During my trip to Toronto this summer I was struck by the nature of the health care debate there. Well, there were two debates – the one that a cab driver wanted to stage with me comparing the Canadian system to the US system, and the one I read about in their newspapers. In the latter, health care news centered around issues like citizens who wanted to opt for private insurance and doctors who wanted to conduct more screening not approved for coverage by the government. Conspicuously absent was any angst about anyone not receiving any coverage at all or anyone not receiving routine or preventative care. This is markedly different from the debate about the US system. Or at least, it should be. I used to watch discussions on health care on CNBC and they were pretty aggravating. One group discussion included a bunch of big-time CEO’s and they all just talked about free market and choice. When Starbucks Howard Schultz (who grew up in a housing project) expressed the need for making sure everyone has health care, the others just gave him a blank look. During the CNBC special on Walmart, the interviewer grilled Lee Scott on how Walmart ruthlessly drives supplier prices down, but didn’t ask why Walmart couldn’t do that with potential employee health benefit providers (at the time, Walmart expected employees to just go out and get it themselves, citing free market and choice, again)
For people who just take health care for granted, e.g. the wealthy, those in government or academic or otherwise secure employment with established health care benefits, it’s hard to imagine not having health insurance (I certainly never worried about it while I was working for big companies). But it is an employer-based health insurance system, after all, so draw the logical conclusion. Just try quitting your job (or losing it involuntarily). When I went freelance, it turned out my employer had never offered COBRA coverage to exiting employees before (not the first such employer I encountered, either). Fortunately, I had no preexisting condition, so I ended up picking the lowest-cost, high deductible insurance I could find (which by the way was the same provider as my previous employer, so I figured there’d be some continuity and familiarity with my history), never exceeded the deductible, and yet my premiums quadrupled in five years. And I’m single and healthy!
But availability of coverage is only part of the story. Even if you have coverage, you can never be really sure you’re covered. Again, my own story – my coverage was abruptly terminated when my provider said I hadn’t paid my premium, even though my check was cashed. It took a few months, an email stating I was going to the police to find out who cashed my check, and a letter to the California consumer insurance agency to get an “apology” that effectively put the blame on me.
Here’s an OC Register story that recounts how a woman lost her COBRA coverage, retroactively, because her first premium check was off by six cents. Or rather, it was correct, but the “computer” read it incorrectly. So on the next bill they showed she was behind by six cents, she paid it, and then they cancelled her coverage. The story didn’t go much further into the issue, but it seems to me there are some obvious questions – why didn’t they contact her immediately if it looked like her coverage was in jeopardy, instead of billing her again and then cancelling it. You’d think a company wouldn’t want to arbitrarily lose customers, but her family was incurring signficant medical bills at the time, so you’ve got to wonder if maybe once the claim forms were submitted they automatically look for some way to dump her (I recall there were some recent California state lawsuits against insurers who did just that). And the story doesn’t say anything about whether they refunded the COBRA premiums when they retroactivally cancelled her policy. If they’re going to say you were never really covered, they should return the money. After all, you’re gonna need it.