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I Am the Uninsured

I didn't know I was uninsured. Didn't have any reason to believe I was uninsured. But, for the past four months, I've been among the uninsured.

The story actually starts a decade ago, when I was a part-time tutor for Score Educational Centers, which were later consumed by Kaplan Inc., which is in turn owned by The Washington Post. Fast forward 10 years, and I'm on the phone with our benefits people setting up my health insurance. Everything seemed to work fine — except that I didn't receive any cards or membership information. When I inquired after it, I was informed that I didn't exist in their records at all.

What seems to have happened is that my Social Security number was in the computer system from my time with Score. Since my classification was "part-time employee ineligible for benefits," the computer overrode the effort to choose my health insurer.

The story, of course, isn't typical. But stories like it aren't terribly rare, either. Paperwork gets lost. HR Departments are busy. People are between jobs for a few months, or they pressed submit but not "save." So they go uninsured for a few months. Or maybe more. Maybe they don't notice for a year. That's fine if they don't get hit by a car. It's not fine if they do get hit by a car. The problem with slipping through the cracks is that you don't know how you'll land.

But it's the inevitable product of a fractured system where there's no default insurance status, or continuity between jobs and conditions. If you're born in Canada, you're simply covered from birth until death. Here? You're on your parents' insurance, or maybe S-CHIP. Then maybe you get insurance through your college. Then you're uninsured for a bit. Your first job doesn't offer benefits. Your second job does, but it only lasts a year. So you have to reenroll with a different insurer in your third job, and change your primary care provider. You move. You go to grad school. And so it goes.

People complain about how long and complicated the heath-care bill is. But it's a lot less complicated than the health-care system that it's trying to change. Under reform, the individual mandate would force people to be aware of their insurance plan. The employer mandate would force employers to make sure the paperwork was in order. Over time, the growth of the exchanges would allow you to remain with your insurer even as you changed jobs. The subsidies would make sure people don't become uninsured because they can't afford coverage. You can call that complicated, I guess. But it's a whole lot less complicated than not having insurance.

By Ezra Klein  |  August 28, 2009; 2:50 PM ET
Categories:  Health Reform  
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Comments

And if you finally get it settled, and then have a big claim, would you bet your life things would work smoothly?

Posted by: AZProgressive | August 28, 2009 3:21 PM | Report abuse

You know what would make the plan even less complicated and save tens of thousands of pages of regulations and countless paperwork enforcing those regulations?

Setting up a public option that healthcare insurance co.s were forced to compete with vs. leaving them to continue spending their energies on circumventing regulations and maximizing their medical loss ratios.

Posted by: timmyfuller2 | August 28, 2009 3:23 PM | Report abuse

ezra,

most employees see a portion of the costs coming out of their paychecks so if they pay attention to that (and don't take this the wrong way) they would know if they were uninsured. Was money still coming out of your check? Also you obviously never got an ID card. That's another sure giveaway that you have insurance. if you bring it to the HR dept's attention (especially if it was coming out of your check) they should be able to go to your insurer and backdate the coverage so you were never without so that the devils that AZProgressive can't get the best of you.

A big company like WAPO (if they are self-insured) can wave a magic wand (or type into a computer) and presto, you've always had coverage.

Posted by: visionbrkr | August 28, 2009 3:35 PM | Report abuse

oh and not for nothing but with what you do you should have known better!!

Posted by: visionbrkr | August 28, 2009 3:36 PM | Report abuse

"it's a lot less complicated than the health-care system that it's trying to change."

What it's trying to replace *isn't a system*.

There are distinct systems contained within it, but it fails the basic definitional test of what constitutes a system. When the Taiwanese looked at the US as their first potential model for healthcare reform, they came to the same conclusion.

Posted by: pseudonymousinnc | August 28, 2009 3:40 PM | Report abuse

thank goodness, you are blessed to have health insurance, and that it is straightened out.:-)

Posted by: jkaren | August 28, 2009 3:42 PM | Report abuse

"a whole lot less complicated than not having insurance"

What's less complicated than being uninsured and not seeking medical care? If it is good enough for cavemen and pre-insurance industry modern man, it's good enough for me.

So what if I only have a lifespan of 57 years? It's the quality, not the quantity. And think how much nicer life is when I don't have to stress about paying those big doctor co-pays and insurance premiums. Don't have to stress about what my BP is--because I don't know! Don't know how long my cancer is going to take to kill me--because I don't know.

Nothing is less complicated than living like today is the last day of your life.

Posted by: jc263field | August 28, 2009 3:44 PM | Report abuse

timmyfuller,

you do realize that in every bill out there to date there is a medical loss ratio set at 85% which is greater than any individual state has today, right? That's a band-aid on a gushing wound. Insurers aren't the problem, cost is the problem. Insurers can be fixed or even replaced as some would want but you'd still have the cost issue because you have it in other countries that don't have insurers.

Posted by: visionbrkr | August 28, 2009 3:46 PM | Report abuse

"People complain about how long and complicated the heath-care bill is."

Only the people looking for pretext to kill it.

Posted by: BigTunaTim | August 28, 2009 4:01 PM | Report abuse

visionbrkr,

"you do realize that in every bill out there to date there is a medical loss ratio set at 85% which is greater than any individual state has today, right?"

Sure, and there's an SEC to catch Bernie Madoff. You know any corporate lawyers? Circumventing those rules are a sport. Finding ways around them with byzantine accounting standards is the name of the game.

Competing with a public option is our best chance at beginning to change the incentive structure in a disfunctional industry.

This is of course why it's so important to many on the left, including Ted Kennedy.

Posted by: timmyfuller2 | August 28, 2009 4:22 PM | Report abuse

i don't care how long it is just as long as those that write it UNDERSTAND it and all of its intended and unintended consequences. That's the issue here.

Posted by: visionbrkr | August 28, 2009 4:26 PM | Report abuse

timmyfuller,

you're right and its in every industry, not just health insurers. That's why they need to regulate the "he--" out of them. They're already the most highly regulated industry and i'm fine with a public option as long as it plays fair. A public option that pays premium taxes. A public option that NEVER has the backing of the treasury. A public option that negotiates rates with providers and doesn't impose its will like they do with Medicare.

i'm all for that.

Posted by: visionbrkr | August 28, 2009 4:37 PM | Report abuse

We can disagree on some of that visionbrkr, but the main pt. is that Klein, yglesias, et. al. are living in some fantasy world where Washington has shown itself competent at regulation.

Sure, a plan w/out a public option where regulation of the industry is competently carried out vs. a plan w. a public option might not look that different.

In reality, giving health insurance co.s more customers and more opportunities to consolidate will simply increase their ability to corrupt the political institutions.

You know, corrupt them in essentially the ways they are corrupting healthcare reform and that Klein is excusing.

Again, the public option is an initial strike at the heart of the for-profit incentive structures in the industry. It should not be negotiable.

Posted by: timmyfuller2 | August 28, 2009 4:54 PM | Report abuse

Of course the ultimate irony is that those lucky enough to have employer based insurance won't really benefit from the public plan, because we can't join it. The other regulations in some of the health insurance reform bills will help some, but they won't drive down the cost of care overall. I would love to take my and my employer's contribution to my current insurer and buy into a cheaper better less restrictive government sponsored health care plan, but alas that is not in this bill.

Posted by: srw3 | August 28, 2009 5:03 PM | Report abuse

Thank you!
This is part of my argument why employer sponsored health care is a bad idea.

And I make my living in that environment.

Let me give you another stupid example.
Our plan started to cover domestic partners.

If you are familiar with the HIPAA EDI regs, you know that there is a standard file format for submitting an electronic enrollment file to a carrier. The regs stipulate the code for domestic partner.

However, one of carriers read that code and interpreted it as a dependent child.

There were a few people in this category who were seeing their doctors regularly. Each month after we sent the new file, we would receive several calls from people who were denied treatment from their regular doctor, because the doctor's office called the insurance company and the insurance company had the individual as a child.

Now the insurance company also had the correct birth date, the correct social security number and everything else correct about that person. The doctor's office also knew this individual, because they had been treating them for several months.

Now some will say that this is just a typical computer error that can occur in any system.

But automated stupidity is still stupidity.

Why is necessary to have people constantly moving in and out of insurance coverage or different coverages within coverages.

We set up all of these health care silos and then expect the computers to solve the problems we can't solve.

Let's design a system where coverage is presumed.

Abandon the philosophy "stand at the gate until we know you can pay the freight"

http://thehealthcaremaze.us

Posted by: Jimmy19201 | August 28, 2009 5:18 PM | Report abuse

"won't really benefit from the public plan, because we can't join it."

It's a start. W/out the public option it's not even that.

The CBO scoring shows competition with a public option might have an effect stemming the rate at which premiums rise.

Who knows, maybe in a future stage you might see more of your employment compensation package in the form of wages vs. sent to health insurers.

We can get on that track with a plan containing a strong public option. I don't see how we're even heading in the right direction by accepting one without it.

Posted by: timmyfuller2 | August 28, 2009 5:25 PM | Report abuse

timmyfuller2: A public option does no such thing. The public option is just another non-profit health care insurer, and we already have a bunch of those. The only difference is that it happens to have its administration appointed by the government instead of however non-profit health insurance companies work.

If the regulations don't stick, then private insurers will push the sick off onto the public plan, forcing its premiums to be more expensive. The public plan needs regulations to be effective, not the other way around.

Posted by: usergoogol | August 28, 2009 5:34 PM | Report abuse

"growth of the exchanges" -- future movie title

Posted by: bdballard | August 28, 2009 5:36 PM | Report abuse

Glad you got it worked out. But the public option will be like the post office!!!!!!1!11!eleven

Posted by: Drew_Miller_Hates_IDs_That_Dont_Allow_Spaces | August 28, 2009 5:48 PM | Report abuse

"The public option is just another non-profit health care insurer, and we already have a bunch of those."

If this were just another non-profit, then why are health insurance co.s fighting this tooth and nail? That should be your 1st clue that this is the cruz of real reform.

As for private non-profits, somehow their 'admin' costs are greater than the VA or Medicare. What do the CEOs of 'non-profit' regional BlueCross/BlueShields make? 7 figures + typically. What does K. Sibelius pull down? These costs are not deminimus.

"The public plan needs regulations to be effective, not the other way around."

Somewhat agree. You raise a valid pt. that a public option could e.g. just be a dumping grounds for sick patients while health insurance co.s attempt to collect premiums from the healthy.

It's a problem, but far less than the continued aggregation of wealth and consolidation of power in the private sector that inevitably corrupts government regulation in this country.

It amazes me that Ezra is simultaneously covering the financial scandal and regulatory capture by the financial industries but doesn't make a connection.

Posted by: timmyfuller2 | August 28, 2009 5:49 PM | Report abuse

If this were just another non-profit, then why are health insurance co.s fighting this tooth and nail? That should be your 1st clue that this is the cruz of real reform.


becuase they know once the government drops this in our laps they can then adjust it to do its bidding just like Medicare.

Why shouldn't the public option pay premium taxes? Why should it be able to set rates for providers? How can you sit here and assume it will be a level playing field? It absolutely will dominate the marketplace. Even if its not subsidized with those benefits they'll be 20% less than private plans could ever be. Sure some of the larger insurers with 20-30 million members could force its will but then the smaller insurers would fade away and do we want that?? I thought the idea was MORE competition? And if everybody paid Medicare rates hospitals have already said they'd be in deep trouble. Why do you think hospitals are wary of this all??

Posted by: visionbrkr | August 28, 2009 7:02 PM | Report abuse

Relax, visionbrkr

Your requirement that a public option essentially compete at a level playing field is of course accepted.

Your hysteria is misplaced, however. We're fighting to just barely get a weak public option passed and you're freaking out that the government is going to take over the entire multi-hundred billion healthcare insurance industry.

Yeah, right. You live in the US, right?

The obvious and major threat is the continued bilking of the population by large private insurance co.s. Generally speaking, too much power concentrated in our wealthiest companies is the US's curse -- and government corruption most often can be traced to this source.

Big tyrannical gummint providing social services is a laughable worry in comparison.

btw, smaller insurance co.s have been fading away under our current system -- the trend as in other sectors is towards greater consolidation.

Whereas a government plan might use greater enrollment #s to bargain for lower prices, encourage economies of scale, and lower premiums, a solely private plan will tend towards monopolization, higher premiums, and corrupting the government meant to regulate it.

Read the coverage of financial institutions and tell me this isn't the real problem the US faces vs. Big Scary Social services.

Posted by: timmyfuller2 | August 28, 2009 8:26 PM | Report abuse

timmy,

while i appreciate your assurances unless you're Max Baucus i'm not taking them. Have you read HR 3200?

it states that the public plan would pay no premium taxes and the jist of the deal between the blue dogs and the liberals was that the secretary of HHS (currently Sebelius) would determine IF they negotiate or set rates at medicare or medicare plus 5%. What do you think she'd choose???

HR 3200 is not an emasciated public option. Now I'll admit that the Senate Finance version sounds as if it may end up being one if one is included but if a co-op acts just like a public option then what's the difference?? I'd rather have a more funded co-op but force them to negotiate rates.

Oh and when has the government once something was put in not tilted the playing field to whatever they favor?

Kind of like the nice discount of $7500 people are going to get for the Chevy Volt?

Posted by: visionbrkr | August 28, 2009 8:54 PM | Report abuse

visionbrkr,

Of course I haven't read HR 3200. I read *about* bills like every other person with a life.

You lack perspective. Until you've got a sense of the forest you won't know what a tree means.

Max Baucus is not trying to pass a bill that will kill private healthcare insurance. That would be unthinkable in this country given the way $ and politics work.

Baucus, Conrad, Grassley, etc. have nothing to gain by passing a bill that will kill health insurance co.s and they are being flooded with health insurance $.

You don't need to know every detail of the bill to know that the danger is that a bill being passed will be a giveaway to health insurance co.s.

Forgive me, but your mind is rather obviously bent solely towards the evils of big government takeovers. This is a problem in other countries -- Venezuela, for example, but not in ours.

We have a society where the struggle is against the private sector taking over government. Until you calmly admit that that could also be a problem you will be incapable of thinking through this issue.

The co-ops are of course an emaciated alternative to a robust public option. That is their purpose -- smaller, regional, and with lower profiles.

If and when details re: their proposed federal charters are announced this will be clear.

It is why they should be opposed.

Posted by: timmyfuller2 | August 28, 2009 10:46 PM | Report abuse

If a guy like Mr. Klein whose bread and butter is blogging about health care reform doesn't pay any attention to his health insurance status, what hope do we have for the average American whom Klein says would supposedly be "forced" to be aware of their insurance plan because of the individual mandate?

HR 3200 isn't going to make people any smarter than they already are, just as it won't make people like Klein take personal responsibility for their affairs.

P.S. Visionbrkr, you seem to have read, understood, and forecasted the (perhaps) unintended consequences of HR 3200, unlike others here. Kudos for adding an informed opinion based upon actual legislative language, as opposed to rumor and rhetoric.

P.P.S. Anyone here besides perhaps Visionbrkr ever heard of Flesch scores as they pertain to insurance policies? Didn't think so.

Posted by: Policywonky | August 28, 2009 11:03 PM | Report abuse

timmyfuller,

sorry while i haven't read the bills in their entirety i've read a lot. I also watched the Senate HELP and Energy and Commerce Committee debates on cspan.org. I've seen what's in there and what's not. There's no death panels, no more rationing than there is right now, just different rationing but the thought that something would cost in private insurance $1000 while a public option could undercut it at $700 would lead me to believe that Pelosi and Reid want to destroy what they themselves have called the "evil insurers". I've also seen and heard from legislators that in the first year only individuals and employers under 10 employees would be allowed into the public option. Second year 25 employees. Third year 50 employees. After that open to the general public.

I've seen how these things work in risk management. The ones to move into a lesser expensive category are the ones that are healthy. The ones that think they're getting no benefit from it. The ones that stay are the sick ones who are afraid to move for fear they're losing something whether they are or not.

Look up MEWA's and their failures and you'll see what I mean.


policywonky,

thank you. Honestly I had to look up Flesch scores as I hadn't heard about them but it makes sense. I'm an agent that's how I know as much as I do. Part of the bills also does state that it is required to be in plain English. Ya right. Government doesn't know plain English and neither do insurers. that's going to be a difficult process. I've talked to CEO's of major corporations that have no clue what's covered and what's not in their policies even after I sit down with them and go through it in detail. I had one client yell at me the other day because I recommended at age 67 for him to drop his more expensive group coverage and go to a Medicare Supplement plan and a Part D plan. It saved him $900 a month. He got ticked at me when I explained that while I'd help him with it, the insurer didn't work with brokers so I could only help him as long as I had a HIPAA auth filled out for him.

The scariest thing is that I went to a town hall this past week with Rep Frank Pallone. I went with another agent friend of mine and we had crazies from the left and right there and it was kind of sad and funny. No one had a clue about much of anything and even Rep Pallone didn't even know the current laws in NJ correctly. That's scary considering he's supposedly one of the architechts of HR 3200.

It would have been nice if they consulted insurers in the process because they know how to manage risk better than anyone but they demonized them early in the debate. I guess it didn't help either that President Obama called Aetna's CEO Ron Wilson (when his name is Ronald Williams) at the town hall in the White House.

Posted by: visionbrkr | August 29, 2009 12:01 AM | Report abuse

The co-ops are of course an emaciated alternative to a robust public option. That is their purpose -- smaller, regional, and with lower profiles.

If and when details re: their proposed federal charters are announced this will be clear.

It is why they should be opposed.

Posted by: timmyfuller2 | August 28, 2009 10:46 PM

-------------------

how do you know that they're emaciated until their rules are set up? You do realize that a co-op if structured like a public option could be stronger than an emaciated public option. Who cares what the name is. What matters is what it does and who it does it to.

And you yourself are saying that they should be opposed and yet there's no details on them yet. that to me is as bad as the dummies screaming against reform.

And co-ops can and would be set up they've said on a regional and NATIONAL basis. The issue is that we'll have every Tom Dick and Harry putting together a co-op. Considering the general public has no clue about how all this works it'll only serve to confuse the confused even more. (ya i'm talking to you pseudo)

oh and if a strong public option is put in place and employee dumping becomes the norm in 5 years or so then I'll be the one on here saying i told you so.

Posted by: visionbrkr | August 29, 2009 9:35 AM | Report abuse

timmyfuller2: "Setting up a public option that healthcare insurance co.s were forced to compete with vs. leaving them to continue spending their energies on circumventing regulations and maximizing their medical loss ratios."

It's so cute when people who have no idea what they're talking about act as if they have some inside insight as to what goes on inside a health insurance company. Are you the new lensch?

Posted by: ab13 | August 29, 2009 11:07 AM | Report abuse

" (ya i'm talking to you pseudo)"

Well, that's nice. Keep showing your insider knowledge of the buffet table on the Titanic, poolboy.

Posted by: pseudonymousinnc | August 29, 2009 4:37 PM | Report abuse

ab13 --

You consider mentioning recissions and their purpose to be copping 'insider insight'?

Condescension fail. It's a familiar topic to anyone who reads newspapers.

visionbrkr - "how do you know that they're emaciated until their rules are set up?"

It's an inference based on the process by which they're being produced. Call me gifted I guess.

The alternative is to believe Conrad, Baucus et. al. are delaying passing a bill while sucking in health insurance co. $ b/c they intend to beef up healthcare reform in the form of co-ops.

And surely no one is dumb enough to believe that, right?

Posted by: timmyfuller2 | August 29, 2009 4:51 PM | Report abuse

pseudo,

do you really think it upsets me, your poolboy comments? Are you 2 years old or what?

You are either (in my opinion):

1- a paid left wing blogger
2- a doctor that hates insurers (oh wait doctors have to be smart, scratch that one.
3- a patient that got denied services in the current system or a relative of one.

In other words, your views are completely slanted.


timmyfuller,

and i take the view if a public option is let into the arena they can emaciate it now and then when they see good and fit adjust it to do their bidding kind of like has been done with adding to Medicare and its $600-$700 billion annual budget and growing. Its the start that concerns me. I'd rather keep fighting the back and forth regulating game than add another entitlement we all know we can't afford. Again just one person's opinion.

Posted by: visionbrkr | August 30, 2009 1:18 PM | Report abuse

"You consider mentioning recissions and their purpose to be copping 'insider insight'?"

No, I consider you incorrectly claiming to know the purpose of rescissions (and making ridiculous comments about 'maximizing (sic) the loss ratio' to be copping 'insider insight'. You seem to think you are knowledgeable on this but you clearly are not.

Posted by: ab13 | August 30, 2009 8:49 PM | Report abuse

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