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In 2010, the Larchmont Gazette ceased publication. In 2011 the publishers donated all contents to the Larchmont Historical Society, which will continue to make the Gazette archives available online.

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Think Your Health Insurance Has You Covered? Think Again

Unless you are really sick, you have no idea how good your insurance is, Dr. Betsy Rosenthal told the Local Summit at its February 23rd meeting.

Dr. Rosenthal, who has had a private dermatology practice in Mamaroneck since 1976, was a member of a panel discussing patient coverage issues and advocating for health insurance reform. Adding their perspectives to the panel were Lucille Winton, RN, coordinator of patient and family services at Cancer Support Team serving southern Westchester County and Lillian Jones, regional advocacy director for the American Cancer Society in the Hudson Valley.

Hidden Costs of Health Care

Ms. Winton, in her role at the Cancer Support Team, sees many people who become ill and, since they have private insurance, expect to receive good medical treatment without becoming destitute. However, she has come to see that co-payments, deductibles and other out-of-pocket expenses for medications and essential treatments can quickly mount to the extent that the patient cannot afford both medical care and normal household expenses.

Even when an individual becomes eligible for Medicaid, enrollment is a complex process and there is typically a lag of six weeks before an application is approved. Most people do not want to wait that long before seeking treatment because of the health risk involved.

Judy Dobrof, executive director of Cancer Support Team and panel moderator, pointed out that all of this was true not just for cancer, but for any chronic illness or acute health issue.

We Hear These Stories Every Day

Real life stories shared by Ms. Winton illuminated the problem. She told of one patient who required radiation treatments. While these were covered by private insurance, the co-payment was $50 per treatment, with 30 to 35 treatments being required. This was just one of the many costs he was required to pay out-of-pocket.

Another cancer patient with private insurance coverage had 2009 out-of-pocket costs totaling $23,000. Now that it is 2010, she is facing new deductibles and increased co-insurance costs. This patient actually has limited her visits to the oncologist because of the unaffordability of her health care, putting her in a terrible Catch-22. Without consistent treatment, her condition will deteriorate. But if she can’t work, she won’t be able to pay for her insurance.

This case prompted Dr. Rosenthal to point out what she believes to be one of the ironies of our current health care system: “If you are too sick to work, what do you lose? Your health insurance. Just when you need it.”

Ms. Winton ended her case studies with the sobering statement, “We hear these stories every single day.”

Medical Debts Add Up

Dr. Elizabeth Rosenthal described difficulties her patients encounter with their health insurance coverage. Photo by John Gitlitz

Dr. Rosenthal echoed Ms. Winton’s statements, noting many people do not realize they are in for a “really, really horrible surprise” about how much coverage they have when faced with a catastrophic health care issue. She has experienced situations where she could not prescribe what was needed because her patients could not afford it, and has also seen patients bankrupted due to medical debt.

Dr. Rosenthal cited a recent study in the American Journal of Medicine that found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of these, nearly 80 percent had health insurance.

A Flawed System?

Dr. Rosenthal argued that even basic American health care is just not affordable. Physicians for a National Health Program, an organization of which Dr. Rosenthal is a member, projects that by the year 2025, the average health insurance premium for a family of four will equal the average income for a family of four, based on the explosive growth in insurance premium rates.

In Dr. Rosenthal’s view, private health care is systemically flawed, because collecting premiums and not paying all of what is collected for treatment is the only way these companies can make a profit. She further pointed out that insurance companies have incentives to cover only healthy people, not sick people.

Lobbying For Change

Lillian Jones spoke about the concerns the American Cancer Society (ACS) has regarding the current health care system.  She said ACS realizes that although great strides are being made in the prevention, detection and treatment of cancer, these are only meaningful if people have access to the appropriate screenings, care, drugs and treatment. Because of this, the non-partisan, issues-oriented American Cancer Society Cancer Action Network is kicking off an electronic petition drive, entitled “Don’t Give Up on Health Care Reform,” through their website later this week.

Panel members stressed the importance of lobbying on the outcome of health care reform. Dr. Rosenthal said heath insurers are front and center in the debate, lobbying hard, because they have revenues at stake.

Ms. Jones pointed out that 95% of the calls our Westchester legislators are getting are anti-health care reform, which surprised many in the audience.

Some of the attendees voiced concern over what they felt was purposeful misinformation being propagated by organized opposition to health care reform. One described a sign which read, “Government — Keep Your Hands off My Medicare,” when in actuality, Medicare is already a government program.

Dr. Rosenthal said many fear that the government cannot manage efficiently or effectively, but the Veterans Administration system, Medicare and Medicaid are all generally viewed as good, if not perfect, government-run health care programs.

Message Now Is Just “Reform”

Other audience members expressed the opinion that many have kept silent because of the complexity of the issue. So many health insurance models have been introduced that it is difficult to keep track of the differences. Ms. Jones said this problem can be solved quite simply by just coming to legislators with the message that reform is needed, and not sweating the details, because the program can always be modified later.

If we do not pass reform now, it will be many years before we will get the opportunity again, she emphasized.

The Local Summit, which hosted the meeting, is an informal community council that seeks to make Larchmont/Mamaroneck a better place to live for everyone. Its regular monthly meetings take place at 7:45 a.m., typically on the third Tuesday of the month at the Nautilus Diner in Mamaroneck.

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1 comment to Think Your Health Insurance Has You Covered? Think Again

  • Bemused

    Winton/Rosenthal highlight some of the problems of the current system without looking at the causes. “Reform now, sweat the details later” is a recipe for disaster – look at Obama’s wasted opportunity. If Obama had set out a plan based on a few key fundamentals and had worked with a few members of Congress to sponsor a bill, the chances are we would have reform by now. Instead he punted…
    It is equally simplistic to say insurance companies only want to insure healthy people; the same applies to all business – you want the good bit and try to avoid the losers.
    The solution starts with universal mandated insurance. Some countries provide this directly, others enforce a payroll deduction to pay for private coverage which seems more likely to work here. To make it work, you need a level playing field, open competition, equal tax treatment for individuals and companies and some rules to prevent huge variances in cost. On the care side, sensible efficiencies, tort reform, greater use of nurses, reduction of per item fee billing, etc should at least control costs. Similar reforms applied to Medicare would reduce costs; yes there would be less free general coverage for seniors but it seems a fair trade-off for universal coverage. Since there will be extra costs, HSAs are essential and ultimately the state will have to support hardship and low income cases. But a system which covers everyone, makes the costs transparent and obliges each of us to take responsibility for our health ought to bring costs under control and provide universal coverage. of course this would have to be phased in over many years to make it acceptable to people closer to retirement and with good company coverage.