Now that I’ve returned to the US and I’m trying to get health insurance, I’m being viewed by US insurers has as one of those people who chose to be uninsured “unininsured” for the past five years, when in fact, I was insured.

Due to the fact that I was successfully treated for cancer while I lived in Canada, the US insurers want nothing to do with me now. They can legally exclude me, despite the fact that I have never been without health insurance.

If I die or go backrupt because of this, let it rest on your conscience and on the rest of everyone else who thinks that the system is OK.

Reminds me of what an insurance agent told me years ago, “tell me when you are going to die and I will tell you when to buy your life insurance.” It doesn’t work that way.

If everyone in the country could have the health insurance that the federal hierarchy gets, no one would have to worry except the Secretary of the Treasury.

Give me a break!

Many of the uninsured are really not exactly uninsured by choice although some clearly are.

Point by point about “what Elizabeth Edwards doesn’t know”:

1) Her comment is not about Senators’ FEHBP insurance coverage. The problem is that a US citizen with cancer as a preexisting condition would find it difficult to obtain health insurance coverage on the individual market. An insurer may reject an insurance application because the applicant or his/her family has a minor or a serious disease – as minor as occasional migraines.

2) This is not about cancer patients being “willfully uninsured”. It is about cancer patients being unable to obtain health insurance coverage outside of employer (or group) sponsorship.

3) “Letting a thousand flowers bloom”, in state-by-state experiments in health policy, is not a solution for companies that are national, nor is it a viable alternative now, as many states are in deficit and unable to fund new health care coverages. In fact, some are reducing Medicaid coverages at this time.

4) This argument is specious, as the “new plan” may just as easily have better benefits and lower or the same premium as the “old plan”. The point is that the “old plan” is only perceived as good for those who are insured, and even for them, insurer cost shifting in the form of higher deductible and coinsurance is dramatically increasing out-of-pocket cost.

5) Personal and portable health insurance would be a wonderful solution. But the following must first be fixed: Individuals purchasing health insurance in the private market face medical underwriting (meaning that coverage can be denied, premiums increased or specific diseases excluded for defined periods of time) for reason of preexisting conditions), and insurers’ administrative costs for individual plans are much higher than group plans – which means that the medical cost ratio (amount of premium paid out in medical benefits) is lower.

6) Those over 65 years of age and eligible for Medicare do not face a medical underwriting problem. That is not what this problem is about. The problem is for those of us who are not Medicare-eligible, and particularly for US citizens who are employed by employers who do not offer health insurance or who are self-employed.

Point-by-point regarding “key questions for Elizabeth Edwards”:

1) “Do you really want a health care system in wich insurers have incentives to attract the healthy and avoid the sick” describes the current system perfectly, for the individual market. For the group (insured or self-insured) market, it ignores the trend to insurer cost shifting to beneficiaries through ever higher deductibles and cost sharing.

2) “…every health plan has an incentive to overprovide to the halthy and underprovide to the sick” is a nonsensical comment. Benefit schedules and provider compensation schedules emphasize coverage and care for the sick, such as treatment of broken bones and chemotherapy for cancer. Preventive care services (well baby, inoculations, mammography, etc) are typically supported by health insurance, to different degrees depending on the coverage.

3) “people who remain uninsured while healthy are allowed to get insurance (without penalty) after they get sick” ignores the outrageous cost of health insurance today, unaffordable for people with modest incomes, particularly if they are of middle age or older (because health insurance premiums become dramatically higher with increasing age, even if there is no preexisting condition that would yield rejection of an application for health insurance).

Elan Rubinstein, Pharm.D., MPH
EB Rubinstein Associates
ebra@pacbell.net