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‘Connecting' with affordable insurance is no holiday

By D.B. Reiff
MetroWest Daily News (Framingham, Mass.), Dec. 28, 2014

For many in Massachusetts, the holiday break is here. But for hundreds of thousands of us, the rush is to navigate the Mass Healthcare Connector site to find insurance that we can afford but that won’t leave us bankrupt if we get sick or have an accident. And that’s no holiday vacation.

Despite my difficulties with the Connector site last year, I started this year optimistically. After all, it’s a brand-new, field-tested system, and we’ve been assured of its usability. Yet after filling out my family’s information, I could not get the blue “Find a Plan” button at the top of the page to work. Eventually, I devised a work-around. I later learned from the Health Connector via Twitter that this problem is quite common but as yet unresolved.

Once I did get to shop for a plan, there were 109 plans from which I could choose. One hundred and nine plans each with dozens of variables beyond the low monthly price/high deductible tradeoff. Many have a $2,000 deductible plus $1,000 co-pays for day or inpatient surgery, skilled nursing facility, or imaging studies such as MRIs or CT scans.

But the real shocker - and danger - is buried in a sea of numbers, and it is one that will push many Massachusetts families to the financial brink: co-insurance.

Here’s an example. In a plan that cost $548.51 a month ($6,582 a year) with a $500 deductible, there was a 30 percent co-insurance cost on everything from the doctor’s bill and facility fee for both day and inpatient surgery, to MRIs and durable medical equipment.

That means that the 30 percent co-insurance would apply to a $5,000 emergency room bill, a $30,000 day surgery, or a $100,000 hospital stay. Imagine the cost of cancer.

Massachusetts has been a leader in health insurance coverage, but no one in civilized society should have financial ruin as the cost of being sick. No one should have to forego the care they need because the cost is so high.

And no state should have the cost of health care squeeze out every other main budget item, but that is how it is here in Massachusetts. For the last 15 years, spending on health care has gone steadily up, and spending on all other major line items, including overall spending on education, infrastructure, and aid to cities and towns, has stalled.

This year, 44 percent of every dollar the state spends of its $40 billion budget will be on health care. And that’s before the potential $750 million shortfall the state is facing, according to the Massachusetts Taxpayer Foundation.

Remember the 109 insurance plans I got to choose from? Hospitals and doctors spend enormous resources administering all those plans, but ultimately, it comes from our pockets. That’s why we all need a solution, not just to help those of us who pay for our own insurance, but to fix the system as a whole.

And that solution is Medicare for All, also known as single payer.

Medicare, the health insurance that almost everyone over 65 has and loves, would curb the spiraling spending. It runs with one percent overhead instead of producing double-digit insurance company profits. It pays administrators government salaries not CEO packages, and has offices in government buildings not fancy corporate towers. With Medicare for All, doctors and hospitals wouldn’t have dozens of different insurance plans to administer and could focus on treating patients according to their needs not their insurance plans.

The McKinsey Global Institute says that approximately 30 percent of health care spending is wasted, and two of the biggest drivers of the waste are administration and insurance. MassCare, an organization that supports Medicare for All in Massachusetts, says such a system would save $17 billion by eliminating for-profit brokers and administrative waste caused by private insurance companies.

The state knows how to save itself and its citizens from the financial quicksand that the current healthcare system has created. There will be a bill in the legislature to do just this. What’s needed is political courage and voter support. Between now and Jan. 7, we can call our state senators and representatives and let them know we support Single Payer legislation.

Massachusetts is national leader in many ways. Now we can show the country that we understand the economics of health care and that we have the wherewithal to build a system to benefit one and all.

When the historian Thucydides was asked when justice would come to Athens, he replied, “Justice will not come to Athens until those who are not injured are as indignant as those who are injured."

This is an opportunity to bring justice home to Massachusetts.

D.B. Reiff of Brighton is a writer and workplace communication/conflict resolution consultant.

http://www.metrowestdailynews.com/article/20141228/OPINION/141227524/116...