Saturday, April 17, 2010

A Painful Lesson in Health Reform from New York

When her small executive search firm in New York City canceled its health insurance policy last year because of the recession and rising premiums, April Welles was able to buy her own plan and still be covered for her cancer and multiple sclerosis.

She was lucky to live in New York, one of the first states to require insurance companies to offer comprehensive coverage to all people regardless of pre-existing conditions. But Ms. Welles, 58, also pays dearly: Her premium is $17,876 a year.

“That’s a lot of groceries,” she said.

New York’s insurance system has been a working laboratory for the core provision of the new federal health care law — insurance even for those who are already sick and facing huge medical bills — and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients’ advocates say that New York’s extensive insurance safety net for people like Ms. Welles is falling apart.

The problem stems in part from the state’s high medical costs and in part from its stringent requirements for insurance companies in the individual and small group market. In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.
Read the rest here.


Anam Cara said...

This is one of the problems with the current health care plan. It doesn't cut costs at all. It just lets everyone have health care and somebody has to pick up the bill. The focus should be on making health care cost less for everyone.

Anonymous said...

Neither side in the political debate has the stomach to pass legislation that will actually lower costs. There were some provisions in the original bill that would have required cost versus benefit analyses for medical devices and the medical device industry killed it. With the left, it's not "fair" to deny care. With the right, it's "death panels."

John (Ad Orientem) said...

I'd say that's a pretty accurate assessment.

Anam Cara said...

There are other ways to bring down costs. Limiting awards in malpractice suits would reduce insurance costs to doctors and the savings could be passed on that way. No one seems to be exploring ways to cut down on expenses - not death panels, but to really just cut the cost of each procedure. There must be ways to do that.

Anonymous said...

Tort reform hasn't been proven to reduce healthcare costs. Texas instituted caps on malpractice rewards and while the cost of malpractice insurance has declined, those savings have not been passed along to either patients or payors. Also, the experience in Texas disproves the idea that defensive medicine is driving healthcare costs. The utilization of services did not decline and in fact, Texas still has greater utilization of surgical procedures for Medicare beneficiaries.

The only real way to reduce costs is to reduce the utilization of expensive procedures and diagnostic testing. I honestly do not see how that can happen without a significant change in the healthcare culture. I think end of life counseling would help. I work for a provider that provides a very expensive service to patients with a chronic condition. I've been told that many of our patients would choose hospice if they had that choice. I've seen situations where patients have wanted to choose hospice care but have been talked out of it by family members who wanted "everything" to be done (of course the family member isn't paying for "everything").

I supported healthcare reform because I work in healthcare and deal with insurance issues everyday. The current system is absolutely terrible and not sustainable. Something had to be done. I'm not sure what was passed is the best solution but at least it's something. I know that beginning this fall, our patients will begin to have some protection.

Anam Cara said...


I agree. There needs to be practical, realistic counseling.

I think the down side is that that the term "end of life" has come to mean to many "euthanasia." Not sure what to call it.

My husband and I have advance medical directives that say, essentially, "don't do anything - we're ready to go - just feed us while we can eat."