I recently wrote a Letter to the Editor of the Independent Weekly, which is a wonderful weekly magazine with a liberal bent published and circulated in the Raleigh, Durham, Chapel Hill area of North Carolina (the Triangle). My letter was in response to the story published in the 07-15-2009 edition, “A State of Denial,” by Bob Geary (titled “A Face of the Uninisured, A State of Denial”in the Independent Weekly’s on line version). You can read the story by clicking on the link.
I emailed the letter in, and the very next day received the email response I suspected. The paper would not be publishing the reply in their paper. Length was cited. The email suggested I post the letter as a comment on the comments section of their web site. Since the comments section of web sites are usually a wasteland of people’s quick rants about life, I instead will post the letter in its entirety here on my blog.
Before reading the letter, I want to make one point. I hate politics. I have found, with amazing consistency, that anyone identifying themselves as a Democrat (left-leaning) or Republican (right-leaning) are so convinced of their ideas that they leave no room in their grey matter for evaluating the other side’s ideas, or even the facts which are not prone to lean to either side. My letter is not meant to chose a side. My letter is also not intended to advance my ideas of what health care reform should include. Though I have ideas, no one is going to take them seriously because of what I do for a living.
The purpose of my letter was to point out the facts on the ground in North Carolina, and how they fly in the face of many of Mr. Geary’s article’s points, and conflict with many of Mr. Geary’s interview subjects’ assertions. Since these facts clash with the left-leaning focus of this subjective article, it was no surprise that the Independent Weekly chose not to print the letter.
Below is the letter in its entirety:
Dear Editor, Lisa Sorg:
I read the article “A State of Denial” in the 07.15.09 issue with great interest, and finished the article saddened by the situation Rhonda Robinson finds herself in. But, I feel your writer, Bob Geary, missed a few key points.
The article paints Ms. Robinson’s situation as hopeless in terms of getting health insurance. In North Carolina that is not the case. She was eligible for COBRA coverage, and if she had chosen the coverage, there would not have been a “pre-existing conditions exclusion” applied to her insurance policy. In North Carolina, you are exempt from a pre-existing conditions exclusion if you have had creditable health insurance coverage for the past 12 months, without a lapse of more than 63 days. I understand that without a job, she could not afford the $500 monthly premium. But to remind you of the strength of health insurance, paying this $500 premium and two copays for her prescriptions would be a lower monthly cost than having to pay $800 for buying the prescriptions without health insurance.
Ms. Robinson also has access to Inclusive Health, North Carolina’s new health insurance high risk pool. She is eligible, and in choosing it she would not have a pre-existing conditions exclusion. Inclusive Health offers her 3 plan designs, one of which offers a monthly premium of $344. Again, it may be a moot point since she is in school and not working full-time.
The sidebar story “What’s in a “Strong” Public Plan” raises the idea I have heard many times in the health care overhaul debate, the idea of extending Medicare to Americans under age 65, or modeling a public plan option after Medicare, which Jacob Hacker states can control costs better than private health plans.
I don’t think most people, including the author of the story and anyone interviewed within it, understands Medicare, and what Medicare covers. Let’s assume for example’s sake that Medicare was extended as part of health care reform to Rhonda Robinson, the same Medicare plan as what each American who turns 65 receives.
Ms. Robinson would receive Part A (Hospital Care) for free, and receive Part B (Doctor’s Office Care) after paying a monthly premium of $96.40. She would pay a once a year deductible for the first $135 of her doctor’s office visit cost, and 20% of the cost the remainder of the year. Preventative Care is not covered under Medicare, so she would need to pay the full cost of her annual exam, mammogram and physical.
Her most expensive monthly medical costs, the two prescriptions she desperately needs, is not covered by Medicare. Thus, she would still have to pay the $800 cost.
I work as an insurance broker, and work with many people over the age of 65. Most are happy with Medicare, but that happiness stems from pairing Medicare with a Medicare Supplement plan and Part D Prescription Coverage plan they choose and pay premium for, which work to pay some to most of the expenses Medicare does not.
The point I am trying to make is that if we as Americans could extend a “strong public plan” like Medicare to Rhonda Robinson today, she may be in no better position than she is without it.
The other change that is coming, no matter what health care reform ultimately turns out to be, is that health care is going to be rationed, cut out, or utilized in the cheapest way possible, in order to lower the cost to a point of making health care for all feasible. I know people do not understand what this means, because if they did they would be protesting in the streets.
I don’t mean that statement in a way to conjure up those very one-sided stories you see about the “nightmares of the Canadian health care system.” I mean much smaller changes are coming that most people brought up on the copay health care system are going to really hate. Here’s an example that could apply to Rhonda Robinson:
The author mentions that Ms. Robinson has been prescribed Neurontin and Keppra, and from the monthly price tag I can deduct her physician has prescribed the brand name versions of those prescriptions. My data shows me the average cost of brand name Neurontin is $434, and $325 for brand name Keppra, for a total monthly cost of $759.
There are generic versions of both of these brand name prescriptions. Ms. Robinson could take the generic form of Neurontin, gabapentin, for a monthly cost of $20, and the generic version of Keppra, levetiracetum, for a monthly cost of $263. This would bring the monthly cost of prescriptions down to $283.
There may be a very good medical reason Ms. Robinson’s doctor wants her to take the brand name, but with all this talk of cutting costs, I see a future health care delivery system run by the Federal government mandating that the generics be prescribed. Private health plans, though they structure their benefits in a way to entice people to choose generics when they can, put no such restrictions on their member’s care. The day we all wake up with a public option or single payer system that makes these decisions for us, to save money, will be a day many people will not enjoy.
The article briefly touches on Adam Searing’s (of the N.C. Health Access Coalition) contention that one of North Carolina’s biggest threats to fair health care for all is the fact that one insurer, Blue Cross Blue Shield of North Carolina, insures a majority of North Carolinians. He feels this stifles competition, and that a “strong public option” would help create it. The “strong public option” might increase competition, but Mr. Searing has an amazing ability to not see the forest for the trees. Many private insurers offer health insurance plans in North Carolina, and the market is seen as growing, so more insurers are currently entering it. Blue Cross became the insurer who counts more members in North Carolina than any other private insurer through the exact means Mr. Searing thinks they are stifling. Blue Cross has worked hardest it seems, at understanding they were competing with others. And that in order to win, Blue Cross Blue Shield of North Carolina needed to offer the most benefit-rich plans, largest provider networks, most cost-competitive premiums and the best customer service. The brand name they have built in the State is what endears them to potential customers.
I hope you will consider my thoughts, and share them with your readers in the Independent. I sincerely hope for some version of health care reform, because the current system is unsustainable. But, I feel that critics such as N.C. Health Access Coalition Director Adam Searing and others nationwide place too much of that blame on private health insurers. People forget that health insurers do not provide health care, they help people finance it. If Rhonda Robinson had the means to pay the $500 COBRA premium through her former employer, that insurer would have lost tens of thousands of dollars on her. providing her with very expensive care.