enough.

Still, the only responses I get are the usual standards, that have nothing to do with me caring about my health insurance:  “Shut the hell up, Bush is gone, get over it”….”You rich people, all you care about is yourselves”….”Why don’t you grab your bible and your gun and hide inside your panic room”…  And of course, “Only a racist would be against Universal Health Care”.  I get lots of that one.  Funny thing is, I’m none of any of those things at all. (And if people saw the rest of my family – one side’s Lebanese & Syrian and the other is Iranian – I really don’t think the word “racist” would come to anyone’s mind…).

My Letter to my senators is below. I strongly urge all of you who want to protect the private health care insurance system in this country to do the same. They MUST hear from you, they need to hear your insurance challenge stories, too – not just the stories that are fed to them through their biggest political donors.

July 16, 2009

The Honorable Robert Menendez (also addressed one to Frank Lautenberg)
528 Senate Hart Office Building
Washington, D.C. 20510
Fax: (202) 224-4744
Fax: (973) 645-0502

Dear Senator Menendez,

I am writing to you to strongly urge your support in protecting the private health care system in America.

As someone living with Lupus, a devastating chronic illness, as well as a two-time recipient of major spinal surgery to treat a severe permanent back injury, I am a very well-informed patient who has had significant experience dealing with our health care system. More importantly, I have directly experienced the level of service and the costs associated with our nation’s health care system from the perspective of both my employer-provided private health care insurance AND from the state and federal government’s health care insurance as a past recipient of Medicaid.

Under my employer-provided private health care insurance plans I’ve participated in over the years, I have always had the luxury of choosing my own doctors and my course of treatment, in consultation with those doctors. I have had kidney failure as the result of my Lupus in prior years, and I can tell you that the close working relationship that I had amongst my primary care physician, my rheumatologist and my nephrologist has been absolutely invaluable during such times. I have always attributed that to an outstanding primary care physician, XXXXXXXXXXX, who takes the time to consult with my rheumatologist and collaborate on an appropriate course of treatment. No other benefit or amount of money can compare with that valuable bond between doctor and patient.

And so it was with absolute dismay that, when it became necessary for me to go on Medicaid after an extended leave of absence from work for my disability, I was told that I could not see any of the very doctors who’d been treating my illness for years. Even with the assistance of a social services coordinator from MMIS, I was unable to find a single physician, let alone a specialist, that would even accept Medicaid. This was despite the fact that the government websites all list literally hundreds of doctors that supposedly accept the insurance. It simply was not the case, and I was instead referred to a clinic that was not near my home, where I waited for hours to be seen by a physician who incidentally turned out to be a student that was entirely unfamiliar with my disease. To make matters worse, I was told at checkout that I would still be required to pay $75 for the visit because Medicaid would only pay $15 of the total $90 office visit.

The next several months progressed in the same manner. And when I began experiencing issues with my spine from a prior surgery, there was not a single doctor that would see me because of my Medicaid insurance. Even if they had accepted Medicaid, the choice of doctors was non-existent in spine specialists, and the wait for even a basic physician was over a month minimum. As my condition rapidly worsened, I visited the emergency room three times in a few short months, positive that something was very seriously amiss. I pleaded for a simple x-ray and was denied each time – told that my government insurance would not approve such tests. I tried to work regardless, and even began a new job with a new employer. After months of suffering and debilitating pain, I was finally able to see my spine surgeon under my new employer-provided private health care insurance plan. Within no time the issue was finally clearly identified – I had been walking around all these months with broken pieces of hardware lodged in my spine. An emergency revision surgery was performed, at which time the true magnitude of the issue was revealed when the surgeon found that several of the dislodged pieces had been compressing my spinal cord. Had I continued without treatment, I would likely be permanently disabled, possibly even paralyzed by now.

In short, my government health insurance failed me miserably; it was ultimately a private health insurance plan that quite literally saved my life.

These are merely two examples I’ve provided to illustrate the point. I could outline dozens more, and I could further cite the immense cost differences between the government-provided health insurance and the employer-provided private health insurance I’ve experienced. Supporters of the current universal health care proposals might be surprised to find that the costs I incurred for doctor visits, prescriptions, and other medical necessities under the government insurance coverage were far more outrageous – about three times the rate of out of pocket expenses compared with anything I’ve ever paid while insured privately. Worse yet, the choice of doctors and the care provided under Medicaid were absolutely atrocious. The bond that I’d worked so diligently to develop between all of my providers over the years was instantaneously broken the moment that I was placed on Medicaid. I am still suffering the physical costs to my health as the result of that period in time, while my Lupus went untreated, unchecked and was allowed to progress at the hands of government health care.

I would also be remiss if I did not mention the importance of the appeals process that exists between the private health insurance companies and state and federal government agencies as a measure of protection for consumers. While I may have had my issues with private health insurers from time to time over my 25 years of being employed, I’ve always found resolution in the appeals process, and ultimately with the state Department of Banking and Insurance when necessary. In fact, on two specific occasions this very state agency has effectively resolved appeals nearing hundreds of thousands of dollars on my behalf. This was possible because of the delicate balance that has been established between the private sector and government intervention. Possibly my greatest fear is that with a universal government-run health insurance system, the patient loses the objectivity that’s historically been provided in the current appeals process. Instead, when the government plan declines to pay its fair share, as did occur while I was on Medicaid, I would be left to appeal to the very same governing body that declined proper payment in the first place. Even if the system is set up to appeal through a different government agency than that which handles the payment approvals, the fact still remains that this is a very obvious conflict of interest – the government will no longer serve to protect the interests of the consumer, but rather its own competing interest to keep costs to an absolute minimum. It would be extremely naive of any American to think that we could receive the same level of consumer protection that we enjoy today under the current balance between the private sector and government intervention in its role in the claims appeals process.

Let me state that I do not believe that the private sector health insurance is not without its faults; it most certainly is not. I do believe that we can make reforms that will drive down the cost of health care, increase efficiencies, reduce errors and encourage competition to make health care affordable to all Americans. But I believe that this can all be done entirely through the private sector, with consumers driving that change, rather than the government. Additionally, Medicare and Medicaid require substantial reform. We know that expanding the size of the government insurance pool through a new federal plan will reduce the private insurance pool by 70%. Contrary to what President Obama has said, basic market principles lead anyone to conclude that private insurance costs will increase, become unsustainable and the market will subsequently fold with the introduction of a “competing” government plan. In fact, many independent studies in the industry, including the Lewin Group – which Medicare, Medicaid and Congress itself have each contracted with on numerous occasions to provide expert analysis on these very metrics – have indicated that it is the government-run Medicare and Medicaid programs that significantly drive up the rates of the private insurances plans purchased by consumers and their employers. As you know, the low rates of payment and the “volume discount” structure of these government plans must be offset by private insurance plans to make up for payment shortages of 30% per claim. Those offsets are paid by the subscribers of those private insurance plans.

Many studies have provided numerous recommendations for making private health care insurance affordable to consumers simply by reforming how Medicare and Medicaid determines its fee/payment schedules. With additional reform measures, I sincerely believe that quality affordable health care could be made accessible to every American through the private sector, without any government takeover. In addition, Medicaid specifically could then be better leveraged to serve the purpose for which it was intended, which is to provide temporary coverage to those who are uninsured due to a circumstantial change in status. Some estimates state that with these reforms alone, an average policy could be made available for individual purchase for as little as $2,500 – $5,000 a year, with fewer out of pocket expenses and less/no eligibility restrictions. Add to this a federal tax reduction or credit to be used for this purpose, and the majority of Americans would easily have affordable access to private health insurance. Why aren’t such options being considered over a government takeover?

Before we place so many Americans on a Medicare/Medicaid type of health care system, it is the duty of every member of Congress and every other public servant who represents constituents to scrutinize how these plans work today, and in accurately determining what the impact of increasing the pool so significantly, so quickly will be on the overall system.

• If there are very few physicians and medical facilities today who readily accept this insurance, as has always been my experience when on Medicaid, then what is the proposed legislation offering to resolve this issue?
• Since Medicaid only pays 60 cents on every dollar for our claims today, how much worse will it be when millions more are added to the government plan? Today’s Medicaid recipients are already left holding the bag for the other 40% of the bill. It sounds nice to “say” every uninsured American will be covered, but it’s another thing entirely to actually “pay” their claims. Government barely pays what they’re supposed to now, so how can I be assured you’ll pay when millions more are added to the pool?
• Under a government plan, to whom will we appeal when the government denies a claim or request?
• What measures have been taken to ensure that the cost of private health insurance will not skyrocket to account for the growth in the public insurance pool, effectively making it unaffordable to anyone left in the private sector? This is the precise prediction in the Lewin Group report and many other independent studies.
• If those with private health insurance truly can keep their plan if they like it, what is in the legislation to protect this promise? And what measures are being taken to keep my relationship with my doctors in tact?
• Why won’t legislators consider changing the oppressive regulations that restrict consumers from purchasing our own individual insurance directly from insurance providers?
• Why in this bill is the government “not required to comply with the insurance regulations”, as are the States? Who then will provide proper oversight?
• With my other living costs increasing more rapidly than I’ve ever experienced, how will I possibly afford private health insurance under this proposed plan? In just four months, my homeowner’s insurance has increased by 32%, condo association fees by 15%, property taxes by 12%, my energy bill by 200% because of new premium rates “charged for excessive use” (which is unavoidable when occupants are in the home all day due to disability), and even my bonus (which represents 25% of my modest XXXXX salary) may be suspended due to the company’s “fear of public perception in today’s political climate”. Most recently, I received a letter from the NJ Clean Energy Program and JCP&L indicating an “energy counselor” will be visiting my home and I will be required to purchase energy efficient appliances and weatherize my home. I cannot afford all this.

I have not heard answers to such questions from either Democrats OR Republicans, nor have I been able to find these answers in any of the little bits of the draft legislation that have been made available to the public, scarce as those portions are. I can add that I belong to a relatively new non-partisan citizen political action committee that is already over 700,000 members strong – many in NJ, a good majority of whom are now affiliated as independents. These members share these same views; the stories I’ve outlined here could just as easily be any of theirs, and they all struggle to have their voices heard on this issue. Groups like ours may not be as influential and financially-abled as labor unions and lobbyists, but our voices and our votes count every bit as much. We simply ask that we be heard, too.

Please sir, as my representative in the Senate, I am pleading with you and your colleagues to very carefully and very thoughtfully consider constituents like me as you consider this issue, and not forget about us. I ask that you please thoroughly read this legislation. I have provided only a small glimpse into my experiences with both the private and public insurance systems. And as someone who suffers from chronic illness, I live with the reality that I fluctuate between being employed and unemployed due to my disabilities. I know more than most average Americans the struggle that exists for obtaining affordable and accessible health insurance, especially during periods of unemployment. I live it every couple of years myself. But my direct experiences have taught me that in the last 25 years, the private health insurance companies have taken better care of me than our own government has been able to during those difficult times. I am pleading with our lawmakers to please protect my access to the private health care insurance that I so greatly cherish and appreciate in this country. This is the single most important issue to me in my life right now. My very life quite literally depends upon the protection of the private health care system and its sustained affordability.

Respectfully,

XXXXXXXXXXX


==

A few links to other health care union stories:

SEIU wins another election of healthcare workers; LA Times
http://www.latimes.com/business/la-fi-union26-2009jun26,0,1708411.story

Caregivers picket Labor Board after 157 days without a vote;
Nearly 100,000 workers petitioned to join NUHW after SEIU’s hostile takeover of California’s healthcare union in January. NUHW
http://www.nuhw.org

SEIU Creates Union For Health Care Workers, Including Nurses, Service Workers At Hospitals, Nursing Homes;
Medical News Today
http://www.medicalnewstoday.com/articles/74987.php

Tiburcio Vasquez Workers Approve New Contract; Three-year agreement features pay increases and benefit improvements;  SEIU-UHW
http://www.seiu-uhw.org

2nd Circuit – Firing of Non-Union Healthcare Workers for Picketing Was Illegal;
AFSCME represents correctional officers at a state facility in Albany where Correctional Medical Services (CMS) operated a health clinic and fired workers for picketing when they’d denied union’s request to represent as bargaining agent;  Ogletree Firm Publications
http://www.ogletreedeakins.com/publications/index.cfm?Fuseaction=PubDetail&publicationid=832

GM may cut workers’ health care, union says; Dayton Daily News
http://www.daytondailynews.com/business/gm-may-cut-workers-health-care-union-says-197812.html?cxtype=rss_business

Union report says health care workers lack protection from pandemic flu;  HomeStation
http://homestation.typepad.com/home_station/2009/05/union-report-says-health-care-workers-lack-protection-from-pandemic-flu.html

Health Care Union Accuses SEIU of Card-Check Hypocrisy;  Workforce
http://www.workforce.com/section/03/feature/26/52/97/265301.html

Health Care Workers Fight for Union Democracy;
Socialist Appeal Magazine of the Workers International League
http://www.socialistappeal.org/content/view/749/71/

>> While you’re there, read this page. OMG!  http://www.socialistappeal.org/content/view/12/52

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