Reform is not going to better your health!!

**** I started this post sometime ago and just stepped away from it. But now I’ve decided to post it. The bill that just passed occurred after the writing of this post and its late at night and I don’t feel like researching what it includes right now. But if you know please feel free to share. Here’s what CNN posted: House Passes health care reform bill.

This was a complete emotional ramble after a discussion with a friend who also works in health care but in an IT compacity, I am in Marketing. I actually set up the large employer group accounts, so I’m there when benefits are selected… lucky me. Read on, discuss like you got some sense.****

 

Like I always do I write the post in my head and then can’t get it down as perfectly as I had when I finally get to a computer… but anyways, my feelings are the same….

Stop blaming Health Administrative Organizations like your BCBS, Aetna, and UHC for your high premiums and your cost of care. I’ve been trying to keep up the Reform legislation but I hit my wits end last night talking to my homie. When your company seeks out an Administrator to administer group health insurance there is a huge process involved and most of that is the employer telling them what they want and how they want it. Your company decides your benefits. Administrators do their best to suggest a standard benefit but the company is the client and we’re suppose to make the client happy to keep the business. Your employer has to consider costs to their bottom line as well because offering you rich benefits could lead to diminished profits because expenses are higher and that can lead to layoffs and you without a job. Your employer also decides if your co-insurance is going to be 80/20 or 90/10, the later percentage being the portion you pay out of pocket. Your company decides your deductible and to what benefits that deductible will apply. They decide whats covered. I personally get upset when clients decide not to cover Autism Spectrum Disorder which is ever increasing and the therapy and services offered will improve the health of the child in the long term. My son has ASD so its a sensitive topic with me.

And what it essentially what it comes down to is that health care costs are so high because the majority of the country is so damn unhealthy! Unhealthy people cost more to care for in the long run because they have all kinds of health issues. It is my belief…. let me repeat that… it is MY belief that reform can only take place with each individual in this country taking control of their health. If you don’t know anything about Underwriting, evidence of insurability, and pre-existing conditions (which HIPAA provided some good limitations), I suggest you familiarize yourself. Evidence of insurability is dependent on the plan or your companies requirements. But if you have a pre-existing health condition you may have to wait some months even a year to be covered. That’s one of the main issues that people are raising with the reform, and I believe there shouldn’t be a restriction but depending on the size of the organization that have to protect themselves from very costly, unhealthy employees. Unfair but it’s true.

Now what any companies are beginning to do to help their unhealthy employees get healthy is offer great incentives like gift cards if you have a certain preventive check up, reimbursements for gym memberships or qualifying athletic equipment, or offering CDHP (Consumer Driven Health Plans- HSAs/HCAs) to give the member more control over their health. I was reading a fav blog the other day, MrSwagger, and J. McFly detailed the simple little changes he made in his life that lead to him losing weight, eating better, and contributing to the betterment of his health. Americans are too focused on quick fixes, now now now, that when they don’t see results in a diet the first week or two, they’re throwing up their hands. Health issues lead to so many other unsatisfactory views of our lives… hormonal imbalances from the dependency of mood altering drugs clearly comes to mind, our obsession with food to feel that void or make us “feel better,” and the media, yada yada yada, and other health problems. Like so few men know, penile dysfunction can be a serious sign of other serious problems. The issue with Obesity in this country is just pitiful. Possibly a big reason why costs are up because many obese people have many other health problems. If obese and other overweight people just change their eating habits and exercise more, they gradually loose the weight and with weight loss many of those costly health issues go away. Thus lowering that persons expenses on health care.

We need to control of our well being and not rely on government to make it less costly. If your ass wasn’t so out of shape and unhealthy you wouldn’t be going to the doctor so much trying to figure out whats going on, do I have this or that, now this hurts too, oh my insurance doesn’t cover that until I’m 45 cause usually 32 yr olds don’t have this health issue. We are killing ourselves and unless we change our behavior, no reform is going to help. All we’re going to do is divert our money from current health care costs to paying taxes for others health care costs who aren’t getting better cause this reform doesn’t include measures or requirements that will lead these uninsured and underinsured to get healthy. This reform should also only be about providing health care to those who can’t afford coverage. Not those people who just don’t like the benefits or the premiums their company is offering. I haven’t seen anything about the limitations on these plans. How are they going to prevent 75K Joe over here from dropping his companies group health and going to a cheaper government plan? I heard that they are considering modeling these plans after the Congress’ cafeteria plans, just not as rich in benefits of course. But if they’re offering “adequate coverage” now really what’s keeping Joe Blow from switching over? Just in this recession my company has seen a drop in membership because people can no longer afford coverage, or the company can not continue to offer it. There are so many peices to this equation. One of my biggest fears is that folks that don’t even have health care industry experiment and knowledge of different impacts are creating the reform bill. Many concerns, not enough answers.

I totally wrote this out of emotion and it was written over a period of time because there is so much I want to say and so much I want people who don’t understand the insurance they have to understand. You really need to educate yourself about your benefits. Call your customer service hotline before you have a procedure. Some procedures need prior authorization, some maybe subject to only coninsurance and deductible. Don’t sign up for an HSA you if don’t want to pay a lot out of pocket. FSA’s are good if you know, or have an idea of how much you’ll spend on copays and OTC (over the counter) medicines and other medical extras or just put a little in for unforeseen medical costs.

I did a lot of rambling but I’d like to know what you all are thinking about the reform, how do you think it’s going to impact you? For me, a public option may cost me my job, that’s my concern because I work for a privately held insurer. What are you doing to control of your own health care costs? Share and be open to others opinions. Ignorance will not be tolerated, this is a loving and understanding forum.