Lately, the media is converging on one issue like rabid dogs in a gutter littered with trash.  Just what are they salivating over?  Health care.

I just watched the preview for "Sicko," Michael Moore's latest thought-inducing film installment that targets the U.S. healthcare system - health insurance in particular.  Monday, I read the newest Centers for Disease report on your chances of dying from heart-attack related problems at any major hospital.  Yesterday, I spent some time reading through the pro's and con's of expanding the national SCHIP children's health insurance funding to an unprecedented $15 BILLION.  And, last night, I watched the first installment of Shaquille O'Neil's new series working with obese children. 

I work in health insurance and *insert legal language here* NOTHING I AM ABOUT TO SAY represents anything my company supports or endorses.  It is solely my humble opinion.  You may not publish this post nor portions of it in any media outlet nor any local, state, or national news story.  Trackbacks and links from personal blogs is encouraged but must include the bold and underlined text.

That said, I have a few thoughts about all of this.  And I'm not just a neophyte - tunnel-visioned - pro- insurance person either.  I have participated in many think tanks about how to address this serious problem of rising costs and the uninsured.  Aside from my street cred, I am absolutely passionate about helping people get access to care.  Alright, so call me a bleeding heart but ... it is the right thing to do ... give every U.S. citizen access to quality healthcare.

First, I think it's great that Michael Moore has made a film about health insurance and healthcare.  His films are thought-provoking though not all-encompassing.  He pinches the most tender issues surrounding something affecting us all and then hopes for some dialogue.  While I haven't seen the whole film, it's common knowledge that insurance companies take the brunt of this particular squeeze. 

Insurance companies are profiteers or so everyone would have you believe.  And I can say that the past few years HAVE been good to insurance companies; however, it's a very cyclical industry and highly regulated when it comes to rate filings (or should I say, for Blue Plan filings - the commercial giants like Anthem and Aetna and Wellpoint don't have to get approvals).  We're headed for a downturn for the next several years.  It has been, historically, a seven year cycle of gains and losses.  Barring an unforeseen catastrophe or epidemic (which we won't touch on for now but would be DISASTROUS to the entire health care system), that's the cycle.

Most consumers only know how much their share of the pie is each month and that the share they pay is going up every year.  Their employers bear the brunt of the cost for health insurance (if they cover it all anymore due to the insanely high costs to insure an aging population).  Everyone knows that when you hit 40, you start seeing a hell of a lot more of your doctor for back pain, foot issues, diabetes, heart, migraines, cancers, etc.  The body starts showing signs of wear and tear as we age. 

Those same consumers are shocked to the point of near cardiac arrest when they try to buy insurance on their own.  HOLY EFFING CRAP?!  It COSTS that MUCH?!  Well, yeah, it does ... and your employer has been paying most of that for you up until you had to buy your own (plus ... the employer group's risks were spread over the entire group with younger dependents).  But there are limits on how much an insurance company can keep as profit margin from that estimated premium.  Actuaries (the number crunchers) look at how much they think it's going to cost next year based on how many claims they paid last year (that's called experience rated for a particular group's claims and community rated if they have to apply the experience of the claims across a broad spectrum of groups lumped in under community).   

If claims we pay out come in lower than we expected, we make a gain.  Higher, and it's a loss.  Most of that money gets socked away for the next downturn (when claims start to exceed what we guessed they might) or poured into infrastructure like systems to make paying claims more efficient or poured back into the communities we serve (the latter only in the case of non-profit Blues Plans).  And might I say that, in Pennsylvania at least, this is NOT a level playing field between Blues and commercial carriers but that's an entirely different story.

What is driving these escalating costs?  Lots of things. 

1. Technology and every facility that has to have it (how many MRI machines does one town need?) 
2. Litigation against providers so they practice a lot more defensive medicine to ward off potential lawsuits (hey ... let's have that pain in your neck verified with an MRI just to be sure it isn't brain cancer - at $10,000+ a pop). 
3. Mandated benefits by states that health plans MUST include for their members (like prostate cancer screenings for men ... and hey, what male legislator ISN'T going to vote YES to that one?).  We get five or more mandated benefits we must add to benefit packages each year (that adds cost) and while a lot of these make sense, the legislators and special interest groups seem to think there's no correlation between rising premiums and what we have to cover. 
4. Lifestyle and technological wonder drugs that cost bazillions of dollars each year and are bolstered by incentives for providers to push them and big bucks ad campaigns urging people to use them (lest they suffer uncontrollable defication with that GERD). 
5. Along with all of this, we have the first generation of kids that are more likely to die younger than their parents.  Really.  Think about that statement for a minute. 

Okay.  That's really bad news.  And, if I'm to believe the statistics being advertised, nearly one in every 154 children has autism.  Not to mention ADD and ADHD and type two diabetes requiring insulin.  It's a pathetic bunch of kids we've got growing up in the U.S.  Sorry, kids, but your future looks dim.  Unless ... we can get this under control ... which I have every hope we will.  The word is getting out and changes are happening, thank God. 

KUDOS to Shaq for doing what he's doing with the kids on his show.  I can't really fathom a child of 10 years weighing 263 pounds.  Can you?  I mean ... HOLY EFFING CRAP!  And their parents are clueless.  These kids will die of cardiac arrest, diabetes (YES, it KILLS), and countless other comorbid (simultaneously occurring health problems) conditions before they hit 40.  Really.  It's no joke.  And what do you think the health insurance premiums will be like when they hit their 30's?  *GASP*

We need to insure every child.  That's a no-brainer in my book.  It's the funding that's problematic.  But if we can spend TRILLIONS of dollars on a war without an end in sight and unchecked accounting, why can't we spend a few billion on making sure every kid gets the healthcare they deserve?  The SCHIP program makes a huge difference in these kids lives.  I can personally attest to that fact.  You would not believe how many parents tell us that they wouldn't let their kid do anything physical (as in ride a bike, play baseball, jump rope, or go away to summer camp) because they were so afraid they'd get hurt and they wouldn't be able to pay for the care.  Obesity ... ?  Yep.  Insured kids perform better in school because they can see the chalk board and aren't experiencing the crazed frenzy of having untreated ADHD (although that has been diagnosed far too prevalently IMHO).

When the CDC published their hospital rates of mortality and treatment patterns for hospitals, it was a good step forward.  We need more transparency in health care and information to help consumers make better choices.  But ... the study wasn't all that fair.  Hospitals that treat highly complex cases weren't evaluated any differently than those that treated easy cases.  There has to be a better way to present the data and I'm sure they'll find it.  The other thing that consumers and employers need desperately is cost information from provider to provider.  If it costs $100 for an office visit at one doc and $50 at another, we need to be able to see that.  Especially, as health insurance falls more and more into the hands of the consumer with health spending accounts and extremely high deductibles in the $1000+ range. 

Health insurance is not an easily understood topic, by a long shot.  There's so much jargon and heady statistics to consider when weighing options but we have to start somewhere and make good advances if we're to solve the problem. Hopefully, you learned something. 

Drop me a line with your comments on this hot topic.  I'd love to hear from you. 

I'm so with you on this. It's a very tough problem. I'm recently divorced(Thank GOD my kids are still covered by their Dad's insurance) and talked for MONTHS with an Anthem indiviual agent about coverage. Finally settled on a nice little plan that paid preventive care, had an HSA and a few other things I liked. Well, after I applied, because I've been seeing a counselor for my divorce, they decided I couldn't have the above plan at $140.00 a month, but they could offer me some other plan that didn't cover nearly as much for $458.00 a month!!!! Fortunately for me I'm a full time student so I signed up for my schools plan (it's a crappy plan, because I go to a branch campus, but it's better than nothing and they aren't asking questions about my recent counseling) Hopefully by the time I finish school, I'll have finished up with the counseling and I'll be able to find a job with coverage. I work now, but I don't have any insurance benefits.
I think we have the best health care in the world, and the insurance industry does get a bad rap. Consumers tend to be lazy and have a mentality of entitlement when the care they are getting is being paid for by a third party. I think you're right about technology driving a lot of the costs. I also think that there is SO MUCH that we can all do in terms of promoting healthier choices for ourselves and our kids. We shouldn't depend on technology to bail us out of our bad lifestyle choices (poor diet, no exercise, etc)