How Citizens Can Participate in Health Care Reform

The handsome fellow on the right is my dad, Thomas Victor Fuller. He passed away in March this year. He died of cancer which progressed quickly after his initial diagnosis in October of 2008. The life he lived in the face of his own death inspired me to research health care and its relationship to health insurance. Even as he struggled to keep track of medical costs and insurance questions, he maintained a positive attitude, and even took the time to pass what he learned from his experience on to his children. We spent many hours discussing health care in the month I spent with him before he died. His love and compassion for his fellow humans compels me to pass on the lessons we both learned to others who I fervently hope will never need to use it.

My discussions with other Alaskans has convinced me that the greatest challenge faced in reforming health care lies with our understanding of how it works, who runs, who regulates it and its complexities. One cannot fix anything unless one understands its form and function.

I do not intend to launch into a history of health care or health insurance. There are books and articles available on line to enlighten the curious. I do intend, however, to uplift this complex issue out of the realm of moral speculators, and worry warts who believe that any attempt by government to regulate or federalize the insurance industry, which manages the billions of dollars the public spends on health care premiums and deductibles, will result in the utter destruction of the medical industry and society as a whole. Black and white scenarios appall my sense of practicality. Everyday in this country businesses adopt regulations to guide and strengthen themselves, but the reality is that many businesses fold because they fail to do so effectively. Why then, do we assume just because a corporation has grown to mammoth proportions, that its methods are fool proof, and above reproach?

Corporations today are highly diversified. The right hand and the left hand may span continents, and encompass a broad range of disciplines and industries. Simply tracking the ownership of a company can leave a researcher slumped exhausted in a chair praying for divine clarity. It is therefore not inconceivable that the right and left hands of a mega conglomerate corporation made up of many smaller companies do not always know what each is up to operationally or fiscally.

Health insurance falls into the classification of a product/service that can be owned and operated under the of larger, parent companies referred to as "umbrella" organizations. Companies authorized to operate under the umbrella can include banks, investment firms, and mortgage banks, and other financial institutions, and were authorized to exist with the passage of the Gramm, Leach, Bliley Act of 1999.

http://banking.senate.gov/conf/ (a little light reading for those with the time to do so)

Larger companies often purchase health insurance companies because the profits they generate are fairly stable. Yes, we need insurance. Companies are required to provide insurance for employees, so the money in the form of premiums keeps flowing, which means liquidity, cash on hand.

What happens to the money one pays into the policies one purchases? Does it sit in a pool of money to remain untouched until one needs to tap into it for medical treatment? Do the companies reinvest it? Do those investments tend to be safe or risky, and if so, to what proportion? What protects the policy holder from monetary loss should the company be liquidated by the umbrella organization? Does the government insure it against loss like the the FDIC does with our savings?

In a nutshell, how does health insurance really work? Understanding how it works is vitally important when it comes time to discuss how to improve it, or scrap it or whatever works to improve health care for Americans. Knowledge is power. Without it, any future discussions will bog down in accusations and bad information. Nothing will be solved, and even if a solution avails itself to our representatives in Congress, it stands a fair chance of being riddles with flaws and inconsistencies.

And Congress is discussing health care, and passing resolutions, and struggling to get those discussions out onto the floor of the House for open debate. What can we do to help them? How can we aid them in their efforts to simplify a health care system that has become such a tangled, seemingly unresolvable mess?

How can Alaskans and all Americans contribute to health care reform?

Every American who has health insurance needs to pull out their policy and read it thoroughly from front to back. After they have read it, they need to make a tally sheet listing pros and cons, scribble notes on the border with questions to help clarify any gray areas. Then, each policy holder needs to call, write and/or email their insurance company with those questions. If every insured person did this, I am confident that we might begin to find real solutions. Your Congressperson is but one person, but their constituency is mighty, and when well informed nigh unstoppable.

If you participate in a company insurance program, call the local representative and have them walk you through the policy, but press them to provide more than just the company catch phrases. Don't assume that your company fully understands the policy, because often times they do not. Learn as much as you can, and, if possible, share what you learn with other employees.

Some keys questions in addition to those listed earlier:

1. How are my premiums managed?
2. Are they managed by the company listed on the policy or by the parent company?
3. Who is the insurance adjuster? This is the company that will you will be working with in the event that you need to tap into the policy for medical reasons.
4. What is the relationship between the company who underwrites you policy and the adjuster - geographical, financially?
5. How is your medical provider paid?
6. What state and federal regulations govern private insurance? Have them send you copies of the regulations. They will do it.

Note: this last suggestion will take time. Pour some coffee. Grab a note pad, and prepare to take notes.

7. Ask a representative to walk you through the process of making a claim from start to finish. This is the only truly accurate way to know precisely what will be involved should you ever need to go to a doctor for treatment. What type of coverage you carry, make them describe to you how it works.

One very critical impediment to any discussion of health care is the perception by many policy holders that their health insurance works adequately for their needs. Why change what works. However, in a recent poll published by the Washington Post revealed that many of those who made this observation had either never used the policy or had used it for only very minor treatment.

Health insurance, indeed all forms of insurance, is by its very nature, always been a bit of a gamble. One pays for it, but hopes never to use it. Unfortunately, the health care industry over the past twenty or so years has been slowly restructured to function around this gamble. Fees for services, devices, medicines and lodging have been determined by what health insurance companies will pay for them at some indeterminate time in the future. To put it into perspective, what we pay in the event of a medical need is speculative, and based on what-if scenarios. Insurance companies bargain with doctors, hospitals and long term care facilities to make deals on the price of health care. We trust the insurance companies to stay on top of the market, and to make accurate predictions, but how successful have they been thus far? The current situation may be our best indicator, and the figure do not bolster confidence in the general public.

In closing, this blog will attempt to add daily to its list of observations and suggestions, and I hope to hear more from readers. This blogger requests that all opinions and criticism be of a constructive nature. The naysayers and finger pointers already thrive and abound in droves. Any truly profound suggestions or observations will be forwarded on to a Congressperson with permission from the person who submitted along with recognition for the contribution.