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COMMENTOLOGY: Only Two of Millions Who Need Health care

089232-3d-transparent-glass-icon-signs-z-roadsign90 The purpose of this letter is to
produce another example of the health care crisis facing millions of
hardworking Americans.  Both my wife and I are facing medical and
financial hardship due to the pending lack of health insurance coupled
with being diagnosed with two serious illnesses.

My wife and I are 57 and 58 years old
respectively. Throughout our adult lives, we have carried and paid for
health insurance through our jobs for both ourselves as well as our
minor children. We have never gone a single day without health
insurance. In 2003, my wife accepted a promotion resulting in a move
out of state from Minnesota. Five months after moving I was diagnosed
with throat cancer; fortunately I am doing well. In December of 2008,
my wife’s position was eliminated leaving her unemployed. She worked
continuously for this company for 28 1/2 years at the time of her
termination.

Our health insurance was carried through my wife’s employer
and we immediately signed up for COBRA fully intending to find a new
job as soon as possible. In February of 2009, only two months after
losing her job, my wife had a seizure, which turned out to be the first
sign of brain cancer. My wife has had two surgeries for this cancer as
well as chemotherapy and radiation. Because of the extensive care my wife now needs, we moved back to the
Minnesota and Wisconsin area for assistance from family members. She is
currently undergoing evaluation/treatment at the Mayo Clinic in Rochester, MN.

Our
COBRA coverage expires at the end of June 2010, leaving us uninsured.
We are exploring very expensive high risk insurance pools but there is
no guarantee of acceptance. My wife has been declared disabled by
Social Security but will not be eligible for Medicare for another 15
months. I am currently working part-time in order to allow time to care
for my wife. According to several insurance companies to whom we have
applied/inquired, I am not eligible for health insurance due to my
health history.

For all of our adult lives my wife and I have
made every effort to support ourselves and build a secure future.
During the last five years this dream has come crashing down. We now
spend most of our time in some state of anxiety, first worried about
her health and secondly how will we pay for the medical care she needs.
All of the events that have brought us to this point were from illness
or loss of employment due to the economy.

At a recent visit to a doctor he described us as “the perfect poster children of the health care crisis”

My
wife and I are not looking for a handout, just the ability to buy
affordable health insurance. If there are any insurance companies out
there who would be willing to cover us I would love to hear from you.
Also, if there are any employers out there with full-time positions
available including health care benefits please don’t hesitate to
contact me. My wife and I would be willing to relocate if necessary.

At the end of June I don’t know how we are going
to pay our medical bills or buy the incredibly expensive prescription
drugs that my wife has to have.

Everything written above is absolutely true and can/will be documented if necessary. Please feel free to contact us at MKC, PO BOX 37, Alma, WI. 54610 or email us at: mkcneedhealthcarehelp@gmailcom. with any thoughts or suggestions you may have. We can use all the help we can get.

Do you have a true story about the healthcare system that you’d like to share with us?  Or a question you’d like to put to our readers? Email submissions to THCB Associate Editor Cindy Williams. The subject line of your email should include “Commentology” and a proposed title for your post.

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Shereef ElnahalFertilAid ReviewsPeterDavid MDPaolo Recent comment authors
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Nate
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Nate

Peter is price regualtion the same as reimbursement regualtion? No one is forced to sell their product in Canada or under NHS at a price, if you do sell it they are only willing to pay a set amount. As far as I know I think Pharma is free to sell at any price they want in Canada but if they don’t accpept government reimbursement the patient would need to pay full price. I might be wrong but I am pretty certain that is how it works. I know under NHS you can personally buy non covered drugs at street… Read more »

Nate
Guest
Nate

“My John Doe above may be purchasing the same exact product from insurers, but the price he pays (including employer “contribution”) will differ based on his place of employment. That doesn’t make any sense and I’m not sure there are any other similar “markets”.” Group Life and Auto Sam’s Club and Costco Credit Unions Taxes Cost of Beer at the bar, Ladies night should be outlawed, Bunch of women getting drunk and making poor decisions…never mind that one is ok Life is full of discrimintory pricing based on nothing more then where you work, what county or state you live… Read more »

Peter
Guest
Peter

“When has price regualtion worked in a non real market?”
Interesting comment Nate when you send your clients to Canada for less cost healthcare – a price regulated market.

Shereef Elnahal
Guest

I am very sorry for your situation. Your story is yet another example highlighting the absurdity of the regional and employment-based insurance structure in the United States. One wonders what the ability to shop for insurance out-of-state would have been able to provide for you in terms of more affordable options. We can only hope that Obamacare can deliver on this.
Please visit my blog on the business of health care in America:
http://www.shereefelnahal.com

Margalit Gur-Arie
Guest

By regulation, I mean regulation of hospital and provider fees, not insurer premiums. Those should follow the provider prices and be regulated, as the current bill suggests, by fixing the MLR. By arbitrary, I don’t mean capricious or random. I mean a decision without merit, unrelated to the intrinsic status of the person, and enforced with no input from the affected person. My John Doe above may be purchasing the same exact product from insurers, but the price he pays (including employer “contribution”) will differ based on his place of employment. That doesn’t make any sense and I’m not sure… Read more »

Barry Carol
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Barry Carol

Margalit – According to an acquaintance who owns an insurance brokerage firm in CA, individuals in CA that can pass the underwriting screen generally can buy health insurance for 20% LESS on average than small and medium size businesses buying in the small group market (defined by the broker as 2-99 people). This is because in the group market, the insurer has to accept the whole group including anyone who may be sick. I’ve said many times that there is no reason why medical care can’t work like a normal market with the exception of care delivered under emergency conditions… Read more »

Nate
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Nate

do you know what the word arbitrary means? There is nothing arbitrary about it, sorry to but you on the spot but get specific about what you think is arbitrary or stop calling it arbitrary. What makes no sense about two groups of people paying different rates? hint the group in group health insurance means more then one person. They have different rates becuase the other people in the group aren’t exactly the same. Group rates are based on the group not the individual. When has price regualtion worked in a non real market? Consumption is what drives insuranc rates!… Read more »

Margalit Gur-Arie
Guest

Nate, pools may be well defined, but it’s an arbitrary definition aimed at segmenting people to maximize insurer profit. Why is John Doe paying one premium while employed by AT&T and a different one while employed at Jack’s Fine Crab Shack? It’s the same person, shouldn’t his estimated costs be the same? I know the answer, but from an individual person POV, it makes no sense. Price regulation works fine when you are not dealing with real markets. Health care is in no way a real market, yearning to be free. And why would I regulate consumption? All that will… Read more »

Nate
Guest
Nate

Hello chaves, regualting prices has enjoyed such a long successful life. I mean it almost always works doesn’t it? I’ll end the sarcasim, price regualtion always fails and distorts the market, you need to regualte what drives the price if you want to succeed…..that is your goal isn’t it? If you want to regualte you need to regualte consumption, its ugly but atleast it is sustainable.

Nate
Guest
Nate

“prices for insurance are calculated based on arbitrary “pools” and arbitrary “rules””
LOL um no Margalit that is not true. prices for insurance are based on prices for care you mentioned above.
You obviously have no idea what a pool even is if you think it is arbitrary. This is so well definded and codified no one can claim it is arbitrary.

Paolo
Guest
Paolo

Peter, see page 329 of the PPACA:
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590PP/pdf/BILLS-111hr3590PP.pdf
(e) EXEMPTIONS.—No penalty shall be imposed under subsection (a) with respect to—(1) INDIVIDUALS WHO CANNOT AFFORD COVERAGE.—
‘‘(A) IN GENERAL.—Any applicable individual for any month if the applicable individual’s required contribution (determined on an annual basis) for coverage for the month exceeds 8 percent of such individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act.
Or the summary by the CRS.
http://bingaman.senate.gov/policy/crs_privhins.pdf

Peter
Guest
Peter

“…a legal requirement to commit less than 8% of your income to health insurance (above 8% you either get subsidies or are exempted).”
Show me the text.

Margalit Gur-Arie
Guest

There are two types of prices and neither one is “fair”. Prices for care delivery, particularly hospitals, are extorted based on market power and prices for insurance are calculated based on arbitrary “pools” and arbitrary “rules”. So here is something to think about for all those who receive payments from the health care system: the “market” cannot bear the current prices, let alone any increases. The good times are over. So we either go with option 1, and every working citizen of this country lives with the knowledge that if he/she, or their children, get really sick, they will have… Read more »

Paolo
Guest
Paolo

Peter, your bank account will not by emptied because of a legal requirement to commit less than 8% of your income to health insurance (above 8% you either get subsidies or are exempted). What might empty your bank account is opting not to get insurance and then getting sick.

Peter
Guest
Peter

“its fair price” Only those that profit from the system think the price is fair. I actually agree on a mandate, just not one that forces everyone to pay the cadillac prices the “system” has defaulted to. “But realistically, you are not going to get prices to go down.” Then any system insituted here will fail, because it’s the high prices that are killing us. I don’t want my bank account emptied by force because no one has the balls to take on high prices, and I won’t become poor just to give the insurance industry some profit time until… Read more »