The Globe’s Alice Dembner continues her invaluable work in telling the story of the uninsured, and those affected by our new health care law:
As many as 30,000 low-wage workers face a Catch-22 that could leave them uninsured, despite the state’s new healthcare initiative.
They can’t afford the insurance offered by their employers, yet they aren’t eligible for state subsidies because their employer offers coverage.
After being out for two days last week with severe back spasms, O’Brien dragged herself back to her counter job at Dunkin’ Donuts in Milford, where she is on her feet all day. Without insurance, she doesn’t have the money to see a doctor for treatment or to get the doctor’s note that Dunkin’ Donuts requires for an absence of more than two days.
“It’s totally and completely unfair,” said Sandy O’Brien, 53, who hasn’t had insurance for years.
Dunkin’ Donuts offers her insurance, but on a yearly income of about $15,000, she can’t afford the monthly premium of $98. She sees other people with equally low wages signing up for the new state- subsidized insurance plans. But she’s not eligible.
 |
You can’t get blood from a turnip, and you can’t get $98/month out of someone making $15k a year.
You can, however, get blood from someone making $15k a year, and that’s what’s going to continue to happen.
Let’s keep in mind — Chapter 58 has newly insured some 120,000 people who weren’t before, which is terrific news. But if it doesn’t help people like Ms. O’Brien, can it be considered a success? All the exemptions seem to leave people at the bottom of the ladder uninsured. How can that be right?
Let’s keep at it.
She would be better off if her employer did not offer her insurance at all. She would qualify for subsidized Commonwealth Care insurance.
To start developing plans for our switch to true universal, single-payer health care. I really don’t think anything else has a chance of saving the health care system.
What do we do?
<
p>
I mean, we talked about it, and decided to hire some folks at minimum wage to put our hats together.
<
p>
So now what? Do we offer full boat, bells and whistles health coverage outta our pockets, although we’re just a start-up and may not be able to afford it? And are we “deadbeat” employers if we don’t.
<
p>
Let’s call a board meeting. Have your girl call mine.
Most DD locations are franchises, owned by local people and operating on a relatively small scale. DD the franchisor is a huge business that was purchased by a group of investment funds that includes Bain Capital. Maybe Mitt will call his old pals at Bain, and encourage them to come up with a plan to offer insurance to DD employees . . . or maybe he won’t bother.
Declare as an illegal alien, then go to the ER. Then you do not have to worry about the ability to pay.
<
p>
The foolish Americans will pay!
I’m not sure in this case you can call DD a deadbeat employeer for offering a $98/month policy. That, while unfortunatley out of the price range of Sandy, is pretty damn cheap comparitively.
<
p>
I went to the conntector site and the cheapest policy I could find for a single person policy was in the $300 range. I also noticed that is asked if my income was lower then 30k because in that case it I might be eligible for Mass Care. On the surface it would seem she may be eligible.
<
p>
is either working for less than minimum or working part time. I know for a fact that some folks put an extra ten to twenty bucks in their pockets each day working at DD.
This woman can’t get a part time job or work more than 40 hours. If she is suffering from some disability then why is she not seeking some dispesation from MASS Health. There are so many programs out there that she would certainly qualify for something.
<
p>
For you folks out there who are not employed in healthcare I have some bad news. Our present healthcare system currently has insuffient providers. Talk to any woman about finding a OB/GYN and getting an appointment. GP’s are overwhelmed. You get an appointment and a practitioner (MD/PA/RNP) is going to spend 10 minutes with you. Is that what you folks want, assembly line medicine? It’s absolutely appalling. We need to fix our current system before we unleash the sick, lame and lazy on the current group of overworked, overwrought, and underpaid medical professionals.
It is always important to remember the good things that Chapter 58 has done. Last year’s reforms:
<
p>
That is all excellent news.
<
p>
But it is also important to remember what Chapter 58 didn’t do. Chapter 58 didn’t demand:
<
p>
In short,
<
p>
We poured new money into the old bloated system so we still face the same structural problem:- health care costs are rising far faster than wages, profits and tax revenues. The options are ugly – raise premiums, shrink coverage and/or raise taxes. Same old, same old.
<
p>
These problems can be solved. But it will take a kind of Legislative leadership we haven’t seen in my memory – and I’m getting to be a pretty old bag.
<
p>
Cost and quality are next on the health reform agenda we hear – even though this discussion started over 30 years ago.
<
p>
Under fire from the press, employers and insurers, hospitals are working on their own to eliminate the most flagrant medical errors with the help of non-profits like the IHI. Insurers are working on coordinating care to reduce costs but no shredded red tape so far.
<
p>
If the Legislature had taken the lead on the medical error issue in 2000 when the Institute of Medicine first issued its report To Err Is Human over 10,000 Massachusetts lives might have been saved – 2,200 last year alone. That’s the number of Massachusetts patients who died needlessly last year from medical errors. Those errors are not just paid for with tears. They cost $675 million last year – many billions since 2000. All totally avoidable.
<
p>
If the Legislature had taken the lead on administrative waste Massachsuetts might be a national leader in electronic medical records, uniform internet claims billing and electronic patient safety monitoring. It might have saved thousands of lives and billions of dollars. Our software manufacturers are national leaders in these areas. But because the Commonwealth hasn’t taken used its tremendous buying power and because the Legislature hasn’t made their use a licensing standard most of our insurers and providers are just beginning to jump on board now – even though early adopters have proven these reforms increase their profits!
<
p>
But the political reality is that if the Legislature had forced these issues in 2006 there would have been no health reform law – no access expansion. That’s why they punted with the commission on cost on and quality.
<
p>
But that political reality should make us very nervous. Will ever catch up to other industrialized nations when it comes to cost and quality? More specifically, will WE as patients, premium payers and taxpayers, ever see the savings that come from quality improvement and streamlining. Capturing potential savings and making sure WE get a fair share takes government leadership.
<
p>
Single payer is a proven option. But public/private hybrid systems can also do the job.
<
p>
Every national health system delivers better health care outcomes at lower costs than we do. Only two of the 30 are pure single payer systems – Canada and the UK. The other 28 are hybrid systems sort of like Massachusetts.
<
p>
There are two HUGE differences, however, between those systems and ours. They all ensure everyone affordable, comprehensive coverage. In every one it’s the government’s job to make all the parts and pieces of the health care delivery and financing systems serve the needs of the people.
<
p>
In those systems the bottom lines of insurers and hospitals are less important than whether everyone gets the health care they need. This is not a universally popular idea here – particularly with insurers. But interstingly, the insurance biz is very profitable in most hybrid national health care systems. Profitable private insurers are in the national interest for hybrid systems – AS LONG AS THEY RUN LEAN AND MEAN OPERATIONS.
<
p>
If Chapter 58 is going to work we’re going to need a lot of leadership from the Legislature and the Governor. They can’t just sit back, cross their fingers and hope the market will do its magic and watch patients die and premium payers and taxpayers get the shaft. They need to roll up their sleeves and make it happen – better quality at lower costs AND a fair share of the savings back to the folks who pay.
<
p>
The Commonwealth has the political power and the buying power to demand change if it has the will. Consumers need to join together to make sure their elected representatives protect their interests. We need to make it clear that their jobs are on the line if they don’t. After all, they do work for us (I think).
<
p>
Barbara Waters Roop