Tumulty: The Health-Care Crisis Hits Home

Karen Tumulty wrote this article for Time. Its thesis was suggested when her brother was diagnosed with kidney failure:

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage. Until that happened, "unexpected illnesses and accidents happen every day, and the resulting medical bills can be disastrous," Assurant's website warned. "Safeguard your financial future with Short Term Medical temporary insurance. It provides the peace of mind and health care access you need at a price you can afford."

...Pat's decision to save some money by buying short-term insurance was a big mistake, says Karen Pollitz, project director of Georgetown University's Health Policy Institute and a leading expert on the individual-insurance market. "These short-term policies are a joke," she says. "Nobody should ever buy them. It is false security that is being sold. It's junk."

That's because diagnosing and treating an illness may not fall neatly into six-month increments. While Pat had been continuously covered since 2002 by the same company, Assurant Health, each successive policy treated him as a brand-new customer. In looking back over Pat's medical records, the company noticed test results from December, eight months earlier. Though Pat's doctors didn't determine the precise cause of the problem until the following July, his kidney disease was nonetheless judged a "pre-existing condition" — meaning his insurance wouldn't cover it, since he was now under a different six-month policy from the one he had when he got those first tests.

After 33 years of wrestling with insurance companies, Deborah Haile, payment coordinator at the San Antonio Kidney Disease Center, where Pat went for treatment, has pretty much figured out the system. So when I put in my first desperate call to her, on Aug. 20, 2008, she offered to make another run at Assurant. Within an hour, Haile called back, her voice bristling with anger. "Cancel that policy," she advised me. "Your brother is wasting his money on premiums, and he's going to need it."

The underinsured, which as Tumulty puts it, is "the shadow problem facing an additional 25 million people who spend more than 10% of their income on out-of-pocket medical costs." And they usually don't realize it until disaster hits. They think they're covered.

John Aravosis of Americablog.com recently discovered how antiquated his prescription drug coverage was when they began denying his asthma medication at the end of last year, and John has the best self-employed health insurance with the most prescription drug coverage available. When he first got the insurance, $1500 a year was adequate. But as the premium rose, the ceiling on coverage didn't and the drugs got more and more expensive. He even discovered that if he used a mail-order company to provide his needed medication cheaper, his co-pay would increase. Can there be a more Walgreen's-friendly rider?

Today President Obama brought together the major players in a White House Forum on Health Reform:

If we want to create jobs and rebuild our economy and get our federal budget under control, then we have to address the crushing cost of health care this year, in this administration. Making investments in reform now, investments that will dramatically lower costs, won't add to our budget deficits in the long term -- rather, it is one of the best ways -- in fact maybe the only way -- to reduce those long-term costs.

Now, I know people are skeptical about whether Washington can bring about this change. Our inability to reform health care in the past is just one example of how special interests have had their way, and the public interest has fallen by the wayside. And I know people are afraid we'll draw the same old lines in the sand and give in to the same entrenched interests and arrive back at the same stalemate that we've been stuck in for decades.

But I am here today and I believe you are here today because this time is different. This time, the call for reform is coming from the bottom up and from all across the spectrum -- from doctors, from nurses, from patients; from unions, from businesses; from hospitals, health care providers, community groups. It's coming from mayors and governors and legislatures, Democrats, Republicans -- all who are racing ahead of Washington to pass bold health care initiatives on their own. This time, there is no debate about whether all Americans should have quality, affordable health care -- the only question is, how?

There are going to be plenty who yell about socialism. These ninnyheads should be ignored. The general welfare of Americans is best served by all of its citizens gaining access to some basic levels and more of health care, and all of our society will be better served by eliminating the scourge of medical bankruptcies. America pays more per capita for health care than any other nation by far, and yet we still rank far below most other industrialized nations in all other leading indicators of a healthy populace. It is time for this state of affairs to end.