Vol. 13, No. 3,197 - The American Reporter - July 3, 2007

Market Mover

by Mark Scheinbaum
American Reporter Correspondent
Lake Worth, Fla.

Printable version of this story

LAKE WORTH, Fla. -- It seemed to be a sad truth about the health care insurance industry today when the Blue Cross agent explained the monthly premium for one person would be about $850. But the real sticker shock came when he said, "That's for the $10,000 deductible with no co-payments."

Intellectually, I probably knew that no matter how many times he repeated this information, or how loudly he repeated it, the result would be the same, but I still had to ask: "You mean I go for a check-up and pay full price, I go to the pharmacy and pay full price, and I go to the hospital and pay out of pocket for everything until I hit $10,000, and on January first the clock starts again?"

"Correct," came his response.

Thus speaks loudly and clearly the reality of 42 or perhaps 46 million Americans who have no health care coverage, and the parade of peripatetic politicians who offer Band-Aids where intensive care is needed.

Most HMO, PPO and hybrid providers have a book filled with various individual, small business, spouse, and family plans at many prices on a "grid." Study them carefully, and you will find that for the healthiest, youngest, and nonsmokers among us, the almost affordable premiums are only for deductibles of $3,000, $5,000, $7,500 or $10,000.

As with collision coverage on your new car. If you want $500 deductible, you probably can't afford the premium.

To be sure there are plans for adults still waiting five or perhaps seven years for Social Security and Medicare, where for $400 or $500 per month per person, and a $5,000 deductible, the insurer will structure a $35 to $75 co-payment for office visits and a sliding scale of $20 to $50 for brand name and generic drugs. I said "almost" affordable, because it's human nature to roll the dice and stay "naked" or "self-insured" for a few years, hoping you will stay healthy.

Some family practitioners offer a stop-gap measure such as Medicus Corporation provides. For $125 per month, you pay $29 for an office visit and get 50 percent discounts on basic X-rays, urine and blood tests, etc. This means no cardio stress tests, no substantive colon-rectal exams, and nothing beyond basic mammography. The old joke lives: it's great insurance if you never need to use it.

Florida, Hawaii, New Mexico, Oregon and other states at least have a safety net for kids, even kids from poor families. The theory is that by ignoring the middle-aged - and the middle class of the middle-aged - society will spend less on catastrophic and epidemic diseases and chronic ailments in old age. In doing so, we allow kids to grow up in a healthy environment with regular checkups and filled prescriptions. But they need to ask hospital administrators with piles of unpaid emergency-room bills if the system is working.

The private sector needs to understand the stakes for future growth. We've said it before: Ford and GM are HMOs that also build cars.

Finally, this week we have seen the future and it is Qwest Communications, one of the Baby Bell remnants. Employees will have their health insurance cut and pay more for what is left. Retirees will get no cost-of-living adjustments in health care, and get fewer benefits. The cherry on top of this management sundae is news that post-1990 retirees who were told that when they croak their beneficiaries will get the payment on a term life insurance policy equal to their last year's income will now be "capped" at $10,000.

Methinks that national health care would be a reality if it was being pushed by Trent Lott instead of Ted Kennedy.

Copyright 2007 Joe Shea The American Reporter. All Rights Reserved.

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