The Face of the Debate

September 25, 2009

By Giles Morris
Original Publication: rhinelanderdailynews.com

Last week, Necia Merckx of Rhinelander fell into the middle of the great American health care debate when she lost her job as a title clerk.

The 28-year-old Merckx and her husband, Nick, pay $350 per month for an insurance plan with a $4,000 deductible that doesn’t cover her prescriptions.

Merckx says she and Nick are close to becoming casualties of the system, because they make too much money to qualify for government programs but can’t afford to pay for adequate coverage.

“We make too much to qualify for any state programs, county programs or federal programs, but we’re just barely over the edge,” Merckx said. “It’s just impossible to make ends meet. We have this huge chunk out of his paycheck each month and we don’t see it. It’s like ‘Do we get birth control or do we get food?’”

Merckx needs a prescription for a condition she was diagnosed with as an 18-year-old and she takes birth control pills because she says she and Nick aren’t financially ready to start a family. The medication her doctor recommended for her condition would cost $120 per month under their current plan, so she took the next best option for $40 per month. Birth control would cost her $60 per month so instead she uses the reproductive clinic at the Oneida County Health Department, which bills on a sliding scale.

“It’s tough. You have the insurance but it’s a double-edged sword because you pay so much a month but it doesn’t cover anything,” Merckx said. “We can’t even afford the medication I need to be on.”

The Merckxs find themselves in a category of working Americans often referred to as “the underinsured.” The health insurance they can afford has such a high deductible that they can really only use it for catastrophes.

“How many people want to pay $350 out of pocket for the doctor to say it’s a virus and you have to wait it out?” Merckx said. “I was talking to my husband the other day and saying maybe we should drop our health insurance. With the economy the way it is we really have to assess what’s more important. It’s a sad thing if you have to decide between a roof over your head or health insurance this month.”

Merckx said she has never been a political person and hasn’t kept close track of the debate in Congress over different health care bills.

“It is what it is and right now nothing has changed,” said Merckx. “I’ll just wait around until it does change. We don’t have any other option.”

Merckx said her current predicament really hit home when she had an allergic reaction to aspirin that closed her throat.

“We actually sat down and debated whether or not to go to the hospital. It was like ‘Will this go away?’ We know we can’t afford to go to the hospital right now. None of it was covered because we hadn’t met the deductible,” Merckx said.

But Merckx said she needs healthcare, pointing out that women need annual check-ups and she has her prescriptions to think about. Her husband rarely goes to the doctor.

Nick’s use of the coverage has been limited to a hernia operation and an accident in which he lost the tip of his finger. But in addition to her prescriptions and doctors’ visits, Necia also went to St. Mary’s Hospital for a urinary tract infection and ended up having her appendix removed at a cost of $26,000. “You never know what’s going to happen. What accidents might happen. When you need to go to the hospital next, so we have to have it,” she said.

Five years ago, before she was married, Merckx had her own insurance. She paid $50 per pay period for comprehensive coverage with a $500 deductible.

“I don’t know why insurance went up so much, but it would be nice to know. Did it go up because the insurance companies are padding their pockets? Or because the cost of everything else went up?” Merckx said. “If you make it more affordable people are going to pay. If it’s reasonable there won’t be all these outstanding debts.”

Dr. Terrance Moe of Country Doc’s in Eagle River runs an independent general medicine practice. Moe is all too familiar with cases like Necia Merckx’s.

“Even when they do have insurance they’re undercovered. They end up with a deductible that’s so high they refuse to get healthcare. They start making bad decisions,” Moe said.

Moe has been a doctor for 35 years and has run his current practice for the last five. He said his decision to open an independent practice was based on his desire to espouse older values that govern the doctor/patient relationship.

“I’m projecting an image of the old country doctor that everyone could rely on and would put their concerns first and treat them as human being not as a piece of cattle with a number,” Moe said. Moe has strong feelings about what Congress should do to solve the problem of providing more affordable healthcare to its workforce. He believes insurance companies have engineered a system that puts too much emphasis on profit and not enough on care. The effect is the emergency rooms and general practice physicians end up treating people who can’t pay them.

“I just get by. I’ve given an incredible amount of free care because people come in without insurance and they run up a bill and I treat them and they can’t pay and then I don’t see them again,” Moe said. “I have a tremendous amount of uncollected bills. If we had a single payer system there wouldn’t be any unpaid bills.” Moe concedes that the political climate may not support a single payer system, but he still thinks there needs to be a public option or standard low-cost insurance plan in Congress’ healthcare reform package.

“Single payer makes the most sense, but it appears to be too radical a concept for the present climate. The alternative is a strong public option that would provide competition with the insurance companies and result more affordable coverage for everyone,” Moe said.

Moe believes the first step in the solution should be preventing insurance companies from denying coverage on the grounds of pre-existing conditions.

“They’re not in the business of providing insurance anymore. They’re in the business of denying coverage,” said Moe. “Instead of spreading out the costs across the population that’s insured, they want to cherry pick the healthy ones and keep the profits for themselves.”

When insurance companies “cherry pick” the result is higher costs for consumers, because the risk associated with covering people with health issues is not spread across the system. Moe said he has seen lots of people like Merckx in his practice. “She’s screwed. The way our system is right now she can end up being one of the bankruptcies that occur every year. One half of the bankruptcies that occur happen because of medical bills. That’s insanity,” Moe said.

Moe said the American healthcare system will not suffer as a result of a public option.

“Will you have to wait longer for an elective procedure? Yes. But that’s a small inconvenience compared to someone going bankrupt because they don’t have insurance,” said Moe. “The whole thing can be done revenue neutral. All you do is extend the benefits of Medicare to age 45 and sell it at cost to the people between 45 and 50.”

Moe said he is disappointed with the stances of some Democrats in Congress who have backed off supporting a public option. “The Republican leadership isn’t the issue,” Moe said. “The issue is the blue dog Democrats being funded by the healthcare industry.” The term “public option” is a catch-all phrase for a plan that would create a standard low-cost health insurance plan available to anyone, with the costs of the system being shared between Medicare and private insurers.

Democrats in the House of Representatives have supported that kind of proposal, but their colleagues in the Senate have remained split on the idea. Republicans in both houses have mostly rejected the idea.

An alternative option that would create state-level non-profit cooperatives with federal money has been presented in the House. These “exchanges” would allow for the creation of regional buying pools that could negotiate independently with insurance companies for lower rates on healthcare services.

Pete Biolo has served as president of the Oneida County Republicans and he has taken an active role in the political debate over healthcare reform. Biolo concedes that there are gaps in the current healthcare system, but he objects to proposals that include a public option for health insurance.

“I think you can show in polls that most Americans are satisfied with the quality of our healthcare,” Biolo said. “What we would have to deal with is the cost or our healthcare and there’s a number of ways to do that.”

Biolo said Republicans are not rejecting reform initiatives — pointing to Newt Gingrich’s Center For Health Transformation plan and to Congressman Paul Ryan’s (R-Janesville) “Patients’ Choice Act” — but instead are rejecting solutions that interfere with a market-based approach.

“One of the big misconceptions is that the Republicans are the ‘no’ party and don’t want to do anything about it,” Biolo said. “Where the Republicans and the Democrats in control disagree is they want the government in control of healthcare and we would like to see the market work these things out.”

Biolo said the tenets of such a proposal would entail tax breaks for small business, legal reform to limit medical malpractice suits, and systemic reforms to eliminate waste in Medicare and open up competition between insurance companies across state lines. Biolo believes the Democrats are rushing to ram a bill through Congress before the costs of their proposals can be analyzed.

“One of the concerns I have in this whole healthcare debate is I don’t know what the rush is. The president wanted this done before the break but there’s people on the Democrats side also who are saying we should wait and see what all these measures are going to cost,” said Biolo.

Biolo acknowledged that right now people like Merckx are struggling to pay for insurance.

“I think we could all agree that people that are down and out a compassionate society would want to take care of their healthcare, but the debate should be about how we are going to pay for them,” Biolo said. “We need to engage in these specific kind of arguments and we haven’t really done that. It sounds cold, but I don’t know of anything in the Constitution that guarantees the right to healthcare.”

Biolo said the current debate over different reform initiatives is not transparent because there are too many different versions of bills in both houses of the legislature.

“I think they ought to have one bill, get it written, and then let people know what it’s going to cost with hard, solid facts,” said Biolo.

Biolo said part of the pushback from Republicans in the rank and file is based on a cumulative mistrust of overspending in the past two administrations accentuated by the way the stimulus package was created. He sees the issue as part of a larger struggle to contain the growth of federal government.

“The conservative concept is not as much about healthcare as it is about control,” Biolo said. “Once the government has control of the system instead of the market, that is a really big concern.”

Congressman Steve Kagen (D-Appleton) ran on the issue of fixing the healthcare system and as a physician he has taken a leading role in writing legislation in the House. On Friday morning, Kagen was busy drafting an amendment to a resolution that would create a “standard plan” for the health insurance system.

“There will be a public option in the House bill,” Kagen said. Kagen has pushed for a reform package that contains three fundamental features — no discrimination due to pre-existing conditions, pricing transparency for healthcare services across the system, and a standard plan for insurance that would create competition between government and private providers.

“When each and every insurance corporation has to offer a standard insurance plan, then we as consumers can compare the prices and services,” Kagen said. “We already have achieved that in Wisconsin with our auto insurance and it should be the same with health insurance.”

Kagen believes the three features of his plan are linked, because they would together force insurance companies to compete with one another on a level playing field.

“In my lifetime our insurance companies divided our communities. They separated mother from child,” Kagen said. “When America begins to stop pointing fingers and start solving problems as a community then we can move forward on this issue.”

Kagen wants to see a system in which the prices for all healthcare services — from prescriptions to tests to treatments — are advertised so that they can be compared side-by-side with the lowest price becoming the standard for a region.

“Today we don’t have a medical marketplace,” Kagen said. “The price today is whatever they can get.”

Kagen pointed to Merckx’s hospital visit.

“Did she ask them to negotiate the price?” Kagen said. “What your readership needs to understand is that the hospitals are charging what they can get. I would ask, ‘What’s the lowest you’ve charged in the past for that procedure?’”

Kagen admitted the specifics of the healthcare debate are complex. He pointed to Wisconsin’s Senior Care program as a success story for the type of state-level insurance cooperative outlined in the plans calling for “exchanges.” The program has allowed around 100,000 low-income seniors to obtain cheaper prescription drugs by negotiating as a large purchasing pool.

According to Kagen, the plans he supports would allow small businesses to purchase insurance in similar purchasing pools. Kagen said his sources have told him that about 50 members of the Senate currently support some kind of public option but that Sen. Max Baucus’s (D-Montana) Senate Finance Committee has voted against the creation of a standard plan for coverage.

“When people look at this issue they’ve got to start saying, ‘Who’s side are you on?’ I’m working hard to make sure that there’s a bill in the House that works because small businesses can’t hold their heads above water any longer and people can’t continue to pay exorbitant prices for insurance,” Kagen said. In the House, Kagen said the process continues to be fast-moving and fluid.

“I’m confident we will pass a bill. I’ve yet to see a final language and it’s still in flux,” Kagen said.

In the meantime, the Merckx family and a whole host of other people are waiting and watching to see if healthcare reform will actually result in affordable health insurance.

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