Apr 23, 2008

Getting Health Insurance

David Spero

This blog entry warns you about one of the biggest threats to health in America. It’s not a chemical or a lifestyle. It’s our own health insurance system. I know some readers won’t like this, so I’m telling you my opinion right at the top.

Next to our obsession with drugs, our insurance system is the number one way American medicine hurts people. And which people get hurt the most? According to the American Diabetes Association (ADA) and other experts, it's usually people with diabetes.

An "uninsurable condition"
According to the ADA, in many states, "state law allows health insurance companies to turn people down for individual health insurance coverage based on the status of their health. In most cases, diabetes is considered an uninsurable condition." In theory, you cannot be denied insurance through an employer because of diabetes. In practice, some insurers will raise rates so high that employers will not enroll people with diabetes or will not be able to hire them at all.

Many stories of people with diabetes being excluded from health care are written up in a study called "Falling Through the Cracks: Stories of how health insurance can fail people with diabetes," conducted by the ADA and Georgetown University and published in 2005.

Because of strong lobbying led by the ADA, the Juvenile Diabetes Research Foundation International (JDRF), and many others, a few states now have laws mandating that people with diabetes be given access to medical insurance. But it can still be extremely difficult to get and extraordinarily expensive.What's available (isn't much)
People with diabetes usually face much higher rates when they try to buy insurance. There are some cheaper "bare bones" policies, but they're not right for people with diabetes, in my opinion. You may be able to get coverage for "catastrophes" such as major hospitalizations. But you probably aren't covered for physician visits and medicines, much less blood glucose monitoring supplies and education. Without ongoing care, you're more likely to experience a catastrophe.

If you have a large employer who offers benefits, you might have a better chance. If not, some states have programs for people who can't get covered in other ways .

A particular issue is coverage for diabetes supplies and self-management training. Advocates for people with diabetes have won laws in 46 states mandating that health insurance cover blood glucose monitoring equipment, education programs, and other needed benefits. Insurers have tried to get these laws overruled at the federal level but have failed so far.

Impact of insurance problems
Lack of medical insurance has major effects on people's lives and health. A recent article on the insurance web site Allied Quotes detailed how amputation rates have risen dramatically among Hispanic people without health insurance. People don't get timely care, and they develop complications.

Other people have reported losing jobs or even homes to medical costs. Medical expenses contribute hugely to more than half of nearly two million bankruptcies in the U.S. each year. And 75% of these people had insurance at the beginning of their illness. Lack of insurance has also been found to contribute to late cancer diagnosis, increased heart disease, and higher levels of mortality.

Why is this happening?
Only the U.S. has such a patchwork system of health care, where 45 million are uninsured and another 60 to 100 million underinsured. America spends more than half again (150%) as much per person on health care as any other industrialized nation and has worse health outcomes than any of them.

Wasteful health insurance overhead is a major reason. Administrative overhead, including marketing and profit margins, added at least $399.4 billion (25% of total expenses) to U.S. medical expenses in 2003, and it's much higher now.

This is not leftist/Green propaganda (as I have been accused of propagating before). It's from mainstream medical news publications like Medical News Today, which goes on to report that if we streamlined bureaucracy to Canadian or even to Medicare levels, we would save enough money to fully cover all the uninsured, even without other needed medical system changes. Far from "taking away your choice in medical care," universal insurance would open choices to millions who have none. I myself have Medicare and find very few restrictions on my care.

Next time, I'll write about what individuals and families can do about medical insurance problems. It would help if you wrote in with your own experiences dealing with health insurance companies.

I also urge everyone to take a minute to find out about the movement for universal health care in the U.S. The life and financial sanity you save might be your own.

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