Being in the Health Insurance Business, I have some insight in this highly charged political discussion.

First and foremost I want to be clear that reform is necessary and WAY overdue. Every week I get calls from people who can not get Health Insurance. No Insurance Company will cover them. This should not be allowed. If a 19 year old person with a bad driving record can get car insurance (because law requires it) then everyone should be able to get Health Insurance.

After having established that fact there are many many moving parts to this arena. How much should be covered by insurance and how much by the patient. Ar what levels should physicians and hospitals be compensated? Who pays for this coverage?

At some level the Government will be involved. They are already involved in Health Care. Medicare, Medicaid, Veterans Insurance already cover a large part of our population. What do we know about this insurance? We know that it is so underfunded that it is bankrupting state and federal budgets. What is the coverage like?

For Medicaid in the State of Arizona the patients pay nothing for their care. Only certain facilities and physicians accept Medicaid patients. As unemployment rises and more people have become Medicaid covered, the State budget has suffered huge deficits. It only makes sense with 100% coverage and no premiums required that the taxpayers pick up the whole tab. Should we eliminate it? I doubt that any of us want to live in a society where the poor die on the streets because we will not give them medical care.

I also know that the State and Federal Government subsidies to Hospital and physicians are so low that many doctors can not afford to see Medicare and Medicaid patients. I had one client call over 80 specialists to see his wife and was told by all 80 that they are not seeing new Medicare patients. He never found a specialist for her. To support this fact I am quoting from an article today June 15 about President Obama’s speech to the AMA.

“The AMA acknowledges the need for reforms but opposes any public option plan that forces physicians to participate, expands the fiscally challenged Medicare program for senior citizens or pays Medicare rates.”

I am also aware that because hospitals and Doctors actually lose money when they see Medicare and Medicaid patients that they are forced to negotiate higher fees from private insurance companies to make up the difference. Approximately 12% of the Health Premiums we pay are actually “overpayment” to cover government underpayments. So we pay for government insurance through our taxes AND the overpayment on our premiums.

The cold truth is that Americans can not afford the quality health care they want for all citizens. There will have to be some basic coverage available to all who can not afford coverage with cost covered by the taxpayers. I suggest that there will also be a need for those who want quality coverage with choice of care and can afford to buy it.After all this settles out, I think there will be a need for supplemental or private insurance for those who want better coverage. In the Medicare arena, few people live with just Medicare. the deductibles and 20% charges are large. People but Medicare supplements and Advantage plans to make up the difference.

This is, by necessity a very surface look at the issue. I would thoroughly enjoy any comments form you.

Scroll to Top