When I moved back to the United States from England in 1999, I was spoiled on the healthcare front. Republicans love to scare you with all the horror stories about the NHS and “socialized medicine.” I’ll admit it’s not perfect and there are problems with wait lists for non-urgent procedures. But let me tell you a true story. When I had my kids, I paid nothing. Zero. Zilch. But wait, there’s more. A midwife came to my house to check up on each of my babies and me for eight days after the birth – and I lived in the “suburbs” of a rural English village. And get this – my general physicians practice made house calls in the middle of the night. If that’s the evils of socialized medicine, sign me up.
But here’s the thing. I was also able to get private insurance at a very reasonable cost, in case I wanted to go see a London physician or go to a different hospital. I had a choice, and it was affordable.
When we moved back here, we were confronted with the ugly reality of the U.S. healthcare system. No insurer would cover us because of pre-existing conditions, even though we’d had private insurance abroad for years. It was terrifying.
As a self-employed person I’m able to get insurance these days as a small business, but it’s extremely costly, and each year my insurer charges more and covers less. So I was very excited to read about HealthyCT, a nonprofit entity launched by the Connecticut State Medical Society and the Connecticut State Medical Society-IPA. The group has filed a letter of intent with the U.S. Department of Health and Human Services to become a Consumer Operated and Oriented Plan (CO-OP) under the Patient Protection and Affordable Care Act. HealthyCT will offer consumers and employers primarily in the individual and small-business market an additional choice for health insurance through the state’s newly created health insurance exchange.
“As physicians – and as employers and consumers ourselves – we know that it’s time Connecticut had more options in the health insurance marketplace from an insurer that puts patients before profits,” said David S. Katz, immediate past president of the CSMS. “We at CSMS know from our own involvement fighting rate hikes on behalf of our patients that they don’t have access to insurance options that focus on quality of medical care and emphasize the patient-physician relationship.”
This is music to my ears. While I know that there are those who persist in believing that the free market solves every problem, as someone who has confronted the ugly reality of the for-profit health model vs. the alternative, I firmly believe that the free market, where lives are at stake, is not the best option. Sarah Palin might yack on about “death panels” under “Obamacare,” but believe me, if you’ve ever been through the appeals process with your health insurance company, you know full well that they already exist.
HealthyCT will be designed with quality and the physician-patient relationship at its core, not profits, according to Matthew C. Katz, executive vice president of the Connecticut State Medical Society. “Today, there is no not-for-profit option in the commercial market space. Unlike traditional health insurers that focus on claims and claims denials — which is to say, denying care or simply setting up administrative barriers — our focus will be on developing quality-based programs and processes that encourage the appropriate use of health care services and incentives for early detection and prevention of illness and access to medical care,” Katz said.
Of course the for-profit insurers aren’t as happy about this new development as I am. The national trade association for the health insurance industry, America’s Health Insurance Plans, wrote a letter to the DHSS on Sept. 16, detailing their objections to the CO-OP proposals. In this epistle, AHIP Executive Vice-President for Policy and Regulatory Affairs, Daniel T Durham, repeats the phrase: “level playing field” like a mantra.
I find this ironic and having been on the receiving end of the insurance company appeal process. It actually makes me furious. Consumers, the ones whose lives are actually at stake here, don’t have anything like a level playing field when it comes to purchasing healthcare, yet insurers insist on one for selling it.
As the CSMS’s Matthew Katz observed: “The health insurers don’t want real competition. They have been enormously successful in limiting competition in Connecticut in recent years through mergers and acquisitions. We have a highly concentrated market in Connecticut, and it is hard for a new insurer to come in and offer competitive rates. The benefit of the CO-OP is that it is not-for-profit and receives some federal funding to start, which helps level the playing field: It infuses competition into a market that desperately needs it. In this case the investor is the federal government and the ones who will benefit are the consumers, the plan members, who will own the plan.”
I, for one, can’t wait.
Sarah Darer Littman is a columnist for Hearst Newspapers and an award-winning novelist of books for teens. Long before the financial meltdown, she worked as a securities analyst and earned her MBA in Finance from the Stern School at NYU.