It is hard to compete with a famous musical performer and a maverick politician. But health insurance reform—not to be confused with heath care—is too important to neglect, because it impacts us all. It’s not just about money. Health reform reaches places few citizens can imagine.

Congress is holding hearings and endless committee meetings; but they haven’t invited me, nor others from the waiting room, who know first hand what’s wrong and who have no-nonsense solutions.

Last year, well before Reform was a popular term, I repeatedly tried to get our Alaskan delegation to respond to my practical solutions for fixing Medicare—beyond that of simply adding money. One did respond, but without conviction to tackle the biggest stumbling block to Reform—the lobbyists.

Congress would be farther ahead if they’d listen to common people, like me, because:
· I’m old and am on my third level of appeal for a Medicare claim;
· I’m familiar with private health insurance plans;
· I’m being bombarded with alarming TV ads from health insurance companies, yet
· I’m a savvy consumer with enough gray matter left to think for myself;
· I talk to my health care providers about their insurance problems and Reform;
· I understand how land use development and transportation shapes our health;
· I know what fast food does to my body;
· I care.

Private vs. Public Health Insurance:
A key issue seems to be whether there will be a public component to health insurance. How could anyone miss the ominous TV ads from the for-profit health insurance companies that threaten doom should there be a public option and ask us to convince Senator Mark to vote against it.

These for-profit companies are spending over $1 million a day on advertising. Are we so gullible that we can’t see through their fear and greed? Are we also ready to admit our own culpability? If we own health insurance stock, we’re part of the problem.

If for-profit health insurance is the answer, then why have so many small companies dropped their insurance due to rising costs? Do they think we haven’t noticed that health insurance has shifted from employer to individual-based plans where it is now nearly worthless because of huge deductibles and exclusions for pre-existing conditions?

For-profit insurance companies keep raising the rates for group plans when employees’ claims cut into their profit margin until finally the employers drop the unaffordable programs. Insurance companies love that because it means more profits for their stockholders. Never forget, for-profit insurance companies are just that—they exist to make a profit for their stockholders and they figure out ways to exclude us who need more health care than healthier folks do.

The $1 million a day advertisements neglect the other side of the public health care debate—that other developed countries have public health care programs that function very well at a fraction of the cost the US pays. These populations are healthier and often live longer than we do.

Regulations that Hinder Public Insurance:
To be fair, let me touch on my experience with public health insurance. Aside from Medicare’s low reimbursement rates to doctors, it is their illogical rules and endless paperwork that is just as damaging. Doctors don’t seem to have a problem filing claims with the for-profit insurance companies, so why can’t Medicare use a similar system. Before becoming a Medicare client, my practice was to pay my doctor or lab bill, get my Alaska Airline miles, submit the claim myself and get reimbursed a month later. It was simple because all the needed information was on the receipt—the diagnosis and procedure codes.

Medicare won’t allow patients to file their own claims. So even though I pay $1,200 a year for Medicare insurance, my doctor, who has opted out of Medicare, can’t legally file my claim and neither can I. So I end up paying twice, once for Medicare insurance and again for each doctor’s visit, simply to keep my access to my primary care doctor. Shouldn’t I at least be able to get reimbursed for the pittance that Medicare would have paid if my doctor hadn’t opted out? If I were able to find a primary care doctor who’d accept Medicare, I still could not pay up front and file the claim myself. But this is a fixable problem that any public health insurance program could overcome.

Medicare’s rules actually result in greater costs. For instance, there is a rule that says labs can’t charge too little for a procedure; so a local lab that does not compromise on quality, but rather has a contract with a national lab to do the work cheaper, can’t pass on the savings to Medicare. Trust me this is actually happening in Anchorage. Even though our blood is drawn here—at any number of labs—it is often processed overnight by a nationally recognized lab outside and each local lab may have different rates.

Another instance where Medicare pays more for procedures is due to the rule that requires all lab and radiology procedures to be billed separately. Today’s technology is geared to run multiple tests on one tube of blood. It actually costs more to separate out tests. What should it matter that my doctor may not need every one of those tests in a general health panel to deal with my condition if the end result means lower costs? Again, these should not be insurmountable problems for a public health insurance program.

Medicare’s appeal procedures are maddening and appear to be patterned after the for-profit companies where employees must process a certain number of claims per hour. I’m convinced Medicare’s subcontractor (yes Medicare doesn’t even process its own claims) does not train their personnel well, nor test their proficiency. The second level of Medicare appeals is suppose to be done by an independent, medical contractor. I think they are in the same situation where speed and profit trumps logic and accuracy.

One more example, not long ago Medicare said they would not pay hospitals when patients contracted ‘avoidable’ infections. As a result, hospitals routinely test all incoming patients for certain infections; this only increases costs. I agree that some basic procedures should be followed like reducing infections by not leaving catheters in too long, but I’m afraid some hospitals will soon refuse to take Medicare clients because of stringent and sometimes illogical rules.

Positive Outcomes and Our Responsibility:
There has been talk about paying doctors for positive outcomes. So how would this work? How can a doctor ensure that we exercise more and eat better? What about the millions of diabetics who refuse to track their glucose levels daily? Would it help to have calories and fat listed on menus? I may not want to know, but I know I need that information. Did you realize that McDonald’s already does this? Turn over the paper liner on the tray—it’s all there. But that information can’t help us lazy folks who go through the drive-in.

If a health club membership was prescribed, would that produce better outcomes? Studies have shown that our health has declined since the automobile replaced walking. Cities that promote efficient land use with plentiful parks and trails and where public transportation is a priority, have healthier populations. So how do we get our elected officials to build fewer roads, but more parks/trails? And what are we teaching our kids when won’t even walk them to school?

Maybe payment for positive outcomes should be given to the patient; after all we are the ones who will benefit by following healthy guidelines.

We deserve no less than other developed countries. Universal health insurance is realistic and affordable—if Congress will simply give the lobbyists the boot and listen to people in the waiting room.