Held to answer

When Richard Nixon, Hillary Clinton and Barack Obama all dreamed of creating a more affordable health care system for Americans, they probably didn’t envision a cheerleader like Greg Schoenberg.

He’s an insurance broker, and he smells opportunity.

There are health plans to be sold, and Schoenberg is doing his part as a registered agent with Cover Oregon.

He has a simple name for people who don’t want to buy insurance under the Affordable Care Act: freeloaders.

Schoenberg foresees a future when the tax penalties on people who don’t buy insurance will be hiked sufficiently to seriously punish them.

“What I really hope for is the ranks of the (uninsured) will drop so low that hospitals will be able to collect in force against freeloaders,” Schoenberg wrote in one of his many comments posted in a recent story about Cover Oregon in The Oregonian.

Bill collectors don’t target freeloaders. They go after the insured, particularly working-class families and the dwindling middle-class, who are easier to browbeat with phone calls and letters threatening to destroy their credit rating.

These patients are not freeloaders who want something for nothing. They can’t keep up with the demands on their take-home pay. Medical care increasingly takes a bigger chunk.

Schoenberg doesn’t want these folks to look too closely at the fine print and the asterisks in the various bronze, silver, gold and platinum plans offered by insurance carriers under Cover Oregon. (If you can afford a gold or platinum plan, the fine print probably won’t scare you.)

Many of the less-expensive plans have high deductibles. Simply calling them “affordable” does not make them so. Unfortunately, much of the news coverage about the Affordable Care Act has been shallow and misleading.

“They won’t have to wait to file their income taxes to get the money,” gushes a typical wire story.

It sounds like people are pocketing huge subsidies. They aren’t. The monthly subsidies go to the insurance carrier, then the individual or family pay their monthly share on top of that. In some cases, particularly for the younger and lower-income, the subsidy may cover the entire monthly premium.

However, that individual or family will have to meet a deductible. For an individual, many of the deductibles are about $5,000. For a family, deductibles can exceed $10,000. After the deductible is met, the insurance carrier will pay for a percentage of doctor visits (the percentages vary greatly, starting at 30 percent).

The yearly out-of-pocket maximums also vary. Many of the plans I looked at show an out-of-pocket maximum of around $5,000 for individuals and $12,000 for families.

Clearly, some people like the insurance plans being offered, especially if they don’t have access to job-based coverage. Others have reason to be concerned. A $12,000 out-of-pocket maximum could be devastating to some families who have a medical crisis. That doesn’t make them freeloaders.

The tech problems on the federal and state Websites are only speed bumps to what Schoenberg looks forward to – a big stick, courtesy of the government, to force people to buy insurance.

“Eventually, the website will work and then the real question will come to light. Whether the government has the stomach to enforce the individual mandate,” he said on The Oregonian’s website. “If it does not, then millions of irresponsible people will remain uninsured, perpetuating the system that exists today where the insured pay for the (uninsured’s) medical bills.”

It’s not that simple. We have high medical costs in this country for several reasons, not the least being that the health insurance industry has come to represent “the house” in a long-running card game. The deck is stacked against people who cannot afford high premiums or high deductibles. If they have insurance and need to use it, they may find out how little insurance they actually have.

It’s true that hospitals will use the insured to cover costs of the uninsured. I don’t see the insurance industry going to bat for their insured customers who are used like this. Instead, the customers are cut loose from coverage or left to fight the hospitals on their own.

I know what it is like to be sent to the hospital under a dubious diagnosis on a Friday night and, once tethered to a heart monitor, told I would have to stay there until I could get an echocardiogram, which might be Monday at the earliest.

A friend of mine, who knew a lot more about hospitals than I did, advised me to demand to speak to a social worker about the costs of waiting all weekend for a test. I did, and about an hour later I got an echocardiogram that showed nothing unusual. I was out of there in 19 hours.

It would not surprise me that the hospital, noticing that I had insurance, was motivated to drive up costs for their own purposes.

When a $6,000 bill for that 19-hour hospital stay arrived, I requested a cost breakdown and was warned that an audit could lead to increased charges.

The Affordable Care Act is supposed to require hospitals to now post the cost of routine procedures, which they should have been doing all along, instead of demanding blank checks from patients.

This feature of the Affordable Care Act drew no praise from Schoenberg. Here’s his take on what he calls the beauty of ACA: “It enhances competition in the individual marketplace by forcing the insurance companies to play by the same rules.”

I don’t know what that means, but there’s something about it that reminds of the first time I used a professional interstate moving company. All the estimates I received were the same. How could that be? Hadn’t the moving companies been deregulated? Yes, and they were charging pretty much the same. So much for competition.

It’s too bad President Obama played it safe in his attempt at health care reform and piled on the compromises to get it approved. He should have started with a bold, independent move and solicited the help of a true outsider, someone like consumer watchdog Ralph Nader.

Even with a couple of runs at the White House, Nader has more credibility with the public than many Democrats and Republicans. And although he’ll turn 80 in February, Nader might have galvanized young adults to get more interested in health care reform than the silly ad campaigns comparing daily insurance rates to vanilla soy lattes or beer kegs.

Nader understands that no health insurance system is problem-free. He has studied the Canadian single-payer, Medicare-for-all system and thinks it could work in the U.S.

To anyone who assumes that Website problems are proof the American government couldn’t handle a single-payer system, Nader points out that in the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months, and he did it with index cards – not Websites.

He notes that in 2012, CEOs at six of the largest insurance companies in the U.S. received about $83.3 million in salary and benefits. Nader predicts more of the same under the Affordable Care Act.

He’s a consumer watchdog who’s had friends in the corporate world.

In December, Nader wrote a lovely remembrance of his friend, Peter Lewis, founder of Progressive Auto Insurance.

“Peter was my classmate at Princeton. More than 25 years ago, I suggested he equip his company cars with air bags, both to prevent costly crash injuries to his employees and also to set an example for other insurance companies to give meaning to their ‘loss prevention’ rhetoric … . He grasped the suggestion immediately and agreed,” writes Nader.

Nader never expected much from talking to corporate chiefs “about what they should do in their own and the public’s interest. In my experience, they had difficulty listening to anything not on their bureaucratic wavelength.”

Lewis, however, had a sense of the “unconventionally possible.”

We need the unconventionally possible to bring real change to America’s health care system.

We won’t find it by arming the Greg Schoenbergs with a big stick.

– Pamela Fitzsimmons

Related:

A Toast to Health Care

Dr. Strangelove Will See You Now