How are Healthcare Workers Insured?
Have you ever heard the saying by Ghandi, “Be the change you want to see in the world”? If we apply this idea to the need for change in our country’s healthcare system as it relates to how people who work in the healthcare industry are insured, we have an interesting set of issues that are readily visible. Many healthcare institutions bemoan the effects of uninsured or under insured patients that flow through their doors because of the money they lose. There is an opportunity for these institutions to examine the effect of their insurance plans on their employees to understand how their policies may contribute to the numbers of uninsured, under insured, and insured but still in debt.
The following examples are food for thought.
When I worked for a nonprofit children’s hospital in New Orleans, our health insurance covered no well visits. Most children only see their pediatricians for well visits which include immunizations. These visits were not covered by insurance. Can you believe that a hospital whose mission is to serve the health needs of children did not provide a health insurance policy to its employees that covered well visits? Imagine how the employees who worked there and did not earn a living wage fared with this insurance policy. For immunizations, employees were encouraged to visit a free immunization bus that traveled around the city. While this would allow everyone to have their children immunized, it did not provide for well visits with a pediatrician to screen children and provide anticipatory guidance to parents.
Many businesses are now encouraging their employees to open Health Savings Accounts for their health insurance. I understand the idea behind such accounts, but I think they are a potential disaster for people with lower incomes. I am concerned about how employers are encouraging people to enroll in these plans as if they are less expensive for everyone. The system is complicated enough that we all need to carefully weigh the costs and benefits associated with various plans, the propaganda about these plans is misleading, in my opinion. If I were to change to this type of plan, I would not have sufficient cash to start the account such that if I had a catastrophic illness before I had put several thousand dollars in the account, I would have a serious financial problem.
Similar problems can occur with PPO plans. These were also touted as better than HMO plans because they have lower premiums and you have more choices. You also have a much higher deductible. I had this type of plan at one time. When I needed a minor surgical procedure, I ended up paying about $800 between my deductible and some other fees not covered by the plan. It was very difficult for me to pay this much cash, even though I have a very good income. Imagine what happens to people who make less than I do.
I do not believe that it is fair for the housekeepers upon whom we depend to keep our facilities clean pay the same premiums for healthcare that we do when those premiums will constitute a significantly higher proportion of their incomes. If I made minimum wage, I do not believe that I would enroll in the health insurance plan my employer provides because it would be financially implausible for me to have health insurance and pay my bills. This phenomenon has been noticed by forward thinking living wage advocates who have advocated for a living wage ordinance in Los Angeles. This is a description of the rationale for their efforts to include health insurance premiums in their living wage calculations.
If we want more Americans to have the befit of health insurance, we may look to the practices of our own employers and start the dialogue about how we are insured. Contact your Human Resources Department and ask them to investigate how many of their employees are uninsured and why. Also ask them to investigate what proportion of their employees require public assistance to be insured. Remind them if we want to change the flood of uninsured that come into our facilities, we need to look at how their own practices contribute to the numbers of uninsured in their area. I would advocate researching the costs and benefits of instituting a sliding scale of insurance premiums for employees that would set the cost of the premium at a proportion of your income.
In the meantime I devoutly enroll in my HMO plan during benefits renewal every year, until my employer or the insurance company decides that it costs them too much money. I may need a referral or a PCP, but I choose not to pay 10% of my hospital bill.
I work for one of the ten largest companies in the US. You might think health insurance policies here would be enlightened. At my company they used to be among the best in the country, but despite increasing revenue, profits, and executive perks our health insurance is declining. Last year our deductible tripled (and now applies to prescriptions as well as doctor visits) and our maximum out-of-pocket rates per year quintupled. Even more discouraging what used to be a $3-million maximum payout for the life of an employees coverage under the policy was cut to $1-million. It probably won’t be a problem for a geyser like me with no dependents, but a young employee is just one premature birth or catastrophic illness to one of their dependents away from reaching the maximum policy payout and going without coverage.
At my company, employees are paid a salary that is commensurate with their job description plus a premium so they can afford their own health care policy. This is actually less expensive for a small company and allows them to select the plan that is best for them. More importantly, they are not bound to their employer and their plan with its locked premiums travels with them. No cobra, no probation without coverage. Perhaps considering that employers are solely responsible for health insurance is part of the problem? If individuals started taking responsibility for their own health care, then employers would not have the opportunity to cause devastating hardship on their employees when they decide to switch plans on their powerless staff. Just a thought but certainly has opposing sentiment.
Dave. Thanks for sharing your perspective. I take it you like John McCain’s plan for reforming health care? I think there are some good ideas in shifting the burden off employers but there are some huge problems. Without knowing how much money your employer provides for people to find their own insurance, it is hard to determine how well this is working for all people in your company. For a family, premiums for a year will cost about $12,000.
For most employer-based insurance plans, we pay a portion of that amount, with pre-tax dollars and our employer pays the rest. If your company gives you money to buy your own plan with pre-tax dollars that money goes a little further. Is your company mandating that everyone purchase insurance coverage with the money they provide?
One of the problems with that approach is what happens to people who are unable to obtain coverage at a reasonable rate when they go to purchase their own plan. If you are healthy and are not among the working poor (making over 36,000 a year for a family of 3) you can probably find a plan you can afford. Hopefully it is not a plan with a high deductible or a catastrophe plan. If you have a child with a chronic disease or a child who had leukemia, or if you have diabetes you will have a hard time finding coverage. Insurance companies want to make money, so insuring people who are sick and will cost them money by needing more health care is not good for business. So they will either deny them coverage or charge them out the nose. I know one woman with a PhD who had a lump that was non-cancerous but was being monitored. The only coverage she was able to find on the open market was a high deductible plan that had a premium of $3,000 dollars a month. She couldn’t afford it and ended up as one of the 47 million uninsured people in this country. In addition, there is no regulation of individual plans and many people who purchase them while healthy are dropped when they have an illness. The advantage of employer-based plans is that they are group plans where the risk pool is larger and insurance companies will insure the group, warts and all, because there are enough healthy people in the group to alleviate the risks of the sick. In addition, the employer helps absorb the rising costs. Obviously, this is tough on the employer, especially small businesses, as the costs of health benefits rise, they are forced to raise premiums and change the plans so that they can continue to provide coverage. Art eloquently described his experience with this above. The idea that people are not responsible for their own health care as part of the problem is something that is easy to say when you sit safely on the other side of the issue with insurance, no major medical problems and a hefty income. But the reality is that many hardworking Americans cannot find coverage–either through their employer or independently. I agree that we have issues with how individuals access the system, but uninsured people tend to avoid care until they are sicker and enter the system at a point that they costs us all more money. If the whole country switched to the system your employer uses without regulating the private insurance industry, I believe we would see a rise in the number of uninsured people in this country, which would increase costs for all of us. because when the uninsured cannot pay, we will pay higher premiums with less coverage.
I think we will either have to regulate insurance companies more heavily or provide a national health plan that will cover the currently uninsured. Either way the government needs to be more involved.
In your case, I hope your employees are well paid and stay extremely healthy.
In a global market, as long as employers bear the burden of health insurance coverage, companies will struggle to compete, especially smaller companies. However, tax breaks or credits given in the hopes that individuals will purchase their own insurance is just plain short-sighted and wishful thinking. All that “individual responsibility” will even further fill up our emergency rooms with people who could/should otherwise be helped in a well visit.
I agree that we are in a huge crisis, not only because there is a huge lack of health care coverage, but the ‘cracks’ that people fall through are getting wider and deeper. “If individuals started taking responsibility for their own health care”. Brilliant, Dave. And they should also take responsibility for their names, where they are born and the language they speak.
The fact is, people are denied insurance for “pre-existing conditions” at alarming rates. Without the group bargaining power of employers, or, do I dare say, the GOVERNMENT, individuals will continue to be denied coverage. Then what?
The “just don’t get sick” philosophy of our insurance system only works for those who are very healthy and/or very wealthy. But even the wealthiest can be put in the poor house if left to pay full cost for their hospital bills.
And for those that are so adamantly opposed to any government involvement in health care, how do you feel about the government’s role in national security, national defense, relationships with Saudi Arabia and Iraq, protection of the airwaves, construction of roadways, law enforcement and fire protection? “By the people, for the people.” That’s right, it says “FOR” the people.
I will never understand why people are so freely willing to spend billions and billions to prepare for and engage in the killing of citizens of other countries (i.e. the military budget), but are willing to spend nothing to help their own citizens.