Rationing by Any Other Name

A man from Jackson County called me asking for help finding affordable health insurance. He ran a small tourism related business that suffered this summer from too few visitors.

This business owner had insurance. “I can’t afford not to – with my business,” he told me.  But he paid too much for a policy that covered too little; “I have a $5,000 deductible. I need health care but I just can’t afford it.”

You see, every day this gentleman goes to work with one hand holding his intestines in place. Years ago, after a surgery, he developed a hernia. Unable to afford to get the hernia repaired he is forced to hold his insides in to keep doing his job.

“It really hurts some times,” he told me. “Is there anyway you can help me?”

A Trempealeau County dairy farmer who milks 115 cows called a few Saturdays ago.

“I’ve had two heart attacks,” he told me. “The price of milk is awful and I am paying $3,800 a month for health insurance.”

I almost dropped the phone as I questioned him, “You pay $3,800 a month?”  The farmer replied “Yes and Anthem is raising my rate $600 a month. What can I do?”

Wisconsin has roughly 500,000 people without insurance. But not counted in this number are the millions paying too much for poor coverage. High deductibles, exclusions, riders and denied payments often cause our neighbors and friends to do without care even when they have insurance.

Twenty-five million Americans pay for health insurance but have inadequate coverage. Many employers have switched to ‘consumer driven’ plans that require employees to cover the first five or ten thousand dollars of medical bills. For many people, this is tantamount to not having any insurance.

Mr. Wendell Potter, a former health insurance executive explained the industry’s practices before a U.S. Senate Committee this summer.

“The high deductible plans many of them [employees] have been forced to accept – like I was forced to accept at Cigna – require them to pay more out of their pockets for medical care whether they can afford it or not. …in selling consumer-driven plans, insurers often try to persuade employers to go ‘full replacement’ which means forcing all of their employees out of their current plans and into a consumer-driven plan. At least two of the biggest insurers have done just that, to the dismay of many employees who would have preferred to stay in their HMOs and PPOs. Those options were abruptly taken away from them.”

In his testimony, Potter also say the “industry is bigger, richer and stronger” and “has a much tighter grip on our health care system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers.”

Opponents of health care reform scare us by saying health care reform will lead to rationing.

In fact, insurance companies are rationing care every day.  When your insurer decides what procedures to pay for and which doctors to cover, health care is rationed.  When your insurer denies coverage for a pre-existing condition or cancels your policy when you have a serious, expensive medical need, health care is rationed.  When you go without treatment because you cannot afford to pay your deductible of $5,000 or more, health care is rationed. 

The truth is millions of hard working people across this country are lining up for hours to get care at free health clinics.  Others simply suffer until emergency care is required which is the most expensive time to treat someone.  These are images that come to my mind when I think about third world countries – not the United States.    

Helping people who need help is a basic tenant of the fabric of our lives; especially in rural Wisconsin. 

Helping a man with two heart attacks or one whose intestines won’t stay put is an obligation we have as humans to our fellow humans.

In response to the call for help, thousands of Wisconsinites have one simple demand – “Let’s get it Done.”