OPINION: Solid facts and reason needed in the health care discussion

Today I’m weighing in on what has been called the health care debate.
It seems to me, though, that little debate is going on with so many people disseminating misinformation and drowning out other voices.
In an earlier pre-journalism career I worked in the health care industry for more than a decade, first as a social service counselor in a hospital, then in medical administration and marketing for a private, nonprofit health care organization.
From that vantage point I’m presenting my perspective on three of the reasons I hear most frequently from people who oppose making changes to the current health care system.
• Issue: “I want to keep my present doctor and insurance plan.”
Reality: If you are covered by an employers sponsored private insurance plan you have little or no control over either of these issues. When employers choose an insurance plan for employees they are evaluating the balance of premium costs and covered benefits. If you have a benefit plan that you love right now, but someone covered by the plan becomes very sick and requires expensive treatment in a contract year, the employer might change the insurance plan at contract renewal time because premiums to renew with the same company are too high. Does the company’s management consult you as they prepare to make these decisions? Probably not.
An example from one of my family members demonstrates both points. A few years ago her employer switched to a new insurance plan that cost them less money and offered similar benefits. However, the company was based in Tennessee, the new insurance plan was in based Tennessee, and she lived and worked at the company location in Mississippi. The plan did not cover all the doctors in Mississippi that my family member was accustomed to using, so she had to decide to pay more out-of-pocket to stay with the same doctors, or change doctors to get a higher benefit paid. This is the same dilemma one faces if covered by a health plan that uses the HealthLink or similar physician network and you prefer a physician who is not part of the network. Your benefits are paid at a lower level if you do not use a network physician, and you must choose the higher out-of-pocket cost or a change in physician. And we haven’t even talked about the specialists the doctor might refer you to for the plan to cover it fully, or the hospitals where the doctors have admitting privileges if you require hospitalization for something as routine as delivering a baby or as drastic as open heart surgery.
Under the present health care system “choosing” your doctor, insurance or hospital is a privilege that is grossly overstated.
• Issue: “They’re going to ration health care.”
Reality: What do you think is in your health care benefits book that tells you what is covered and what is not covered under your present plan? Does anyone out there really have an insurance plan that covers all of your health care needs? Are you required to obtain precertification for certain procedures? Has your insurance company ever disagreed with your doctor’s assessment of the situation and denied your insurance claim? Is there anywhere in your benefit book that tells you that your benefit maximum is $1 million lifetime, or $250,000 per year, or … you fill in the blank. The people who talk about health care rationing under any new health care options never stop to think that if they have health insurance coverage at all, it has always been rationed.
• Issue: “We don’t want socialized medicine.”
Reality: This is the one that really seems to raise the blood pressure of people who oppose any government-sponsored health care option, comparing it to the health care delivery systems in Great Britain and Canada.
What most people don’t realize, however, is that many of them have been beneficiaries of
social health insurance for perhaps a lifetime as a member of Blue Cross Blue Shield. With social health insurance an individual transfers risk to a pool by paying a premium based on ability to pay, rather than health status Click here for link to more on this topic.
From its inception in 1929 at Baylor University in Dallas, Blue Cross Blue Shield was an alternative health care institution, a nonprofit voluntary prepaid health plan. As Blue Cross Blue Shield plans spread to other states across the nation throughout the 1930s and 1940s, they were organized as charitable trusts, a public benefit to fill holes in the existing health care system, with the mission of providing nonprofit prepaid health coverage. Blue Cross Blue Shield plans were able to become so entrenched across the nation because they received support from every sector of the community. Most people with private insurance today think of Blue Cross Blue Shield as the Cadillac of health coverage, yet are unaware that it began as a social insurance enterprise and remains so in many states today. Until 1994, all Blue Cross Blue Shield plans were nonprofit charitable and benevolent organizations. Of the 64 Blue Cross Blue Shield plans providing coverage at the end of 2007, 31 of them remained nonprofit, while 18 – including Mississippi – were mutual plans with profits shared by its policyholders and 15 were for profit corporations.
Certainly arguments over where health care coverage and financing in this country are headed will be topics of discussion for weeks and months to come, but let us at least have our facts straight about where we’ve been and where we are now.
This issue is too important for anyone to simply fling out emotional buzz-words that remove all reason from the discussion.

Lena Mitchell is the Daily Journal Corinth Bureau reporter. Contact her at 287-9822 or lena.mitchell@djournal.com.

Lena Mitchell/NEMS Daily Journal

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