Wednesday, March 03, 2010

No insurance? tough

Still watching the birds out in our yard, there seem to be more this year than in the past. I put seed in the feeder a few times a week and as a result our yard is filled with the chirps of the little finches. The robins are still around - seems to be two groups of four birds that hang about, and visit the fountain a few times a day. Don’t remember seeing any robins in previous years and we are wondering if they are wintering here from some colder place or will stay around for the warm summer. We have been commenting on the lack of pigeons scrabbling around under the feeder. Usually a half dozen pigeons show up to grab the falling seeds, but none have been around for a while.

Today the probable reason was revealed. We had just let Buster out to wander around (the birds have learned to ignore him, no threat there) and I filled up the bird feeder. A small group of finches had just zipped down, a half dozen on feeder perches attacking the seeds directly and about a dozen more underneath. I was at the sink and B, looking out the window called me over and asked if the big bird on the wire right outside was the sapsucker (a flicker I’ve been told) that frequents the yard. It wasn’t, but it was either a small hawk or falcon, sitting up there watching Buster down below. I didn’t think Buster was in any danger, even though the bird was bigger than him. Then I noticed that the yard was quiet and all the finches had disappeared from the feeder. The big bird flew off, and it took quite a while for the little birds to come back. We hadn’t seen a raptor like this around our neighborhood before, but either the pigeons noticed and flew away, or didn’t notice and became someone’s lunch. Yea!! (sorry, I don’t like pigeons)

On to a little story on politics, which I have been trying to avoid here by posting interesting pictures and videos and funny stories. It’s a story of some friends here in town. One of my wife’s cousins is married to a teacher. Well, retired teacher. He was part of the Clark County school district for a great many years, working his way up to assistant principal before retiring. Part of his benefits package is medical insurance coverage, which worked pretty well for them. But last year they went to take care of his mother in central Arizona. They found out that the medical insurance was only valid for Nevada doctors and medical providers, and thus they basically were not covered in Arizona. They had to drive a few hundred miles back to Vegas to see doctors, and if an emergency had happened they would not have been covered by the insurance. They are now back in Vegas, and she commented on a change to their coverage that she was just notified of: since they are now both in their mid 60’s they are eligible for Medicare, and the school insurance told them that they have to be covered under Medicare, and it listed as their primary insurance, with the school retirees insurance as supplemental coverage. I know that the state is trying to save money, but after thirty plus years with the school system this seemed a little too tight fisted. They now had to pay for Medicare (I know, not much, but still money out of pocket on a retired person’s lower income) but at least they would have Medicare coverage if they were stuck in Arizona again. The bad part, besides paying out more, is that because of low reimbursement rates a lot of doctors will not take Medicare patients, and they are subject to all of the Medicare pre approval restrictions.

Their daughter is also caught up with some problems. She has a degree in hospitality, and has been working for several larger hotels and casinos for the past fifteen years. A number of years ago the casino industry started to take the path that a lot of grocery chains have taken, which is giving a large number of employees only 38 or 39 hours a week of work. This means that these employees do not meet the 40 hour requirement to receive insurance coverage, accumulated vacation, holiday pay or other benefits that a 'full time' 40 hour a week employee receives, thus saving the employer a lot of overhead expenses. As a result she has not been to a doctor for regular checkups for quite some time. She was recently diagnosed with some type of large growth in her abdomen, which is up over six inches (15cm) in diameter. Not having health insurance she is having problems finding a doctor that can tell her exactly what is wrong; she cannot get some expensive test to check things out; and no hospital will permit potentially expensive surgery or an extended stay without insurance (not even a pay in advance plan, as the hospitals don't really know what it would take). There are laws that require emergency rooms to treat patients with medical problems, but since this has occurred over time it is not considered an 'emergency' so she cannot get treatment. She owns a condo, but with the economy and declining prices her mortgage is about equal to the potential sales price of the place. She pays all her bills, has worked steadily all her life, and has not called on welfare or any government program for anything.

So here we have some people that have been good citizens, working steadily and meeting their obligations. One couple went to care for a sick parent in another state, and was not covered by their health insurance plan, the other not able to get health insurance and now in need of medical care that she cannot get. Somehow the concept of your employer supplying medical coverage, if you even are employed, has disappeared for a large segment of the population. The school system has shifted insurance costs for retirees over to the federal taxpayer (well, paying taxes for schools made us cover them to begin with) if they are old enough to be eligible for Medicare. Some employers save overhead costs by reducing the number of full time employees. Next time you shop for groceries ask your checker if she (or he) is full time - I always talk to the ones here and usually find that only the store manager and two or three supervisors are considered full time. From news stories we all know that Walmart, the biggest retailer in the US, does the same thing; only classifying a few people per store as full time employees leaving the majority of employees ineligible for benefits.

I hear the arguments about the health care plan being pushed in congress right now, and wonder where people come up with their numbers and examples. I know 'universal' coverage would be expensive, and it is not even being considered. There is something in the current bill about requiring coverage, and putting a new tax on those without insurance. Would that mean that all of those minimum wage Walmart not-full-time employees would now have to pay out more for nothing? What about the retirees traveling out of state that aren't covered, such as our relatives? What about the 12% official unemployed here in Las Vegas (not talking about anyone particular here; considering that since my layoff in June I haven’t been able to find work) or those unemployed too long to be part of the official statistics with no employer to supposedly provide coverage? There is nothing in the bill to prevent a casino (or big retailer) with ten thousand workers from only classifying a few hundred as 'full-time' eligible for benefits, leaving the rest with no options. Perhaps it is time to consider having a real government run health care system.

One of the complaints about countries with health care systems is supposed long waiting times to get care. I know our cousin’s daughter would much rather be on a three month waiting list for surgery than waiting for whatever it is to kill her. Our son-in-law is from Canada; his parents would love to move down here and be close to their son and granddaughter, but will not mainly because of their health coverage at home. Our friend in Sweden is a cardiologist, part of the government health system there, and he does research funded as part of his job that no other country does, writing articles and speaking all over the world about his findings. I hear people saying the US system does not need to change, yet as a nation we spend more per capita on health care than any other country and still are rated down in the thirties as best medically, so don’t tell me we have the best system.

I don't have any answers, just more questions, and am pretty dissatisfied with the results of our government. Big insurance companies sure can afford to make large political donations which supposedly have no influence on our representatives (sure, yea, right), yet the average person gets a form letter from their congressman (if any response at all). I see all these letters to the editor and web postings complaining about potential costs yet no one else has a good suggestion either. Telling people to get a job and buy insurance? Our relatives have jobs and insurance which doesn’t work out of state. Or jobs and no ability to get insurance. Or no job and no insurance and no money to buy any. Somehow telling someone to buy insurance on their own is not valid if the cost of that insurance is so high they cannot afford rent or house payments (if available at all). Or how about the insurance company saying that you’ve reached the maximum lifetime limits of payout, and that surgery that your kid just had - yes - we only cover a little up to the limit, so the extra $250,000 is yours; sell your house to pay for it. The next life saving surgery? Yes, not us, it’s on you. Don’t have the money? Sell everything, cash in the retirement savings and go on welfare to get the government to pay . . . oh, wait, your husband has a job, sorry, he makes too much and already has health insurance for the kid . . . over limits? Sorry, rules say he’s covered. Between jobs and run over by a hit and run driver crossing the parking lot? Sorry, sell your house to pay for that one.

Our local hospitals are going broke from providing care to people without insurance. Several nationwide have closed emergency rooms to avoid those expenses, leaving everyone with reduced availability of care. I looked at the insurance statements from when we went to the doctor; a $120 charge for something reduced down to a $12 payment? I don’t see how our doctor can stay in business with reimbursements like that. And if I don’t have insurance that would be a $120 bill to me, or somebody that can’t afford insurance - how can you afford to be sick with costs like that? Congress is supposedly reducing the Medicare payments for service, which already is so low that many doctors refuse to take Medicare patients.

Whatever it is we are doing has stopped working, and something needs to be done. I know it would cost money, but as a nation we are already shelling out big bucks to provide coverage to the percentage that can get it. Yes, government can’t provide everything to everybody, since they don’t make money just take ours and redistribute it (with overhead). You go tell our cousin she is going to die slowly and painfully. Or that due to cutbacks your job has been eliminated, so your kid's next operation will leave you in such debt that you will never pay it all, if you can find a hospital to even let you in. I don’t know. Sorry, just here to complain again.


Anonymous said...

Okay, 3rd times the charm. Trying to comment and being thwarted by my stupid hands.

Anyway, I agree cmpletely. Anyone who has ever worked without insurance should be able to understan why there's a need for coverage for everyone. I'm tired of the politicians coming up with all this crap about why we shouldn't have it. Obviously they've never had to worry about coverage.

Rob said...

Joe, you've got plenty to complain about. I knew about a lot of the healthcare issues, but I hadn't bumped into the part-time employee one. In the UK, part-timers generally get the same benefits as full-timers, just pro-rated down (so if you work half time you get half the pay, half the holidays, half the entitlements in general). For the less basic benefits such as private health insurance (and some people use it over here to cut waiting times etc, though you hear horror stories from the private hospitals sometimes) the entitlement normally kicks in on a grade basis rather than working hours. So a manager working part-time (say on a job share) might qualify where a full-time subordinate wouldn't. Same goes for things like company cars, gym membership etc. Sometimes lower level employees can buy extra benefits out of their salary (sometimes before tax). Even Wal-Mart in the UK will be obliged to provide the legal minimum paid holiday (I think it's 20 days) pro-rata to its part-timers.