Condition of nation’s healthcare is making her sick


By Sondra L. Shapiro

On the day I turned 50 almost seven years ago, I couldn’t have imagined suffering the ensuing laundry list of aches and maladies.

Stiff joints when I drag myself off the couch to grab a snack during nightly TV viewing, weight gain even though I still eat sensibly and regularly exercise, difficulty with the glare of headlights when I drive at night. The list goes on and on.

But when it comes to making me feel the harsh reality of advancing age, nothing compares with those yearly increases in my health insurance premiums.

Though I am certainly not the same spry woman I was 10 years ago, I am probably healthier and in better shape than most Americans half my age — a fact that makes little difference to my health insurer, who raised my rates by 38 percent this year.

Since I have worked for the same company for 30 years, and with mostly the same co-workers, we are now branded an “old” company by the insurance industry. Because I am getting so expensive to insure, my employer can no longer foot the bill entirely for my insurance. So each year I pay more and more out of pocket while getting less and less for my money. To keep my insurance premiums relatively reasonable, our company is forced to purchase policies with higher deductibles. So, I am responsible for a good chunk of change for even yearly routine medical tests.

In this or in any economy, the extra expense is tough to swallow. Yet across the country, insured working households who buy their own coverage are reporting double-digit premium increases. So those of us who are being singled out for those escalating premium costs should know what’s at stake if we don’t get a decent healthcare reform law, soon.

Just last month the health insurers submitted to the state the following premium request increases: Blue Cross-Blue Shield, 10 to 19 percent, Harvard Pilgrim Health Care, 8 to 12 percent, Tufts Health Plan an average 15 percent, and Fallon Community Health Plan, 18 to 32 percent. In some cases, these numbers are even higher for individuals and small business, depending on average age and other factors.

While watching the nightly news recently a worker, not much younger than me, complained that his health insurance premium has almost doubled over the last couple of years. He is a member of WellPoint Anthem Blue Cross, which raised individual insurance plans by as much as 39 percent.

Billionaire Warren Buffett, who describes healthcare costs as an “economic tape worm,” and a major drain on U.S. businesses, said the nation’s healthcare system needs fundamental reform to attack costs because it’s not practical to continue devoting roughly 17 percent of the U.S. gross domestic product (GDP) to healthcare.

We should be ashamed and dismayed that the rest of the world pays only 9 percent of GDP for healthcare, and has more doctors and nurses per person.

The cost inequities to individuals alone should have voters demanding reforms. One would think that aging Americans especially would be clamoring for change when you consider the following:

•Millions of seniors who signed up for Medicare Advantage, private health plans through Medicare, are facing premium increases of 14.2 percent this year, after an increase of only 5.2 percent the previous year, according to a newly released Avalere study.

Avalere, which analyzes Medicare financial data for government and private foundations, reports the upsurge in premium costs is because the feds cut payments to private plans last year.

The study found that the average monthly Medicare Advantage premium for 2010 is $39.61, representing an increase of nearly $5 a month from the previous year. That compares with a rise of less than $1.75 a month in 2009. The averages are adjusted based on enrollment levels in particular plans that offer medical and prescription coverage, reflecting the choices that seniors make.

•The average yearly cost of long-term care in the Boston area is rather steep: Home health care, $28, 600; assisted living, $51, 480; and nursing home care, $105,485, according to 2008 federal figures.

The best way to pay for this kind of care for middle-class individuals is to purchase long-term care insurance. The premiums can be costly depending on the age you are when you jump in, the level of benefits you purchase, and the amount of time you wait to cash in on those benefits.

According to the American Association for Long-Term Care Insurance, a policy that pays out $100 a day for three years would cost an average 55-year-old $709 in annual premiums, and $1,342 for a 65-year-old

I always intended to purchase long-term-care insurance when I turned 55, but this economy combined with my larger out-of-pocket expenses for healthcare forced me to put it on the backburner.

The reticence among older Americans is a result of Republican fear mongering: The message being spread is that reform will result in cuts in the care they receive under Medicare (Advantage programs), which is negligibly accurate, since Democrats would also reinforce original Medicare by improving preventive benefits and narrowing the prescription coverage gap. And, since about three-fourths of Medicare recipients remain in the traditional program, I’d say there’s more to gain under health reform for seniors.

So, rather than cowering in fear, retirees should be leading the charge for reform.

The back-and-forth volley of blame for the state of healthcare is giving me whiplash. And, I don’t have the extra cash right now to visit a chiropractor.

Individuals complain about the status quo without bothering to educate themselves about the cost of care or even ways to take care of themselves.

Politicians play partisan games — each party blaming the other for the mess.

Insurers complain about the price they are forced to shell out for care and unrealistic government regulations.

Hospitals complain they don’t get paid enough by insurers while at the same time charging ridiculous amounts for services and materials. I was enlightened and dismayed during a recent CNN report by Dr. Sanjay Gupta, the network’s chief medical correspondent. Gupta took viewers through a typical hospital operating room where he singled out individual items: a standard IV bag, $280; a stapler used for surgery, $1,200; a suture, $200; and a needle used for biopsies, a whopping $800. Holding up the needle, he said, “If you ask the manufacturer why it’s so much money for a device like this, they will say it took years to develop something like this, and research and development costs are so significant. Also they are guaranteeing a certain level of effectiveness of the needle.”

But when you look at a hospital bill, it is not just the cost of the supplies, Gupta said, there are administrative costs built in and the expense of covering individuals who don’t have insurance and who cannot pay the bill.

He pointed out that most people never know what their care is costing because they have insurance so they never ask. So we should read those insurance statements and insurers should have to provide them. We should question the costs. We need to take responsibility and be more educated about our care. Gupta suggested calling the hospital and requesting a breakdown of charges. He said if the price seems high, you might be able to negotiate some of them down.

Someone needs to take a stand.

As an aging baby boomer, I find it difficult to accept that my healthcare expenses could be quite literally the death of me. This, despite being an educated consumer, who has religiously put money away for old age. I keep thinking, how much is it really going to take?

It is wrong that I am forced to pay more for my insurance because of my age or that others are denied insurance because of pre-existing conditions.

It is wrong that the government programs on which we have depended and that have helped previous generations are being allowed to crumble because of the lack of guts among our political representatives to fix them.

It is wrong that the cost of long-term care is out of reach for so many Americans.

Our nation’s healthcare reform package needn’t be a cumbersome tome that no one understands or that is outrageously costly — especially since we are already spending far too much for healthcare as a nation.

But what truly makes me sick is the thought that if we lose the opportunity to finally enact a federal healthcare law, matters will continue to worsen. Costs will continue to rise and fewer Americans will get the care they require.

Sondra Shapiro is the executive editor of The Fifty Plus Advocate. She can be reached at