Health Care is Anything But Affordable

Posted on May 6, 2011

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By Rissa Grey-Myrie.

In “The Allegory of the Cave,” Plato writes of prisoners in a cave who can only see images on a wall, and concludes, “all in all, then, what people in this situation would take for truth would be nothing more than the shadows of the manufactured objects” (1).   This means that what people take for the truth is not.  Perhaps there are bits of truth but not the whole truth.  The shadows are a metaphor for the lies and deceptions we are fed every day.  We are only shown or told what people in power want us to know or believe as the truth, when in reality the truth is nothing like what we are being told or shown.  Plato’s Allegory applies to the case of affordable health care in New York State.  We are often told that there are affordable health care options out there; but this is really a shadow on the wall.  The reality is that health care is anything but affordable.

What is affordable health insurance?  Is it health insurance with a low monthly premium that provides access to quality health care?  Is it free health insurance that provides access to quality health care?  Is it health insurance with a high premium that provides access to quality health care?  Is it health insurance with a low monthly premium or free premium that provides access to mediocre health care?  For purposes of examples, I will be using figures for a family of two without children.  Finding affordable quality health insurance in New York is almost impossible if your household income exceeds $3000 a month.  Three thousand dollars a month is not a great deal of money in today’s society, yet it is too much money to qualify for any affordable health insurance program New York has to offer.

For instance, Medicaid is a program for New Yorkers who can’t afford to pay for medical care and meet certain income eligibility requirements.  Medicaid is health insurance funded by the federal and state governments and run by the state.  The income limit for a family of two without children is $883 a month, $10,595 annually.  How does one survive in New York City on an income of this amount?  I supposed they are subsidized by the government.  Ones status as an alien does not eliminate them from obtaining benefits.  Most illegal aliens are not employed via normal channels, i.e., on the books, and therefore pay no taxes yet get the benefits that taxpaying citizens who might fall on hard times are not able to obtain.  I find this disturbing.  Everyone who lives in this country should have to pay taxes and contribute to the infrastructure.

Another example, Health-Plus insurance is available for New Yorkers ages newborn to 64.  It is free; however, the catch is you must be poor to qualify.  Let’s say you are a household of two people (husband and wife) and only the husband is working, but is not offered health insurance coverage by his employer.  The income limit for Health-Plus for that family is $1226 a month.  That salary is a minimum wage earner and I find it hard to believe that someone can pay rent, buy food and pay for transportation on that income in New York City.  Being that poor means your health care will suffer, regardless of access to health insurance – another disturbing scenario.

Another so called affordable health insurance plan is Healthy New York.  This plan requires that one person in the household must work, but the income limitation for a family of two is $3,065 a month.  This plan requires a monthly premium of $365 for one person and $821 for two people.  That is about $10,000 a year for two people.  That doesn’t seem very affordable when your gross income is $3065 a month.  That means a quarter of the annual income is spent on health insurance.  It just isn’t fair.

One of the reasons that health insurance is so expensive is the high cost of prescription drugs.  There are several ways to help make prescription drugs more affordable, asking for generic instead of brand name, shopping around for the least expensive price and finding a price for multiple months’ supply.  You could also ask your doctor about prescribing a stronger dose and splitting the pills in half, providing the pills can be split safely.  Ironically, some drug companies have programs that offer assistance to help pay for the very prescriptions they charge exorbitant prices for.

Another major factor in the rising cost of healthcare is the administrative equation.  The high costs of running the actual insurance companies, hospitals, etc. is driving the cost of insurance out of reach to many of the so called middle class.  Not so much the actual costs but the extras that the top executives of these private firms get or the salaries and bonuses that they receive at the cost of higher premiums to the consumer.  For example, standard perks like country club memberships, company cars, private jets, severance benefits and lucrative retirement plans.  Top CEO salaries can be viewed on the AFL-CIO’s Executive Paywatch website.  There must be some checks and balances to ensure that healthcare is available and affordable for all Americans.  A recent development to the healthcare industry is the Standard & Poors Healthcare Economic Indices which will track the change in the cost of healthcare services in the United States.  “Healthcare constitutes almost 20% of the American economy, but the cost drivers are often misunderstood,” says Milliman principal and HCI creator John Cookson. “The S&P Healthcare Economic Indices introduce unprecedented transparency and will help people better understand changes in the cost of medical care and insurance. A tool like this is especially important now with healthcare reform introducing all kinds of new cost dynamics to the system as a whole”(Drug Week 1057).

Another issue with what causes health insurance costs to be high are coverage for cigarette smokers and the obese.  Researchers found that overall annual medical costs for an obese person were about 37.7 percent more, or $732 higher, than the costs for persons of normal weight.  An obese Medicare recipient incurred medical expenses of $1,486 more a year than one of healthy weight, and an obese Medicaid recipient cost $864 more than a normal-weight Medicaid recipient.  For persons with private health insurance the per capita increase among obese people was $423 (1219).  In an article by Peter Goodspeed in the National Post quotes a figure from a study by the Center for Disease Control (CDC) states that New York tops the list in obesity-related Medicaid expenses at US$3.5-billion (A11).  Most insurance companies or employers impose a higher rate for cigarette smokers but not obesity.  The debate is on that obese people should pay a higher rate to cover some of the extra costs for their medical treatments due to their obesity.  I believe that if you smoke cigarettes or are obese, you should not receive free medical insurance.  If a person can afford to buy a $12 pack of cigarettes, they should have the money to pay for their own health insurance.  Along the same lines, if a person is obese; they have the money or food benefits to buy enough food to cause them to become obese, so why should the taxpayers keep enabling people to get fatter and unhealthier.  There should be consequences for those people with these unhealthy habits that incur greater medical costs.  As it stands now, they are handed free medical coverage and most likely food benefits too.  It has been proposed that a premium be imposed for cigarette smokers and obese recipients who receive Medicaid.

Recently, the Federal Government passed a health care bill that might provide a real alternative for people seeking affordable health care The Patient Protection and Affordable Care Act (PPACA), a federal statute that was signed into United States law by President Barack Obama on March 23, 2010, proposes that all Americans will have health insurance or pay a fine (with some exclusion based on income).  It will offer health insurance exchanges in each state, offering a marketplace where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible).  We have to wait a few years before this takes effect, so all one can do is hope that these Exchanges will offer truly affordable health insurance plans.

The focus must be on prevention and promoting public health and containment of medical costs or improving health and health care will not happen.  Despite the President’s plan to ensure that all American’s have health insurance, there is still too little emphasis on prevention, which would help to drive down costs even more.  The President’s plan does include a new medical loss ratio for insurance companies that require them to spend 80-85% of premium dollars on health care and the remaining 15-20% on overhead and salaries.  This new regulation should help Americans with insurance to get better medical care.  We cannot blindly stand by and accept what we have been told about health care insurance options.  We need to take action and contact our Senators and insist that affordable, quality health care insurance is made available to all Americans.

Works Cited

1. Affordable Health Care for All Americans: The Obama-Biden Plan, Senator Barack Obama, JAMA. 2008; 300(16):1927-1928.doi:10.1001/jama.2008.515.  Print.

2. AFLCIO.org.  2011.  American Federation of Labor-Congress of Industrial Organizations.  Web.  4 May 2011

3. Goodspeed, Peter.  “Cost of obesity in U.S. rivals that of smoking: US$75-billion a year: Study comes as Washington blocks WHO campaign.”  National Post [Canada] 23 January 2004. Friday National Ed.: World; A11.  Print.

4. Health Plus.  2011.  Web.  6 April 2011.

5. Healthcare Economics:  S&P, Aon Consulting and Milliman Set to Launch Industry’s First Barometer of U.S. Healthcare Costs.  Drug Week via NewsRx.com.  1057.  Web.  15 October 2010.

6. Healthy New York.  2011.  Web.  6 April 2011.

7. Medicaid.  2011.  Web.  6 April 2011.

8. Patient Protection and Affordable Care Act (‘‘PPACA’’), Pub. L. 111–148. May 2010.  Print.

9. Plato.  The Republic.  Allegory of the Cave.  Ed. G.R.F. Ferrari.  Trans. Tom Griffith.  New York: Cambridge UP, 2000.  220-26.

10. The Economics of Overweight and Obesity – The High Cost of Overweight and Obesity.  LexisNexis Academic.  Web.  6 April 2011.

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