“Obama Care” Part 1, The History

Since President Obama has been re-elected, I decided that I had better educate myself on the question of the Health Care Reform Act and find out what is really at stake.  I do believe that the only way the President will get the support he needs to make this initiative successful is if he and his Administration educate the public with the same energy and coordination that they used for his election and re-election.  For my part, I will begin with the history of the universal health care question in our country and move forward.

Many people think that the whole question of universal health care was “pushed” on us  by “this” president.   Untrue.  Universal health care has been a topic of discussion since the turn of the century — the 20th century.  Yes, since the early 1900s.  Why is it that the idea of universal health care has not been embraced by our country, the only advanced nation in the world not to have universal health care?  The answer to that question has many components.  Jill Lepore, in an article  she penned December 7, 2009 for the New Yorker, wrote that a group of economists which included Louis Brandeis, Jane Addams and Woodrow Wilson formed a committee they called the Committee on Social Insurance.  By 1915, the committee had drafted a bill to provide universal medical coverage.  At the time, the American Medical Association enthusiastically supported the idea and by the end of 1916, the idea was presented to Congress for their approval.

According to Lepore, part of their presentation lauded Germany as the great example to be emulated.

“Germany showed the way in 1883,” Fisher [one of the committee members] told his audience. “Her wonderful industrial progress since that time, her comparative freedom from poverty . . . and the physical preparedness of her soldiery, are presumably due, in considerable measure, to health insurance.”

However, in April 1917, the United States declared war with Germany,  killing, along with some German soldiers, any move towards Universal Health Care which was now being correlated as a product of Germany.

In Lepore’s article, we learn that:

In California, where the legislature had passed a constitutional amendment providing for universal health insurance, it was put on the ballot for ratification: a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it “would spell social ruin to the United States.” Every voter in the state received in the mail a pamphlet with a picture of the Kaiser and the words “Born in Germany. Do you want it in California?” (“If you are opposed to a thing these days,” one frustrated health-care advocate wrote, “the cheapest way to attack it is to call it ‘German.’ ”) The people of California voted it down. By 1919, John J. A. O’Reilly, a Brooklyn physician, was calling universal health insurance “UnAmerican, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.”

Hm.  This certainly sounds familiar, although these days, the word German has been replaced with the word socialist.

Fast Forward to Franklin D. Roosevelt and the New Deal.  Once again, universal health care was bandied around as a right of all citizens.  But opposition came, in the form of Southern Senators (who were mostly Democrats at the time, because Abraham Lincoln had been a Republican), concerned about the implications that a National Health Insurance (NHI) might have in their segregated societies.  They aligned themselves with Republican senators and brought the American Medical Association (AMA) into the fold to put a block to this.  President Roosevelt, concerned that other New Deal reforms would not pass if he pushed too hard on NIH, dropped it.

However, after World War II ended, President Truman tried to implement the national health insurance once again. His plan proposed a single insurance program that would cover all Americans with public subsidies to pay for the poor.   Once again, according to an article published by the Kaiser Foundation:

Southern Democrats in key positions blocked Truman’s initiative, partly in fear that the federal involvement in health care might lead to federal action against segregation at a time when hospitals (in the South) were still separating patients by race. [The irony of the fact that it was President Obama who successfully brought universal health care into law is not lost on me.]

Also “an increasingly powerful AMA opposed National Health Insurance believing that physicians would lose their autonomy, be required to work in group practice models and be paid by salary or capitated methods.  In addition, business and labor groups were not supportive, nor was the emerging private health insurance industry. “

Now the opposition was becoming stronger.  The area of health care was being recognized as a potentially huge money making enterprise by the business class.  But the government continued to plug away at the idea of universal healthcare.  President John F. Kennedy presented the concept in the form of health care coverage for all those on Social Security.  This was in 1962.  President Lyndon B. Johnson was able to pass legislation creating Medicare/Medicaid programs to provide comprehensive health care coverage for people aged 65 and older, as well as for the poor, blind, and disabled in 1965.  At this point, healthcare related spending started to skyrocket.  Health care became a lucrative business.

In 1971, confronting the escalating costs of healthcare, President Richard M. Nixon backed a proposal that would require employers to provide a minimum level of health care for their employees, while maintaining competition among insurance companies, keeping medicare/medicaid for those over 65 and creating a pool insurance coverage for self-employed individuals.  Senator Teddy Kennedy at the time was promoting a universal health care coverage directed and financed entirely by the government.

In hindsight, President Nixon’s proposal might have helped to contain health care costs.  The issue that was being challenged by Senator Kennedy was that President Nixon’s program supported private insurance companies as the providers of health insurance.  Kennedy’s proposal would take health care out of the private sector.

The debate that occurred between President Nixon and Senator Kennedy probably best epitomizes the struggle our country has had throughout its existence [go back to the acrimonious exchanges between Thomas Jefferson and Alexander Hamilton].  The debate has always centered around the rights of the citizenry and the rights of businesses to thrive and keep this country moving forward economically.  What the debate never seems to quite latch onto is that there are some areas that are service areas by nature and other areas that fit under the intent of business.  Health care is a service area.  It should not be a money making enterprise.  When the focus is on making money, the focus is no longer on service.    [to be continued….]

© Yvonne Behrens, M.Ed  2012



Insurance Companies: Got You Coming and Going

insurance: photo by Alan Cleaver

Recently, I received my monthly bill from my insurance company and found that they had increased my premium by approximately $50.

About five years ago, my husband and I both found ourselves no longer receiving insurance through the companies we were working for because the companies were closing their doors.  Thankfully for my husband, he was at an age where he could receive medicare benefits.  But I was in the “doughnut hole” of insurance coverage.  I had to seek an individual policy and fully pay out of pocket for that individual policy.

Every year, my premiums have gone up.  As I do every year, I called them to ask why they had increased my premium rates since the only thing I cost them was the paper and stamp they used to send me my premium bills.

The first year I had asked that question, the reply was, “because you are a year older.”  I screamed “Ageism!”  Must have been marked on my records, because that is no longer the answer I receive.

This year, the answer I received was, “We increase everyone’s premiums every year. This year the increase is much higher because of President Obama’s Health Reform Act and, in general, healthcare has become more expensive.”   Hunh?  Has the Health Reform Act even started?  I thought it was in the high courts being challenged as unconstitutional. “Are you telling me that the Obama Healthcare Initiative, which is presently tied up in the higher courts, is the cause of health care going up and my premiums going up?”  “No. That is not what I said.  We are needing to cover the costs and healthcare has gone up this past year.”  Hm.

My existing policy included free preventative care, which meant a free physical, a  $3,000 deductible, an 80/20 on pharmaceuticals, and catastrophic coverage at 80/20.

Oh, two weeks earlier, I had received a letter telling me that I could choose to remain in my present coverage and I would be grandfathered.  However, should I choose another option, I would loose the benefits of that current plan.

Grandfathered. That was the term they used when I was teaching and there was a whole new system introduced around our retirement funds.  We older employees were given the option to remain “grandfathered” in the previous system.  The older system benefited the employees more than the new system and so “grandfathering” was a good thing.  I was understandably feeling a little nervous about changing anything on my insurance coverage.

However, my outrage at the price increase was stronger than my fear of change.  So I timidly inquired whether there were other options out there that might not cost me as much in premiums but also provide for catastrophic.  The “customer advocate” did not know the answer to this question, but she could transfer me to a “Health Plan Agent” who might be able to tell me.

It turned out that there was a very similar plan to the one I had.  Not only was it similar, but it included dental!  To boot, the premium per month was going to be $75 less than the latest premium on my old policy.  Eureka!

But this did not make sense.  Why was I being offered a better deal that was cheaper than the policy they so graciously offered to grandfather me into?  Also, the only way I found out about the plan was because of the query into the price hike of my old policy.  The answer  I was given was that they had created this new plan and because more people were signed on the new plan than on the old plan, they could provide it for less money.

They sent me a 26 page application form, which I dutifully printed out, filled out, and sent back to them via fax.  When two weeks had gone by and I had not heard back from them, I called to find out what may have happened.  They had no record of the document, but after another hour and a half, I was informed that I should just fill out another document and fax it (not the original one because of some slight something or another that was different).  Again, I did this, and again I waited.   A few weeks later, I received a welcome letter congratulating me on my choice, and “our customer care advocates are here to assist in any way they can if you have any questions.”

I eagerly looked to see the premium amount and to my horror  it was $60 more than the recent hike on the old policy!  What happened?

So back to the “We are here to serve you Health Care” Adviser, who told me that underwriting must have determined that for some reason, a reason that she, in her role, was not privy to, the need for the price hike, but if I wished, she could transfer me and I could ask them.  The underwriter informed me that I had been accepted at level 2 (because I had a back problem situation in 2006).  “But I have not had a back problem situation since then!  Does that not count?”  “If you have gone to a chiropractor anytime during that period of time, you continue to be considered Level 2”  Groan!  “But the Agent told me this policy would cost me $230!”  “Sorry.  I don’t know anything about the agents and I am not sure why she would have told you that.”  “But I usually go to my chiropractor as a preventative.”  “That is not how we define visits to chiropractors.”  “What should I do to clarify this?”  “Not my department.”

I gave up.  I just gave up.

I decided that I could not continue with a system the deck of which was so stacked against the consumer, there was no way of playing ball with them.  My husband, were he still alive, would have insisted I bite the bullet.  But my sense of justice or of the injustice was too great.  I would not play the game the way they presented it to me.  Another month went by and by this time, I had been uninsured for three weeks.  Treading on thin ice.  Okay, okay I will stop with the analogies.

Unfortunately, because we live in a country that really does require one to have health insurance and since I am at an age where one really should be covered by health insurance, I found myself once again making a call to my insurance company to try and explore another means of getting insurance coverage.

After the third transfer which followed the, “Sorry not my department,” response, I found myself speaking with an agent who actually seemed to know something.  It turned out that I had marked the wrong box for premiums on my application, inadvertently opting for a higher premium with a lower benchmark for the catastrophic and, because I had seen a chiropractor in the last twelve months (it did not matter that it was for an unrelated issue from the one that branded me a level 2 originally), underwriting was still assessing me at level 2.  Hence the price hike.

However, I learned that I could possibly get down to Level 1 if I got the Chiropractor and my primary physician to both write letters stating that I was no  longer being seen for my back problem.

(to be continued)



Aging in a Youth Focused Society

Last week, along with five other experts in the field of aging, I was invited to give a presentation to employees of the County of Roanoke in Virginia.  My presentation focused on aging in a youth-oriented society.

Aging Actress with Face Lift

Most people in our society dread the idea of aging and/or dying.  Either or both are inevitable parts of our life experience and the sooner we acknowledge this, the better prepared we will be when it catches up with us.  Because we do not want to confront our aging process or death, we enable the medical and beauty industries to make millions.   In the end, however, these two realities of life will triumph.

In my presentation last week, I covered the many different ways in which we can better prepare ourselves for the “twilight” years.  We need to face our aging and become friends with it.  This is not an easy thing to do in our youth focused society.  The first step to altering our feelings about aging is to recognize just how much society, through media, advertising, and Hollywood enhances a negative view of aging (I will write more extensively on this in a later blog).

During my presentation, I showed a favorite video (see below)in which a couple, Richard and Alice Matzkin, decided to confront their aging process.  I really love this video and their story.  I think I resonate with it so much because, just as all of us who are noticing more wrinkles on our face, or more aches in our joints or whatever aging indicators are starting to take over, their initial fear and upset may seem familiar.  Over and above the familiarity of their initial reaction, however, was the positive approach they decided to take in confronting their aging process.

I suggested to my audience that the time to plan for one’s later years should be when they have the energy and motivation to take the actions that are needed to establish an environment that will enable them to age gracefully.  This is when one can handle remodeling, if that is the decision.  A universally designed space can allow parents and children as well as couples who may have a disability to interact with their environment fully.  Not only should we be reflecting on our personal spaces, but also the larger areas in which we reside.

Liveable communities, the concept that neighborhoods have easy access to shopping, medical care, parks, entertainment, transportation, and safety, along with affordable housing, is another idea that can only benefit everyone across the generations, whether young professionals, parents, or the elderly.  But the time when we have the energy to solicit our local politicians is before we get to that point in our aging process.

If one has decided that they will go the retirement community route, one should take the time to visit several before making a decision.  Each community has its own personality.  Ask to see all levels of care since the assisted living and nursing care will be your environment in your more vulnerable stages.

Communes are familiar to the baby boomer generation and it might be worth exploring the idea of sharing home space, or at least share with neighbors expenses for those tasks that become more difficult for us to accomplish as we age.

My hope is that the audience came away with an understanding that we can be pro-active in how our older years will unroll before us and it does not have to be all negative.

© Yvonne Behrens, M.Ed  2011