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When the COBRA Strikes
More and more patients have been presenting to my office for complete physical examination, asking for extensive lab work and refills of medications. Why? They are losing their insurance, often due to losing their jobs. And, even if they do quickly find a job in this troubled economy, there is often a delay of months until a new insurance will be in effect. To make matters worse, the new insurance may be an HMO may not have our office as a preferred provider. This visit may be their last visit to our office. Obviously, continuity of care and provider preferences are not high priorities for insurance companies. Their unwritten goal is to provide an acceptable quality of care for the least amount of money.
It is required by law that employers offer COBRA insurance when an employee leaves or is terminated. The law does not require that the insurance is affordable. Since many companies pay all or at least a significant part of the premiums, the terminated employee, without an income, is required to pay the full amount. In many cases, it can cost a family $1000 a month. I like to call this the bite of the COBRA. As long as people do not eat or pay their housing costs, their unemployment checks may cover COBRA costs.
Companies have group insurance, usually at a discounted rate, and usually from the low-bidder. The insurance company is required to insure all employees (and their family members), even if they have a pre-existing medical condition, such as diabetes or cancer. When the employee loses their jobs, any pre-existing condition would preclude them from getting private insurance from another vendor. So, often, the only option for recently terminated employees is to pay the astronomically-high COBRA premiums.
Obama's Economic Incentives Plan has a provision for the government to pay about 65% of the cost of COBRA for people who have lost their jobs, for up to nine months. This will help, but what will really help is complete health care reform, and some government oversight on what insurance companies can charge. The housing market has taken a huge dive, so it is really time for a substantial adjustment in health care costs, including insurance premiums and drug costs. Health care giants, like oil companies, have taken huge profits in the last few decades. Universal health coverage is in all industrialized countries, except the U.S. About 28 percent of the country is receiving health benefits through the federal government, however, through Medicare, Medicaid, and Veterans services. All in all, 15% of our country's GNP is health-related services, more than any other country. In addition, illegal aliens living in the U.S rack up billions of dollars in charges just using the emergency room for mostly non-emergencies.
Compared to other countries, the cost of medical care in the U.S. is among the most expensive. An American friend of mine, living in Mexico, pays only a few hundred dollars a year for basic health insurance. While the level of technological care in Mexico may not be up to U.S. standards, neither are their standard fees. Granted, I would rather receive medical care in the U.S. if I were ill, but it would really be nice if those fees reflected the cost of doing business. A private doctor that I know once bragged about charging $30 for a lab test that cost him about three CENTS in his office. He laughed all the way to the bank.
While traveling in New Zealand years ago, I saw a posting of charges on a health clinic wall. I was shocked that the same services provided in the U.S. are many times greater. One common antibiotic in the US was nearly sixty dollars; it was on eight dollars in New Zealand. The pharmacist explained to me that the entire country of New Zealand is the collective bargaining unit, so the government negotiated for a lower fee. In the U.S., we pay what the market allows. Walmart is advertising hundred of prescriptions now for just $4.00 and why not? Naprosyn 500mg, for instance, costs a pharmacy about $17 per thousand. They are able to fill over 17 prescriptions of sixty tablets - a one month supply - at $4.00 each, they would still make a 388% profit (not counting the cost for the pharmacist to put it in a smaller bottle, of course).
Basically, insurance premiums are high largely in part because medical charges are high. Medical charges are high for many reasons - high malpractice premiums, high salaries, expensive laboratory tests, expensive imaging (x-ray, CT, MRI) studies, administrative costs, and of course, expensive medications. In the end, the wage-earning consumer (or the federal government) eventually picks up the heavily inflated tab.
A former patient of mine, a Hiroshima survivor and now a U.S. citizen, was between a rock and hard place. She is entitled to free medical care in Japan, but in the U.S., she has to pay out of pocket. She cannot afford health insurance. Since the atomic bomb dropped on her city, she has been worried about cancer (rightfully so). Every time she had a sore throat, she would think it was throat cancer. When she coughed, it was lung cancer. I spent a great deal of time reassuring her and trying to keep down her costs by charging less (sometimes free). I was on vacation when she ended up at the local emergency room with a cough. Since they were not familiar with her medical history, they ran some very extensive tests. Her total ER bill for a one hour ER visit was about $5000. In tears, she showed me the bill. I spent the better part of one month trying to negotiate a lesser fee for those excessive charges, to no avail. She ended up paying it all from her savings. She told me that it would have been less expensive for her to fly back to Japan for care. More and more Americans are doing just that - they are flying to other countries to get medical care, like hip replacements.
The cobra is one of the most poisonous snakes on this planet. Like its insurance namesake, its bite can kill and certainly disable a victim - medically and financially.
I am in my 36th year of medical practice and I pray for health care reform. I pray for less-expensive insurance and medical services. I pray that Mr. Obama can pull it off. If not, praying may be our ONLY insurance.
Related Topics:
It is required by law that employers offer COBRA insurance when an employee leaves or is terminated. The law does not require that the insurance is affordable. Since many companies pay all or at least a significant part of the premiums, the terminated employee, without an income, is required to pay the full amount. In many cases, it can cost a family $1000 a month. I like to call this the bite of the COBRA. As long as people do not eat or pay their housing costs, their unemployment checks may cover COBRA costs.
Companies have group insurance, usually at a discounted rate, and usually from the low-bidder. The insurance company is required to insure all employees (and their family members), even if they have a pre-existing medical condition, such as diabetes or cancer. When the employee loses their jobs, any pre-existing condition would preclude them from getting private insurance from another vendor. So, often, the only option for recently terminated employees is to pay the astronomically-high COBRA premiums.
Obama's Economic Incentives Plan has a provision for the government to pay about 65% of the cost of COBRA for people who have lost their jobs, for up to nine months. This will help, but what will really help is complete health care reform, and some government oversight on what insurance companies can charge. The housing market has taken a huge dive, so it is really time for a substantial adjustment in health care costs, including insurance premiums and drug costs. Health care giants, like oil companies, have taken huge profits in the last few decades. Universal health coverage is in all industrialized countries, except the U.S. About 28 percent of the country is receiving health benefits through the federal government, however, through Medicare, Medicaid, and Veterans services. All in all, 15% of our country's GNP is health-related services, more than any other country. In addition, illegal aliens living in the U.S rack up billions of dollars in charges just using the emergency room for mostly non-emergencies.
Compared to other countries, the cost of medical care in the U.S. is among the most expensive. An American friend of mine, living in Mexico, pays only a few hundred dollars a year for basic health insurance. While the level of technological care in Mexico may not be up to U.S. standards, neither are their standard fees. Granted, I would rather receive medical care in the U.S. if I were ill, but it would really be nice if those fees reflected the cost of doing business. A private doctor that I know once bragged about charging $30 for a lab test that cost him about three CENTS in his office. He laughed all the way to the bank.
While traveling in New Zealand years ago, I saw a posting of charges on a health clinic wall. I was shocked that the same services provided in the U.S. are many times greater. One common antibiotic in the US was nearly sixty dollars; it was on eight dollars in New Zealand. The pharmacist explained to me that the entire country of New Zealand is the collective bargaining unit, so the government negotiated for a lower fee. In the U.S., we pay what the market allows. Walmart is advertising hundred of prescriptions now for just $4.00 and why not? Naprosyn 500mg, for instance, costs a pharmacy about $17 per thousand. They are able to fill over 17 prescriptions of sixty tablets - a one month supply - at $4.00 each, they would still make a 388% profit (not counting the cost for the pharmacist to put it in a smaller bottle, of course).
Basically, insurance premiums are high largely in part because medical charges are high. Medical charges are high for many reasons - high malpractice premiums, high salaries, expensive laboratory tests, expensive imaging (x-ray, CT, MRI) studies, administrative costs, and of course, expensive medications. In the end, the wage-earning consumer (or the federal government) eventually picks up the heavily inflated tab.
A former patient of mine, a Hiroshima survivor and now a U.S. citizen, was between a rock and hard place. She is entitled to free medical care in Japan, but in the U.S., she has to pay out of pocket. She cannot afford health insurance. Since the atomic bomb dropped on her city, she has been worried about cancer (rightfully so). Every time she had a sore throat, she would think it was throat cancer. When she coughed, it was lung cancer. I spent a great deal of time reassuring her and trying to keep down her costs by charging less (sometimes free). I was on vacation when she ended up at the local emergency room with a cough. Since they were not familiar with her medical history, they ran some very extensive tests. Her total ER bill for a one hour ER visit was about $5000. In tears, she showed me the bill. I spent the better part of one month trying to negotiate a lesser fee for those excessive charges, to no avail. She ended up paying it all from her savings. She told me that it would have been less expensive for her to fly back to Japan for care. More and more Americans are doing just that - they are flying to other countries to get medical care, like hip replacements.
The cobra is one of the most poisonous snakes on this planet. Like its insurance namesake, its bite can kill and certainly disable a victim - medically and financially.
I am in my 36th year of medical practice and I pray for health care reform. I pray for less-expensive insurance and medical services. I pray that Mr. Obama can pull it off. If not, praying may be our ONLY insurance.
Related Topics:
- Laid Off? 10 Health Care Tips
- Hefty Health Spending in Stimulus Bill
- Living Better Newsletter - Wellness news to keep you healthy and strong!
Labels: COBRA, health insurance, Obama, reform, universal health care
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