Insured but not covered -- Oct. 22, 2009 column

By MARSHA MERCER

Catherine Howard was 29 and an independent, documentary filmmaker in San Francisco when she found a health insurance policy she thought perfect for a healthy, young person.

It was affordable – only $140 a month – and Howard figured the most she’d need would be stitches after a snowboarding mishap.

Unfortunately, she was wrong. A diagnosis of breast cancer brought surgery, chemotherapy and radiation, which left her too weak to work full-time. Under her insurance policy, Howard wound up owing $40,000 in medical bills – more than twice her yearly income – and another $60,000 in living expenses and other bills.

Howard put the bills on her credit card, thinking, “`If I don’t die, I will just deal with this later,’” she told a House panel last week that is investigating underinsurance. “I didn’t die, and this is later,” she said.

Howard refuses to declare bankruptcy. Rather than saving money for a down payment on a house or buying a car, she’s paying off her bills month by month.

Her diligence is commendable, of course. But it raises a troubling question: Should Americans be forced into financial ruin because they get sick?

The focus of health-care reform originally was the 46 million who lack insurance, but the current system has a myriad of other flaws. Many who buy health insurance are subject to the odious practice by insurance companies of canceling coverage for people once they get sick – antiseptically called rescission. Others are denied coverage because of preexisting conditions.

And, there are the under-insured -- people like Catherine Howard, whose insurance is woefully inadequate because of high deductibles and co-pays.

As Congress considers mandating that everyone purchase health insurance as part of reform, some warn that the prescription could make the system worse by expanding the ranks of the under-insured. Low-income people could be forced into cheap insurance plans with huge gaps in coverage.

Congress could help by limiting out-of-pocket expenses and banning junk policies. The real solution – universal health coverage – is not even on the table, even though the rest of the industrialized world has such coverage.

That’s why news this week that a public option isn’t dead offered a glimmer of hope.

The Congressional Budget Office found a Democratic plan containing what House Speaker Nancy Pelosi calls a “more robust” public option might actually reduce the federal deficit. These preliminary estimates were based on a plan to tie reimbursement rates for doctors to current Medicare rates, plus a 5 percent increase.

It’s far from certain that Congress will create a government-run health insurance plan to compete with private insurers. Some critics complain that could lead to a single-payer system as people flock to a public plan and abandon private insurers. Others say costs will be on borne by seniors through cuts in Medicare. We shouldn’t have to rob one group to help another.

President Obama has said repeatedly he won’t add to the deficit and he prefers to build on the current insurance-based system.

Dr. Steffie Woolhandler, a professor at Harvard Medical School, is among those who believe the insurance-based model is broken and can’t be fixed. She co-founded Physicians for a National Health Program in 1986. The 17,000-member group supports a single-payer system -- “Medicare for all” -- which it says could be paid for with $350 billion a year saved by eliminating insurance administrative costs.

Woolhandler also works with the Cambridge Health Alliance, which recently produced a study that found 62 percent of all bankruptcies in the United States are due in part to medical illness and bills.

That study has been criticized because of its methodology, but even if 62 percent is high, medical bankruptcies are a uniquely American phenomenon.

Ours is the only country in the industrialized world that refuses its citizens universal health care, author and journalist T.R. Reid found in researching his book, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”

Rep. John Conyers Jr., D-Mich., has introduced a single-payer bill in Congress. It has 88 cosponsors and is languishing in committee. Nobody wants to touch it.

Five years after her diagnosis, Catherine Howard is a cancer survivor. She’s also uninsurable on the individual market because of her pre-existing condition. Fortunately, she has an employer who provides health insurance. She’s one of the lucky ones. We can do better.

(c)2009 Marsha Mercer. All rights reserved.