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What's the real issue in the Health Insurance debate?

by Robert Randle  
4/16/2010 / Politics

When the Founding Fathers drafted the Constitution of the United States and in THE DECLARATION OF INDEPENDENCE, penned these words: ". . . that they [Men] are endowed by their Creator with certain inalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness. . ." Now, these great statesmen and intellectuals did not mention anything about the right of every American to affordable Health Insurance, but rather continued allegiance the King of England and the tyranny imposed upon the colonial settlers by him.

Somehow, there are many voices in and out of the political arena today who seem to think that surely this august document written nearly 234 years ago must have had them in mind. The thing is, very few individuals have read and understand all the nearly 2,000 pages of the Health Care Bill, and doubtless, because it was drafted by politicians who included some of their own personal pet projects "pork" among the usually confusing 'legalese' (lawyer script); much like the prescriptions written in Latin by medical doctors. Perhaps the first thing that needs to be understood and accepted is that any company which offers 'Insurance" of any type is underwriting "risk" and like any business, the objective is to make a profit. There is no legal mandate, either at the federal or state level in America that compels any of these organizations to offer this benefit; which by the way, is NOT a 'Right' that someone is entitled to.

Before going even further into this matter, it may be a good idea to look at this term called "risk" again. Essentially, it is all about statistical analysis, mortuary tables, age, race, lifestyle, and other demographics, etc. When a policy is issued to an individual/family for a particular coverage of benefits, this same "umbrella" insures or manages 'risk' for others who fall into the same category. When a claim is filed, deductibles satisfied, and payments made for medical treatment, premiums paid by the insured are already calculated into the payments because statistically, the chances of a significant number of the insured filing benefit claims at the same time that you do, albeit for different medical treatment, are relatively low. The deductibles that you pay are your part in assuming part of the risk for going to the doctor or dentist.

If a statistically high cluster of claims are filed, adjustments have to made; either in the form of increased premiums or a reduction in benefits. Several decades ago, there used to be a much simpler coverage plan: (PLAN A) for a single employee and (PLAN B) for the employee's family with 90% or in some cases 100% for all medical expenses. Insurers were prone to favor single individuals who didn't have children because maternity claims were very expensive, especially as more and more females had C-sections (Caesarean births). Also, if a husband and wife both worked for an employer with health benefits, both of them and their family were covered as Primary beneficiaries; meaning, for any medical or dental claim submitted by either party, both companies would pay as the Primary insurer. Since the insurer paid the claim check to the employee and left it up to him/her to pay their physician, it doesn't take a rocket scientist to figure out that they made some money in the deal because more often than not, both checks were an overpayment and was more than the doctor's charges. Add to that, most of the time when someone made an appointment to see the doctor, one of the 'first' questions that was asked by the receptionist or office staff is "Do You Have Insurance?" before they even mention your name or ask who you were. Even on the "New Patient" intake form that you complete, it is not just to list your symptoms but rather as a screening process to see if you have any pre-existing medical conditions or the potential to develop something down the road.

All this fact-finding just adds to the amount on your bill and after-all, as they used to say, you don't have to worry about it because, "YOU HAVE INSURANCE." Many of the insurance companies were usually based on the East coast and the rates that were paid out in benefits were calculated based upon the medical charges in this region as opposed to states in the South, Midwest, or in WA and OR. Eventually, the insurance companies caught on to this over-billing scheme, sometimes by hiring medical professionals into their own organizations who are knowledgeable as to what certain costs for services rendered should or should not be. The insurance companies started billing the medical service provider directly instead of remitting a check to the patient and let him/her be responsible for paying off the cost of their treatment for services rendered. Not only that, but these insurers placed a lower maximum ceiling on how much they would pay for any type of treatment, irregardless of circumstances or need; and they transitioned from the "STANDARD/UNIVERSAL" coverage model to the more familiar "CAFETERIA-STYLE" where you pick your own benefits among a sliding scale of reduced coverage and premiums. Usually, the amount of coverage that a person or family may need they cannot afford to pay for nowadays.

PANDORA'S BOX has been opened now, and no one can back all the little gremlins of greed and selfishness; besides all of that, somebody has to pay for all those shiny, new high-tech and life-saving medical devices. So what's the answer, then? The first thing is: "Don't Believe the Hype." Don't take as the Gospel what you hear from TALK RADIO (AM Radio), ABC/CBS/NBC NEWS, women of "The VIEW," political pundits, Think Tank spin-meisters, members of Congress, or even President Barack Obama. The best thing to do is find some clear-thinking person who is articulate and can make sense out of this 'ball-of-confusion.' Here is a radical idea: instead of trying to insure everyone on a macro level, perhaps it is best to see if there is a plan where people are adequately insured at affordable rates and use this example as a model to be implemented state by state until almost everyone who wants and can afford to pay for insurance coverage will have access to quality medical care.

There are already laws in every state where no hospital or clinic can refuse to treat someone who has a medical emergency just because they don't have insurance; so a lot of this anger, threats of violence, as well as acts of violence is irrational and dangerous. To reiterate: Health Insurance coverage is a privileged benefit that is offered by companies who are in the business of risk management, with the objective to make a profit. It is offered as a service to the millions of individuals who cannot afford to pay for the unexpected circumstances in life when a medical takes them by surprise (in most cases) and they have incurred sizeable financial liability to which they must now pay the costs; but it is in no sense of the word a "RIGHT" to which any Federal, State, City, Township, privately or publicly held company/organization is obligated to provide, and as some "inalienable ['divine'] right" to which someone is entitled.

Robert Randle
776 Commerce St. #B-11
Tacoma, WA 98402
April 10, 2010

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