Fixable US Health Crisis

By Frida Ghitis

Providence Journal News Service

ATLANTA _ Considering what I've been through, it's amazing how well I feel. I had surgery recently, my insurance company just informed me. Surgery! And I didn't even notice. In fact, nobody noticed. Not even my doctor. Only Blue Cross/Blue Shield, which seems to spend a great deal of time examining what goes on with me, and finds creative ways to change its own rules so it doesn't have to pay.

We have heard much about the plight of some 50 million Americans without health insurance. I'm one of the lucky ones. I have insurance. And, like millions paying for individual policies, I find health care has become a source of anger, frustration and anxiety. Individual coverage is the last step before the abyss of total lack of insurance.

My latest renewal notice informs me my premium will again rise almost 25 percent, to $326 a month _ almost $4,000 a year _ for coverage that in any industrialized country would be laughable, if it weren't so sad. I have a $3,500 deductible. I plan to continue buying insurance, but I know the cost as I grow older becomes prohibitive, and the coverage becomes worse. Many in my situation decide to risk it without protection.

Nine out of 10 Americans who try to buy their own health insurance fail, either because they cannot afford it or because they are turned down, according to a 2006 study by the Commonwealth Institute.

The most tragic aspect of America's disastrous health-financing system is that it is absolutely fixable. And it can be fixed without resorting to socialized medicine, Marxism, socialism, or any of the absurd labels used by politicians _ as Rudy Giuliani recently did _ trying to dodge meaningful action on this inexcusable crisis.

Sure, the problem is difficult, but there is no need to reinvent the wheel. In the Netherlands, where I spend part of the year, the government requires everyone to have private insurance. The government helps pay the premiums of low-income people, but the system is hardly socialized medicine. You choose your own doctor and your own insurer. Insurance companies are not allowed to turn anyone down, and they charge everyone the same premium for the same product. That means young, healthy people are in the same risk pool with those who need more care. This lowers the average cost of care per insured person. Companies compete, offering different products, although minimum _ excellent _ coverage is required. The cost is about $150 a month, but you can pay more for more luxurious coverage.

The system does encourage cost-consciousness by doctors. Tests and procedures are done only when truly needed, and every procedure is not a separate charge bringing more income to the doctor.

My so-called surgery came when I went to a dermatologist to check a dime-sized discoloration on my shoulder. She said it was nothing, but sprayed an aerosol for a few seconds to make it go away. That's what Blue Cross's Explanation of Benefits called “surgery." My policy allows me six office visits a year for $40 without paying the astronomic deductible. “Surgery," as it happens, is not part of the office visit, which means it is subject to a deductible; hence I have to pay $104 out of my pocket. But a spray is surgery? After an admittedly heated (on my part) discussion, the representative agreed that surgery requires “breaking the skin," and this procedure did not.

Then why wasn't it covered as part of the visit? The representative put me on hold. After a while she returned to confirm the procedure was not covered. End of discussion. I could file an appeal, a complicated process hardly worth the $104.

Finding a way to protect the uninsured is important, but without changing the way insurance works -- with its mysterious exclusions and denials, especially for individual policies -- the other solutions will just not work. The answers are already available. There's no excuse: If other countries can do it, so can America.

The article is distributed by Scripps Howard News Service (www.shns.com).