DAVID ROSMAN: Improving insurance coverage would be boost to all

Wednesday, October 9, 2013 | 6:00 a.m. CDT

COLUMBIA — The problem is far from simple — so far from simple that the Affordable Care Act may or may not be a solution. If Washington University health economist Timothy McBride is correct and 13 percent of the state’s population is uninsured, or some 710,000 people, why are our legislators still screwing around?

And, although Lt. Gov. Peter Kinder is telling us not to buy insurance through "Obamacare," maybe others in the GOP are seeking a state solution — something the legislators rejected last session. The expansion of Medicaid.

State Sen. Gary Romine, R-Farmington, chaired last week’s hearings concerning Medicaid reform and expansion. I do not envy his position, faced with the ultra-right wing anarchists who see Medicaid and the Affordable Care Act as the evil twin, socialist systems that breed dependence on the government, and the rest of us who see both programs as being able to provide much needed health care to at least 300,000 Missourians who now fall in the cracks.

Not that health care is not available. Family Health Center, Boone County’s clinic, provides what I consider superior health care to the under- and uninsured, many on a sliding affordability scale. And who is paying for this? The taxpayers of the state. If the individual is sick and there is no clinic available, then it is to the emergency room. And when the person cannot pay the bill it falls to the insurance companies who insure you and me. It's one reason our health insurance premiums are so high.

How high? We spend more per capita on health care than the next 10 countries combined, and some can say we are not getting our money’s worth. The World Health Organization ranks the United Sates 37th in the world for quality of health. In fact, the nations with the best health care are those which have some form of universal health care coverage, whether it is a single-payer system or one fashioned as the Affordable Care Act, utilizing private insurance companies in an open market.

I have written before that one of the reasons for poverty in the United States is the loss of manufacturing jobs. That loss of skilled and unskilled labor opportunities has resulted in many more Americans lacking health insurance. As more uninsured Americans' use of clinics and the emergency rooms for basic health care increases, the more insurance premiums go up. The more the premiums go up, the less likely employers are to offer health insurance to their employees.

It is a vicious cycle that will stop only when insurance — affordable insurance — is made available to everyone regardless of an ability to pay. That is the cycle the Affordable Care Act is meant to break. That is the cycle that the expansion of Medicaid is meant to break.

We have socialist systems already in place: Medicare, Medicaid, the Department of Veterans Affairs and other programs that work very well. No program is 100 percent perfect, and someone will always find a method to “beat the system.” My years in the Colorado Division of Insurance have proven to me the unlimited imagination of people who want to “beat the system.” We tend to hear the bad stories not because they are so bad, but because they are so rare — like airplane accidents or train derailments.

It should not be a question as to whether to provide insurance to the uninsured, but how soon we can do it. And not just health insurance but dental insurance as well. Dental emergencies account for more than 41 percent of all emergency department visits in the U.S.,  and the number has doubled in the past 10 years.

Can you imagine what life would be like if the United States were in the top 10 countries for quality of health and dental care? Could you imagine the thriving economy, the lower unemployment and underemployment rates and the feeling of well-being we have not seen since the 1960s?

While we are reforming our health care laws, let Missouri take the lead and require a standardized health insurance claim form so medical offices can get back to providing health care and not searching through the files to get the correct form with the correct company with the correct coding.

Expanding Medicaid, adding dental insurance to the Affordable Care Act and standardizing the claims form could go a long way to reducing medical and dental costs and keeping Missourians healthy, employed and productive.

David Rosman is an editor, writer, professional speaker and college instructor in communications, ethics, business and politics. He writes a weekly column for the Missourian. 

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Ellis Smith October 9, 2013 | 8:54 a.m.

When will the United States of America end the present practice of deficit spending (in large part to bankroll new or expanded socialist programs)? If these programs are worthwhile, and some may very well be, THEN PAY FOR THEM IN REAL TIME! You can't, because we are already overextended.

Anyone who continues advocating having ever larger budget deficits is either inherently evil or monumentally stupid. Both conditions are dangerous.

(Report Comment)
Michael Williams October 9, 2013 | 9:23 a.m.

"...the feeling of well-being we have not seen since the 1960s?"

Lol, it's absolutely wonderful that Rosman finally admits that perhaps things were REALLY better in the old days.

PS: The Cuban Missile Crisis was a bit dicey, tho.

Folks without insurance, and folks like Rosman, may be in for an abrupt surprise. You see, getting on an exchange may indeed mean you can get a subsidy, but you still have to pay the rest of your premium. $100/month? $200/month? I don't know (no one else does, either) the amount since I've not even tried for a quote, but you still have to pay your part of the premium. Got an extra thousand or two?

And, those subsidies DO NOT go towards payment of your deductible. So, if you are on a bronze plan and your deductible is...oh, let's start low at $1000...YOU still will have to come up with that $1000 before your insurance kicks in. Loosely translated, you go to the doc, you finish your visit, you go to the checkout counter, are asked to pay money until your deductible is met. Could be 10 bucks, 25 bucks, probably more like 80-125 bucks...but YOU have to pay it.

Until the deductible is met.

So, once this ACA kicks in and poorer folks start screamin' "I thought this was free! I can't pay this!!!", the NEXT thing the libs will be discussing is that the poorer folks need help, so we need to also pay for their deductibles.

Hell, we had a similar thing when they went directly to the ERs!

All in all, this is nothing but a three-card monte game where the cards (money) gets moved around. There will be no savings on health care; I'm convinced that part is all a lie. And folks currently without insurance WILL get insurance, but they are unaware they will have to pay, too. Where-oh-where will they get the money?

They won't. Office docs will identify the non-payers and refuse to schedule them, and the non-payers will end up back at the ERs.

Take home message: At the start, even poorer folks will have to pay their part of the premiums and their deductibles.


PS: Oh, did I mention that if you are on an individual exchange and pick Anthem, you will currently be considered out-of-network for all BJC hospitals? Yes, you can still go to Boone Hospital, but you'll pay more. LOTS more.

So much for keeping your own doctors.

Fun, ain't it?

(Report Comment)
Michael Williams October 9, 2013 | 10:10 a.m.

Oh, and PS: If you want to improve the economy, how 'bout modifying these damned HIPPA rules that require me to WASTE TIME AND DRIVE ALL OVER THIS DAMNED COUNTY FILLING OUT AUTHORIZATION FORMS SO MY DOCTORS CAN COMMUNICATE WITH ONE ANOTHER!!!!!!!!!!!!!

I can't wait until a large group of doctors hereabouts with diverse specialties that I need decide to go the boutique route. I'll drop insurance companies and the gov't quicker than red-hot molten steel. Such a thing is worth MANY THOUSANDS/YEAR to me.

Take note, you young docs..........the mark of financial success in this world is getting yourself to the point where you can separate yourself from the jerks of this world...and that truism now includes your own governments.

(Report Comment)
Ellis Smith October 9, 2013 | 3:30 p.m.

"Michael Williams said:

...the mark of financial success in this world is getting yourself to the point where you can separate yourself from the jerks of this world...and that truism now includes your own governments."

True. When the train derails, you really don't want to be a passenger. With everlasting deficit spending we must eventually run out of rails.

(Report Comment)
Skip Yates October 9, 2013 | 3:48 p.m.

What Mr. Roseman never seems to really understand is fiscal responsibility. He is a standard Mk 1, Mod 0, Democrat!

(Report Comment)
Mark Foecking October 9, 2013 | 7:12 p.m.

"Can you imagine what life would be like if the United States were in the top 10 countries for quality of health and dental care? Could you imagine the thriving economy, the lower unemployment and underemployment rates and the feeling of well-being we have not seen since the 1960s?"

Actually, our economy and feeling of well-being has little to do with the quality of our health care. Health care is not a big part of most people's lives. Jobs and prices have far more to do with it.

The 1960's were an economic aberration caused mostly by the dominant position of the US after WW II. None of the conditions that made us top dog then apply today, and there's little we can do to remedy that, no matter what our health care system.


(Report Comment)
Michael Williams October 9, 2013 | 11:18 p.m.

Here's a pretty good explanation that at least jives with what I have heard (from a source some of you will like):

You still have to pay your part of the premium and the deductible no matter what plan you choose (bronze, silver, gold, platinum). Subsidies do reduce your premium and are apparently calibrated on the silver plan. I think that means if you choose gold or platinum plans, your subsidy remains the same as if you chose silver.

But, if you meet certain poverty guidelines, you can get additional subsidies to reduce deductibles, out-of-pockets, etc., but you have to choose the silver plan to get these extras.

Yes, you will be paying....The only question is, "How much."

But it won't be FREE! Got extra cash?

Griping not allowed for supporters.......

(Report Comment)
Ellis Smith October 10, 2013 | 5:56 a.m.

Mark Foecking has raised a point which goes beyond the current topic. WHY is the dollar the world's reserve currency? It traces back to the end of WWII, when only the United States was in good economic condition. Not only were the war's losers (Germany, Japan, Italy) in dire economic shape but most of the "winners" (United Kingdom, France, China, Union of Soviet SOCIALIST Republics*) were in terrible shape.

Today that inbalance isn't present, and there is now serious talk about replacing the dollar with what is called "a basket of currencies." What does that mean? The reserve currency would consist of several current national currencies. Without doubt the dollar world figure large in the "basket," but it would no longer be the sole reserve.

The "basket" approach HAS one huge advantage over using a single currency as a reserve: the reserve currency wouldn't be so connected to the economic fortunes or misfortunes of a single country.

Let's move on to petroleum. All petroleum transactions are priced in U.S. dollars. WHY? It's a convention, set up back after the war (see above). THERE IS NO RATIONAL ECONOMIC REASON WHY IT SHOULD BE THAT WAY TODAY! There's a move to end that too.

Having the dollar as the world's reserve currency and pricing petroleum in dollars has been helpful to the United States and has to some extent facilitated our running up debts. How much longer will that last?

* - Damn! There goes that pesky "caps lock" key again. :)

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